On April 6, 2015, Raul Ernesto Morales-Ramos, a 44-year-old citizen of El Salvador, died at Palmdale Regional Medical Center in Palmdale, California, of organ failure, with signs of widespread cancer. He had entered immigration custody four years earlier in March 2011. He was first detained at Theo Lacy Facility, operated by the Orange County Sheriff’s Department, and then at Adelanto Detention Facility, operated by the private company Geo Group, both of which had contracts with US Immigration and Customs Enforcement (“ICE”) to hold non-citizens for immigration purposes.

An ICE investigation into the death of Morales-Ramos found that the medical care he received at both facilities failed to meet applicable standards of care in numerous ways. Two independent medical experts, analyzing ICE’s investigation for Human Rights Watch, agreed that he likely suffered from symptoms of cancer starting in 2013, but that the symptoms essentially went unaddressed for two years, until a month before he died.

Throughout this time, Morales-Ramos repeatedly begged for care. In February 2015, he submitted a grievance in which he wrote, “To who receives this. I am letting you know that I am very sick and they don’t want to care for me. The nurse only gave me ibuprofen and that only alleviates me for a few hours. Let me know if you can help me.” At the time of ICE’s report on its investigation, the final cause of death had not yet been determined, but as detailed below, the facts revealed in the ICE investigation show that systemic indifference to his suffering and systemic failures in the healthcare system spurred his death.

This report examines serious lapses in health care that have led to severe suffering and at times the preventable or premature death of individuals held in immigration detention facilities in the United States. The lapses occur in both publicly and privately run facilities, and have persisted despite some efforts at reform under the Obama administration, indicating that more decisive measures are urgently needed to improve conditions. At time of writing, it was unclear how the Trump administration would address the issue, but its pledge to sharply increase the number of immigrants subject to detention and reports it is also planning to roll back protections for immigrants in detention, raise serious concerns that the problems fueling the unnecessary suffering could grow even worse.

– Report by the Human Rights Watch