Physicians for
Human Rights

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CLINI CAL PROGRAM-

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“Endless Nightmare”
Torture and Inhuman Treatment
in Solitary Confinement in U.S.
Immigration Detention
February 2024

PEELER
Immigration

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Acknowledgments
		Contents
1 Executive Summary
3 Recommendations
5 Introduction
6 Background
9 Methodology and Limitations
14 Key Findings
32 Legal and Policy Framework
34 Conclusions and Recommendations
37 Appendix A
43 Appendix B
44 Endnotes

This report was written jointly by students and faculty of the Harvard Immigration and Refugee
Clinical Program (HIRCP) and Harvard Law School (HLS), members of the Peeler Immigration Lab
(PIL) at Harvard Medical School (HMS), and Physicians for Human Rights (PHR).
The PIL writing and analysis team included Caroline H. Lee, MD, resident physician in the
Department of Emergency Medicine, University of California San Francisco; HMS students Natalie
Sadlak, Brian Benitez, and Anand Chukka; and senior author Katherine Peeler, MD, MA, Division
of Medical Critical Care, Boston Children’s Hospital, assistant professor of pediatrics at Harvard
Medical School, Justice, Health and Democracy Impact Initiative Fellow at the Edmond and Lily
Safra Center for Ethics at Harvard University, and PHR medical expert.
Interviews were conducted by PIL students and faculty Caroline Lee, MD, Natalie Sadlak, Brian
Benitez, Isaiah Baker, Julie Castro, Amina Rahimi, Anand Chukka, and Katherine Peeler, MD.
The HIRCP writing and research team for this report included Harvard Law School students Felicia
Caten-Raines (JD ‘25), Jiwon Kim (JD ‘24), and Ennely Medina (JD ‘23) under the supervision of
Sabrineh Ardalan, Clinical Professor of Law and Director of HIRCP, and Philip L. Torrey, Assistant
Clinical Professor of Law and Director of the Crimmigration Clinic.
Dr. Arevik Avedian, Lecturer on Law, and Director of the Empirical Research Department at Harvard
Law School conducted and supervised HIRCP’s statistical analysis in the report. This report would
not have been possible without the work of numerous HIRCP clinical students, summer interns,
and research assistants from 2017 to the present, who drafted, filed, and litigated numerous FOIA
and state privacy act requests.
The PHR writing team included PHR staff Tessa Wilson, senior program officer, Asylum Program.
The report benefitted from review by PHR staff, including Christian De Vos, JD, PhD, director of
research and investigations; Ranit Mishori, MD, MHS, MSc, FAAFP, medical advisor; Michele Heisler,
MD, MPA, medical director; Madhuri Grewal, JD, interim deputy director of advocacy; Erika Dailey,
MPhil, director of advocacy, policy, and communications; and Saman Zia-Zarifi, JD, LLM, executive
director. The report benefited from contributions by Brittney Bringuez, former asylum program
coordinator, and Anna-Theresa Unger, former research and case management intern. Julie Castro
and Brian Benitez graciously supplied written translation for the executive summary.
The report also benefited from external review by PHR board member and Publications Committee
co-chair Adam Richards, MD, MPH, PhD and by Parveen Parmar, MD, MPH, professor, clinical
emergency medicine, Keck School of Medicine, University of Southern California and PHR expert.
The report was edited and prepared for publication by Rhoda Feng, publications consultant,
PHR. Hannah Dunphy, PHR’s Senior Communications Manager, prepared the digital presentation.
The entire study team would like to thank Ellen Gallagher, DHS whistleblower and current
Acting Deputy Chief of Staff at the DHS Office of Inspector General, who is represented by the
Government Accountability Project; the current and former clients of HIRCP who were held in
solitary confinement and willing to share their story; and local advocates who have been fighting
these issues for decades.

Cover: View through a peephole
into a single cell at the police
department.
Photo: Thomas Imo via
Getty Images / Contributor

Additionally, we are immensely grateful for, and humbled by, the 26 participants in the interview
portion of this study. Their generosity and strength in sharing their stories with us so that others
may hopefully one day benefit from this information is unmeasurable.
Funding support for this study was provided by the Boston Children’s Hospital Division of Medical
Critical Care IGNITE MCC grant. Dr. Peeler’s research time was also supported by the Edmond &
Lily Safra Center for Ethics at Harvard University. The HLS study benefited from the support of the
Bellow Scholars Program and the HIRCP FOIA litigation from co-counseling with Jenner & Block LLP.

Executive Summary
The United States maintains the world’s largest
immigration detention system, detaining tens of thousands
of people in a network of facilities, including those managed by
private prison corporations, county jails, U.S. Immigration and
Customs Enforcement (ICE), U.S. Customs and Border Protection
(CBP), and the Office of Refugee Resettlement (ORR). At the
time of writing, ICE is detaining over 35,000 people, including
long-term residents of the United States, people seeking asylum,
and survivors of trafficking or torture. Instead of finding
refuge, these people are held in ICE custody for extended
periods, enduring inhuman conditions such as solitary
confinement (dubbed “segregation” by ICE), where
they are isolated in small cells with minimal contact
with others for days, weeks, or even years. In many
instances, such conditions would meet the definition of
torture, or cruel, inhuman, or degrading treatment under
international human rights law.
Solitary confinement causes a range of adverse health effects,
including post-traumatic stress disorder (PTSD), self-harm,
and suicide risks. Prolonged confinement can lead to lasting
brain damage, hallucinations, confusion, disrupted
sleep, and reduced cognitive function. These effects persist
beyond the confinement period, often resulting in enduring
psychological and physical disabilities, especially for people with
preexisting medical and mental health conditions or
other vulnerabilities.
In recognition of this well-documented harm, ICE issued
a directive in 2013 to limit the use of solitary confinement
in its facilities, especially for people with vulnerabilities. A
2015 memorandum further protected transgender people,
emphasizing solitary confinement as a last resort. In 2022, ICE
reinforced reporting requirements for people with mental health
conditions in solitary confinement, highlighting the need for
strict oversight. Despite these directives, however, government
audits and whistleblowers alike have repeatedly revealed stark
failures in oversight.
This report – a joint effort by Physicians for Human Rights (PHR),
Harvard Law School’s Immigration and Refugee Clinical Program
(HIRCP), and researchers at Harvard Medical School (HMS) –
provides a detailed overview of how solitary confinement is being
used by ICE across detention facilities in the United States, and its
failure to adhere to its own policies, guidance, and directives. It is
based on a comprehensive examination of data gathered from ICE
and other agencies, including through Freedom of Information
Act (FOIA) requests, first filed in 2017, and partly acquired after
subsequent litigation. It is further enriched by interviews with
26 people who were formerly held in immigration facilities and
experienced solitary confinement over the last 10 years.

Physicians for Human Rights

The study reveals that immigration detention facilities fail
to comply with ICE guidelines and directives regarding
solitary confinement. Despite significant documented issues,
including whistleblower alarms and supposed monitoring and
oversight measures, there has been negligible progress. The
report highlights a significant discrepancy between the 2020
campaign promise of U.S. President Joseph Biden to end solitary
confinement and the ongoing practices observed in ICE detention.
Over the last decade, the use of solitary confinement has persisted,
and worse, the recent trend under the current administration
reflects an increase in frequency and duration. Data from solitary
confinement use in 2023 – though likely an underestimation as
this report explains – demonstrates a marked increase in the
instances of solitary confinement.
This report exposes a continuing trend of ICE using solitary
confinement for punitive purposes rather than as a last resort – in
violation of its own directives. Many of the people interviewed
were placed in solitary confinement for minor disciplinary
infractions or as a form of retaliation for participating
in hunger strikes or for submitting complaints. Many
reported inadequate access to medical care, including
mental health care, during their solitary confinement,
which they said led to the exacerbation of existing
conditions or the development of new ones, including
symptoms consistent with depression, anxiety, and
PTSD. The conditions in solitary confinement were described as
dehumanizing, with people experiencing harsh living conditions,
limited access to communication and recreation, and verbal
abuse or harassment from facility staff.

“ICE oversaw more than 14,000 placements
in solitary confinement between 2018
and 2023. Many people who are detained
in solitary confinement have preexisting
mental health conditions and other
vulnerabilities. The average duration of
solitary confinement is approximately one
month, and some immigrants spend over
two years in solitary confinement.”

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Executive Summary
continued

Analysis of FOIA data revealed persistent and prolonged use of
solitary confinement and demonstrated significant inadequacies
of current oversight and accountability mechanisms. In the
last five years alone, ICE has placed people in solitary
confinement over 14,000 times, with an average duration
of 27 days, well exceeding the 15-day threshold that United
Nations (UN) human rights experts have found constitutes
torture. Many of the longest solitary confinement
placements involved people with mental health conditions,
indicating a failure to provide appropriate care for
vulnerable populations more broadly.
Some solitary confinement placements lasted significantly
longer, with 682 lasting at least 90 days and 42 lasting over one
year. Many of these instances involved people with mental health
conditions and other vulnerabilities, with 10 placements lasting
over a year in solitary confinement. Data provided by ICE
also demonstrated a disproportionately harmful impact
on people with vulnerabilities, particularly transgender
people and those with mental health and medical
conditions.
The treatment of people in immigration detention facilities
and the excessive, punitive use of solitary confinement is
not only contrary to ICE’s own policies and guidance but
also violates U.S. constitutional law and international
human rights law. The Fifth Amendment prohibits the
deprivation of life, liberty, or property without due process of law,
protection that extends to all persons within the United States,
including people in immigration detention. The government has
a duty to ensure the health and safety of people in immigration
detention facilities by providing for their basic needs such as
food and medical care. Persons in detention also have First
Amendment rights, including the freedom to protest conditions
or report issues without fear of retaliation.

2

International human rights law has also made clear that the
detention of immigrants, especially in solitary confinement,
should be a last resort, for the shortest time possible, and used
only for limited purposes. The United States has signed and
ratified the International Covenant on Civil and Political Rights
(ICCPR), which prohibits arbitrary and unlawful detention. The
use of prolonged solitary confinement, especially for people with
mental health conditions, is prohibited under the UN Standard
Minimum Rules for the Treatment of Prisoners (the Nelson
Mandela Rules). The United States has also signed and ratified
the UN Convention against Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment. The UN Special Rapporteur
on Torture has highlighted the severe psychological and physical
harm caused by prolonged solitary confinement, especially for
people with mental health conditions.
ICE’s failure to adhere to domestic and international law
and its own guidelines has created dangerous conditions
in detention centers, particularly for people with mental
and medical health conditions or other vulnerabilities.
The persistent use of solitary confinement over the last decade
underscores the need for radical changes in ICE policy and
practice. The evidence of profound physical and mental
health deterioration caused by solitary confinement, in
combination with ICE’s inability to implement policies
around its use that adhere to its own guidelines as well
as constitutional and international law, necessitates an
immediate commitment by ICE to end the practice entirely.
Prior to publication, the authors of this report had the opportunity
to present the findings to key personnel in DHS and ICE.

“Endless Nightmare”

Recommendations
The report makes the following recommendations to the
Secretary of the U.S. Department of Homeland Security
(DHS) and to the Director of ICE, which serve as a road map
to completely phase out the use of solitary confinement in
immigration detention. Full recommendations to other engaged
actors can be found starting on p. 34.
1. Publicly commit to ending the use of solitary confinement
in all immigration detention facilities. As it abandons
solitary confinement, DHS and ICE must express this
commitment in the form of a binding directive. The
directive should:
a. Require a presumption of release from ICE detention
for people who have reported existing vulnerabilities,
including, but not limited to, people with serious medical
conditions, mental health conditions, disabilities, LGBTQIA+
people, and survivors of torture and/or sexual violence. These
people should be released into the safety of their community
with post-release care plans in place, per the 2022 ICE directive,
in addition to providing resources and referrals for social, legal,
and/or medical services as appropriate.
b. Mandate that any person in detention be afforded
24-hour access to qualified mental and medical health
care professionals who respond in a timely manner and
in compliance with the Health Insurance Portability and
Accountability Act (HIPAA).
c. Require increased transparency from ICE’s Detention
Monitoring Council by making properly redacted
or deidentified reports and reviews related to solitary
confinement publicly available on the agency’s
website within 72 hours of the order. to place someone
in solitary confinement.

Physicians for Human Rights

2. Amend the 2013 “Segregation Directive” to ensure that
every immigration detention facility, public or privately
contracted, is required to report concurrently to ICE Field
Office Directors and ICE headquarters within 24 hours of
placing someone in solitary confinement. ICE headquarters,
in turn, must share this consolidated “segregation”/solitary
confinement data with the DHS Office of the Secretary within
72 hours. This requirement must apply to every confined person,
regardless of the duration of their confinement or whether they
have a vulnerability. Additionally:
a. For those who are currently in solitary confinement, require a
prompt and meaningful psychosocial and medical evaluation,
undertaken by qualified medical professionals, who can assess
the prevalence and extent of existing vulnerabilities.
b. For those scheduled for placement in solitary confinement,
require a meaningful psychosocial and medical evaluation by
qualified medical professionals who can assess the prevalence
and extent of existing vulnerabilities prior to such a placement.
c. Mandate the reporting of race and ethnicity of each person in
solitary confinement.
d. Mandate reporting of the justification provided for initial
confinement; justification for continued confinement; duration
of the confinement; any vulnerabilities identified; and a detailed
description of the alternatives to solitary confinement that
were considered and/or applied, as listed in 5.3.(2) of the 2013
“Segregation Directive.”
e. Require daily checks and regular monitoring and
documentation by qualified and licensed health care
professionals against a detailed checklist created in partnership
with independent medical professionals, that includes reviewing
vital signs, checking for signs of self-harm, and any other
indicators of deteriorating mental and physical health.
f. Require the routine sharing by ICE of deidentified data acquired
from the above reporting mechanisms on its website every two
weeks as part of its release of Detention Statistics, until it has
ended the use of solitary confinement.

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Recommendations
continued

3. Revise current contracts and agreements with
immigration detention facility providers and contractors
to include stringent performance standards and
clear metrics for compliance regarding the use of
solitary confinement. Compliance should be assessed
through regular and comprehensive inspections by the
Contracting Officer. Additionally, to increase adherence to
detention standards, ICE must:
a. Introduce a performance-based contracting model, where
a portion of payment is contingent upon meeting certain
performance and reporting indicators, including those listed
in recommendations 1 and 2 herein; and
b. Impose immediate financial penalties for any violation
of performance and reporting indicators, and contract
termination for repeated or persistent violation.

4. Establish a task force led by the Office of the Secretary of
DHS to develop a comprehensive plan including specific
recommendations for phasing out the use of solitary
confinement. The task force must include:
a. Members with knowledge of, or expertise regarding, the
mental and physical health consequences of the use of solitary
confinement;
b. Independent medical experts;
c. Independent subject matter experts from civil society (including
those with expertise in the use of solitary confinement in
criminal and civil custodial settings and human rights);
d. Formerly detained immigrants who have experienced solitary
confinement in ICE custody; and
e. Employees of the following offices:
I. Civil Rights and Civil Liberties (CRCL);
II. ICE Health Services Corps (IHSC);
III. Immigration Detention Ombudsman (OIDO);
IV. Enforcement and Removal Operations (ERO); and
V. Office of Professional Responsibility (OPR).
The plan must be presented to Congress and publicly accessible on
ICE’s website upon completion, which shall be no later than one
year after formation of the task force. Finally, recommendations
included in the plan should ensure the end of ICE’s use of solitary
confinement in immigration detention within one year of
presentation of the plan to Congress and the public.

4

“Endless Nightmare”

Introduction
The United States operates the world’s largest immigration
detention regime. On any given day, tens of thousands of
adults and children are detained in a vast network of facilities,
including those operated by private prison corporations,1 county
sheriffs, U.S. Immigration and Customs Enforcement (ICE), U.S.
Customs and Border Protection (CBP), and the Office of Refugee
Resettlement (ORR). Immigration detention is legally considered
civil rather than criminal custody, but many immigrants are
held in correctional facilities, which means the conditions of
confinement are often the same as criminal incarceration.
As of the writing of this report, ICE is currently detaining more
than 35,000 people.2 These include people who have built a life in
the United States for decades as well as people who have recently
arrived seeking asylum, including trafficking or torture survivors
who fled their home countries for their own safety. Those hoping
to find refuge in the United States are instead imprisoned, often
for months or even years while they wait for their immigration
applications to be resolved or to be deported. As they wait, they
are frequently subjected to inhuman conditions, including, as
this report details, the danger, indignity, and harm of solitary
confinement – being held in small cells with little or no contact
with other people for days, weeks, or even years at a time.3

Physicians for Human Rights

Given the lack of oversight and transparency regarding the use
of solitary confinement in immigration detention, Physicians
for Human Rights (PHR), along with faculty and students at
Harvard Law School (HLS) and Harvard Medical School (HMS),
have sought to spotlight what is happening in the “black box” of
solitary confinement in ICE detention centers. This report is the
culmination of that work and reflects years of research to uncover
how many people have been held in solitary confinement, the
conditions in solitary confinement, the sense of helplessness felt
by those subject to solitary confinement – sometimes for months
or even years – and the harmful impact of solitary confinement on
people after their release from detention.
Much of the data in this report was obtained by faculty and
students at HLS through Freedom of Information Act (FOIA)
requests and subsequent litigation that builds on records
previously obtained by the Project on Government Oversight
(POGO) and the International Consortium of Investigative
Journalists (ICIJ). This report also draws on dozens of personal
interviews with survivors of solitary confinement conducted by
faculty and students at HMS. This report details the abusive and
excessive use of solitary confinement in immigration detention.
For example, ICE oversaw more than 14,000 placements in
solitary confinement between 2018 and 2023. Many people who
are detained in solitary confinement have preexisting mental
health conditions and other vulnerabilities.4 The average duration
of solitary confinement is approximately one month, and some
immigrants spend over two years in solitary confinement,5
illustrating how concerns repeatedly raised by members of
Congress, government auditors, and whistleblowers alike about
the prolonged and excessive use of solitary confinement have
been ignored.6

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Background
Solitary Confinement in ICE Detention

ICE Directives on Solitary Confinement

Solitary confinement is generally defined as isolating someone
in a cell for 22 hours or more per day without meaningful human
contact.7 However, ICE describes this practice euphemistically
as “segregation” or “segregated housing,” using it as both
punishment (termed “disciplinary segregation”) and ostensibly
for safety (“administrative segregation”).8 In this report, the term
“solitary confinement” will be consistently used, unless directly
quoting ICE or other official government records where the term
“segregation” was applied. Notably, the need for medical isolation
when no “designated medical unit exists” is one stated purpose of
administrative “segregation.” However, this is in stark contrast to
standard medical care of patients who need isolation for medical
reasons. In the latter, isolation rooms are simply normal rooms
with windows and regular furniture and bedding but the influx
and egress of persons are controlled. Rooms are not locked,
isolated persons do not lose most of their “privileges,” and while
confined, one is made to feel like a patient, not a prisoner.

