A transgender asylum seeker from El Salvador died in Immigration and Customs Enforcement (ICE) custody on June 1, the first day of LGBTQ pride month. Johana Medina Leon, known as Joa, had been detained at the Otero County Processing Center in New Mexico for nearly two months and had repeatedly sought help for her ailments.

In an official statement on Joa’s death, ICE El Paso Field Office Director Corey A. Price blamed “a mass influx of aliens lured by the lies of human smugglers who profit without regard for human life or well-being.” Yet, had Joa received prompt medical care, she may have lived. And, in a disturbing pattern of bureaucratic obfuscation, ICE won’t count Joa’s death among those that occurred in its custody.

Joa’s death comes almost on the anniversary of Roxsana Hernandez Rodriguez’s death in ICE custody, making Joa the second recent transgender woman asylum seeker to die in New Mexico. From 2003 to 2018, 176 people officially died while in ICE custody, and the agency has reported an additional 10 deaths since 2018. The National Immigrant Justice Center (NIJC), however, has found that ICE dodges accountability by failing to meaningfully review deaths and that at least three deaths from 2018 went unreported. NIJC concluded that most deaths in ICE custody were related to unreasonable delays in obtaining necessary medical care, poor administration of that care, or a botched emergency response. In El Salvador, Joa had been a registered nurse and yet, in ICE detention, medical neglect appears to have played a role in her death.

Joa’s tragic death follows a series of troubling incidents that occurred at Otero County Processing Center, which is run by the for-profit Management and Training Corporation (MTC) and falls under the jurisdiction of the El Paso ICE Field Office. In March, a group of attorneys from the American Civil Liberties Union (ACLU) of New Mexico, Santa Fe Dreamers Project, and Las Americas Immigrant Advocacy Center issued a collective letter calling attention to horrendous detention conditions that were putting LGBTQ asylum seekers held at Otero in danger. As visitors to the facility, we’ve personally spoken to three of the 12 individuals referenced in that letter. Moreover, visiting LGBTQ and other persons detained at Otero, we’ve been personally subjected to threatening behavior and verbal harassment by members of the facility staff who hold leadership positions. Thus, albeit in comparatively small doses, we’ve witnessed the types of abusive attitudes and behaviors that we have heard are far worse behind locked doors.

Unfortunately, the reality of Otero is a stark contrast to MTC’s gladsome marketing slogans of being a “leader in social impact” and operating under a “believe it or not I care” (BIONIC) philosophy. The letter from ACLU and other activist attorneys detailed rampant sexual harassment at this facility. One gay detainee reported being repeatedly groped and was asked to perform sexual favors for food. In addition to being forced to shower and sleep beside cisgender men, MTC staff reportedly would tell transgender women to “walk like a man” and make other demeaning comments. One of the transgender women detained at the facility explained to us how frightening it was to shower naked in a room of 50 men, many of whom were leering and making lewd comments. Recalling these events caused her to tremble; the memories of these incidents were clearly traumatic.

When LGBTQ individuals complained about the ongoing sexual harassment, MTC placed them in solitary confinement. Otero staff gave them the option to remain in solitary or return to general population, where they would suffer continued sexual harassment. Other grievances were denied or ignored. In violation of ICE detention standards, transgender women who were already receiving hormone therapy weren’t afforded the opportunity to continue with their treatment. The ACLU complaint letter indicated that, in general, medical response at Otero was slow. After poor facility sanitation, this is among the most frequent complaints we’ve heard about this facility. Given the unresolved problems with LGBTQ persons at Otero, Joa should never have been placed in the facility to begin with.

Due to the now well-documented Customs and Border Protection policy of “throttling” asylum applications at official ports of entry, on April 11, after having waited on a list in Juarez for months, Joa’s number finally came up, and she presented herself at the Paso del Norte port of entry in El Paso seeking asylum. She was officially transferred to ICE custody on April 14 and was held at Otero—the very place where just weeks before incendiary allegations of assaults, rampant sexual harassment, and medical neglect of LGBTQ individuals remained unaddressed. MTC and ICE were already on notice before Joa even arrived.

When Joa came to Otero, there were two other transgender women at the facility, and they were being kept in solitary confinement. In late April, the transgender women complained about receiving poor-quality food. Two of the women, who were part of the ACLU complaint letter, had previously been held in general population and knew that they were not receiving the same meals as everyone else. On May 3, the women complained of having colds and expressed concern that they weren’t being seen by the medical staff. They also said their recreation time was being cut short, and that they weren’t being allowed to access religious services or the facility library. On some days they were only allowed a half an hour of recreation time, while on other days, they had none at all. On several occasions, MTC staff told them that they had to choose between the library and recreation time. One of the women said their requests to visit the library had been rejected so many times, she gave up asking. Denial of access to and ultimatums regarding participation in facility activities violates ICE detention standards.

