95 Percent of Deaths in ICE Detention Could Likely Have Been Prevented With Adequate Medical Care: Report

A new report released today by the American Civil Liberties Union, American Oversight, and Physicians for Human Rights (PHR) exposes the Department of Homeland Security’s (DHS) flawed internal oversight mechanisms and failure to provide adequate medical and mental health care, resulting in preventable deaths of immigrants in Immigration and Customs Enforcement (ICE) facilities. 

“Deadly Failures: Preventable Deaths in U.S. Immigration Detention” provides a comprehensive examination of the deaths of 52 people whom ICE reported to have died in its custody between January 1, 2017 and December 31, 2021. Independent medical experts found that 95 percent of deaths in detention were deemed as being preventable or possibly preventable if ICE had provided clinically appropriate medical care. 

“Each of these deaths represent a preventable tragedy, and underscores the systematic danger posed by placing people in immigration detention. ICE has failed to provide adequate — even basic — medical and mental health care and ensure that people in detention are treated with dignity,” said Eunice Cho, senior staff attorney at the ACLU’s National Prison Project and report co-author. “Abuses in ICE detention should no longer go ignored. It’s time to hold ICE accountable and end this failed, dangerous mass detention machine once and for all.”

The report is one of the most comprehensive studies on deaths in ICE custody to date. Over 14,500 pages of documents — most made public for the first time — obtained through Freedom of Information Act (FOIA) requests, state public record act requests, and civil litigation reveal a wide array of harmful and egregious practices. Of the 52 deaths examined from 2017-2021, the report found:

• Persistent failings in medical and mental care have caused preventable deaths including suicides, as ICE failed to provide adequate health care, medication, and staffing.
• Medical staff made incorrect or incomplete diagnoses in 88 percent  of deaths, and also provided incomplete, inappropriate, or delayed treatment and medication that in some cases directly contributed to deaths of detained immigrants. 
• ICE detention facilities failed to provide timely and appropriate emergency care, and take basic precautions during the COVID-19 pandemic.
• ICE’s detainee death investigations have allowed the destruction of evidence, have failed to interview key witnesses, and have omitted key inculpatory facts. Medical staff were also deemed to have falsified or made insufficient documentation in 61 percent of detainee death cases.  
• Oversight processes have failed to result in meaningful consequences for detention facilities, including those whose conditions have caused the greatest number of deaths. 

“The report’s independent medical reviews reveal egregious failings in health care. In most of the reviewed cases, inadequate or absent care directly contributed or possibly contributed to fatalities,” said Michele Heisler, MD, MPH, medical director at PHR and professor of internal medicine and public health at the University of Michigan. “This report reinforces a grim reality that has been well documented over the last twenty years: healthcare in ICE detention is often profoundly flawed. Effective and more humane alternatives to detention enable people seeking asylum and other immigrants in the United States to receive medical care in their local communities.”

The report also reviews ICE’s own investigatory reports into deaths in custody, as well as interviews with two family members of people who died in ICE detention during the studied period. Within the report, Neda Samimi describes how her father, Kamyar Samimi, died of cardiac arrest in ICE detention due to medical negligence. “He was unjustly detained,” Ms. Samimi told researchers. “Two weeks later, after none of his medical concerns were heard, he died. There is nothing in the world that can bring back my father.” 

“Today’s report underscores the importance of transparency. Until now, the full extent of ICE’s systemic failures has remained shrouded in secrecy — a direct result of its unlawful delays and unjustified withholdings in releasing public records,” said Chioma Chukwu, interim executive director of American Oversight. “The documents underpinning this report can’t undo the harm caused by ICE’s failures, but they can provide something invaluable: accountability. That’s why American Oversight fought to shine a light on these records — to provide answers to deserving loved ones and to ensure those responsible for preventable tragedies are made to answer.”

The report offers guidance to protect the health, rights, and dignity of people detained in ICE detention, issuing detailed policy and practice recommendations to DHS, the Department of Justice, U.S. Congress, and state and local government actors. Above all else, the ACLU, American Oversight, and PHR call on the U.S. government to end its reliance on the dehumanizing and abusive immigration detention machine.

“No family should be kept in the dark about how their loved one passed away under the government’s care,” said family members of Jean Jimenez, who died by suicide at the Stewart Detention Center in Georgia after failing to receive timely mental health care treatment. “We lift up Jean’s memory by fighting for records that might provide answers to our family and others — not just for the closure they can bring, but also to prevent future tragedies.”

The full report is available here.

The executive summary is available in Spanish here.

Records and documents noted in the report can be accessed here.