2013 “Segregation Directive”
After years of documentation and advocacy by civil society, ICE
issued a directive in 2013 – over a decade ago – that mandates limiting
and monitoring the use of solitary confinement in immigration
detention. The 2013 “Segregation Directive” describes two forms of
solitary confinement: administrative segregation and disciplinary
segregation.17 Before someone can be placed in disciplinary
segregation, the directive states that there must be a hearing and a
finding by a disciplinary panel.18

The adverse health effects of solitary confinement are welldocumented and include post-traumatic stress disorder (PTSD)
and increased risks of self-harm and suicide.9 According to
research, isolation can cause lasting brain damage and trigger
symptoms such as hallucinations, confusion, heart palpitations,
disrupted sleep, and reduced cognitive function.10 These
symptoms can extend beyond the period of solitary confinement
and affect people after their release by causing enduring
psychological and physical disabilities and impairments.11 For
people with preexisting medical and mental health conditions,
solitary confinement can worsen existing conditions and even
lead to suicide.12 Solitary confinement thus exacerbates the
well-documented high rates of suicide of immigrants in ICE
detention.13
International law clarifies that prolonged solitary confinement
“can amount to torture or cruel, inhuman or degrading treatment
or punishment when used as a punishment … for persons with
mental disabilities or juveniles.”14 As such, in 2011 the UN Special
Rapporteur on Torture called for an “absolute prohibition” on
solitary confinement for more than 15 days.15 Additionally,
the Rapporteur recognized that shorter periods of solitary
confinement for legitimate disciplinary reasons can constitute
“cruel, inhuman or degrading treatment or punishment where
the physical conditions of prison regime (sanitation, access to
food and water) fail to respect the inherent dignity of the human
person and cause severe mental and physical pain or suffering.”16

6

According to the 2013 “Segregation Directive,” administrative
segregation is “a non-punitive form of separation from the general
population” and is authorized “only as necessary to ensure the
safety of the detainee, facility staff, the protection of property; or the
security or good order of the facility.”19 Consequently, the directive
warns that placement in solitary confinement “is a serious step that
requires careful consideration of alternatives” before it is used.20 For
people with special vulnerabilities, such as those with mental health
conditions, serious medical conditions, disabilities, LGBTQIA+
people, and torture, trafficking, and trauma survivors, the directive
mandates that solitary confinement should be “only used as a last
resort and when no other viable housing options exist.”21 Facilities
must notify the ICE Field Office Director (FOD) if someone has a
special vulnerability as soon as possible but not more than 72 hours
after placement in solitary confinement, or when anyone has been
placed in solitary confinement for 14 consecutive days or 14 days in a
21-day period.22

Special Protections for Vulnerable Populations
2015 Memorandum: Transgender People in Detention
In 2015, ICE issued a memorandum emphasizing the need for
additional protections for transgender people in detention. Like the
2013 “Segregation Directive,” the 2015 guidance emphasized that
transgender people should be placed in solitary confinement only “as
a last resort and when no other temporary housing option exists.”23
Under the guidance, if a facility cannot meet this requirement or
if there are concerns about the conditions of confinement, ICE is
required to examine whether transferring the person to a different
facility is a viable option.24
2022 Directive: “Individuals with Serious Mental Illness”
In 2022, ICE issued a further directive related to detained persons
with serious mental health conditions that reiterated the heightened
reporting requirements when placing such persons in solitary
confinement.25 The directive further echoed the 2013 “Segregation
Directive” by specifically mandating that facilities notify the ICE FOD
and the ICE Office of the Principal Legal Advisor within 72 hours of
placing any immigrant with a serious mental health condition in
solitary confinement.26
“Endless Nightmare”

ICE Solitary Confinement
Oversight Mechanisms
The 2013 “Segregation Directive” requires FODs to collect data
from facilities on their use of solitary confinement so that ICE
headquarters can provide oversight. Specifically, immigration
detention facility administrators are required to notify FODs
within 72 hours of the use of solitary confinement on anyone who
has medical or mental illness, has a special vulnerability and/or
because the detained person is an alleged victim of sexual assault,
is an identified suicide risk, or is on hunger strike.27 The 2013
“Segregation Directive” also mandates reporting on the prolonged
use of solitary confinement for any person with or without these
vulnerabilities when they have been held “for 14 days, 30 days, and
at every 30-day interval thereafter” or “for 14 days out of any 21 day
period.”28
ICE’s oversight mechanism for solitary confinement has been
described in more detail by the U.S. Government Accountability
Office (GAO) in a 2022 report.29 Per the report, ICE headquarters
staff within “Custody Management” conduct reviews of
all solitary confinement placements in what is known as a

“Segregation Review Management System” (SRMS).30 The staff
review compliance with ICE detention standards and directives.
Representatives of a select group of ICE offices, including Custody
Management, Office of the Principal Legal Advisor attorneys,
and ICE Health Service Corps, also conduct weekly reviews for
compliance with detention standards.31
ICE also maintains a “Detention Monitoring Council,” comprised
of management officials who meet quarterly to discuss overall
detention-related issues, including solitary confinement.
Headquarter officials from Custody Management present a report
on solitary confinement statistics, which includes, among other
things, length of solitary confinement, reasons for confinement,
and how many individuals were considered members of
vulnerable populations.32
In addition to oversight through the mechanisms described
above, solitary confinement practices are also monitored through
facility inspections and onsite monitoring of detention standards
compliance, including by independent inspectors, and by the DHS
Office of Inspector General (OIG).33
A process map of ICE’s oversight mechanism for solitary
confinement, as described in the GAO report, can be seen in
Graphic 1, below.34

Graphic 1: ICE Solitary Confinement Oversight Mechanism Process Map

ill

Detention facility makes
a solitary confinement
placement and reports it
to the field office

DDDDD
DDDDD
DDDDD
D
D

,,.
Field office reviews and reports
immigrants in detention who
have vulnerabilities or who
have been in the Segregation
Review Management System
(SRMS) for 14 days or longer

Group of headquarters
officials meet weekly
to review a selection of
placements

Group of ICE
management officials
meet quarterly to review
trends in solitary
confinement use

Physicians for Human Rights

ICE headquarters reviews
solitary confinement
placements in SRMS

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Background
continued

Documentation of Noncompliance
and Abuse
Despite these directives, whistleblowers and government
investigators alike have documented the abuse and overuse of
solitary confinement in immigration detention over the past
decade, particularly among vulnerable groups such as people with
mental health conditions, physical disabilities, LGBTQIA+ people,
and survivors of torture and domestic violence.35 Oversight
mechanisms have also been repeatedly flagged as failing to
ensure compliance.36 Indeed, current Homeland Security
Secretary Alejandro Mayorkas has been on notice about these
failures related to solitary confinement since 2014.37 The OIG,
which provides independent oversight of DHS, has expressed
concern about ICE’s repeated failure to follow its own directives
limiting the use of solitary confinement.38 In a 2021 audit, OIG
reiterated those concerns while flagging ongoing problems with
complying with reporting requirements and record retention
policies related to “segregation.”39 Recognizing that solitary
confinement can result in severe negative psychological effects,
particularly for people with preexisting mental health conditions
or people at risk of suicide, OIG also concluded that ICE had failed
to document whether it properly considered alternatives before
placing someone in “segregation.”40
Similarly, a 2022 report from the GAO again highlighted
that ICE did not consider alternatives to “segregation” for
most placements.41

Recent Developments and Persistent Failures
In September 2023, the Department of Homeland Security’s
Office for Civil Rights and Civil Liberties (CRCL) and the DHS
Office of General Counsel issued a memorandum documenting
more than 60 complaints over the past four years regarding
people with serious mental health conditions or a mental health
disability held in solitary confinement in ICE custody across the
country.42 The seven examples provided in the memorandum
reflected a range of issues, including immigrants held in solitary
confinement while on suicide watch and with diagnoses such
as chronic PTSD, major depressive disorder, bipolar disorder,
and schizophrenia.43 The memorandum also revealed that
immigrants were reluctant to report suicidal ideation and mental
health concerns because they feared being placed in solitary
confinement.44 According to the complaints, immigrants were
often left without access to psychiatric medication, access to
counsel or legal visits, or the ability to send or receive mail while
in solitary confinement.45
These concerns are longstanding. In 2012, PHR, in partnership
with the National Immigrant Justice Center, published a report
on solitary confinement in ICE detention, “Invisible in Isolation:
The Use of Segregation and Solitary Confinement in Immigration
Detention.”46 That report demonstrated how solitary confinement
of people in ICE custody was applied arbitrarily, inadequately
monitored, harmful to health, and a violation of their due
process rights.
Between 2012 and 2014, experts submitted reports to CRCL
documenting deaths of people detained in solitary confinement,
where the deceased had presented signs of mental illness,
ranging from depression to schizophrenia. Despite having special
vulnerabilities, they were nevertheless subjected to solitary
confinement without consideration of more appropriate care
or medication.47

“Between 2012 and 2014,
experts submitted reports to
DHS’ Office of Civil Rights and
Civil Liberties documenting
deaths of people detained in
solitary confinement …
Over 10 years later, little
has changed.”

8

Over 10 years later, little has changed. Recent complaints filed by
advocates continue to highlight the arbitrary and excessive use
of solitary confinement in immigration detention. In a Colorado
facility, for example, advocates documented escalating misuse
of solitary confinement, including its use as a retaliatory threat.
One person was placed in solitary confinement more than 10
different times for reasons ranging from eating “too slowly” and
speaking “too loudly” to having suicidal thoughts and being upset
about deportation.48

“Endless Nightmare”

Methodology and Limitations
A two-pronged approach guided the data collection for this report.
First, faculty and students at HLS collected and analyzed data
that they obtained from ICE and other federal agencies, including
through litigation under FOIA. This data included reports, excel
spreadsheets, e-mails, and other documents from ICE and other
federal agencies concerning the use of solitary confinement
in immigration detention. Second, HMS faculty and students
conducted qualitative, structured interviews with formerly
detained immigrants who had experienced solitary confinement.
While the aim with the ICE data was to generate aggregate
statistics on people detained in solitary confinement in facilities
nationwide, the goal of the interviews was to explore personal
experiences in confinement.

ICE FOIA Data Analysis
With some limited exceptions, FOIA requires federal agencies
like ICE to disclose previously unpublished or unreleased
information pursuant to public records requests. In
November 2017, HIRCP submitted FOIA requests to several
federal agencies, including ICE, to obtain previously unpublished
communications, records, training materials, evaluation
reports, and memorandums documenting ICE’s use of solitary
confinement in detention facilities.
After the agencies failed to adequately respond to these requests,
HIRCP successfully sued ICE and other federal agencies in
federal court. In July 2023, the U.S. District Court for the District
of Massachusetts ordered ICE to respond to many of HIRCP’s
requests.49 In October 2023 – six years after HLS filed its original
FOIA requests – ICE finally produced records detailing its use and
misuse of solitary confinement in immigration detention.

Physicians for Human Rights

ICE uses the SRMS to track solitary confinement placements.
HIRCP received a redacted SRMS spreadsheet from ICE detailing,
among other things, the reasons for placing people in solitary
confinement, the dates those people were placed in solitary
confinement, the duration they were held in solitary confinement,
and the names of facilities that placed people in solitary
confinement.50 The spreadsheet is similar to records obtained by
POGO and ICIJ,51 but the information obtained by HIRCP includes
more recent data on solitary confinement placements with release
dates between September 4, 2018 and September 13, 2023. This
data came from 125 facilities throughout the United States that are
run by or contract with ICE.52
HLS faculty and students analyzed the data using Microsoft Excel
and Stata to determine the average length of time that people
were held in solitary confinement as well as the total number of
solitary confinement placements. Further analysis was conducted
to compare this data across years and facilities. Additionally, HLS
assessed some of the reasons listed for why immigrants were
placed in solitary confinement. The code and data to reproduce
these analyses are available online at Harvard Dataverse.
HLS faculty and students also reviewed several ICE quarterly
reports as well as medical expert reports commissioned by
CRCL that were produced in response to the FOIA litigation.53
The medical expert reports focused on assessing mental health
conditions of people detained, as well as assessing mental
health resources at the Henderson Detention Center, Nevada;
Etowah County Detention Center, Alabama; Clinton County
Correctional Facility, Pennsylvania; and Houston Contract
Detention Center, Texas.54
Despite the significant disclosures obtained through the FOIA
process and litigation, several limitations restricted HIRCP’s
analysis. By the time of this report, ICE had still not released all
the data the district court ordered it to produce.

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Methodology and Limitations
continued

Limitations of FOIA Data Analysis
ICE has consistently provided inaccurate information about the
use of solitary confinement in immigration detention facilities
via its SRMS. Firstly, the SRMS data documented far fewer
placements of people in solitary confinement than calculated
by the OIG in its 2021 report, in which OIG obtained records
directly from detention facilities for a sample of 474 individual
“segregation” placements from fiscal years 2015 to 2019.55
Specifically, the SRMS dataset for these chosen placements
lacked about 16 percent of the solitary confinement placement
records that the detention centers reported for the same
time period.56
Second, comparing ICE’s SRMS data with vulnerable
population data trackers, a 2022 report from the GAO revealed
underreporting.57 To reach this conclusion, GAO compared
data produced by ICE to available vulnerable population data
trackers and found serious discrepancies with the SRMS data.58
For instance, it found that only about 76 percent of people with a
mental health condition and only about 12 percent of the people
with a serious mental health condition were actually reported
by SRMS.59

Inconsistencies with SRMS data continue, as data that ICE
has only made publicly available for 2022 and 2023 reflects.
Comparisons between publicly published quarterly ICE aggregate
statistics from 2022 and 202360 and data HLS obtained through
FOIA litigation61 revealed a substantial underreporting in the
number of placements and length of solitary confinement
of vulnerable populations reflected in the FOIA SRMS data.62
According to the publicly available ICE data, there are up to
twice as many placements of vulnerable immigrants in solitary
confinement during 2022 and 2023 than reflected in the FOIA
SRMS data.63 In addition, the publicly available ICE data for 2022
and 2023 show that the number of placements of vulnerable
immigrants in solitary confinement is increasing at a faster rate
than the number reflected in the FOIA-obtained SRMS data.64

Graphic 2: Number of Solitary Confinement Placements for Immigrants With Vulnerabilities

I
I

400

300

200

100

Q1 2022

10

Q2 2022

Q3 2022

Q4 2022

Q1 2023

“Endless Nightmare”

Q2 2023

Q3 2023

ICE Quarterly
Placements

SRMS FOIA
Placements

Similarly, the average length of time in solitary confinement
of vulnerable immigrants was much longer in ICE’s publicly
available quarterly statistics than reflected in the FOIA
SRMS data. With an increasing trend, the duration of solitary
confinement ranged from one to 10 days longer in the ICE publicly
available reports than the FOIA-obtained estimates.65 These
publicly available quarterly aggregates of vulnerable populations
suggest a strong possibility of longer solitary confinement
durations for people with mental illnesses than this report shows.

Lastly, CRCL evaluations also revealed that immigration facilities
misrepresented their use of solitary confinement.66 One CRCL
evaluator encountered an “especially disturbing” incidence of
misreporting at the Houston Contract Detention Facility in 2014.67
Though ICE policy requires staff to offer programs in a comparable
fashion to detained persons in administrative “segregation” and
those in the general population – and the staff at the Houston
facility actively assured the evaluator that they had complied with
this – the evaluator reported that “none of this turned out to be
true.”68 The evaluator found that immigrants in administrative
“segregation” were denied access to programs, shackled, and
locked in their cells for approximately 22 hours a day.69 The
staff’s offering of misinformation “compromised the integrity
of [the] facility review.”70 Without accurate ICE reporting, other
immigrants may similarly suffer in silence. Due to a combination
of these issues, this report may in fact underrepresent the total
number of immigrants placed in solitary confinement, their
mental statuses, and their durations in confinement.

Graphic 3: Length of Solitary Confinement for Immigrants With Vulnerabilities

ICE Quarterly
Length

20

SRMS FOIA
Length
15

\

\

10

Q1 2022

Q2 2022

Physicians for Human Rights

Q3 2022

'

Q4 2022

'

Q1 2023

'

phr.org

Q2 2023

'

Q3 2023

'

'

11

'

Methodology and Limitations
continued

Structured Interviews with
Formerly Detained People
From March 6 to August 17, 2023, the HMS research team
conducted 26 interviews with people formerly detained in
immigration detention using a standardized questionnaire
developed by the research team. All study participants were
18 years of age or older, had been released from immigration
detention, and had experienced at least one period of solitary
confinement during detention in the United States after
September 4, 2013. This date corresponds to the day in which the
ICE “Segregation Directive” was published that ordered limits
on the usage of solitary confinement in detention centers and
contained a pledge to “ensure the health, safety, and welfare of
detainees in segregated housing.”71 All interviews were conducted
by WhatsApp or standard telephone call, in languages in which
participants were fluent (English or Spanish). While the study
was open to speakers of any language, all participants spoke
either fluent English or Spanish, so no outside interpreters
were necessary. Interviews lasted approximately one hour.
Participation was voluntary, and all participants provided verbal
informed consent to participate in the study. A $40 electronic gift
card was offered to participants as reimbursement of a standard
meal and phone minutes. This study was reviewed by the HMS
Institutional Review Board and determined to be exempt from
further review. The study was also reviewed and approved by
PHR’s Ethical Review Board.

Participant Recruitment
Participants were recruited through outreach to immigration
attorneys. Attorneys were asked to present information about
the study to clients released from immigration detention who
met inclusion criteria using a standardized script and flyer.
Additionally, participants were able to refer other potential
study participants.
Attorneys and participants were notified that this study did
not include a language restriction. All referral information
was placed into an anonymous, secure REDCap referral form.
Referral information included the participant’s phone number,
time availability, preferred language, and preferred mode of
contact (WhatsApp or telephone). Names of participants were not
requested or collected via the referral form to ensure anonymity
and protect participants. Thirty-two potential participants were
referred to the study and contacted by research staff. Six referred
persons either decided not to participate or were unable to be
reached to schedule the interview. Twenty-six people participated
in the study and completed the entire questionnaire verbally.
All participants accepted the electronic gift card.