On May 10, one of the women expressed concern about Joa’s declining health. She indicated that Joa was a vegan, not receiving appropriate food, and losing weight rapidly. On May 17, all of the transgender women were transferred out of solitary and into a new segregated pod where they were housed together. During that week, the food improved a bit. By this time, the Department of Homeland Security Office of Inspector General had interviewed several of the transgender women investigating the allegations of mistreatment. It seems that both inside and outside of the facility, MTC was doing damage control after the fallout caused by the ACLU complaint letter.

On May 18, John Colquitt, the Otero volunteer liaison for MTC, an elderly Otero County real-estate and utility magnate, crafted a glowing opinion essay extolling the virtues of the facility as upholding the dignity of detained migrants. Colquitt’s well-timed essay lauded the facility for being “a great example of the way a detention center should be run,” cited impressive medical care, claimed that “a lot of these people” had never seen a doctor before, and asserted that “you can see in the faces of the detainees that they feel comfortable with staff and with the services they receive.”

As regular visitors to the Otero facility, we’ve met several individuals like Joa who worked in the medical profession before detention. We’ve never met someone who hadn’t seen a doctor before, nor have we talked to someone who was pleased with their medical care. We certainly do not see the same grateful look in the faces of detained individuals that Colquitt describes. Rather, people describe their time at the facility as “mental torture.” Unsurprisingly, Colquitt’s ebullient panegyric is now hosted on the MTC website along with his portrait and pull quotes featuring his fulsome remarks. As Colquitt’s praise of Otero went to press, Joa’s health began to decline further.

On May 24, the transgender women again complained of being ill. As before, medical staff were still nonresponsive. For Joa, the food situation had not changed. She was still not being given vegan options and was losing yet more weight. By this time, one of the other women reported that Joa was experiencing severe stomach issues and requested suero, a product like Gatorade, for replacing electrolytes and minerals. Staff told the women there wasn’t any to dispense and offered no solutions. At this point, the other transgender women were deeply concerned about Joa’s health.

On Friday, May 31, during a visit, one of the women conveyed that four days earlier, Joa had developed spots on her face and was taken to medical. According to ICE, on May 28 Joa complained of chest pains, requested an HIV test for which she was found positive, and was transported to Del Sol Medical Center in El Paso, Texas. That same day, ICE reviewed her case and “she was processed for release on parole.” Four days later, she died in the same hospital where ICE dropped her off on the very day it released her from custody.

This is not the only time when ICE released someone on their deathbed. In February 2019, José Luis Ibarra Bucio, a 27-year-old man from Mexico, fell into a coma. Though he never regained consciousness, he was released from detention and died a short while later when the family opted to terminate life support. In 2017, Saliou Ndiaye, an asylum seeker from Senegal, attempted suicide while in detention, fell into a coma, was put on life support, and released from detention by ICE while still comatose. In 2015, Teka Gulema, an immigrant from Ethiopia fell ill, lapsed into a coma, was released by ICE while still on life support, and died in the hospital. Prior to becoming sick, Teka wrote letters complaining about medical neglect in ICE detention. His concerns were prophetic.

By releasing detained individuals on their deathbeds, ICE avoids the medical costs of life support, evades congressionally mandated reporting requirements for deaths in custody, and artificially suppresses the number of deaths for which it is considered responsible. It’s a custody decision with clear financial and PR benefits. Releasing Joa into the hospital where she died days later fits this pattern, wherein ICE moves people out of custody to avoid accusations of medical delinquency and to ensure its continued funding. Joa’s death also fits the pattern identified by the NIJC—that deaths in ICE custody are most frequently associated with, and caused by, a combination of unnecessary delays and poor administration of medical care.

Back in March, we wrote in The Nation about the treatment of hunger-striking asylum seekers in detention who were force-fed, one of whom we saw collapse before our eyes. We expressed grave concern that because of medical neglect and spiteful retaliation this individual might die. When advocates called for the release of the hunger strikers, the El Paso ICE Field Office responded that they could not release people in a weakened state. Yet, in the case of Joa, José Luis, Saliou, Teka and others, ICE seemed to have no problem releasing individuals who were literally on their deathbeds. While ICE didn’t want to release hunger strikers, possibly because it feared that would incentivize a legitimate form of nonviolent protest, the agency repeatedly releases people who are either on life support or fatally ill.

Immigration detention, having doubled over the last four years, is a rapidly growing industry. As more public money is allocated to private-prison contractors like MTC, facilities seem to be becoming more abusive and dangerous. Whether run by ICE or its contractors, immigration-detention facilities are demonstrably unsafe places, which have been resistant to repeated attempts at reform. Given its stated purpose of ensuring that people are present for their immigration proceedings, detention is expensive, abusive in practice, morally dubious, and unnecessary. Congress must move quickly to pass legislation that halts the rapid expansion of detention facilities, phases them out completely, and puts in their place community-based alternatives to detention. Because of the dangers people face while detained by ICE, vulnerable groups such as LGBTQ individuals or those with serious medical conditions must be released well before their situation worsens.