The guards said he was always “clowning around,” so they locked him up alone to keep him out of trouble for 20 days. But when they discovered him on day 19, he was drugged and hanging by a “makeshift noose” from a shower head. The death last May of 27-year-old JeanCarlo Jimenez-Joseph, who was taken into federal custody in Georgia while suffering schizophrenia, followed a series of missteps that were wholly avoidable, according to advocates.

A new report by Human Rights Watch (HRW) traces over the past several years a devastating trail of epitaphs dotting the vast system of immigrant detention—a burgeoning network of facilities ranging from federal prisons to private commercial detention centers to tent cities in the desert. The official records generally list nondescript reasons for death, such as “cardiac arrest.” But ICE’s opaque bureaucracy masks a metastasizing crisis: Researchers note the growing frequency and patterns of neglect displayed in many of the death cases as warning signs that went ignored. (In fact, just days after Jimenez-Joseph’s suicide, a middle-aged Indian detainee in Georgia, Atulkumar Babubhai Patel, died after being hospitalized. He had previously been diagnosed at the detention center with diabetes and high blood pressure.)

In fiscal year 2017, according to federal statistics, 12 detainees died on Homeland Security’s watch, a record number since 2009 and double the death rate of four years ago.

Now advocates fear that Trump is turning the country’s immigrant-detention system into a new kind of death row along the border.

As the Trump administration dramatically expands the deportation regime, the government insists that mass detention of people who have committed no “crime” other than border crossing is necessary for maintaining law and order (although there is actually no federal code that mandates mass detention), or that it must “teach migrants a lesson” (though there is scant evidence that refugees have been deterred from fleeing for their lives).

With about 2,300 children separated over the past few weeks in recent weeks and warehoused in tent cities and retail buildings, mental health experts have warned of profound damage caused by the toxic stress of protracted separation, including deep anxiety, depression, and chronic post-traumatic stress disorder. Similar traumas could afflict thousands of other youth who were taken into custody after arriving at the border as unaccompanied minors, having already been estranged from their families.

Parents, too, suffer massive anguish, facing deportation alone while their children remain separately imprisoned. One father threatened with separation from his son committed suicide; many parents might be stranded without means of communicating with their kids. Claudia Valenzuela, detention project director at National Immigrant Justice Center, says, “You don’t have to be an expert necessarily to see that just the physical need of children to be near their caregivers could have…a profound physical, psychological impact on individuals.”

From the Port Isabel detention center in Texas, the sound of detained children’s cries have echoed across the global media. But in the backdrop a silent shadow of death stalks the concrete walls. Just weeks ago, Ronal Francisco Romero, a 39-year-old from Honduras, died several days into his detention at Port Isabel after crossing the Texas border. According to HRW’s analysis of his autopsy report, Romero had suffered “a form of bacterial meningitis that began as an infection of the right middle ear and subsequently spread to the brain.” The autopsy report shows that he “would have been intensely, visibly ill and in severe pain for several days” prior to his hospitalization. In the same facility where Romero perished, scores of separated children remain incarcerated.

In addition to traumatized children, HRW highlights other health threats that disproportionately impact other vulnerable groups of detainees, especially women with acute reproductive-health-care needs, including pregnancy, and transgender people.

In one of the most recent detainee death cases, Roxana Hernandez, a 33-year-0ld transgender woman who had arrived at a border checkpoint in San Ysidro, California, to claim asylum (as part of the high-profile migrant protest caravan that arrived at the border in May) died several days later after being dragged through various facilities along the border. According to the migrant-rights group Pueblos sin Fronteras, Hernandez had “spent five days freezing in the ‘hieleras’–or cells with very cold temperatures…without adequate food or medical attention, being guarded and without a way to rest in the cold under 24-hour lighting.” Shortly after Hernandez landed at the transgender unit of a New Mexico detention center, she died in hospital, reportedly for cardiac arrest that was compounded, according to her supporters, by “pneumonia, dehydration and complications associated with HIV.” The public outcry following her death led activists to demand a halt to all detentions of LGBTQ immigrants, since transgender people are routinely subjected to abuse and massive gaps in health and psychiatric care, according to HRW.

ICE has responded to the HRW report by reiterating that every detainee death is carefully reviewed to assess compliance with “nationally recognized standards of detention health care and practices.”

However, the whole crisis of health care in detention would be avoidable if the government simply stopped imprisoning the vast majority of these migrants, who have no serious criminal convictions and pose no security threat. There are numerous alternatives to detention that do not involve locking up adults or children, including community-based housing and social-support services, so families are kept intact while they fight for their lives in the courts.

Valenzuela also noted the underlying profit motive that is fueling the industry of private immigration prisons, with many detention facilities and services—including medical programs—managed through massive federal contracts with security corporations. The detention business, she says, is designed to “ration essential services like food and medical care…. It’s a combination of wanting to maximize profit and the idea that these individuals are somehow expendable or are not worthy of basic human rights protections.”

Many around the world are looking at the US border in horror and wondering how the crisis was allowed to happen. The only rationale seems to be the desire simply to extract profit through the political and economic exploitation of the suffering of families. Yet for better or worse, not even those powerful business incentives will ever trump the power of a mother’s bond with her child.