Structured interviews were based on a questionnaire (see
Appendix A) that was designed to assess the implementation of
ICE’s National Detention Standards (NDS) (Version 2.0, 2019).72, 73
The questionnaire included three sections: 1) Demographics; 2)
Solitary Confinement Conditions; and 3) Solitary Confinement
Experiences. The data collected during the interviews were both
quantitative and qualitative in nature. All quantitative data were
statistically analyzed in Excel (Version 16.40).

12

“Endless Nightmare”

Human Subjects Protections

Limitations of the Interview Study

Most participants were contacted through WhatsApp, which
provides end-to-end encryption. For participants who did not
have or prefer WhatsApp, a regular telephone line was used
to conduct the interview. Prior to initiating the interview, the
consent form was verbally reviewed with participants in its
entirety, and verbal consent was obtained. Written consent
forms in participants’ preferred language were also sent prior
to the interview or offered. Participants were assured that their
interview was confidential, that no identifying information
would be collected, and that none of their responses would
be communicated to their attorney or affect their pending
immigration case (if they had one – many had already been
deported). During the interview, quantitative and qualitative
data was collected in real time in a secure REDCap database.
No identifying information was collected or stored. Participant
information (including the participant’s phone number) was
collected in a separate REDCap database that could not be linked
to participants’ survey responses. Finally, participants who
accepted the electronic gift card for participation were sent the
electronic gift card through WhatsApp, short message services,
or, if preferred, e-mail. Any e-mail communication with lawyers
and participants was conducted through a Harvard Medical
School delegated-access e-mail account used exclusively by study
staff, and all correspondence was deleted 30 days after completion
of the study. The study staff’s WhatsApp accounts used to contact
participants and conduct the interviews were also cleared of
correspondence data after completion of all interviews.

The data presented in the report represent the reported
experiences of 26 people held in immigration detention in a
limited number of facilities across the United States. Given the
study’s modest sample size, we do not capture the full range
of experiences of ICE-detained people experiencing solitary
confinement in the United States. Additionally, some facilities
were only known to the participants by their state location
rather than the city, so it was not possible to know how many
distinct facilities were represented. The interview portion of this
study may also suffer from sampling bias in that attorneys may
have only referred specific participants whom they felt would
be comfortable participating. Participants sometimes referred
friends they had made while in detention together, representing
additional sampling bias. Although this study did not include
a language restriction, lawyers may have been more likely to
refer clients with whom they could communicate more easily
without the use of an interpreter. This data was also subject to
potential recall bias, as responses were based on participant
memory of detention conditions. There was potential for variation
in interview style among interviewers, but care was taken to
minimize this variability through extensive interviewer training
before and during the study period and by including at least
two staff members per interview (one interviewer, one recorder)
for each interviewer’s first interview. The use of a structured
questionnaire with consistent wording was designed to reduce
interviewer bias. Prior to publication, the authors of this report
had the opportunity to present the findings to key personnel in
DHS and ICE.

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13

Key Findings
View from Government Records
Immigration Detention Facilities Used
Solitary Confinement Extensively
One of ICE’s directives recognizes that the use of solitary
confinement “is a serious step that requires careful consideration
of alternatives” and calls on facilities to limit their use of
solitary confinement only to situations where it is “necessary.”74
Despite this standard, ICE documented well over 14,000
solitary confinement placements in the past five years alone.75
These placements lasted 27 days on average, well in excess of
the 15-day period that constitutes torture, as defined by the
Special Rapporteur on Torture. Indeed, with a median length of
confinement of 15 days, nearly half of the recorded placements
exceeded 15 days and many placements lasted far longer: 682
solitary confinement placements lasted at least 90 days, while 42
lasted over a year.76 In almost 30 percent of solitary confinement
placements lasting over 90 days and 25 percent of placements
lasting over 365 days, the people placed in solitary confinement
suffered from a mental health condition.77
Additionally, the FOIA data reveal numerous egregious
examples of facilities holding people in solitary confinement
for years at time:78
▪ Just under two years (727 days) (Denver Contract Detention
Facility, CO)
▪ Over a year and a half (759 and 567 days) (Otay Mesa Detention
Center, CA)
▪ Over a year and a half (652 days) (Buffalo Service Processing
Center, NY)
▪ Over a year and a half (637, 559, and 550 days) (Northwest ICE
Processing Center, WA)
▪ Just under a year and a half (526 days) (Eloy Federal Contract
Facility, AZ)
Strikingly, for-profit corporations operate all five of the facilities
with the longest periods of detention.79

The Northwest ICE Processing Center also had one of the highest
(ninth out of 125) average lengths of solitary confinement stays on
record (average length at this location was 55 days).80 Conditions at
the Denver Contract Detention Facility were also poor overall: the
average length of stay at this facility between 2018 and 2023 was
52 days.81 The American Immigration Council and other groups
have documented the repeated misuse of solitary confinement
at the Denver facility and in July 2023 filed an administrative
complaint with DHS’s Office of Inspector General, CRCL, Office
of the Immigration Detention Ombudsman, and ICE’s Office of
Professional Responsibility.82
Data Spanning Several Years Shows No Improvement
In every year between 2019 and 2022, there were several thousand
new solitary confinement placements (between 2,000 and 3,300),
reported in immigration detention.83 As of September 2023, there
were already 2,301 reported placements.84 In light of the recent
uptick in immigration enforcement,85 and assuming a similar
number of new solitary confinement placements in each of the
remaining four months of 2023, the total number of placements
in solitary confinement for 2023 likely surpassed 3,000 people.
The proportion of people in solitary confinement in ICE, out of
the total number of those in ICE detention overall, has varied
over time.86 This number spiked in 2020 in conjunction with
COVID-19 because immigration detention facilities used “solitary
confinement under the guise of medical isolation.”87 While the
number of people held in solitary confinement has declined from
its peak in 2020, there has generally been an upward trend in the
percent of people detained who are held in solitary confinement
since its lowest point in mid-2021.88
According to ICE’s own quarterly reports, there were 1,106 solitary
confinement placements in the third quarter of 2023.89 This
represents a 14.6 percent increase from the previous quarter, and a
61 percent increase from a year ago, based on the most recent data
that ICE had released at the time this report was written.90
Also, the average length of solitary confinement placements
remained well above 15 days in each of the past five years.91 For
2023, this average was already at 23 days by September.92 The
average length of placements was 65 days for people who were
placed in solitary confinement but were not released by the date
ICE produced the SRMS data. As it is unknown when and if they
were released, this is an underestimate.

14

“Endless Nightmare”

Graphic 4: Number of Immigrants Held in Solitary Confinement
out of Total Population in Detention
200

Per 10,000 Detained Immigrants

150

100

50

0
2023

2022

2021

2020

2019

Graphic 5: Detained People in “Special Management Unit” by Fiscal Year
1200

1106

1000
855
800

600

685

776

965

894

958
860

816

•
•

Total Detained
People in SMU
Distinct SMU
Placements

620

400

200
0
Q3 2022

Q4 2022

Q1 2023

Q2 2023

Q3 2023

Note: ICE released this graph of 2023’s third quarter solitary confinement statistics on October 16, 2023.

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Key Findings
continued

Graphic 6: Average Number of Days in Solitary Confinement

Average Number
of Days in Solitary
Confinement

35
30

UN Definition
of Torture

25
20
15
10
5
0
2019

2020

2021

Solitary Confinement Used Arbitrarily and as Punishment
Immigration detention facilities are authorized to use solitary
confinement only as a last resort.93 Yet facilities often placed
immigrants in solitary confinement to punish minor disciplinary
infractions. For example, FOIA documents indicate that on
at least one occasion an immigrant was placed in solitary
confinement for 29 days for “using profanity” and two immigrants
were placed in solitary confinement for 30 days because of a
“consensual kiss.”94 In another record, ICE documented that an
immigrant was placed in solitary confinement for 38 days because
they “refused to get out of bunk during count.”95
This pattern of arbitrary solitary confinement placement is
reflected in the administrative complaint filed regarding the
Denver Contract Facility, where the facility put one person
in solitary confinement for “eating too slowly.”96 This same
person faced solitary confinement 10 more times, for similarly
groundless reasons:
“ If I climbed on top of a table to get a guard’s attention,
solitary [confinement]. If I had suicidal thoughts, solitary
[confinement]. When the guards would tease me about
being deported back to my home country and make
airplane sounds at me and gesture like a plane was taking
me away, I would become upset and then get solitary
[confinement] for being upset.”97

16

2022

2023

In other cases, immigration detention facilities appear to have
deliberately discriminated against immigrants identifying
as transgender.98 In 2014, a CRCL evaluation of the Houston
Contract Detention Facility found multiple incidents of facility
discrimination against transgender immigrants.99 The evaluator
stated that transgender immigrants were disproportionately
subjected to security measures typically used for immigrants
placed in solitary confinement for aggressive behavior, such
as “lock-down in their cells[,] use of cuffs for movement within
the facility [and] inability to attend groups available to general
population inmates.”100 CRCL further noted that this treatment
can “cause mental trauma and distress that resulted in avoidable
suffering, depression, and suicidality.”101 “The FOIA data included
62 detainees that were placed in confinement for the following
reason: “Protective Custody: Lesbian, Gay, Bisexual, Transgender
(LGBT).”” The average length of stay for these detainees was
57 days, with a median of 34 and maximum of 286 days. In
addition, a recent ICE report with quarterly statistics on solitary
confinement reveals that the number of transgender immigrants
in solitary confinement more than doubled (increased by
114 percent) in the third quarter of 2023, the most recent quarter
of available data shared by ICE.102

“Endless Nightmare”

Unsafe Detention Facility Conditions Exacerbated
the Misuse of Solitary Confinement
Immigration detention facilities often placed people in solitary
confinement to purportedly address issues such as overcrowding
and threats to harm staff and/or other people in detention. In
2016, a facility put one person in administrative “segregation” “due
to no available [bed] space” elsewhere in the detention center.103
The facility’s staff left this person in administrative solitary
confinement for 372 consecutive days because she requested
to remain there “due to being afraid of being around other
detainees.” Yet she was diagnosed by the facility psychologist as
having multiple severe mental health conditions: PTSD and Major
Depressive Disorder (MDD).104 Though this person was not the
only person to request solitary confinement in detention, solitary
confinement is not an appropriate solution to a lack of safety
among the general detention center population.
When people requested solitary confinement or facilities put
them in it for other non-disciplinary reasons, they have been
unable to “make any legal calls, have legal visits, [and] have
access to [their] legal documents.”105 Solitary confinement under
the guise of protection can also be life-threatening. In one
person’s words,
“ [the staff] told me solitary kept me safe and helped
me, but it was only ever a punishment . . . I have
tried to kill myself three times already because of this
endless nightmare and the consistent torture of solitary
confinement.”106
Another person felt that the stress of returning to solitary
confinement was “too much for him to bear,” and he also
attempted suicide.107

The percentage of immigrants with mental health conditions
placed in solitary confinement jumped from 35 percent in 2019
to 56 percent in 2023.114 Additionally, while SRMS reported
that 20 percent of the solitary confinement placement records
for immigrants with mental illnesses in 2019 involved an
immigrant with a serious mental health condition, close to
27 percent of immigrants with mental health conditions in
solitary confinement in 2023 were classified as suffering from a
serious mental health condition.115 Among people whom SRMS
labeled as suffering from a mental health condition, the average
length of stay in solitary confinement was approximately
23 days; however, the average length in solitary for detained
persons suffering from a serious mental health condition was
33 days.116
Some of the facilities with highest average confinement lengths
for immigrants with mental health conditions included the
Richwood Correctional Center (LA), Denver Contract Detention
Facility (CO), Yuba County Jail (CA), Otay Mesa Detention Center
(CA), and Henderson Detention Center (NV).117 The average length
of solitary confinement for immigrants with mental health
conditions at these facilities ranged from three to six months.118
Immigration detention facilities also likely violated the 2022 ICE
directive related to the treatment of immigrants with serious
mental health conditions by denying immigrants with mental
health conditions the “necessary and appropriate treatment and
monitoring” that the directive requires.119 For example, the 2023
CRCL memorandum reported how one immigrant was placed
in solitary confinement even though they suffered from MDD,
bipolar disorder, PTSD, and schizoaffective disorder or psychosis;
their placement in solitary confinement caused “the delay or
discontinuation of important mental health medications.”120

People with Mental Health Conditions
Unfairly Discriminated Against
According to the UN Special Rapporteur on Torture, people
with mental health conditions should not be held in solitary
confinement.108 ICE’s 2013 “Segregation Directive” mandates that
its facilities must not place vulnerable populations in solitary
confinement unless as a “last resort.”109 Yet many of the people
placed in solitary confinement in immigration detention between
2018 and 2023 had documented mental health conditions and
it was unclear what alternatives, if any, to solitary confinement
were considered.110 Among the 8,788 records for this period where
ICE’s SRMS reported the mental health status of immigrants in
solitary confinement, over 40 percent had documented mental
health conditions.111 In the redacted SRMS spreadsheet produced
in the FOIA production,112 ICE reported immigrants’ mental health
status in only 62 percent of its total solitary confinement records.
Based on multiple findings of discrepancies with SRMS data,113 the
actual number of immigrants with mental health conditions who
were placed in solitary confinement between 2018 and 2023 could
be much higher.

Immigration detention facilities also used mental health
conditions as a justification for placing immigrants in solitary
confinement despite the well-known negative effects of solitary
confinement.121 In one record, ICE reported that a “[s]ubject was
placed in protective custody after he was not able to properly
care for himself in general population. Subject has been
diagnosed with schizophrenia.”122 This person was held in solitary
confinement for 56 days.123 In another instance, an individual
with a mental health condition was held in solitary confinement
for 28 days because they reportedly responded to officers with
“irrational answers” and were observed making “unusual body
movements.”124

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Key Findings
continued

Substandard Medical Care in ICE Custody
Caused Severe Health Consequences
ICE’s failure to ensure adequate medical resources in detention
centers created life-threatening conditions for immigrants in
solitary confinement. CRCL reported that between 2012 and 2014,
some facilities left immigrants without any meaningful access
to a mental health professional.125 In at least one facility, mental
health professionals stopped working altogether.126 Another
facility had nursing staff without psychiatric training performing
suicide risk assessments, staff giving medications to immigrants
without their consent, and medical forms lacking immigrants’
past medical histories.127 These conditions can acutely impact
immigrants in solitary confinement.128 For instance, one of CRCL’s
evaluations reported that an immigrant was “[u]nable to sleep”
and “starting to have hallucinations due to being locked in cell
all the time.”129 This immigrant stated that his depression was
“getting worse day-by-day.”130

Immigration facilities also punished suicidal immigrants with
solitary confinement.131 At one facility evaluated by CRCL in 2012,
facility staff “actively discourage[d] [suicidal] detainees from
seeking help.”132 This hostile environment was created by staff that
forced suicidal immigrants to undress except for a safety smock
and remain in solitary confinement without access to counseling
until they denied their “current suicidal thought[s].“133 These
procedures humiliated and punished immigrants in critical need
of medical care.134

Graphic 7: Percent in Solitary Confinement With Mental Illness
100

35

33

44

55

56

Percent

80

Mental Illness

60

No Mental Illness

40

20

0
2019

18

2020

2021

2022

“Endless Nightmare”

2023

In Their Own Words: Interview Findings of
Experiences in ICE Solitary Confinement
Participant Demographics
Twenty-six participants were interviewed (questionnaire provided
in Appendix A) in total; 23 identified as male (88 percent), and
one each identified as female, agender, and transgender man
(4 percent each). Interviewee ages ranged from 29 to 56 years
old (average 36.2 years). Participants were originally from 19
different countries, including 31 percent who were from Mexico,
23 percent from Colombia, and 12 percent from Honduras. Eight
percent of the people were multilingual, comfortably speaking
more than one language. Thirty-one percent of the participants
felt “uncomfortable” or “very uncomfortable” speaking English
and would have very likely required translation services while
in detention to easily communicate with non-bilingual staff
members. A comprehensive list of countries of origin and
languages spoken by participants is included in Appendix B.

These 26 participants were detained in at least 34 unique
detention facilities in the United States – representing 11 county/
public facilities, 22 private facilities, and one mixed-status facility
– across 17 different states. Some participants could not recall
the exact name or city of the facility in which they were held, so
this list is not exhaustive of the locations where interviewees
were detained and/or experienced solitary confinement. Of the
private facilities, 12 were run by GEO Group, five by CoreCivic,
and one facility each by Ahtna Support and Training Services,
Immigration Centers of America, LaSalle Corrections, and
Valley Metro Barbosa Group. One location, the Donald W. Wyatt
Detention Facility, is publicly owned but privately operated. Of the
34 identified facilities, people experienced solitary confinement
in 23 of them (68 percent).

Graphic 8: ICE Detention Facilities Where Study Respondents
Reported Experiencing Solitary Confinement

Private Detention
Facility
Public Detention
Facility
Public/Private
Detention Facility

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Key Findings
continued

Misuse of Solitary Confinement
Spending up to a Year in Solitary Confinement
Interviewees experienced an average of 3.6 separate stays in
solitary confinement (range 1–30 stays). Each stay lasted an
average of 32.2 days, with a median of 14 days. This is nearly
six days longer than the average confinement in “segregation,”
as seen in the FOIA data between 2018 and 2023. There was
substantial variation in how long detained persons stayed in
solitary confinement, as seen in Graphic 9.
Out of 55 described distinct placements in solitary confinement,
a majority (61 percent) lasted longer than 14 days (what ICE
defines as “extended segregation”), and 37 percent were greater
than a month. One person stated that they were in solitary
confinement for more than a year (32-year-old agender person,
Etowah County Jail).

