ICE Is Turning Warehouses Into Detention Centers Across the Country. A Doctor Who Has Audited the Records Says People Will Die.
Dr. Kate Sugarman has spent 20 years inside ICE jails reviewing records she says are falsified. She knows what these warehouse detention sites will become.
She had never thought much about her grandmother’s sister; rarely spoken of and gone before she was born. That changed when she protested outside a warehouse near Hagerstown, Md., where the federal government is planning to detain up to 1,500 immigrants — one of dozens of industrial sites the agency is converting into detention facilities across the country.
There, she thought about Auschwitz — once an army barracks in a Polish village, repurposed into a death camp whose name is now synonymous with genocide.
“Do we want our children to say, ‘My neighbor’s sister died in Hagerstown?’” said Dr. Kate Sugarman, a family physician who has spent more than two decades performing medical evaluations inside ICE detention facilities. Dr. Sugarman bears a variation of her grandmother’s sister’s name, who died at Auschwitz — Susan. “We have to act now.”
Sugarman, who is nearly 65, began her work with immigrant detainees around 2004, conducting forensic medical evaluations for asylum seekers — documenting torture scars, injuries and illnesses as part of the legal evidence packages that can determine whether someone is granted protection or deported. That work took her inside the facilities themselves, and what she found there has occupied her ever since.
She now works with Doctors for Camp Closure and with the health justice team at the New York Lawyers for the Public Interest, reviewing medical records for people in ICE custody and writing advocacy letters on their behalf. During the COVID-19 pandemic, she said, those letters helped secure the release of numerous detainees. She is also preparing testimony for legal efforts, led by CASA and the ACLU, to challenge the Hagerstown facility before it opens.
She spoke from her clinic in Washington, D.C., on a Tuesday morning, between patients.
How would you describe conditions in the facilities you’ve visited?
I hate the term “detention center.” To the average person, detention means missing recess because you misbehaved. These are jails in every sense of the word. They’re surrounded by barbed wire. There are guards everywhere. Even for me as a doctor, it was extremely hard to get in — the barriers were immense. Sometimes I had to interview people through thick glass.
ICE says its new facilities will be modern and humane. Does that track with what you’ve seen?
No. And the history says otherwise. In 2019, the Office of Inspector General released a report on the processing center in McAllen, Texas, with photographs of 60 to 70 people crammed into spaces designed for 15 to 20 — parents holding their children up in the air so they could breathe. That was 2019. Nothing has changed.
The thing I keep coming back to is water. In Hagerstown, they're bringing in portable toilet trailers — a truck comes, empties them, and drives away. You can't shower with that. You can't wash clothing with that. Anne Frank didn't die from a gas chamber. She died from typhus. When you crowd people together and deny them basic hygiene, that is what happens.
Researchers who track ICE detention deaths have counted roughly one death in custody every six days. Do you expect that number to rise?
It’s only going to go up. And what people don’t understand is that we don’t even have the full picture. If ICE doesn’t want a death on their hands, they’ll bring someone to a hospital just before they die. If they’ve been neglecting a cardiac patient and that person dies in the hospital rather than in the facility, it doesn’t count as a death in ICE custody. I don’t think we have any idea how many of those cases there are.
One of the most recent deaths in ICE custody was an Afghan man, Mohammed Tajideen Awale1, who died within 24 hours of being taken into custody. What do you make of that case?
ICE hasn't released any details. No autopsy has been done, or at least not one that's been publicly released. Once a person is brought into the ICE detention system, their chances of dying, their chances of injury, their chances of trauma increase exponentially. Most Americans have no idea.
Beyond the physical conditions — what do you say to people who argue that as long as detainees receive basic care, detention itself is acceptable?
People claim to be opposed to family separation, but every time you put a human being in an ICE jail, it is family separation. It is a child that no longer has a parent. It is a family that’s lost their breadwinner. It’s a child who can no longer focus at school because their loved one has disappeared. It’s a child who can no longer sleep at night. Think about dropping a child off at daycare, and the child is crying, and you say, “Don’t worry, mommy’s going to work and mommy will come back.” We can’t tell our immigrant children that now. These are irreparable scars we’re putting onto our communities. You close your eyes to go to sleep at night, but when you wake up — their loved one is gone. You don’t come back from that. These are permanent scars.
Pediatricians are being asked all the time to write letters explaining why the child with cancer, or why the child with autism, needs their parent released from the ICE jail. How outrageous is that? The child is no longer sleeping at night. How does anybody recover from that?
What about the medical records — are they accurate?
