In April 2019, 37-year-old Nebane Abienwi left his wife and three children at home in Bafut, Cameroon, to embark on a journey that would take him across three continents and nine countries. His goal was to reach the United States through Mexico, but his life ended tragically in Immigration and Customs Enforcement (ICE) custody at the Sharp Chula Vista Medical Center in San Diego, California, on October 1, 2019, from a cerebral hemorrhage following a stroke caused by extremely high blood pressure.

Abienwi was an accomplished mechanic back home, and had been the breadwinner for his family since his parents died when he was 18 or 19, his younger brother, Akongnwi, said. But when civil conflict broke out in his town of Bafut between the Cameroonian government and armed groups advocating for independence in the Anglophone regions of the country, Abienwi chose to migrate to the United States in search of safety and financial stability for his family.

Abienwi thus became one of some 10,000 Cameroonians to try to seek asylum or otherwise enter the United States since 2016, according to the president of the Cameroon American Council Sylvie Bello. These migrations increased after the European Union cracked down on migration from Africa in 2016. In April 2019, Abienwi flew to Ecuador, which allows most African nationals to enter without a visa. Then, he began the difficult overland journey to the United States.

Abienwi first got sick in Mexico, after making it through rough patches of jungle in Central America, his brother said. “There were situations when he was actually feeling down, like this journey is very, very stressful…the time he was in Mexico, he said that he was feeling a bit down, that he wasn’t well, so he had to take some pills from the hospital.”

Abienwi’s ICE medical record shows that he was hospitalized twice in Mexico for hypertension, including on August 23, 2019 in Tijuana, less than two weeks before he crossed the border.

Before he crossed, he sent his siblings a message on WhatsApp. “He said, ‘I’m actually leaving Mexico now to the other side, which is the United States, so I’ll talk to you guys when I can. I love you all. Take care,’” said Akongnwi.

Abienwi entered the United States at the San Ysidro border on September 5, and despite his brother’s attempting to call him five times when he was in detention, the family never spoke to him again.

After he presented himself for asylum and was detained to await his hearing, the authorities brought Abienwi to Otay Mesa, an ICE facility operated by the for-profit firm CoreCivic. The morning of September 26, 2019, in an adjacent cell he shares with seven other detainees, 24-year-old Cameroonian asylum seeker Landys Tenangfie learned that Abienwi was “bleeding through his ears and his nose,” and that ICE health workers took Abienwi to the hospital.

According to ICE, Abienwi had a stroke and fell from his top bunk onto the floor of his cell. He was brought to Sharp Chula Vista, and he was quickly placed on a ventilator for life support.

After difficulty communicating with Abienwi’s wife in Cameroon, ICE called Akongnwi, who lives in South Africa, to tell him that his brother’s brain was bleeding and that it would be a matter of days before he died. They asked if he would give permission to take him off life support, and he said no. “The doctors said it would take a miracle for him to survive, but I said, OK, let’s pray and see what happens,” Akongnwi explained. But on October 1 at 2:37 pm, the hospital declared Abienwi brain-dead and removed him from the ventilator.

According to two medical professionals, the lack of proper medical attention indicates that he was a victim of medical negligence. “It’s just inconceivable to me that he’s…been hospitalized three weeks ago [in Mexico] for severe hypertension and then can come into a facility and be totally normal,” said Dr. John Flack, hypertension specialist and Chair of the Department of Internal Medicine at Southern Illinois University, adding that his symptoms appeared to have been “woefully undertreated.”

Dr. Craig Spencer, director of Global Health in Emergency Medicine at New York-Presbyterian/Columbia University Medical Center, said that not treating Abienwi’s blood pressure amounts to medical neglect.

Akongnwi agreed. “The doctor I spoke to actually made it clear that it’s on record, they said that when he got there, he was fine. So I really do not understand that part. He was fine, then all of a sudden, how can he be that sick?” he asked.