Solitary Confinement Was Often Misused as Punishment
The most commonly reported reason for solitary confinement
placement was disciplinary “segregation” (n=16, 62 percent) (Graphic
10). ICE’s standards explicitly state that disciplinary “segregation”
can only be used after receiving “a hearing in which the detainee
has been found to have committed a prohibited act and only when
alternative dispositions would inadequately regulate the detainee’s
behavior.”135 However, only seven (44 percent) of those placed for
disciplinary reasons received an official hearing for disciplinary
“segregation.” The majority did not receive this due process. One
person reported that intimidation was used to dissuade him from
having hearings. Instead, he was encouraged to plead guilty to
the charges, because, contrary to guidance and directives, he was
told that if he went to a hearing, “they would often double the
punishment or the time. So instead of 10 days, suddenly you would
get 20–30 days” (30-year-old man, Kandiyohi County Jail).
Accounts from study participants conflicted frequently with the
regulations as outlined in the aforementioned ICE “Segregation
Directives.” Solitary confinement was commonly used to
punish people who submitted complaints, organized protests,
or required medical isolation. For instance, eight people (31 percent)
reported being put in solitary confinement after participating in a
hunger strike.

Graphic 9: Length of Stay in Solitary Confinement in Days,
Per Instance of Solitary Confinement Among Interviewees
2

<1 day

17

Length of Confinement

1-7 days

10

8-14 days

17

15-30 days
5

31-60 days
61-90 days

2

90+ days

2
0

5

10
Number of Instances

20

“Endless Nightmare”

15

20

“If you don’t listen to their rules, that’s a reason to go to the hole.
If you don’t do anything they ask you, that’s a reason to go to the hole.”
35-year-old man, Caroline Detention Facility
The decision to place someone in solitary confinement often
relied on the discretion of correctional officers, leading to
instances where detained persons were placed in solitary
confinement as a punitive measure despite not having done
something that would warrant disciplinary “segregation.” One
participant shared that he was assaulted by one of the officers
in the facility, which led to chest pain. He then tried to relay his
medical concern:
“ I had chest pain [from the assault] but the correctional
officer said I was lying so they put me in solitary
confinement.”
34-year-old man, Bristol County Correctional Facility

Solitary confinement was also abused for minor offenses, such
as taking food from the cafeteria to their rooms. One respondent
who spent nearly his entire time in detention inside of solitary
confinement stated,
“ I would go on a walk without a uniform and that was
enough to be put in solitary. For any minimal thing, they
would find an excuse to put me in solitary. Even to use
the stove to heat up coffee, they gave me 7 days of
solitary [confinement].”
37-year-old man, Orange County Jail
One interviewee reported a common understanding that people
exhibiting symptoms of serious mental health conditions would
be placed in solitary confinement instead of being connected to
care. One participant said he saw people placed in straitjackets
and thought of solitary confinement as where “mentally and
psychologically unstable” people were placed (32-year-old man,
Richwood Correctional Center).

Graphic 10: Reported Reasons for Placement into Solitary Confinement
Reason
Disciplinary
“Segregation”

Number of Individuals
16

Participation in
Hunger Strike

8

Medical Isolation

7

Victim of Sexual Assault

1

Protective Custody

2

Suicide Risk

1

Other

11

Physicians for Human Rights

Additional Information

In some cases, for positive
COVID-19 infection

For retaliation (for organizing protests, participating in
a riot, filing complaints), racism (for not speaking
English), sexual assault allegation
phr.org

21

Key Findings
continued

“They give you a paper saying what they say happened.
If you don’t agree, they put you in longer.”
31-year-old man, Bristol County Correctional Facility

A Lack of Transparency
When people were put into solitary confinement, there was
often uncertainty regarding how long their stay would last.
Thirteen people (50 percent of interviewees) were never given
an estimate of how long they were going to stay in solitary
confinement, and if they were, this estimate would often
change. One participant stated,
“ when you go to ‘the hole’ [solitary confinement] you
don’t know how long you are going to be there.”
39-year-old man, Eloy Detention Center
Study participants noted that officials exploited loopholes to
keep detained persons in solitary confinement longer, through
either enforcing multiple separate solitary confinement stays or
transferring persons in solitary confinement between facilities.
“ They just kept me there until they transferred me,
because by the policy you can’t keep people for more
than 2 weeks in solitary [confinement],” said one
participant, “So when I complained about it, they just
transferred me.”
33-year-old man, Caroline Detention Facility
According to various directives, those in disciplinary
“segregation” should have received reviews every seven
days. However, only nine people (35 percent) remember
being interviewed by a supervisor and only 14 people (54
percent) received a written review of why they were placed in
solitary confinement. This suggests that there was a lack of
transparency with people in solitary confinement, who may
have had only brief interactions with supervisors overseeing
their solitary confinement stay and did not have clear
communication regarding this process.
Concrete Beds and 24/7 Lights Were Commonplace

Being placed in solitary confinement meant experiencing
substantially worse living conditions than those in the general
population at those same facilities. While specific descriptions of
each cell differed, almost every participant described minimal
furniture, uncomfortable bedding, small room sizes, and small
windows. Eleven people (42 percent) reported having worse
mattresses and bedding in solitary confinement compared to
those issued in the rest of the detention facility. Specifically, seven
people reported bedding was of poorer quality or described having
no mattress at all, noting that the “bed was made out of cement
with no cushion, only a blanket” (29-year-old man, unknown
center in Louisiana) or just steel surfaces.
Interviewees described a lack of autonomy over basic control of
their living conditions. One participant described how
“ the correctional officer (CO) had control of the light and
flushing of the toilet; [I] had to bang the door and say ‘CO,
bathroom! or CO, light!’”
34-year-old man, Bristol County Correctional Facility
ICE standards require that all “cells and rooms used for
purposes of “segregation” must be well-ventilated, adequately
lit, appropriately heated/cooled, and maintained in a sanitary
condition at all times, consistent with safety and security.”136
Despite these specifications, the lighting and temperatures of the
rooms were controlled by the facility staff to create uncomfortable
living conditions, leading to sleep deprivation and disorientation
as to the time of day. For example, several people described the
temperature in the rooms as being unbearably cold, with the air
conditioner on at all times and not being provided blankets or
jackets if they asked.
One person stated,
“ I lost all sense of time – lights were on all the time and
there were no clocks on the walls or windows”
32-year-old man, Richwood Correctional Center

“The light is on 24 hours a day … the
guards wouldn’t dim or turn them off at
times … we went crazy, we tried to cover
those lights with paper.”
30-year-old woman, Irwin County Detention Center

22

“Endless Nightmare”

When one participant asked for water, he
was told “to drink water from the toilet”
37-year-old man, Orange County Jail
Twenty people (77 percent of interviewees) described having
fluorescent lights in their room that were turned on either
24 hours per day or for prolonged periods, such as from five in
the morning until midnight.
Keeping lights on for prolonged periods of time is known to
cause sleep deprivation through dysregulation of the body’s
natural sleep–wake cycles, or circadian rhythm, and may lead
to cognitive disorganization, paranoia, and hallucinations.137
These conditions included social isolation, constant bright
lighting, and cold exposure are well-documented strategies
for torture and interrogation designed to inflict psychological
distress and have been described in immigration detention
settings in the United States.138

Smaller and Worse Meals in Solitary Confinement
ICE’s own standards state that while in detention, people
should be given “nutritious, attractively presented meals” and
that “food rations shall not be reduced or changed or used as
a disciplinary tool.”139
However, eight people (31 percent) reported that their meals
in solitary confinement were worse than those served to the
general population. Three people said that the portions were
smaller than usual – even half the size of normal. Although
most participants reported being served three meals a day, three
people reported that the facility sometimes only provided two
meals (breakfast and dinner) a day to them while in solitary
confinement. When one participant asked for water, he was told
“ to drink water from the toilet”
37-year-old man, Orange County Jail

Graphic 11: One Interviewee’s Description of the Solitary Confinement Cell
Individual
56-year-old man originally from Italy

Room
“7 feet by 12 feet in length.”
“All concrete: floor, ceiling; bricks
on the walls all painted in white.
A concrete desk and a concrete
stool attached to the floor.”
“The toilet and sink were stainless
steel and placed in the corner. Issues
related to flushing over flushing and
overflow from the adjacent cell.”

Bed
“The bed was something called
‘the boat,’ which is a steel platform
with pipe around which allows the
guards to handcuff you in both your
wrists and your ankles and render you
completely immobilized.”
“On top of that was a padded sheet
that they call a mattress, but it's not
a mattress. No pillows, two sheets.”

Lighting
“The windows to the outside was (sic) scratched to the point that you couldn't
see anything to (sic) the outside, you could only see if it was day or night.
The windows to the outside was (sic) maybe 3 feet in height and 3 inches
in width.”
“The lighting was probably 12x36 inches, was on the ceiling, was fluorescent,
was flickering sometimes, and had a buzzing sound that makes people crazy.
Guards controlled the “lights from the outside.”

Physicians for Human Rights

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23

Key Findings
continued

Meals could also be of such poor quality that the food was
inedible, because it was either expired or unappetizing, such as
resembling “vomit” (32-year-old agender person, Etowah County
Jail) or “soggy tuna on bread” that looked like “cat food” (29-yearold man, unknown center in Louisiana).

detainees in SMU (Special Management Unit) “may not be denied
legal visitation,” people reported variable access to their lawyers.140
While some people could see their legal team once a week, others
could only reach them on the phone and faced significant barriers
to receiving legal advice.

Dietary restrictions for various medical conditions or religious
exemptions were not always accommodated. One interviewee
with food allergies said that he “told the kitchen [about the
allergy], they told me to talk to the doctor. Then the doctor told
me to talk to the kitchen. I couldn’t eat anything for months. I’m
allergic to the turkey, I’m allergic to basically everything. So, I
didn’t eat most of the time in there.” (41-year-old man, Golden
State Annex). Another participant shared that, “I asked for a halal
meal and the correctional officer was like ‘when you want to eat
good food, go back to Africa.’ He said, ‘if you don’t eat this, I’m
not giving you no food.’ But that’s my right to eat halal meals.”
(34-year-old man, Bristol County Correctional Facility).

Limited Access to Recreation, Hygiene, and
Religious Services
Interviewees described frequent limitations to recreation and
hygiene instituted as punitive measures. Even when these rights
to participate in recreation and religious events were explicitly
protected in ICE’s NDS guidelines,141 people reported being unable
to do so while in solitary confinement.

Access to Communication and Services
Restricted Legal and Personal Communications
While people were held in solitary confinement, all
communication outside of the detention center was closely
monitored and restricted. Seven people (27 percent of the
participants) were never able to call anyone on the telephone
while in solitary confinement, and eight people (31 percent) could
not write or receive letters. The remaining interviewees often
had significant limitations on who they could talk to, even facing
cases where “they blocked every number on my phone. It got to
the point where I was only able to talk to my attorney” (38-yearold man, Montgomery Processing Center). These constraints
meant that sometimes people could not let their loved ones
know that they were in solitary confinement. There were also
time limitations (as brief as five minutes per call), prohibitive
costs (video calls cost $3 a minute), and sparse access to phones
(sharing one telephone between 20 to 40 cells). Five people also
said that their calls were monitored and recorded – especially
calls to their lawyers or to the press – and that they could have
their connections cut if they were heard discussing the living
conditions inside detention or other complaints. The majority
(65 percent) of participants also experienced staff violating their
privacy by not keeping mail private, One in particular cited that
facility staff would “open and read your letters and decide whether
or not to send them; or keep them there” (34-year-old man, Bristol
County Correctional Center).
These restrictions on people’s ability to communicate with
the outside world also prevented interviewees from relaying
information to their legal teams. Several people reported that the
times they had to access the phone were at night, and they [facility
staff] “only let me out after work hours so I couldn’t get in contact
with anybody” (33-year-old man, LaSalle Processing Center). Even
though the National Detention Standards (NDS) maintain that

24

People in solitary confinement should be offered at least “one
hour of recreation per day … at least five days a week.”142 While the
remaining 23 hours were spent confined inside the cell, this one
hour a day represented the only time people had to shower, talk
on the phone, and use the recreational facilities. Seven people (27
percent) “rarely” or “never” received this much recreational time
in solitary confinement. In these cases, the detained persons
should have received a form of written correspondence about why
and for how long their recreation was to be suspended.143 Yet no
interviewees received any such notice.
The NDS say that people in solitary confinement can “shower at
least three times weekly” to maintain their personal hygiene.144
A majority (73 percent) of participants could shower between
three to seven times a week; however, seven (27 percent)
could only shower twice a week or never. For some in solitary
confinement, showering was only allowed during their limited
designated recreation time, forcing them to make difficult
decisions about if they should allocate their time to shower or talk
to others on the telephone.
While in detention, people are reliant on the commissary
to purchase basic necessities such as soap, shampoo, and
deodorant. However, 15 people (58 percent) were not able to
use the commissary while in “segregation” at all.
Finally, although the NDS state that persons in solitary
confinement “shall be permitted to participate in religious
practices” unless there is an explicit safety concern,145 most
people reported that they were not allowed to leave the cell to
attend religious services and their requests to join were denied.
A majority of participants (16 people; 62 percent) reported never
being able to participate in religious practices while in solitary
confinement. Two interviewed persons reported that they faced
discrimination as Muslims: there were no specialized Islamic
services, and the Qur’an was only available for purchase at
exorbitant prices whereas the Bible was provided for free.

“Endless Nightmare”

“If I ever told my wife about mistreatment during a phone call or showed my wife
the living conditions during a video call they would end my call immediately.”
50-year-old man, Northwest ICE Processing Center

“When you’re in solitary
[confinement], you don’t get
to see any doctors, nurses,
dentists, anything … There
would have to be something
really wrong with you ...
But usually you don’t see
any doctors, or nurses,
dentists, or anything when
you’re in seg.”

Medical Health Care in Solitary
Lack of Regular Medical Assessments in Solitary
Many interviewees had significant medical needs requiring
attention during solitary confinement. Fifteen people (58 percent
of interviewees) had a medical condition requiring care during
solitary confinement, and 12 people had new medical conditions
arising while in solitary confinement. Examples of these medical
conditions and the time passed before seeing a provider are listed
in Graphic 12 below.
ICE regulations outline that “[d]etainees must be evaluated by a
health care professional prior to placement in an SMU (or when
that is infeasible, as soon as possible and no later than within 24
hours of placement).”146 Yet, of the 26 participants included in this
study, only 11 people (42 percent) reported being seen by a medical
professional before being placed in solitary confinement and only
nine people (35 percent) were screened for preexisting mental
health conditions.

30-year-old man, Kandiyohi County Jail

Graphic 12: Days to See a Medical Provider for Each Medical Condition

Up to
1 day

0
Scabies
Surgical Complications

Physicians for Human Rights

Up to
2 days

____

Up to
7 days

I
I

'

0

Arthritis
Chest Pain
Foot Swelling
High Blood
Pressure
Hemorrhoids
Head trauma

Knee Pain
Rash

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25

Key Findings
continued

In addition to the initial assessment, there should also be
frequent “face-to-face medical assessments at least once daily for
detainees.”147 However, only 13 people (50 percent of the study’s
respondents) remembered being routinely evaluated by a health
care provider. Only those participating in hunger strikes or who
were deemed suicide risks were consistently seen by a health care
professional daily. Otherwise, the frequency with which people
were seen by a health care professional varied from daily (four
people) to approximately every three to four days for those in
medical isolation (two people). Others, even those with chronic
or acute medical conditions, were seen either intermittently or
not at all over the duration of their confinement. Many recounted
that it felt like staff were just going through the motions to fulfill
detention center requirements and documentation.

There was a high bar to receive medical care while in solitary
confinement, and the burden to overcome that bar rested solely
with the detained person despite ICE standards requiring routine
evaluations by health care providers.148 Multiple respondents
reported that their medical issues were ignored unless they were
persistent with requests:

Interviewees reported difficulty identifying the role of various
health care professionals who interacted with them, suggesting
that interactions were either unduly brief or that staff members
failed to appropriately clarify their role during their care. As one
person described,

Medications were also difficult to access while in solitary
confinement. Six of the interviewees (33 percent) who needed
medications during solitary confinement did not receive them
during at least part of their solitary confinement period, with
three people denied medicine the entire time. Examples of
medications people were denied included naproxen (for pain
relief from chronic osteoarthritis), antibiotics (for a skin/softtissue infection at a surgical site), and an inhaler (for wheezing
and trouble breathing from asthma). Interviewees reported
that they were not provided medications for a variety of reasons
including participation in hunger strikes and perceived overuse
by detention facility staff. One participant with a known Tylenol
allergy noted that detention facility staff failed to provide
appropriate alternatives, so he was denied any analgesia (56-yearold man, Buffalo (Batavia) Service Processing Center). One person
even mentioned that over-the-counter medications, such as
ibuprofen, were only available to purchase.

“ [Health care professionals] come around, they make
their rounds. But if you want to talk to them, you got
to stop them. You got to be up at a particular time …
Because they come by at 5, 6 in the morning. Otherwise
you miss them.”
38-year-old man, Montgomery Processing Center
When participants were able to identify the types of health care
professionals, the majority (56 percent) reported being seen by
a nurse, with a minority being seen by physicians, physician
assistants, therapists, psychologists, or medical assistants.
Multiple respondents reported that nurses were the primary
health care providers in these facilities; doctors were either
reserved for more serious concerns or entirely unavailable. One
interviewee raised concerns about the licensure of health care
staff employed by the detention center, relaying reports that the
doctor where he was detained had had his license suspended.
Long Waits and No Medications
Of the 14 people who submitted requests to see a medical provider,
only three people (21 percent) reported being seen within 48
hours. Of the remaining cases, eight (57.1 percent) waited one
week or more to be seen. Notably, these cases included potentially
serious complaints such as chest pain, lower extremity swelling,
and head trauma. Despite placing multiple requests for conditions
including migraines, insomnia, and dental pain, three people
were never medically evaluated while in solitary confinement.

