Consumption is flourishing in immigration detention centers across the country, yet another sign that America is grinding its way through a second Gilded Age. It’s better known now by its other name, tuberculosis, and it’s the most deadly infectious disease in the world, the World Health Organization says, responsible for killing 1.5 million people each year, even though it’s both preventable and curable.
Detainees have tested positive for tuberculosis at the Anchorage Correctional Complex in Alaska and Adelanto ICE Processing Center in California, according to news reports. One immigrant died days after a diagnosis of the disease in the Eloy Detention Center in Arizona, an ICE death notice shows. Detainees may have been exposed at the Denver Contract Detention Facility in Aurora, according to a lawsuit. And in Washington state, several possible cases of tuberculosis in the Northwest ICE Processing Center in Tacoma were reported this month to state authorities, and one man was hospitalized for it, his attorney said.
U.S. Immigration and Customs Enforcement (ICE) did not respond to a request for comment. Officials have previously downplayed the presence of tuberculosis, the reports show, including responding to questions about the cases in Tacoma by saying, “This false claim needs to stop.”
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The same conditions that allowed the disease to flourish at the end of the 1800s are hallmarks of immigration detention, medical experts and immigration advocates told the Prospect, including overcrowding, poor sanitation, and a breakdown of health protocols.
Tuberculosis outbreaks can allow the disease to become more resistant to treatment, one of the major global concerns about the massive outbreaks in post-Soviet Russia. And, of course, the disease doesn’t recognize the limits of prison walls, Dr. Leonardo Martinez, assistant professor of epidemiology at Boston University, noted. If someone leaves ICE with an active case of tuberculosis, they can transfer it to the larger population. “By protecting people in carceral settings,” he said, “we’re protecting people outside of carceral settings.”
There is no good reason why tuberculosis is spreading in ICE detention, Martinez and other medical experts said. They called on the Centers for Disease Control teams to control outbreaks and for federal detention sites to provide proper screening, isolation, and care, and to follow their own protocols.
Even simply giving detainees more space would make the situation safer, medical experts said. But they doubted ICE will spend much of its new windfall from the GOP mega-bill, which includes billions more for detention facilities, on detainee health measures. As the Prospect reported earlier this month, the two big companies that provide or run most of ICE’s detention centers, CoreCivic and Geo Group, are raking in the cash, with plans to expand thanks to “unprecedented growth opportunities.”
“I hesitate to say there aren’t enough resources,” said Dr. Katherine Peeler, medical adviser for Physicians for Human Rights and assistant professor of pediatrics at Harvard Medical School. “ICE just got an appropriation of $45 billion, but if I had to predict, the line item for health care is not the thing that’s going to be increased.”
TUBERCULOSIS THRIVES IN CARCERAL SETTINGS of all kinds. It spreads through the air when an infected person coughs, sneezes, or spits, and it only takes a few droplets to sicken someone.
Those with active infections can develop symptoms that grow progressively worse, including a chronic cough that brings up blood, high fever, and “wasting,” the process of unintentionally losing significant amounts of weight. Almost everyone who contracts it needs treatment to survive, and those who do may live with lungs so damaged they struggle to breathe.
The federal government has long acknowledged that tuberculosis is a problem in immigration detention. More than two decades ago, the Department of Homeland Security and other federal agencies examined the spread of the disease among ICE detainees and decided not to remove or release from custody anyone suspected of having an active tuberculosis case without first consulting the U.S. Public Health Service. Agencies have addressed the issue repeatedly since then, such as in 2011, when they held a conference about how to halt the spread among people in ICE detention.
National medical care standards in immigrant detention facilities require all facilities where detainees are held for more than 72 hours to have on-site clinical settings. But that doesn’t necessarily happen, as the recent lawsuit against the Department of Homeland Security over its dirty and overcrowded makeshift detention site on the tenth floor of Manhattan’s 26 Federal Plaza illustrates. A judge last week ordered ICE to improve the conditions immediately.
Tuberculosis outbreaks can allow the disease to become more resistant to treatment, and the disease doesn’t recognize the limits of prison walls.
Under federal law, everyone entering an ICE facility must be screened for tuberculosis within 12 hours of intake, then subsequently retested every 12 months. But that doesn’t always happen, either, the government also acknowledges. At the now-shuttered Nye County Detention Center in Pahrump, Nevada, for example, unannounced inspectors from the Department of Homeland Security Inspector General found that staff failed to perform such screenings before transferring detainees to another facility, according to a report published in May.