Although ICE sent Abienwi’s belongings directly to Cameroon just two days after his death, the family had a hard time accessing his body. ICE protocols say that next of kin can gain access to identify the body and bring him home to Cameroon to be buried, but Abienwi had no close relatives in the United States, and Akongnwi was twice denied a US visa to come pick up the body after applying in both South Africa and Cameroon.

ICE told the family that they had to coordinate the return of the body with the Cameroonian embassy in Washington, DC, even though the Cameroonian embassy has an adversarial relationship to Anglophone asylum-seekers. After giving Akongnwi the runaround, the embassy demanded multiple administrative papers from Cameroon, which meant that he had to go back from South Africa to find them.

This period was especially hard on the extended family in Cameroon, who did not know if and when Abienwi would be able to receive proper burial rites. Abienwi’s aunt died suddenly two weeks after Abienwi’s death, and her husband (Abienwi and Akongnwi’s uncle) then also died on the day that his wife was buried.

Eventually, the funeral home in San Diego was able to communicate with the Cameroon embassy and the body was sent home.

Like Abienwi, Landys Tenangife is from an Anglophone region of Cameroonian caught in a war with the Francophone government and had made the arduous, dangerous journey through Latin America from Ecuador, which allows most African nationals to enter without a visa. He was detained in Otay Mesa in December 2018, and has had elevated blood pressure since security forces in Cameroon beat and tortured him in 2018, after which he fled to the United States to seek asylum, his sister Melette Tendongim said.

During the winter holiday season, just a couple of months after Abienwi died, Tenangife was hospitalized for the third time, spending three days being treated for extreme hypertension. His blood pressure of 200/100 prompted his sister to lobby for him to be released on bail because of medical concerns, which request has been denied thus far by ICE. Tenangfie has been in detention for 13 months, significantly longer than most other detainees at Otay Mesa, because he is appealing a deportation ruling. If he is deported back to Cameroon, he will almost certainly be arrested on arrival, likely tortured, and possibly killed, his sister said.

But Tenangfie’s family are worried he will die in ICE detention as well, and are mobilizing support from members of Congress for Tenangfie’s immediate release as well as raising funds for his legal defense through the Cameroon American Council. “Looking at his medical record, I can assure you that if care and action is not taken he may end up dying from a hemorrhagic stroke just like Nebane Abienwi,” his sister said.

Conditions at Otay Mesa and other ICE and CPB facilities are notoriously dangerous for detainees. Three other Africans died in ICE and CPB custody over the winter holiday season, while a Ugandan woman died in September in Juarez, Mexico, while waiting for her CBP interview under Trump’s new metering process. A 2019 California Department of Justice report found that immigrant detention facilities were often characterized by “superficial medical examinations, delayed or inadequate medical care, inadequate mental health staffing and services” and other malpractice.

A 2019 class action lawsuit filed in California against ICE and DHS drives stated that “to seek care, detained individuals regularly must make repeated requests to staff for medical attention—and then wait for days for a response.”

An internal memorandum leaked to Buzzfeed in December noted that the DHS Office of Inspector General stated that “ICE Health Service Corps (IHSC) has systematically provided inadequate medical and mental health care and oversight to immigration detainees in facilities throughout the U.S.” The memorandum described four cases in which detainees died in custody at least partially because of medical neglect.

In December, Border Patrol refused to administer flu vaccines, despite the death from influenza of at least three children in detention. The ACLU has called the lack of proper medical attention for children in detention “simply the latest attempt to dehumanize asylum-seekers and migrants, including children, and deny them basic care and dignity.”

The fact that hypertension cases are ignored also points to a difference of experience for black people, who are more likely to suffer from the condition than other groups. “You’re going to see more severe blood pressure elevation than you’re going to see in any other racial ethnic group,” said Dr. Flack.

As the Department of Homeland Security takes more aggressively racist measures targeting migrants, including adding six more countries to the travel ban, ICE and CPB continue to put asylum seekers in danger through medical negligence and a lack of accountability.