26

“ The thing with immigration and with the medical,
they’re just trying to give you the minimum. You gotta
keep going and going, bugging and bugging, to get the
help you need. You gotta keep bugging them, that’s the
only thing. So, your medical issue might be ignored in the
temporary time.”
39-year-old man, Eloy Detention Center

Disturbingly, two participants reported being given unknown
medications without being told their purpose and against their
will. They reported side effects following the administration
of these unfamiliar medications, including upper extremity
swelling and slurred speech, with no further evaluation or followup care.
In addition to poor quality of medical care, several respondents
reported being denied a sense of privacy in their interactions with
health care workers. Although guidelines require that “the facility
shall provide out-of-cell, confidential assessments and visits for
detainees whenever possible, to ensure patient privacy and to
eliminate barriers to treatment,”149 many interviewees reported
that most evaluations occurred across their locked cell doors.
One participant recounted, “The worst part is that they do that
through the metal door, so you have to say loudly – everyone can
hear your mental health conditions” (56-year-old man, Buffalo
(Batavia) Service Processing Center). This treatment is in violation
of the federal Health Insurance Portability and Accountability
Act, which classifies peoples’ health information as protected data
that cannot be disclosed to others without their consent.150
“Endless Nightmare”

Enough Done to be “Kept Alive,” But Not Cared For
Multiple participants described substandard medical care while
in solitary confinement, including denying detained persons
of emergent care in life-threatening situations. One person
described having to perform
“ CPR on another inmate while a guard stood there in shock
.... A nurse came back later and said that there was no
doctor and that they would have to wait until the next day
to be seen.”
50-year-old man, Northwest ICE Processing Center
Another participant recounted an incident when he had chest
pain with electrocardiogram findings, which could have
represented a heart attack or cardiac arrhythmia, but doctors
refused to transfer him to a hospital because he was getting
deported that same night. These findings are consistent with
the recently published finding of potential underutilization of
emergency medical service systems as compared to the number
of ICE-documented medical emergencies in their detention
facilities.151
Interviewees described dehumanizing treatment while seeking
medical care in solitary confinement. Three people reported
being handcuffed and shackled prior to being brought to medical
care, despite not being in criminal custody:
“ You could see a doctor if you put in a request ... if there
was an emergency, like if there was something really
wrong. I’ve seen guys go back there, but you would have
to be handcuffed and shackled. Then you could go back to
the clinic area to see the nurses and doctor.”
41-year-old man, Joe Corley Detention Facility
Interactions with medical providers were often cursory, with one
person noting that he
“ never felt like [he] was taken care of medically and
providers will do the most they can to not spend time
with you.”
50-year-old man, Tacoma Northwest Detention Center
Another person reported that the prevailing attitude was
“ just keep him alive until they can get deported.
They didn’t care about how you felt.”
35-year-old man, Caroline Detention Facility

Lasting Negative Impacts on People’s Physical Health from
Solitary Confinement
Of the 15 people who required medical care during solitary
confinement, 12 (71 percent) had a new medical problem while in
solitary confinement. Some people attributed the development
of their medical conditions to the poor sanitation in solitary
confinement. As one participant described,
“ I got scabies from the solitary confinement room. All you
got was a bottle of disinfectant. I sprayed and cleaned the
room, but it was not good enough. It’s really disgusting.”
35-year-old man, Caroline Detention Facility.
Other conditions were not necessarily related to their
confinement, such as viral and dental infections, but still required
medical assessment.
Other interviewees reported complications of existing conditions
due to inadequate health care while in solitary confinement. For
example, one person described an untreated leg wound that led
to increased swelling and infection, which required two surgeries
and put him at risk for an amputation.
The high levels of stress associated with solitary confinement
could also have lasting physical impacts.
“ I would get so stressed out that there would be physical
problems … lots of sweating, my blood pressure would be
affected,”
30-year-old man, Kandiyohi County Jail;
another had worsening migraines
“ triggered by the light [and] constant worrying about when
you will get out.”
35-year-old man, Donald W. Wyatt Detention Facility

“There are no doctors, just nurses.
When there’s an emergency, they don’t
know how to handle it. They come, and
they bring a ton of pills to the person,
but they don’t know what it’s for or
why they’re using it.”
32-year-old agender person, Etowah County Jail

Physicians for Human Rights

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27

Key Findings
continued

In addition to stress and delayed medical care, others felt that the
conditions within solitary confinement itself negatively impacted
their health:
“ Because the room was very small, I was unable to exercise.
With my eyes, I wasn’t able to see very clear(ly) because of
the light. The bunk hurt me. Sometimes I had to lie on the
floor. My skin, rash, dry skin – it was all because I didn’t
have access to all the regular stuff that people in detention
have access to. My back hurt, my kidneys. I was groggy all
the time and tired.”
31-year-old man, La Salle Detention Facility
One person noted that protracted time that he spent with his
hands in either handcuffs or zip-ties led to lasting sensory
damage, in the form of residual numbness and tingling.
Many interviewees testified to long-lasting ramifications of
solitary confinement on their physical health. Some reported
continuing pain or complications from injuries that went
untreated during solitary confinement, including residual back
pain, chest pain, and infections. Others discussed how they were
denied access to their medical information, rendering them
unable to seek appropriate follow-up care after being released.

Mental Health Care in Solitary Confinement
Mental Health Care Did Not Meet Basic Standards of Care
Fifteen interviewees (57 percent) had a condition requiring
mental health care while in solitary confinement, five of whom
had preexisting condition(s) and the other 10 who developed
symptoms in solitary confinement. These conditions and related
symptoms included: anxiety, depression, PTSD, and a variety of
symptoms such as paranoia and hallucinations.
While in solitary confinement, access to mental health care
was limited unless officially placed on “suicide watch.” Of the 15
people in solitary confinement who required mental health care
assessment, 13 placed an official request to see a mental health
care provider. According to ICE, people in detention are supposed
to be evaluated within 24 hours after voicing a request.152 However,
only two people (15 percent) were seen within this time period.
Another four people (31 percent) had their requests fulfilled in
less than a week. However, three people (23 percent) were never
evaluated for their mental health concerns, which included
depression and PTSD, and for another three people (23 percent),
it took greater than a month. Notably, someone experiencing a
dissociative episode – a period often associated with amnesia and
a sense of detachment from their everyday experiences or actions,
commonly associated with experiencing significant trauma and
PTSD – waited approximately five months before being evaluated.

Graphic 13: Reported Length of Time to See Mental Health Provider

7.7%

Never

23.1%

> 4 weeks

23.1%

1-4 weeks

15.4%
< 1 week

30.8%

28

< 1 day

“Endless Nightmare”

“The numbness on [my] right hand due to prolonged handcuffs remains – it is a constant
reminder. When you use a mouse, you feel the numbness.”
56-year-old man, Buffalo (Batavia) Service Processing Center
Even among those who ultimately received mental health care,
interactions were often brief and inconsistent. Sometimes a
mental health provider might be available for “maybe 5 minutes”
at a time (34-year-old man, Bristol County Correctional Facility).
Study participants described that some mental health providers
would come for mental health checks, but these checks mostly
occurred through the doors rather than taking the person out of
the cell for a private conversation. This led one participant to state
that one would
“ just sign this paper outside your door that they saw you,
but as far as actually engaging you? They’re not engaging
you.”
38-year-old man, Montgomery Processing Center
Despite the increased stresses associated with solitary
confinement, psychotherapy and access to medications
were limited.
Solitary Confinement Created New Mental Health Illnesses
Research has shown that solitary confinement can exacerbate,
cause a relapse, or lead to the development of new mental health
conditions. “Security Housing Unit (SHU) Syndrome” is a term
coined to describe symptoms resulting from stays in solitary
confinement consisting of hyperresponsiveness to basic stimuli,
delusions and hallucinations, panic attacks, and obsessional
thoughts, paranoia, and impulse control.153

Depression was commonly reported, which interviewees
attributed to forced prolonged loneliness and the prohibition
of visitors or meaningful activities. One participant described
wanting to “scream and cry” from not having visitors and not
having anyone to speak with (32-year-old agender person, Etowah
County Jail). Multiple participants noted that while regular
detention was also demoralizing, the lack of access to books,
video entertainment, and socialization opportunities drove their
depression. Solitary confinement even led to suicidal thoughts.
“ I ended up losing my mind for two weeks, even talking to
myself. I thought about suicide. I still have those thoughts
in Senegal.”
34-year-old man, Bristol County Correctional Facility
Solitary confinement also drove other serious mental health
conditions in detained people, including psychosis, dissociation,
and obsessive-compulsive tendencies; many participants
reported that these symptoms were not present prior to solitary
confinement. Participants shared many different types of
psychosis-related symptoms, including amnesia, delusions, and
hallucinations. These conditions could also manifest in selfharming behaviors such as one person who hit himself repeatedly
with a cable, and another who felt so “crazy that I kept banging
my head on the door,” which he perceived was the only way he
would be able to see a mental health provider (30-year-old man,
Kandiyohi County Jail).

Our findings suggest that solitary confinement not only provided
inadequate mental health care for those with existing mental
health conditions, but also led to the development of new
symptoms (with possible new diagnoses) for others. Of the
15 people who required care for a mental health condition during
solitary confinement, 10 (67 percent) had new symptoms that
developed during solitary confinement. The most commonly
reported issues were anxiety (n=5) and depression (n=5), followed
by PTSD, disassociation, and claustrophobia.

“Being in solitary [confinement], that is like a whole other level of playing with your mind.
To bother you, to hurt you, to offend you, to make you feel like less than nothing. Even
your biology changes, how you view the world changes … your mind and your body
break into little pieces.”
50-year-old man, Northwest ICE Processing Center

Physicians for Human Rights

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29

Key Findings
continued

Long-term Harms of Solitary Confinement
Solitary confinement not only affected people during their
detention stays, but also created lasting impacts that followed
them after decarceration. When asked how their time in
solitary impacted their lives presently, many people discussed
how they now have increased anger, fear of authority figures,
and trouble socializing.

“Sometimes I feel like someone’s
following me and I’m afraid they’ll take
me to solitary confinement. Sometimes
I’ll wake up and think that I’m in solitary
confinement. I’ll have to look out of the
window to remind myself I’m not there.
I still have the same nightmares I did
while in solitary confinement.”

Several participants noted persistent symptoms of anxiety,
agoraphobia, and recurrent nightmares. One person felt “a lot of
anxiety right after solitary confinement, and couldn’t stop crying
all the time,” which eventually led to an eating disorder (30-yearold woman, Irwin County Detention Center). Another reported
continued claustrophobia whenever he is in elevators where he
feels like he is “without oxygen like I can’t breathe” (36-year-old
man, River Correctional Center). And yet another felt like the
enforced boredom in solitary confinement led to persistent
obsessive-compulsive tendencies, describing how
“ I used to rearrange stuff in my cell … and just cleaning,
cleaning. There was nothing to do, so cleaning would kill
time. Now I do the same thing.”
30-year-old man, Kandiyohi County Jail
Participants reported that they sought professional help for their
mental health symptoms, with one person stating that he now
suffers from “chronic PTSD, anxiety, and depression” (56-year-old
man, Buffalo (Batavia) Service Processing Center).

33-year-old man, Caroline Detention Center

Graphic 14: Impacts on Mental Health from Solitary Confinement

Insomnia
“I wasn’t able to sleep.”

Claustrophobia
“I still don’t like to
be in confined spaces
like a room or bathroom.”
Agoraphobia
“I initially struggled to
leave the house.”

Hyperarousal
“Anytime I heard the door,
my heart would start
beating faster, like I was
having a panic attack.”

Paranoia
“I feel like someone’s
following me and I’m
afraid they’ll take me to
solitary confinement.”

Mood Changes
“[I] easily get angry,
everything upsets me, and
I feel aggressive.”

30

“Endless Nightmare”

Pervasive Humiliation and Violence
Solitary confinement was also associated with experiences of
cruel, inhuman, or degrading treatment for many of the people
interviewed. Twelve people (46 percent) said they experienced
some form of verbal abuse, harassment, or physical violence while
in solitary confinement by immigration detention staff.
Verbal abuse was the most common form of harassment reported,
and commonly included racist or homophobic statements. One
interviewee, who identifies as agender, was harassed by staff for
being perceived as too feminine:
“ they called me slurs like f*ggot (“maricón”), bird (“pájaro”),
b*tch (“puto”) that you call gay people.”
32-year-old agender person, Etowah County Jail
Similarly, a detained person who identified as LGBTQIA+,
described hearing threatening statements:
“ in segregation, I was asked by the guards to ‘suck my d**k,
you b***h,’ or perform oral sex on them.”
56-year-old man, Buffalo (Batavia) Service Processing Center
Another interviewee experienced similar verbal prejudice based
on race:
“ They [facility staff] made fun of me for not speaking
English. They gave me the finger and spit at me.
They said I was a thief and would make the country
worse because I was Black.”
29-year-old man, unknown center in Louisiana

Interviewees reported physical violence and sexual misconduct
by facility staff. Strip searches could happen in front of multiple
guards and other detained people. One participant who had
experienced a sexual assault discussed how being forced to
undress in front of others led to a worsening of his anxiety
(50-year-old man, Northwest ICE Processing Center). Individual
privacy rights were unprotected, as one person said that while he
was in solitary confinement, the
“ guard came in while I was showering and stared at me.
When I complained, they charged me, they made me stay
in solitary confinement longer.”
33-year-old man, Caroline Detention Facility
Two participants described being filmed or photographed while
naked, with one stating that
“ they [facility staff] tied up my feet and hands. They took
pictures of me naked. They brought a camera and filmed
in the bathroom with five or six officials in the bathroom.”
37-year-old man, Orange County Jail
People Held in Solitary Confinement Are Punished
for Complaining
Many study participants spoke out about injustices related
to solitary confinement via formal and informal channels but
were faced with retaliation instead of change. The participants
commonly did so through filing written complaints,
communicating with their lawyers, or participating in
hunger strikes.
In response, 12 people (67 percent) who reported issues related
to solitary confinement faced some sort of punishment for their
actions. The most common form of retaliation was an extension
of solitary confinement (five people), followed by physical abuse
such as pepper spray (three people), and verbal abuse (three
people). One study participant was notably refused necessary
accommodations for his religion – such as being denied a prayer
rug and given non-halal meals – as punishment for his speaking
out about the living conditions in solitary confinement (30-yearold man, Kandiyohi County Jail).

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31

Legal and Policy Framework
The U.S. Government Must Safeguard
the Lives of Immigrants in Detention
Immigrants in detention are protected under the Fifth
Amendment of the U.S. Constitution, which mandates that no
person shall be “deprived of life, liberty, or property, without due
process of law.”154 The Due Process Clause extends to “all ‘persons’
within the United States,” regardless of their immigration status
and guarantees immigrants held in civil detention the right to be
free from punitive conditions of confinement.155 Under the
Due Process Clause, the government has an obligation to protect
the health and safety of people in civil immigration detention
and to provide for their basic needs, including food and medical
care.156 The U.S. Supreme Court has recognized that people
must be afforded greater constitutional protections and more
considerate treatment in civil confinement than in criminal
custody because civil confinement is – at least in theory – not
intended to be punishment.157
Additionally, retaliation against immigrants who protest the
use and misuse of solitary confinement or report issues with
detention conditions violates basic First Amendment rights
under the U.S. Constitution.158 Furthermore, the facilities’
failures to accommodate people’s free exercise of religion
while in immigration detention is a violation of basic First
Amendment rights.159
Agency guidelines set forth specific procedures that detention
centers must follow when placing immigrants in solitary
confinement. ICE issued the 2013 ICE “Segregation Directive”
to supplement preexisting detention standards, including the
National Detention Standards (NDS) and the Performance Based
National Detention Standards (PBNDS), that detention centers
are obligated to follow.160 ICE has periodically revised these
standards to address safety-related concerns, including the use
of solitary confinement and the provision of proper medical
care.161 In the 2019 NDS, ICE significantly weakened standards.162
Furthermore, the required standards vary by facility as the terms
in the individual contracts are set between ICE and each facility.163
The 2013 “Segregation Directive,” however, sets the minimum
standards that apply in all facilities.

32

Prolonged Solitary Confinement and the
Solitary Confinement of People with Mental
Health Conditions Constitutes Torture Under
International Law
Under international law, detention of immigrants – especially
holding them in solitary confinement – should be used only for
limited purposes and as a last resort.164 Arbitrary and unlawful
detention is prohibited under the International Covenant on
Civil and Political Rights (ICCPR), which the United States has
ratified, and the UN Human Rights Committee has emphasized
that detention of people seeking asylum must be subject to
periodic review and that any detention of immigrants beyond a
brief period must take into account alternatives to detention and
impact on health.165 The UN High Commissioner for Refugees
Executive Committee has also noted that people seeking asylum
should only be detained in limited circumstances to verify
identity or travel documents, make preliminary assessments
of claims, or based on an individualized risk and security
assessment.166 Yet the United States consistently flouts these
international standards, detaining thousands of immigrants
every day in inhuman conditions, including in solitary
confinement for prolonged periods of time.
The UN Special Rapporteur on Torture and the UN Human
Rights Committee have long recognized that prolonged solitary
confinement may constitute torture or cruel, inhuman, or
degrading treatment.167 Under the UN Standard Minimum Rules
for the Treatment of Prisoners (known as the Nelson Mandela
Rules), prolonged solitary confinement – defined as confinement
in excess of 15 days – is specifically prohibited.168 Additionally, the
UN Special Rapporteur on Torture has repeatedly emphasized
that such prolonged solitary constitutes torture.169 The Special
Rapporteur has highlighted the debilitating effects of solitary
confinement on people with mental health conditions, stating
that “individuals with mental disabilities should never be
subjected to solitary confinement.”170
The United States is subject to the absolute prohibition of torture
under international law by having ratified the UN Convention
Against Torture.171 Despite these international obligations, the
country continues to subject immigrants to torture and cruel,
inhuman, and degrading treatment through the misuse of
solitary confinement.

“Endless Nightmare”

Indeed, when surveying detention conditions in the United
States, the UN Special Rapporteur on Torture has cited
numerous concerns about the country’s routine use of solitary
confinement.172 The former Special Rapporteur on Torture Nils
Melzer explained in 2020 that the impact of such confinement
includes “severe and often irreparable psychological and
physical” harm, ranging from “progressively severe forms of
anxiety, stress, and depression to cognitive impairment and
suicidal tendencies.”173 The Special Rapporteur concluded that
such “deliberate infliction of severe mental pain or suffering
may well amount to psychological torture.”174 Regional human
rights bodies such as the Inter-American Commission on
Human Rights have also cited the “deeply troubl[ing]” use
of solitary confinement in U.S. immigration detention,
particularly “in the case of vulnerable immigration detainees,
including members of the LGBT community.”175

Most recently, in November 2023, the UN Human Rights
Committee, which monitors state compliance with the
International Covenant on Civil and Political Rights, published its
concluding observations on the fifth periodic report of the United
States, in which it stated that the use of solitary confinement
for “juveniles and persons with intellectual or psychosocial
disabilities” in prison should be prohibited.176 Regarding
immigration detention, the Committee expressed grave concern
over the prolonged use of solitary confinement for the treatment
of immigrants, including refugees and people seeking asylum.177

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ICE’s failures to follow domestic and international laws as well
as its own guidance have created dangerous conditions for
people who are detained – particularly those with mental health
conditions and medical conditions, with no recourse to protect
themselves from life-threatening harm due to the misuse of
solitary confinement.