Anyone in ICE custody with symptoms suggestive of tuberculosis is supposed to be placed into an airborne infection isolation room with negative pressure ventilation, which experts in infectious diseases told the Prospect was necessary to avoid spreading the illness to other detainees and staff. Such rooms reverse the flow of air to make transmission less likely.
But ICE detention facilities don’t necessarily have such rooms, medical experts said. Instead, they often put those with infectious diseases in solitary confinement, which they refer to as “segregation” to avoid criticism. The typical solitary cell does not use negative pressure, detention and medical researchers said.
When they do use a negative-pressure room, there’s no guarantee staff will clean it between patients, as the unannounced inspectors in Nevada found. “We observed that medical staff did not clean the medical isolation room in between medical isolation stays. Additionally, wads of soaked toilet paper were stuck to the ceiling … and there was graffiti on the walls throughout much of the room,” the report stated. “Failure to thoroughly clean medical isolation rooms in between detainee stays increases the risk of disease transmission and other safety hazards for detainees and medical staff.”
Even if a location has competent medical practices, it may not have enough staff to execute them, as an unannounced visit to the Buffalo Federal Detention Facility in Batavia, New York, found, according to a report published in June. Investigators found there was no permanent physician or dentist at the facility, so detainees had to wait months for help when they got sick. As of September 10, 2024, the medical scheduler had a backlog of 150 “specialty appointments” for the next five months. Detainees had a five-month wait for dental appointments, too.
THE OVERALL SENSE MEDICAL DOCTORS have about ICE squares with that of immigrants, their families, and their lawyers: The U.S. government is unconcerned about detainees’ health. The litany of failures specific to tuberculosis is just one symptom. Others include reported outbreaks of COVID-19 and ongoing reports describing how ICE routinely denies detainees medical attention.
A recent report Sen. Jon Ossoff (D-GA) published late last month described such instances in brief but potent detail, such as an attorney who reported that a U.S. citizen child with severe medical issues was detained with her mother, “and that when the girl began vomiting blood, the mother begged for medical attention. A CBP guard reportedly responded, ‘Just give the girl a cracker.’” Ossoff said he has received 510 credible reports of human rights abuses against immigrants in detention since the beginning of the year, including multiple instances of abuse against pregnant women and children.
Melissa Chua, co-director of the New York Legal Assistance Group’s immigrant protection unit, told the Prospect in an interview that immigration detention staff are denying her clients medicine and medical attention, too, including people with life-threatening pre-existing conditions. One client in detention is a whistleblower seeking asylum from Ecuador, who is recovering from a severe liver infection and must eat a special diet. It would be straightforward to provide, but ICE won’t do it. He also hasn’t gotten the medication he needs to prevent the infection from recurring. In another instance, a high-school-age client said he asked for a doctor, only to be met with beratement and, ultimately, silence.
The ultimate symptom of the government’s disregard for detainee health is death, including by suicide. So far this calendar year, ICE has recorded ten people who have died in custody, including the man in Arizona who tested positive for tuberculosis, and at least one who news reports said later died by suicide, though the notice didn’t list that as the cause of death.
But that is an undercount by at least one. Earlier this month, 32-year-old Chaofeng Ge hanged himself in Pennsylvania’s Moshannon Valley Processing Center, according to reports. He is not listed on ICE’s death roster; ICE has 30 days to publish initial information after someone dies in custody and another 60 days to complete and release subsequent reporting.
ICE did not respond to a request for comment about Chaofeng Ge.
Experts expect the situation to get much worse in the months ahead. That’s because Trump’s drive to deport one million people hasn’t yet coincided with the height of flu season, or the GOP’s recent cuts to the health care system, or its exclusion of undocumented immigrants from several social programs. Active Medicaid cuts threaten to kick millions of people off their health insurance and have already shuttered hospitals across the country, as the Prospect reported last month.
Trump’s immigration raids are further eroding societal health by discouraging documented and undocumented people alike from seeking medical care, even when they’re very ill. So, medical doctors told the Prospect, not only will more people enter detention facilities, but more will enter sick and with weakened immune systems, which makes contracting tuberculosis much likelier. It doesn’t have to be that way, Martinez said, but it does indicate political priorities.
“We know this population has a really high risk of tuberculosis and many other infectious diseases,” Martinez said, yet the federal government and prison companies don’t spend the money to control them. “It gives some indication that this health care issue is not being given priority.”