The records are lies. You read the notes and you think, “Oh, this person isn’t so sick.” And then you interview the actual detainee, and it’s a completely different situation.
I can think of a case from years ago where a man had an infection so deep it had gone into his bones — osteomyelitis. His elbow was exuding pus. People were using towels and napkins because the discharge was so severe. The ICE record said: “Slight wound. Topical antibiotics applied. Gauze dressing placed.” When we finally got him released, he went straight to the intensive care unit. How do you square that?
I’m working on a case right now where I can’t get a woman released. Her record says: “Refer to cardiology.” That sounds routine. That sounds elective. But she is not being seen by cardiology — she’s being referred, and the referral goes nowhere. She has chest pain. She needs cardiology now.
And compounding all of this, according to advocates and providers who work in this space, ICE has not been paying for specialty care since at least October. Providers aren’t being reimbursed. Specialists stop accepting the referrals.2 The note says “refer to cardiology,” and there is simply no one to see her.
ICE publishes the National Performance-Based Detention Standards3 — a rulebook of sorts for medical care in its facilities. Are those being followed?
I don't think they're following any of those standards. The standards say detainees have around-the-clock access to sick call. There was a man at Camp East Montana [the tent facility ICE built at Fort Bliss, in El Paso, which saw three detainee deaths in six weeks and a measles outbreak before its operator contract was terminated earlier this month] who kept requesting sick call. He kept saying, “I can't breathe. I can't breathe.” A guard essentially murdered him. So no — they are not following the standards.
These facilities are being sited in small communities — Williamsport, Maryland has a population of roughly 2,000 and is slated to receive up to 1,500 detainees; Social Circle, Georgia has a population of around 5,000 and could receive up to 8,500 — nearly doubling the town overnight. What does that kind of population shock mean for local hospitals?
Meritus Medical Center — the regional hospital serving the Hagerstown area — is already beyond capacity. More than 50 local doctors signed an open letter saying it cannot absorb this. And that pattern will repeat itself everywhere one of these facilities opens.
Tuberculosis and measles4 are already spreading through ICE facilities. We’ve seen that most recently at Camp East Montana. Infectious disease specialists have noted that measles is uniquely dangerous for unvaccinated people — that it can essentially reset the immune system, erasing accumulated immunities and elevating the risk of death from diseases a person would ordinarily survive. What does that mean for communities near these facilities?
When they operate, guards go home to their families every night. Their children go to school. Whatever is circulating inside that facility comes out. That’s not speculation. That’s what the disease does.
And if the Meritus emergency room is overwhelmed, what happens to patients already in the community?
Think about someone sitting in the ER with chest pain. They know the wait is six, eight hours. They think: it’s not that bad. And they leave. That’s a heart attack they missed.
Once someone is having a stroke, there is — and I want to be careful here, because the exact window can vary — roughly 60 to 90 minutes from the onset of symptoms until blood thinners must be administered. That window has to accommodate the ambulance, the triage assessment, the imaging to confirm a stroke and the medication itself. If the emergency room is overwhelmed, that window closes. The difference between life and death, or between recovery and permanent disability, can come down to how long someone waits.
And immigrants themselves will be afraid to go to the ER at all. So they stay home. And the disease spreads further.
What do you say to people living in the communities where ICE is procuring these facilities who feel this isn’t their problem?
It is their problem, because their emergency room will be stretched beyond capacity. And it will be a stain on the community forever.
Auschwitz was a village before it was a name the world would never forget. But so was Minneapolis — and Minneapolis is now synonymous with a community that stood up. Hagerstown can be a symbol of resistance. The government came, and the community said no. That is the choice in front of them.
In Their Own Words
Following our conversation, Dr. Sugarman provided a packet of letters submitted by physicians from across the country opposing the Williamsport facility. The signatories include emergency medicine physicians, obstetricians, pediatricians and family practitioners from Maryland, Washington D.C., California and Washington State.
An open letter organized by Dr. Jennifer Janus, a Washington County physician, bears the signatures of more than 60 local health care providers. Dr. Sugarman also submitted a letter of her own.
The letters are reproduced in full below.
Dr. Sugarman works with Doctors for Camp Closure and the health justice team at the New York Lawyers for the Public Interest. Dr. Sugarman's work has been previously cited in New York Times reporting on conditions in ICE detention facilities. That article can be read here.
This interview has been condensed and edited for clarity.
Wow. Thank you for reporting on this. Excellent work.
This is essential info. Spread it around. Letters to Editors, etc.