33

Conclusion and Recommendations
ICE’s pervasive use of solitary confinement – across over one
hundred facilities at state and local levels – is alarmingly
widespread and profoundly disturbing. This research,
corroborated by findings from myriad sources, including the
DHS Office of Inspector General and the U.S. Government
Accountability Office, reveals the persistent and prolonged use
of solitary confinement by ICE; the harmful, long-lasting impact
on those exposed to such isolation; and the ongoing lack of
meaningful oversight and accountability for violations of law
and policy.
Over 10 years ago, PHR, with the National Immigrant Justice
Center, co-authored a seminal report on the use of solitary
confinement in immigration detention centers. Since then,
despite countless intervening and damning investigations, there
has been no improvement: U.S. immigration detention remains
inappropriately carceral and punitive, and solitary confinement
is routinely used in a manner that meets the definition of
torture, or to cruel, inhuman, or degrading treatment according
to international human rights law. As stated by one DHS
whistleblower, ICE uses solitary confinement as a “first and only
option,”179 rather than as a last resort, as required by ICE policy
and guidelines as well as international law.
The persistent lack of oversight and accountability related to the
use of solitary confinement in immigration detention has not
only allowed abuses to continue unabated, but in fact to intensify
over the past decade. The devolution in care for people in
detention has resulted in egregious breaches of international and
domestic law, foundational principles of the U.S. Constitution,
and ICE’s own directives.
In the last five years alone, ICE placed people in solitary
confinement over 14,000 times, including those with preexisting
mental health conditions and other vulnerabilities. Lasting
nearly a month on average and sometimes for over two years,
this persistent application of solitary confinement illustrates
how concerns repeatedly raised by members of Congress,
government auditors, and whistleblowers alike have been
consistently ignored. The disproportionately harmful impact
of solitary confinement on vulnerable populations, particularly
transgender people and those with mental health and medical
conditions, indicates a pattern of systemic discrimination and
neglect that contravenes ICE’s own policies.

The evidence of profound and lasting physical and mental
health deterioration in people subjected to solitary confinement
demands an immediate end to DHS’s use of this practice. There
is overwhelming evidence and consensus that efforts at
modest reforms such as improving data collection, retention
and reporting, have done little to stop human rights
violations in ICE detention.
The recommendations below serve as a road map for DHS
to completely phase out the use of solitary confinement in
ICE detention. Congress and state and local entities, as well as
international bodies, must also advocate for the end of solitary
confinement, as outlined below.
1. Publicly commit to ending the use of solitary confinement
in all immigration detention facilities. As it abandons solitary
confinement, DHS and ICE must express this commitment in the
form of a binding directive. The directive should:
▪ Require a presumption of release from ICE detention
for people who have reported existing vulnerabilities,
including, but not limited to, people with serious medical
conditions, mental health conditions, disabilities, LGBTQIA+
people, and survivors of torture and/or sexual violence. These
people should be released into the safety of their community
with post-release care plans in place per the 2022 ICE directive,
in addition to providing resources and referrals for social, legal,
and/or medical services as appropriate.
▪ Mandate that any person in detention be afforded
24-hour access to qualified mental and medical health
care professionals who respond in a timely manner and
in compliance with the Health Insurance Portability and
Accountability Act (HIPAA).
▪ Require increased transparency from ICE’s Detention
Monitoring Council by making properly (redacted or
deidentified) reports and reviews related to solitary confinement
publicly available on the agency’s website within 72 hours.

ICE’s use of the “Segregation Review Management System” to
monitor solitary confinement placements is deeply flawed, as
evidenced by incomplete and erroneous data collection, faulty
analysis, and the lack of accountability revealed in this report.
These findings raise serious questions about the reliability and
efficacy of the system’s quality assurance and reporting accuracy.

34

“Endless Nightmare”

2. Amend the 2013 “Segregation Directive” to ensure that
every ICE detention facility, public or privately contracted,
is required to report concurrently to ICE Field Office
Directors and ICE headquarters within 24 hours of placing
someone in solitary confinement. ICE headquarters, in turn,
must share this consolidated “segregation”/solitary confinement
data with the DHS Office of the Secretary within 72 hours. This
requirement must apply to every confined person, regardless
of the duration of their confinement or whether they have a
vulnerability. Additionally:
▪ For those who are currently in solitary confinement, require a
prompt and meaningful psychosocial and medical evaluation,
undertaken by qualified medical professionals, who can assess
the prevalence and extent of existing vulnerabilities.
▪ For those scheduled for placement in solitary confinement,
require a meaningful psychosocial and medical evaluation by
qualified medical professionals who can assess the prevalence
and extent of existing vulnerabilities prior to such a placement.
▪ Mandate the reporting of race and ethnicity of each person in
solitary confinement.
▪ Mandate the reporting of the justification provided for initial
confinement; justification for continued confinement; duration
of the confinement; any vulnerabilities identified; and a detailed
description of the alternatives to solitary confinement that
were considered and/or applied, as listed in 5.3.(2) of the 2013 ICE
“Directive on Segregation.”
▪ Require daily checks and regular monitoring and
documentation by qualified and licensed health care
professionals against a detailed checklist created in partnership
with independent medical professionals, that includes reviewing
vital signs, checking for signs of self-harm and any other
indicators of deteriorating mental and physical health.
▪ Require the routine sharing by ICE of deidentified data acquired
through the above reporting measures on its website every two
weeks as part of its release of Detention Statistics, until it has
ended the use of solitary confinement.
3. Revise current contracts and agreements with
immigration detention facilities providers and
contractors to include stringent performance standards
and clear metrics for compliance regarding the use of
solitary confinement. Compliance should be assessed
through regular and comprehensive inspections by the
Contracting Officer. Additionally, to increase adherence to
detention standards, ICE must:
▪ Introduce a performance-based contracting model, where
a portion of payment is contingent upon meeting certain
performance and reporting indicators, including those listed in
recommendations 1 and 2 herein; and
▪ Impose immediate financial penalties for any violation of
performance and reporting indicators, and contract termination
for repeated or persistent violation.

Physicians for Human Rights

4. Establish a task force led by the Office of the Secretary of
DHS to develop a comprehensive plan, including specific
recommendations for phasing out the use of solitary
confinement. The task force must include:
▪ Members with knowledge of, or expertise regarding, the
mental and physical health consequences of the use of
solitary confinement;
▪ Independent medical experts;
▪ Independent subject matter experts from civil society (including
those with expertise in the use of solitary confinement in criminal
and civil custodial settings and human rights);
▪ Formerly detained immigrants who have experienced solitary
confinement in ICE custody; and
▪ Employees of the following offices:
▪ Civil Rights and Civil Liberties (CRCL);
▪ ICE Health Services Corps (IHSC);
▪ Immigration Detention Ombudsman (OIDO);
▪ Enforcement and Removal Operations (ERO); and
▪ Office of Professional Responsibility (OPR).
The plan must be presented to Congress and publicly accessible on
ICE’s website upon completion, which shall be no later than one
year after formation of the task force. Finally, recommendations
included in the plan should ensure the end of ICE’s use of solitary
confinement in immigration detention within one year of
presentation of the plan to Congress and the public.
5. Strengthen and expand the duties of the Office for Civil Rights and
Civil Liberties to include integrating civil rights and civil liberties
protections into all DHS programs and activities. Additionally,
require that CRCL establish and publicize a system for staff
and people detained in immigration detention facilities
to file grievances about solitary confinement without fear
of retaliation. Further, make complaints filed available to the
public and accessible online, redacting identifying information
from those who have requested confidentiality. CRCL’s
recommendations to ICE based on these grievances or any related
inspections or evaluations must be regarded as compulsory, rather
than optional, and subject to continuous monitoring and oversight
to ensure full implementation of the recommendations.

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35

Conclusion and Recommendations
continued

To the U.S. Congress:
6. Pass binding legislation banning the use of solitary
confinement in immigration detention and legislation that
will significantly decrease the number of people in immigration
detention, including the End Solitary Confinement Act (H.R.
4972 / S.3409) and Dignity for Detained Immigrants Act (H.R.
2760 / S.1208).
7. Pass binding legislation that strengthens and expands
CRCL’s functions and authority, such as the Department of
Homeland Security Office for Civil Rights and Civil Liberties
Authorization Act (H.R. 4713).
8. Use funding bills to incentivize the end of solitary
confinement and adopt community-based alternatives to
ICE detention that are not funded by an enforcement agency
such as ICE or CBP, are not surveillance-based, and that are
contracted to community-based, civil society, and nonprofit
organizations.
9. Conduct semiannual public hearings to hold DHS and ICE
accountable for its use of solitary confinement in immigration
detention, and track progress against the implementation of the
recommendations herein.
10. Ratify the Optional Protocol to the UN Convention
Against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment as a matter of priority to allow
independent monitoring of all places of detention in the United
States.

To State Governors and State Attorneys General:
11. End contracts with facilities that use solitary confinement in
immigration detention.
12. Encourage states to pass legislation establishing state attorney
general oversight of ICE detention facilities and prohibiting local
governments from expanding or entering into contracts with
the federal government or private companies for immigration
detention.
The U.S. President must:
13. Sign the Optional Protocol to the UN Convention
Against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment.
14. End solitary confinement and take steps to operationalize
this prohibition in immigration custody.
To the UN Special Rapporteur on Health, the UN
Special Rapporteur on Torture, the UN Committee
Against Torture, the UN Human Rights Committee,
the UN Working Group on Enforced or Involuntary
Disappearances, and the UN Working Group on
Arbitrary Detention:
15. Request an unconditional country visit to the United States and
monitor conditions of immigration detention, including use of
solitary confinement, as soon as possible.
16. Assess U.S. compliance with the UN Standard Minimum Rules
for the Treatment of Prisoners (the Nelson Mandela Rules) and
where necessary, make recommendations for reform.
17. Raise concern about the U.S. government’s use of solitary
confinement in immigration detention facilities in the context of
its regular dialogue with U.S. authorities and urge its abolition.

36

“Endless Nightmare”

Appendix A. Interview Questionnaire
Section 1. Demographics
Basics
▪ How old are you?
▪

What gender do you identify with?
Male
▪ Female
▪ Nonbinary
▪ Trans Male
▪ Trans Female
▪ Other (please describe)
▪

▪

What country or countries did you live in before coming to the
United States?

▪

What language or languages are you most comfortable
speaking?

▪

During your time in detention, how comfortable did you feel
reading English?
▪ Very Comfortable
▪ Comfortable
▪ Neutral
▪ Uncomfortable
▪ Very Uncomfortable

▪

During your time in detention, how comfortable did you feel
understanding and speaking English?
▪ Very Comfortable
▪ Comfortable
▪ Neutral
▪ Uncomfortable
▪ Very Uncomfortable

▪

Which best describes your race (may select multiple)?
▪ White
▪ Black
▪ Asian
▪ Pacific Islander
▪ Other (please describe)

▪

Do you identify as being Hispanic, Latinx, or Spanish origin?
▪ Yes
▪ No
▪ Unknown

▪

Do you identify as being a part of an indigenous group?
Yes
▪ No
▪ Unknown

Detention Centers Stay
Were you ever transferred between different detention centers?
▪ Yes
▪ What were the names of each center you were at?
▪ When were you at each detention center? If you don’t know
the exact dates, please estimate.
▪ No
▪ What was the name of the detention center you were at?
▪ When did you enter detention? If you don’t know the exact
date, please estimate.
▪ When were you released from ICE detainment? If you don’t
know the exact date, please estimate.
▪ Don’t Know

▪

Identification with Vulnerable Groups
Do you identify as lesbian, gay, bisexual, transgender, or queer?
▪ Yes
▪ What do you identify as?
▪ No
▪ Don’t Know

▪

▪

Did you have any medical conditions during your time in
detention (for example: high blood pressure, diabetes)?
▪ Yes
▪ What condition(s) do you have?
▪ No
▪ Don’t Know

▪

Did you have any mental health conditions during your time in
detention (for example: anxiety, depression)?
▪ Yes
▪ What condition(s) do you have?
▪ No
▪ Don’t Know

▪

Do you have any mental health conditions now, after your time in
detention (for example: anxiety, depression)?
▪ Yes
▪ What condition(s) do you have?
▪ No
▪ Don’t Know

▪

Did you have a disability during your time in detention (for
example: trouble with hearing, vision)?
▪ Yes
▪ What condition(s) do you have?
▪ No
▪ Don’t Know

▪

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Appendix A. Interview Questionnaire
continued

▪

Were you ever pregnant or breastfeeding during your time in
detention?
▪ Yes
▪ Were you ever pregnant or breastfeeding when you were
placed in solitary confinement?
▪ Yes
▪ No
▪ Don’t know
▪ No
▪ Don’t Know

Section 2. Questions on Conditions
in Solitary Confinement
Setting in Solitary Confinement
▪ How many hours in a day did you stay in the solitary
confinement room?
▪

▪

Stays in Solitary Confinement
▪ How many times were you placed in solitary confinement?

▪

How often did someone check on you while in solitary
confinement?
How did they check on you?
Who was it (can select multiple)?
Guard
▪ Medical professional
▪ Supervisor
▪ Other (please describe)
▪ Don’t Know
▪

▪

Only if the participant reported being in multiple locations:
Which detention center(s) were you in when you were placed in
solitary confinement?

▪

Ask for the last instance of solitary confinement:
What was the total length of time you were in solitary
confinement for that particular stay? If you don’t know the
exact days, please estimate.

▪

38

Why do you think you were taken to solitary confinement (mark
appropriate category and open-ended)?
▪ Disciplinary “segregation”
▪ Did you ever have an official hearing about this incident?
▪ Yes
▪ No
▪ Don’t know
▪ Protective custody
▪ Did you ask to be placed in protective custody?
▪ Yes
▪ No
▪ Don’t know
▪ Suicide risk
▪ Hunger strike
▪ Medical isolation
▪ For what condition were you placed in solitary
confinement for?
▪ Transfer to Other (please describe) unit/center
▪ Victim of sexual assault
▪ Other (please describe)

▪

On average, how many meals were you given a day while you
were in solitary confinement?

▪

Were these meals the same as a normal meal in the detention
center?
▪ Yes
▪ No
▪ How were the meals different than in the general detention
center population?
▪ Don’t Know

▪

On average, how many times a week were you allowed to shower
while you were in solitary confinement?

▪

Can you describe the room where you were in solitary
confinement? (For example, describe the furniture, window, how
long the lights were on/off, access to a toilet.)

▪

Were the mattress and bedding in solitary confinement the same
as in the detention center?
▪ Yes
▪ No
▪ How were the mattress and bedding different than in the
detention center?
▪ Don’t Know

“Endless Nightmare”

Access to Medical/Mental Health Care
▪ Were you evaluated by a health care professional before you were
placed in solitary confinement?
▪ Yes
▪ Did they ask you about any existing mental health issues?
▪ Yes
▪ No
▪ Don’t Know
▪ Did they ask you about any prior suicide attempts or
self-harm?
▪ Yes
▪ No
▪ Don’t Know
▪ Did they ask you about your medical needs?
▪ Yes
▪ No
▪ Don’t Know
▪ No
▪ Don’t Know
▪

Were you routinely evaluated by a health care professional while
you were in solitary confinement?
▪ Yes
▪ How often did a health care professional see you while you
were in solitary confinement?
▪ What kind of health care professional saw you while you
were in solitary confinement?
▪ Physician
▪ Physician’s Assistant
▪ Nurse
▪ Other (please describe)
▪ No
▪ Don’t Know

▪

Did you have a medical condition requiring care while you were
in solitary confinement?
▪ Yes
▪ Was it for a new medical condition or one you had before
solitary confinement?
▪ What was it for?
▪ Did you put in a request to see a medical provider?
▪ Yes
▪ How long did you have to wait to see a medical provider
after you put in a request?
▪ What kind of health care professional saw you while
you were in solitary confinement?
▪ Physician
▪ Physician’s Assistant
▪ Nurse
▪ Other (please describe)
▪ No
▪ Don’t Know
▪ No
▪ Don’t Know

Physicians for Human Rights

▪

Did you need any medications while you were in solitary
confinement (either for chronic conditions or new medications)?
▪ Yes
▪ Were you provided your medications while you were in
solitary confinement?
▪ Yes
▪ No
▪ How long were you not provided your medications for?
▪ Don’t Know
▪ No
▪ Don’t Know

▪

Did you have a mental health condition requiring care while you
were in solitary confinement (for example: anxiety, depression,
schizophrenia)?
▪ Yes
▪ Was it for a new mental health condition or one you had
before solitary confinement?
▪ What was it for?
▪ Did you put in a request to see a mental health provider?
▪ Yes
▪ How long did you have to wait to see a mental health
provider after you put in a request?
▪ What kind of health care professional saw you while
you were in solitary confinement?
▪ Physician
▪ Physician’s Assistant
▪ Nurse
▪ Therapist
▪ Other (please describe)
▪ No
▪ Don’t Know
▪ No
▪ Don’t Know

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Appendix A. Interview Questionnaire
continued

Access to Services
▪ Were you ever given a piece of paper explaining why you were
being placed in solitary confinement?
▪ Yes
▪ No
▪ Don’t Know
▪

▪

▪

40

Were you told how much longer you were going to be in solitary
confinement?
▪ Yes
▪ Were you given different estimates of how much longer you
were going to be in solitary confinement?
▪ Yes
▪ How did this estimate change?
▪ Increase
▪ Decrease
▪ Don’t Know
▪ No
▪ Don’t Know
Only if participant mentioned not being comfortable
communicating in English:
Were you provided interpreter or translation services in
solitary confinement?
▪ Yes
▪ How was the translation provided?
▪ Bilingual staff
▪ Telephone interpreter
▪ In–person interpreter
▪ Other (please describe)
▪ How often was the translation provided?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ No
▪ Don’t Know
Did a supervisor ever interview you while you were in solitary
confinement?
▪ Yes
▪ No
▪ Don’t Know

▪

Were you allowed to use a telephone while in solitary
confinement?
▪ Yes
▪ Were there any restrictions on how you could use the
telephone?
▪ Yes
▪ How were you restricted from using the telephone?
▪ No
▪ Don’t Know
▪ No
▪ Don’t Know

▪

Were you able to use any other forms of communication (like
tablets, WhatsApp, or video calls)?
▪ Yes
▪ What other forms of communication were you allowed
to use?
▪ Were there any restrictions on how you could use these
forms of communication?
▪ Yes
▪ No
▪ Don’t Know
▪ No
▪ Don’t Know

▪

Were you provided a list of legal resources while in solitary
confinement (for example, phone numbers of lawyers)?
▪ Yes
▪ No
▪ Don’t Know

▪

Were you able to talk to lawyers or get legal help while in solitary
confinement?
▪ Yes
▪ How were you able to talk to your lawyers?
▪ Telephone call
▪ Zoom
▪ WhatsApp
▪ Text messages
▪ Other (please describe)
▪ No
▪ How were you prevented from getting legal help?
▪ Did Not Try
▪ Don’t Know

“Endless Nightmare”

How often were you able to write, send, and receive letters while
in solitary confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know
▪ If Always/Often/Sometimes/Rarely above:
Was the content of your mail kept private while in
solitary confinement?
▪ Yes
▪ No
▪ How was your mail not kept private?
▪ Don’t Know
▪ If Often/Sometimes/Rarely/Never above:
How were you prevented from communicating via letters
with others, if any?

▪

How often were you able to use the visiting room while in solitary
confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know

▪

How often were you able to use the commissary while in solitary
confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know

▪

How often were you able to participate in religious practices
while in solitary confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know
▪ If Often/Sometimes/Rarely/Never above:
How were you prevented from participating in
religious practices, if any?

▪

How often were you able to use the library while in solitary
confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know

▪

How often were you allowed to have at least one hour of
recreation per day while in solitary confinement?
▪ Always
▪ Often
▪ Sometimes
▪ Rarely
▪ Never
▪ Did Not Try
▪ Don’t Know
▪ If Often/Sometimes/Rarely/Never above:
Were you provided with a written notification why you
were not able to have recreation?
▪ Yes
▪ No
▪ Don’t Know

▪

Physicians for Human Rights

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41

Appendix A. Interview Questionnaire
continued

Section 3. Questions on Experiences of
Solitary Confinement and Abuse
Experience in Solitary Confinement
▪ What do you remember about your time in solitary
confinement?
Punishment and Retaliation
Have you ever been a victim of sexual assault, torture, trafficking,
or abuse before your time in detention?
▪ Yes
▪ No
▪ Don’t Know

▪

▪

Did you experience any verbal abuse, harassment, or physical
violence while in solitary confinement? If so, please describe.

▪

Did you ever report or protest any issues related to solitary
confinement?
▪ Yes
▪ What did you do? (can select multiple)
▪ Verbally complained to a guard or staff
▪ Filed a written complaint through the facility grievance
procedure
▪ Went on a hunger strike
▪ Sent a message to a family member and asked to publicize
it; Spoke with the media
▪ Told an attorney
▪ Other (please describe)
▪ Did you face retaliation for your actions? (can select
multiple)
▪ Verbal abuse
▪ If yes, what happened?
▪ Physical abuse
▪ If yes, what happened?
▪ Extension of solitary confinement
▪ If yes, how much longer were you placed in
confinement?
▪ Pepper spray
▪ Transferred to another facility
▪ Other (please describe)

42

Impact
How did you feel during your transition out of solitary
confinement?

▪

▪

Was your mental health impacted because of solitary
confinement? If so, how?

▪

Was your medical health impacted because of solitary
confinement? If so, how?

▪

Has solitary confinement impacted your life now in any ways?
If so, how?

Reflections on Solitary Confinement
What changes, if any, do you think should be made about
solitary confinement?
▪ Is there anything else you would like to share that we did not
talk about?
▪

“Endless Nightmare”

Appendix B. Countries of Origin and Languages
Spoken by Participants
Country of Origin, n, Percent of Participants
Mexico
Honduras
Colombia
Liberia
Ivory Coast
Italy
Cuba
England
Germany
Ghana
Jamaica
Kenya
Poland
Republic of Guinea
Senegal
Somalia
Tunisia
Turkey
Ukraine

8 (30.8%)
3 (11.5%)
5 (19.2%)
2 (7.7%)
2 (7.7%)
2 (7.7%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)

Language, n, Percent of Participants
Spanish
English
French
Arabic
German
Italian
Krahn
Russian
Somali
Turkish
Ukrainian
Wolof

16 (61.5%)
13 (50.0%)
3 (11.5%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)
1 (3.8%)

Please note that percentages do not add up to 100% because people may have
come from several different countries or speak several different languages.

Physicians for Human Rights

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43

Endnotes
1.

2.
3.

4.

5.
6.

7.

8.
9.

10.
11.

12.

13.

14.

15.
16.
17.

18.
19.
20.
21.
22.
23.

24.

Eunice Cho, “Unchecked Growth: Private Prison Corporations and Immigration Detention,
Three Years Into the Biden Administration,” last modified August 7, 2023, https://www.
aclu.org/news/immigrants-rights/unchecked-growth-private-prison-corporations-andimmigration-detention-three-years-into-the-biden-administration.
ICE Detainees, TRAC Reports, Inc., https://trac.syr.edu/immigration/detentionstats/pop_
agen_table.html.
See Inter-American Commission on Human Rights, “Report on Immigration in the United
States: Detention and Due Process,” December 30, 2010; Jean Casella and James Ridgeway,
“FAQs,” Solitary Watch, http://solitarywatch.com/facts/faq. [hereinafter FAQs, SOLITARY
WATCH].
HLS FOIA: Spreadsheet Showing Solitary Confinement Stays Between September 4, 2018,
and September 13, 2023, released by ICE on October 16, 2023 [hereinafter HLS FOIA:
Spreadsheet]. The spreadsheet was produced in the midst of FOIA litigation, and at the time
HIRCP wrote this report, HIRCP was still waiting for ICE to produce a more complete version
of the spreadsheet as required by court order. See Harvard Immigr. and Refugee Clinical
Program v. U.S. Department of Homeland Sec., 21-cv-12030, 2023 WL 4685961, (D. Mass.
July 21, 2023).
HLS FOIA: Spreadsheet.
DHS OIG, “ICE Needs to Improve its Oversight of Segregation Use in Detention Facilities,”
October 13, 2021, https://www.oig.dhs.gov/sites/default/files/assets/2021-10/OIG-22-01Oct21.pdf.
The United Nations Standard Minimum Rules for the Treatment of Prisoners, Rule 44 (2015)
(https://www.unodc.org/documents/justice-and-prison-reform/Nelson_Mandela_Rules-Eebook.pdf (defining solitary confinement as confinement for 22 hours or more a day without
meaningful human contact.”
DHS OIG, “ICE Needs to Improve its Oversight of Segregation Use in Detention Facilities.”
Peter Scharff Smith, “The Effects of Solitary Confinement on Prison Inmates: A Brief
History and Review of the Literature,” 2006, Crime and Justice, 34(1), 441–528, https://doi.
org/10.1086/500626; See also United Nations, “Special Rapporteur on Torture Tells Third
Committee Use of Prolonged Solitary Confinement on Rise, Calls for Global Ban on Practice,”
Oct. 18, 2011, https://www.ohchr.org/en/press-releases/2011/10/un-special-rapporteurtorture-calls-prohibition-solitary-confinement.
Peter Scharff Smith, “The Effects of Solitary Confinement on Prison Inmates” 337, 441–528.
Brinkley-Rubinstein L, Sivaraman J, Rosen DL, et al. “Association of Restrictive Housing During
Incarceration with Mortality After Release,” JAMA Network Open 2019;2(10):e1912516.
doi:10.1001/jamanetworkopen.2019.12516.
New York Civil Liberties Union, “Boxed in: The True Cost of Extreme Isolation in New York’s
Prisons” at 44, October 2, 2012, https://www.nyclu.org/sites/default/files/publications/nyclu_
boxedin_FINAL.pdf; NIJC & PHR, “Invisible in Isolation” at 13-14, https://immigrantjustice.
org/sites/immigrantjustice.org/files/Invisible%20in%20Isolation-The%20Use%20of%20
Segregation%20and%20Solitary%20Confinement%20in%20Immigration%20Detention.
September%202012_7.pdf; Stuart Grassian, “Psychiatric Effects of Solitary Confinement,”
22 WASH. U. J. L. & POL’Y 325 (2006) at 347-48, https://openscholarship.wustl.edu/law_
journal_law_policy/vol22/iss1/24; Jose Olivares, “ICE Detainee Diagnosed with Schizophrenia
Spent 21 Days in Solitary Confinement, Then Took His Own Life,” July 27, 2018, https://
theintercept.com/2018/07/27/immigrant-detention-suicides-ice-corecivic/.
Erfani et al, full reference available at: https://pubmed.ncbi.nlm.nih.gov/33575408/ (noting
increased suicide rate in detention facilities); Terp et al, full reference available at: https://
pubmed.ncbi.nlm.nih.gov/33575408/.
United Nations, “Special Rapporteur on Torture Tells Third Committee Use of Prolonged
Solitary Confinement on Rise, Calls for Global Ban on Practice,” October 18, 2011, https://
www.ohchr.org/en/press-releases/2011/10/un-special-rapporteur-torture-calls-prohibitionsolitary-confinement.
Ibid.
Ibid.
U.S. Immigration and Customs Enforcement, 11065.1, “Review of the Use of Segregation
for ICE detainees,” 2013 at 2, https://www.dhs.gov/sites/default/files/publications/
segregation_directive.pdf [hereinafter 2013 ICE Segregation Directive]. Detention facilities
across the country often use a range of euphemisms to refer to solitary confinement,
including administrative or disciplinary “segregation,” special or restrictive housing. FAQs,
SOLITARY WATCH.
2013 ICE Segregation Directive at 2.
Ibid.
Ibid. at 1.
Ibid. at 6.
Ibid. at 4, 6.
ICE, Mem. from Thomas Homan, “Further Guidance Regarding the Care of Transgender
Detainees” at 4, June 19, 2015, https://www.ice.gov/sites/default/files/documents/
Document/2015/TransgenderCareMemorandum.pdf.
Ibid.

44

25. U.S. ICE, ICE Directive 11063.2, “Identification, Communication, Recordkeeping, and Safe Release
Planning for Detained Individuals with Serious Mental Disorders or Conditions and/or Who are
Determined to Be Incompetent by an Immigration Judge,” April 5, 2022, https://www.ice.gov/doclib/
news/releases/2022/11063-2.pdf.
26. Ibid. at 5.
27. 2013 ICE Segregation Directive at 6.
28. 28 Ibid. at 4.
29. U.S. Government Accountability Office, Immigration Detention Actions Needed to Collect Consistent
Information for Segregated Housing Oversight, October 2022, https://www.gao.gov/assets/gao-23105366.pdf.
30. Ibid. at 20.
31. Ibid.
32. Ibid. at 21.
33. Ibid. at 21–22; see also DHS Office of Inspector General, “ICE Needs to Improve Its Oversight of
Segregation Use in Detention Facilities,” OIG-22-01, October 13, 2021.
34. U. S. Government Accountability Office, “Immigration Detention Actions Needed to Collect
Consistent Information for Segregated Housing Oversight” at 19, October 2022, https://www.gao.
gov/assets/gao-23-105366.pdf.
35. See Maryam Saleh and Spencer Woodman, “A Homeland Security Whistleblower goes Public about
ICE Abuse of Solitary Confinement,” The Intercept, May 2019, https://theintercept.com/2019/05/21/
ice-solitary-confinement-whistleblower/; Maryam Saleh, “Whistleblower ‘Helpless’ to Stop U.S.
Immigration Solitary Confinement Abuses,” May 2019, International Consortium of Investigative
Journalists, https://www.icij.org/investigations/solitary-voices/whistleblower-helpless-to-stopus-immigration-solitary-confinement-abuses/; Nick Schwellenbach, Mia Stienle et. al, “ISOLATED:
ICE Confines Some Detainees with Mental Illness in Solitary for Months,” Project on Government
Oversight, August 2019, https://www.pogo.org/investigation/2019/08/isolated-ice-confines-somedetainees-with-mental-illness-in-solitary-for-months; Spencer Woodman and Maryam Saleh, “40
Percent of ICE Detainees Held in Solitary Confinement have a Mental Illness, New Report Finds,”
The Intercept, August 2019, https://theintercept.com/2019/08/14/ice-solitary-confinement-mentalillness/; Juan Mendez, Interim Report of the Special Rapporteur of the Human Rights Council on
Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment ¶¶ 21, 26, U.N. Doc.
A/66/268 August 5, 2011, https://digitallibrary.un.org/record/710177?ln=enA/66/268 (August
5, 2011), https://digitallibrary.un.org/record/710177?ln=en; Kenneth L. Applebaum, “American
Psychiatry Should Join the Call to Abolish Solitary Confinement,” 43 J. Am. Acad. Psychiatry L. 406,
408 (2015), http://jaapl.org/content/jaapl/43/4/406.full.pdf; Human Rights Watch, “Do You See
How Much I’m Suffering Here?”: Abuse against Transgender Women in US Immigration Detention”
March 2016, https://www.hrw.org/sites/default/files/report_pdf/us0316_web.pdf [hereinafter Abuse
against Transgender Women]; NIJC & PHR, “Invisible in Isolation” at 13-14, https://www.nyclu.org/
sites/default/files/publications/nyclu_boxedin_FINAL.pdf.
36. GAO Report, OIG Report, NIJC Policy Brief, https://immigrantjustice.org/research-items/policy-briefbeyond-repair-ices-abusive-detention-inspection-and-oversight-systemACLU; ACLU blog: https://
www.aclu.org/news/immigrants-rights/ices-detention-oversight-system-needs-an-overhaul.
37. Maryam Saleh and Spencer Woodman, “A Homeland Security Whistleblower.” (“In July 2014, on the
advice of ethics counsel, Gallagher sent a detailed memo to then-Deputy Secretary of Homeland
Security Alejandro Mayorkas, emphasizing that segregation was not in fact being used as a
last resort in many instances, contrary to ICE policy. ‘Essentially, where a detainee’s behavior or
characteristics are perceived to be disruptive, evidence of noncompliance, or a threat to the general
population or ‘good order’ of the facility,’ she wrote, ‘segregation serves as a default remedy.’”);
Memo of Ellen Gallagher, Senior Policy Advisor, Civil Rights Civil Liberties to Alejandro Mayorkas,
Deputy Secretary, DHS, re The Use of Segregation for Immigration Detainees, July 23, 2014, https://
www.documentcloud.org/documents/5998113-Mayorkas-Memo-07232014.html. Gallagher is
a whistleblower who has publicly flagged issues concerning ICE’s use of solitary confinement for
multiple years. She is represented by the Government Accountability Project.
38. DHS OIG, “Concerns about ICE Detainee Treatment and Care at Detention Facilities,” OIG-18-32,
December 11,2017, https://www.oig.dhs.gov/sites/default/files/assets/2017-12/OIG-18-32-Dec17.
pdf; DHS OIG, “ICE Field Officers Need to Improve Compliance with Oversight Requirements for
Segregation of Detainees with Mental Health Conditions,”OIG-17-119, September 29, 2017, https://
www.oig.dhs.gov/sites/default/files/assets/2017-11/OIG-17-119- Sep17.pdf.
39. DHS OIG, “ICE Needs to Improve its Oversight of Segregation Use in Detention Facilities,” October 13,
2021, https://www.oig.dhs.gov/sites/default/files/assets/2021-10/OIG-22-01-Oct21.pdf.
40. Ibid.
41. GAO Report.
42. Mem. from DHS Office of Civil Rights and Civil Liberties and the Office of General Counsel to ICE,
“Retention Memo: Segregation of Individuals with a Mental Health Disability and/or Serious Mental
Illness,” September 1, 2023, https://www.dhs.gov/sites/default/files/2023-09/23_0901_crcl_
retention_memo_to_ice_segregation_mental_health_or_illness_redacted_508.pdf.
43. Ibid.
44. Ibid.
45. Ibid.

“Endless Nightmare”

46. “Invisible In Isolation: The Use Of Segregation And Solitary Confinement In Immigration
Detention,” September 20, 2012, https://immigrantjustice.org/research-items/report-invisibleisolation-use-segregation-and-solitary-confinement-immigration.
47. HLS FOIA: Evaluations Conducted by the Department of Homeland Security’s Office for Civil
Rights and Civil Liberties on ICE Detention Facilities Between 2012 and 2014, released on
October 25, 2023 [hereinafter HLS FOIA: CRCL Evaluations].
48. American Immigration Council, “Press Release: Complaint Filed Against ICE As Misuse of
Solitary Confinement in Colorado Facility Raises Concerns,” July 13, 2023, https://www.
americanimmigrationcouncil.org/news/complaint-filed-against-ice-misuse-solitary-confinementcolorado-facility-raises-concerns.
49. Harvard Immigr. and Refugee Program v. U.S. Dep’t of Homeland Sec., 21-cv-12030, 2023 WL
4685961, (D. Mass. July 21, 2023).
50. HLS FOIA: Spreadsheet.
51. POGO FOIA: Spreadsheet Showing Solitary Confinement Stays Between January 2016 and May
2018; ICIJ FOIA: Spreadsheet Showing Solitary Confinement Stays Between 2012 and 2017; HLS
FOIA: Spreadsheet.
52. HLS FOIA: Spreadsheet. The SRMS dataset included 14,264 cases, including 155 immigrants
still in solitary confinement as of September 14, 2023. As these individuals’ stays in solitary
confinement were still ongoing, they are not reflected in this report’s analysis of average length
of solitary confinement.
53. HLS FOIA: 2023 Q3 Segregation Metrics from ICE’s Detention Monitoring Council’s Quarterly
Meeting on September 2023, released on October 16, 2023 [hereinafter HLS FOIA: 2023 Q3
Segregation Metrics]; HLS FOIA. The evaluations were conducted between 2012 and 2014 by
doctors in response to complaints CRCL received about the adequacy of mental health services.
54. HLS FOIA: CRCL Evaluations.
55. DHS OIG, “ICE Needs to Improve its Oversight of Segregation Use in Detention Facilities,”
October 13, 2021, https://www.oig.dhs.gov/sites/default/files/assets/2021-10/OIG-22-01-Oct21.
pdf.
56. OIG randomly selected a sample of 265 detention files, based on SRMS data. This resulted
in 474 individual segregation placements, as some persons in detention were placed in
segregation multiple times. Seventy-five of these placements were not required to be reported
under ICE’s reporting requirements (see footnote 10 in the OIG report), which brings the
total number of placements to be compared between SRMS and facilities to 399. Sixty-two
placements were missing from the segregation placements that should have been recorded in
SRMS according to ICE policy. The OIG report miscalculated the percentage of underreported
placements, by including the placements that were not required to be reported, which resulted
in a lower percentage.
57. GAO Report.
58. Ibid.
59. Ibid., from 2017 to 2021. 1,436 (out of 5,907) detained immigrants with a mental condition and
3,541 (out of 4,017) detained immigrants with serious mental condition were not reported by
SRMS (see Tables 6 and 7, pp. 35–36).
60. ICE Detention Statistics, https://www.ice.gov/detain/detention-management.
61. HLS FOIA: Spreadsheet.
62. Two detention stats excel files were downloaded from the ICE detention management webpage,
https://www.ice.gov/detain/detention-management, covering 2022 and 2023 fiscal years (no
statistics on vulnerable populations were found in the earlier years). As ICE provides statistics
based on federal government’s fiscal years (from October 1 to September 30), only aggregate
statistics from the first quarter of 2022 to the third quarter of 2023 (October 2022-June 2023)
were compared. The 2022 file (https://www.ice.gov/doclib/detention/FY22-detentionStats.xlsx)
was used to obtain statistics for the first three quarters in 2022, and the 2023 file (https://www.
ice.gov/doclib/detention/FY23_detentionStats.xlsx) was used to obtain statistics thereafter.
These publicly available files reported a total of 2,314 placements of vulnerable populations
during the observed seven quarters. As ICE’s publicly shared statistics are not disaggregated
by type of vulnerability (for example, mental illness, disability, suicide, and so on), necessary
restrictions were made to construct aggregates comparable to the ICE’s quarterly statistics.
According to the downloaded excel files, vulnerable population includes “reported facilityinitiated segregation placements of noncitizens that self-identify as lesbian, gay, bisexual,
transgender, and/or intersex (LGBTI); have a serious mental or medical illness; are conducting a
hunger strike; or are on suicide watch.” 7,421 observations from 14,264 were removed to restrict
the FOIA-obtained SRMS data to confinements placed from October 1, 2021 to June 30, 2023.
Restricting the data to facility-initiated placements, dropped an additional 2,978 placements,
resulting in a final sample of 3,865.

Physicians for Human Rights

63. FOIA-obtained SRMS variables indicating vulnerability were used to count 1,201 placements
(variables included were MentalIll, SeriousMedicalIllness, SeriousDisability and SuicideRisk). There
were an additional 706 placements that were not identified as vulnerable with any of the abovementioned variables, but a reason for placement was coded as “Medical/Mental.” Without additional
information on the severity of medical illnesses for these placements, it cannot be determined if ICE
was required to report them as vulnerable. Therefore, assuming these cases were vulnerable could
introduce bias. Even if, however, we assume that all these additional placements included vulnerable
immigrants, the number of placements in our FOIA dataset was consistently underreported anywhere
from 8 to 34 percent per quarter.
64. HLS FOIA: Spreadsheet and ICE Detention Statistics, https://www.ice.gov/detain/detentionmanagement.
65. HLS FOIA: Spreadsheet and ICE Detention Statistics, https://www.ice.gov/detain/detentionmanagement.
66. HLS FOIA: CRCL Evaluations.
67. Ibid.
68. Ibid.
69. Ibid.
70. Ibid.
71. 2013 ICE Segregation Directive.
72. Of note, some facilities may be bound by the Performance-Based National Detention Standards or
other versions of the NDS but the requirements regarding solitary confinement procedures, minimum
standards of care, and procedures for implementing and carrying out solitary confinement are
generally consistent across them.
73. Appendix A for questionnaire.
74. U.S. Immigration and Customs Enforcement, “Review of the Use of Segregation for ICE Detainees,”
2013, https://www.ice.gov/doclib/detention-reform/pdf/segregation_directive.pdf.
75. HLS FOIA: Spreadsheet.
76. Ibid.
77. Ibid.
78. Ibid. Seven of these solitary confinement placements were initiated in response to immigrants
requesting solitary confinement. The longest lengths of solitary confinement placements that were
specifically facility-initiated include: 637 days (Northwest ICE Processing Center, WA), 519 days
(Adelanto ICE Processing Center, CA), 485 days (Imperial Regional Detention Facility, CA), 444 days
(Nye County Detention Center, NV), 414 days (Northwest ICE Processing Center, WA), and 404 days
(Central Louisiana ICE Processing Center, LA).
79. CoreCivic, Detention Facilities, https://www.corecivic.com/facilities, last visited January 10, 2024
(listing Eloy Federal Contract Facility and Otay Mesa Detention Center); The Geo Group, Inc., Our
Locations, https://www.geogroup.com/LOCATIONS, last visited January 10, 2024 (listing Denver
Contract Detention Facility, Northwest ICE Processing Center); Detainees Leaving ICE Detention from
the Buffalo Service Processing Center (Federal Detention Facility), Syracuse TRACImmigration, https://
trac.syr.edu/immigration/detention/201509/BTV/exit/, last visited January 10, 2024.
80. HLS FOIA: Spreadsheet.
81. Ibid.
82. Complaint Filed Against ICE As Misuse of Solitary Confinement in Colorado Facility Raises Concerns,
July 13, 2023, https://www.americanimmigrationcouncil.org/news/complaint-filed-against-icemisuse-solitary-confinement-colorado-facility-raises-concerns.
83. HLS FOIA: Spreadsheet.
84. Ibid.
85. Eileen Sullivan, “Crossings at the U.S. Southern Border Are Higher Than Ever,” The New York Times,
October 27, 2023, https://www.nytimes.com/2023/10/21/us/politics/cbp-record-border-crossings.
html.
86. HLS FOIA Spreadsheet and ICE Detention Statistics Excel files from 2018-2023 were used to derive
the proportion, https://www.ice.gov/detain/detention-management.
87. HLS FOIA: Spreadsheet; Physicians for Human Rights, “Praying for Hand Soap and Masks: Health and
Human Rights Violations in U.S. Immigration Detention During the COVID-19 Pandemic,” January
2021, 10.
88. HLS FOIA: Spreadsheet.
89. HLS FOIA 2023: Q3 Segregation Metrics from ICE’s Detention Monitoring Council’s Quarterly Meeting
on September 2023, released on October 16, 2023 [hereinafter HLS FOIA: 2023 Q3 Segregation
Metrics].
90. HLS FOIA: 2023 Q3 Segregation Metrics.
91. HLS FOIA: Spreadsheet.
92. Ibid.
93. U.S. Immigration and Customs Enforcement, Review of the Use of Segregation for ICE Detainees.
94. HLS FOIA: E-mail from the Department of Homeland Security’s Office for Civil Rights and Civil
Liberties, sent on April 22, 2016 [hereinafter HLS FOIA: CRCL E-mail].
95. POGO FOIA: Spreadsheet Showing Solitary Confinement Stays Between January 2016 and May 2018
[hereinafter POGO FOIA: Spreadsheet].

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Endnotes
continued

96. “Complaint Detailing Abusive Overuse of Solitary Confinement and Mistreatment that
Disproportionately Impacts Persons with Disabilities at the Aurora Contract Detention Facility,”
American Immigration Council, National Immigration Project, and Rocky Mountain Immigrant
Advocacy Network, July 13, 2023, https://www.americanimmigrationcouncil.org/sites/default/
files/research/misuse_of_solitary_confinement_in_colorado_immigration_detention_center_
complaint.pdf. [hereinafter American Immigration Council Complaint].
97. American Immigration Council Complaint.
98. HLS FOIA: Evaluations Conducted by the Department of Homeland Security’s Office for Civil
Rights and Civil Liberties on ICE Detention Facilities Between 2012 and 2014, released on
October 25, 2023 [hereinafter HLS FOIA: CRCL Evaluations].
99. HLS FOIA: CRCL Evaluations.
100. Ibid.
101. Ibid.
102. HLS FOIA: 2023 Q3 Segregation Metrics.
103. POGO FOIA: Spreadsheet.
104. Ibid.
105. Dana Salvano-Dunn, “Retention Memo: Segregation of Individuals with a Mental Health
Disability and/or Serious Mental Illness,” U.S. Department of Homeland Security, September 1,
2023, https://www.dhs.gov/sites/default/files/2023-09/23_0901_crcl_retention_memo_to_
ice_segregation_mental_health_or_illness_redacted_508.pdf.
106. American Immigration Council Complaint, at 15.
107. Dana Salvano-Dunn, “Retention Memo.”
108. United Nations, “Special Rapporteur on Torture Tells Third Committee Us of Prolonged Solitary
Confinement on Rise, Calls for Global Ban on Practice,” October 18, 2011, https://press.
un.org/en/2011/gashc4014.doc.htm#:~:text=The%20Human%20Rights%20Council’s%20
Special,terror%E2%80%9D%20and%20%E2%80%9Cthreats%20to%20national.
109. U.S. Immigration and Customs Enforcement, Review of the Use of Segregation for ICE Detainees,
2013.
110. HLS FOIA: Spreadsheet.
111. Ibid.
112. Ibid.
113. DHS OIG, “ICE Needs to Improve its Oversight of Segregation Use in Detention Facilities,”
October 13, 2021, https://www.oig.dhs.gov/sites/default/files/assets/2021-10/OIG-22-01-Oct21.
pdf, GAO Report, HLS FOIA: Spreadsheet and ICE Detention Statistics, https://www.ice.gov/
detain/detention-management.
114. HLS FOIA: Spreadsheet. This percentage is calculated from the number of people in solitary
confinement with recorded mental health status.
115. HLS FOIA: Spreadsheet.
116. Ibid.
117. Ibid.
118. Ibid.
119. U.S. Immigration and Customs Enforcement, ICE Directive 11063.2, “Identification,
Communication, Recordkeeping, and Safe Release Planning for Detained Individuals with
Serious Mental Disorders or Conditions and/or Who are Determined to Be Incompetent by an
Immigration Judge,” April 5, 2022, https://www.ice.gov/doclib/news/releases/2022/11063-2.pdf.
120. Memo from DHS Office of Civil Rights and Civil Liberties and the Office of General Counsel to
ICE, “Retention Memo: Segregation of Individuals with a Mental Health Disability and/or Serious
Mental Illness,” September 1, 2023, https://www.dhs.gov/sites/default/files/2023-09/23_0901_
crcl_retention_memo_to_ice_segregation_mental_health_or_illness_redacted_508.pdf.
121. Stuart Grassian, “Psychiatric Effects of Solitary Confinement.”
122. POGO FOIA: Spreadsheet.
123. Ibid.
124. Ibid.
125. HLS FOIA: CRCL Evaluations.
126. Ibid.
127. Ibid.
128. Grassian, “Psychiatric Effects of Solitary Confinement.”
129. HLS FOIA: CRCL Evaluations.
130. Ibid.
131. Ibid.
132. Ibid.
133. Ibid.
134. Ibid.
135. “National Detention Standards for Non-Dedicated Facilities,” ICE, Revised 2019, https://www.
ice.gov/doclib/detention-standards/2019/nds2019.pdf.
136. Ibid.
137. John Leach, “Psychological factors in exceptional, extreme and torturous environments,”
Extreme physiology & medicine 5 (2016): 1–15.

46

138. Loran F. Nordgren, Mary-Hunter Morris McDonnell, and George Loewenstei, “What constitutes
torture? Psychological impediments to an objective evaluation of enhanced interrogation tactics,”
Psychological science 22, no. 5 (2011): 689-694; Peeler K, Hampton K, Lucero J, Ijadi-Maghsoodi R.,
“Sleep deprivation of detained children: another reason to end child detention,” Health and human
rights journal 21, no. 1 (2019): 317-320, https://www.hhrjournal.org/2020/01/sleep-deprivation-ofdetained-children-another-reason-to-end-child-detention/.
139. “National Detention Standards for Non-Dedicated Facilities.”
140. Ibid.
141. Ibid.
142. Ibid.
143. Ibid.
144. Ibid.
145. Ibid.
146. Ibid.
147. Ibid.
148. “National Detention Standards for Non-Dedicated Facilities”; “ICE Health Service Corps,” Immigration
and Customs Enforcement, accessed October 18, 2023, https://www.ice.gov/features/health-servicecorps.
149. “National Detention Standards for Non-Dedicated Facilities.”
150. “The HIPAA Privacy Rule,” Office for Civil Rights, https://www.hhs.gov/hipaa/for-professionals/
privacy/index.html.
151. Dekker AM, Farah J, Parmar P, Uner AB, Schriger DL, “Emergency Medical Responses at US
Immigration and Customs Enforcement Detention Centers in California,” JAMA Netw Open 6, no. 11
(2023):e2345540. doi:10.1001/jamanetworkopen.2023.45540.
152. “ICE Health Service Corps,” Immigration and Customs Enforcement, accessed October 18, 2023,
https://www.ice.gov/features/health-service-corps.
153. Grassian, “Psychiatric Effects of Solitary Confinement.”
154. U.S. CONST, Amend, V.
155. Zadvydas v. Davis, 533 U.S. 678, 693 (2001).
156. DeShaney v. Winnebago Cty. Dep’t. of Soc. Servs., 489 U.S. 189, 199-200 (1989).
157. Youngberg v. Romeo, 457 U.S 307, 322 (1982).
158. Alina Das, “Immigration Detention and Dissent: The Role of First Amendment on the Road to
Abolition,” Georgia Law Review 56, no. 4 (2022), https://digitalcommons.law.uga.edu/cgi/
viewcontent.cgi?article=1215&context=glr.
159. Aleksandr Sverdlik, “Border Patrol and ICE Routinely Violate Immigrants’ Religious Rights,” ACLU,
March 20, 2019, https://www.aclu.org/news/immigrants-rights/border-patrol-and-ice-routinelyviolate.
160. 2013 ICE Segregation Directive, https://www.ice.gov/doclib/detention-reform/pdf/segregation_
directive.pdf; Detention Management, “U.S. Immigration & Customs Enforcement,” https://www.
ice.gov/detention-management; “Hearing Regarding Oversight of Detention Facilities Before the
Subcomm. on Oversight, Management, & Accountability of the H. Comm. on Homeland Security,”
116th Cong. 2, 3, 2019 (statement of Tae Johnson Assistant Director for Custody Management,
Enforcement and Removal Operations, U.S. Customs and Immigration Enforcement) (hereinafter, ICE
Testimony).
161. “2019 National Detention Standards for Non-Dedicated Facilities,” https://www.ice.gov/detain/
detention-management/2019; “2011 Operations Manual ICE Performance-Based National Detention
Standards,” https://www.ice.gov/detain/detention-management/2011 (“PBNDS 2011 reflects
ICE’s ongoing effort to tailor the conditions of immigration detention to its unique purpose while
maintaining a safe and secure detention environment for staff and detainees …. PBNDS 2011 is
crafted to improve medical and mental health services … [and] improve the process for reporting
and responding to complaints.”).
162. ICE, “2019 National Detention Standards for Non-Dedicated Facilities,” https://www.ice.gov/detain/
detention-management/2019.
163. ICE Testimony.
164. Article 31(2) of the UN Refugee Convention (permitting states to restrict refugee freedom of
movement only when “necessary” and only until their legal status is “regularized” or they are
admitted to another country); Andreas Zimmermann et al., “The 1951 Convention Relating to
the Status of Refugees and its 1967 Protocol: A Commentary,” Oxford Public International Law,
January 2011, https://opil.ouplaw.com/display/10.1093/actrade/9780199542512.001.0001/
actrade-9780199542512.
165. UN Human Rights Committee (HRC), General comment no. 35, Article 9 (Liberty and security of
person), December 16, 2014, CCPR/C/GC/35, para 12, 18.
166. UNHCR ExCom, Conclusion No. 44 (1986).
167. United Nations, “Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” Note
by Secretary-General A/63/174, 77. Special Rapporteur on Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment, Report on Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment, Human Rights; Human Rights Committee, General Comment 20, Article 7,
44th Sess., U.N. Doc. HRI/GEN/1/Rev. 1 para 30 (1994).

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168. United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela
Rules) A/RES/70/175, January 8, 2016, https://documents-dds-ny.un.org/doc/UNDOC/GEN/
N15/443/41/PDF/N1544341.pdf?OpenElement.
169. Juan Mendez, Interim Report of the Special Rapporteur of the Human Rights Council on Torture
and Other Cruel, Inhuman or Degrading Treatment or Punishment 21, 26, U.N. Doc. A/66/268
(August 5, 2011), https://digitallibrary.un.org/record/710177?ln=en.
170. United Nations Press Release, Special Rapporteur on Torture Tells Third Committee Use of
Prolonged Solitary Confinement on Rise, Calls for Global Ban on Practice, October 18, 2011,
https://press.un.org/en/2011/gashc4014.doc.htm. NIJC & PHR, “Invisible in Isolation” (citing
Interim Report of the Special Rapporteur of the Human Rights Council on Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment, para 62 UN Doc A/66/268, August 5, 2011,
[prepared by Juan Mendez]).
171. Art. 10, ICCPR. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment
or Punishment, December 10, 1984. 1465 U.N.T.S. 85, 113; S. Treaty Doc. No. 100-20 (1988); 23
I.L.M. 1027 (1984).
172. Office of the High Commissioner, UN Human Rights, Press Release, “United States: Prolonged
solitary confinement amounts to psychological torture, says UN expert,” February 28, 2020,
https://www.ohchr.org/en/press-releases/2020/02/united-states-prolonged-solitary-confinementamounts-psychological-torture.
173. Ibid.
174. Ibid.
175. Inter-American Commission on Human Rights, “Report on Immigration in the United States:
Detention and Due Process,” at para 337, 2010, https://www.oas.org/en/iachr/migrants/docs/pdf/
migrants2011.pdf.
176. At para 45, https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download.
aspx?symbolno=CCPR%2FC%2FUSA%2FCO%2F5&Lang=en.
177. Ibid., para 54.
178. The recommendations in this section draw on several different sources, including: Project on
Government Oversight, “ISOLATED: ICE Confines Some Detainees with Mental Illness in Solitary for
Months,” August 2019, https://www.pogo.org/investigation/2019/08/isolated-ice-confines-somedetainees-with-mental-illness-in-solitary-for-months; Physicians for Human Rights, “Praying for
Hand Soap and Masks,” January 12, 2021, https://phr.org/our-work/resources/praying-for-handsoap-and-masks/.
179. Maryam Saleh and Spencer Woodman, “A Homeland Security Whistleblower goes Public about ICE
Abuse of Solitary Confinement,” The Intercept.

Physicians for Human Rights

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47

Physicians for
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For more than 35 years,
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