By George B. Sánchez-Tello, CalMatters
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After five months in Adelanto, an immigration detention facility in Southern California’s high desert, Emma Marcela Crespin de Paz is home in Los Angeles. The 58-year-old food vendor was released in October after multiple hospitalizations while in federal custody.
Before she was detained, De Paz had been coping with high blood pressure and diabetes — serious, chronic conditions. Her warrantless arrest and bail bond indicate she shouldn’t have been taken at all.
De Paz’s ordeal highlights both a public component of Trump-era immigration policy — racial profiling — and a burgeoning public health concern that’s hidden from view: the immigrant detention system is ill-equipped for the health needs of those in its care.
Deaths in custody capture public attention, said Dr. Altaf Saadi, an associate professor at Harvard Medical School and neurologist at Massachusetts General Hospital in Boston, where she is the associate director of its asylum clinic.
Less attention is paid to those with chronic illnesses, whose health needs are worsened by indefinite detention in a dragnet, she said. People like de Paz.
At least twice de Paz had to be hospitalized while being held by immigration officials; both times she was admitted without her family’s notification. Because ICE detained her without her medication, she only began receiving her pills after family and attorneys advocated for her wellbeing.
Saadi’s research on the health and wellbeing of California’s immigrant detainees has over five years consistently raised concerns about detention facilities.
“Detention center medical systems have limited health care services, are frequently under-staffed and are focused on managing acute care needs rather than chronic medical problems, resulting in medical neglect, delayed diagnoses and care and severe negative consequences, especially among trauma-exposed individuals,” Saadi and other researchers wrote in the Health and Human Rights Journal in 2020.
Surviving ICE detention despite illness
“The reality is there are harms occurring on a daily basis that people are surviving because people are resilient,” Saadi said in a July interview.
Interruptions of detainees’ regular medicine and treatment routines and ensuing physical harm are likely underreported and under-discussed in local media and communities, Saadi added.
Emma de Paz arrived in the United States in 2001 from Chiquimulilla, in the Guatemalan state of Santa Rosa, said her brother, Carlos Barrera de Paz.
In Guatemala, her family worked in agriculture, as well as construction and street vending. The journey from Guatemala to Los Angeles lasted about 25 days, Carlos explained, including a four-day walk through the Sonoran Desert.
In the United States, De Paz established herself as part of Los Angeles’ informal economy by becoming a regular vendor outside the Hollywood Home Depot. She was known for Guatemalan favorites — black beans, hoof soup, and Guatemalan barbeque.
She also became part of a movement to legalize street vending in Los Angeles, explained Sergio Jimenez of Community Power Collective, a grassroots collective of tenants, street vendors & transit riders working for what they call a “solidarity economy.”
Recently, about the time de Paz returned from detention, Gov. Gavin Newsom signed legislation that de Paz had helped advocate for, to prevent immigration officials from accessing street vendors’ personal information from the licensing process.
De Paz’ brother, Carlos, described his sister’s and family’s struggles with immigration enforcement.
A family’s search amid hospitals’ silence
It began June 19, less than two weeks after federal officials began aggressive raids at a downtown L.A. warehouse and nearby Home Depot. Agents picked up De Paz and took her to the Metropolitan Detention Center downtown. She didn’t have her medicine with her.
De Paz ended up hospitalized nearby at White Memorial Hospital in Boyle Heights. Neither hospital nor immigration officials notified de Paz’s family. Instead they found out through a network of immigrant advocates working to alert communities to raids, identify those taken and track their well being.
Carlos called the hospital in Boyle Heights and asked, in English, if his sister was there, if she was doing well or needed help. But hospital staff would not confirm she was there nor comment on her wellbeing, he said.
Jimenez and her family later learned ICE agents were in de Paz’s room and in the adjacent hallway. Jimenez has met with doctors, nurses, surgeons and dieticians who have raised ethical concerns about ICE presence.
Throughout the summer, L. A. media reported on the presence of ICE in hospital lobbies and patient rooms. The nation’s nursing union has been advocating for the rights of immigrant patients in custody. Even White Memorial released ICE guidelines, though doctors and advocates said they fall short.
“This is a violation of patients’ rights,” Jimenez said. “Medical professionals are questioning the presence of ICE and the lack of (patient) access to their medication.”
Treating ill immigrants poorly
After 10 days in downtown Los Angeles, de Paz was transferred to the Adelanto Detention Center, a private prison operated by GEO Group.
In her first week there, she again was without medication and was given food considered harmful for patients with diabetes and high blood pressure. For instance, de Paz was fed Capri sun and sandwiches for lunch, Jimenez and her family said.
“All that is jeopardizing her health,” Jimenez said. “The conditions don’t change.”
While in Adelanto, de Paz was hospitalized again. The family is still not sure where because, again, hospital staff would not confirm her visit. The family received no explanation or paperwork about the hospitalization.
De Paz told her family the hospital did not provide translation services for her to communicate with the doctor or nurses.
Instances of poor treatment and health care for immigrants at Adelanto have long been documented.
A 2018 Homeland Security Inspector General report titled “Management Alert – Issues Requiring Action at the Adelanto ICE Processing Center in Adelanto, California,” includes a subsection titled “Failure to Provide Timely and Adequate Medical Care for Detainees Increases Health Risks.”
The report states detainees are not ensured appropriate or necessary medical and dental care. Inspectors note doctors spoke in English to Spanish-speakers who did not understand what was said. The report also notes inspectors discovered nooses made from bed sheets, hanging from vents; detainees in interviews gave a variety of reasons for the sheets, including for failed suicide attempts.
A year after that report, the California Department of Justice published a review of immigration detention facilities in California, complying with a law passed in 2017. The review said inspections at 10 facilities — including county jails, private prisons and Adelanto — revealed universal problems with medical record keeping, nurses practicing outside their legal scope, inadequate exams, inadequate medical care, inadequate mental health staffing and unsafe suicide watch and solitary confinement practices.
The report noted that Adelanto was the most difficult source for obtaining medical files. Also, California’s DOJ requested a two-week inspection of Adelanto, but ICE allowed investigators in for only one day and did not permit them to speak with any detainees or staff.
Evidence of medical harm
Detention facilities and staff are not prepared to adequately address the health needs of detainees and are harmful, Saadi reported in 2021 in the Journal of Racial and Ethnic Health Disparities.
That same year, in the Journal of Immigrant and Minority Health, Saadi and another researcher reported on health needs for immigrant detainees amidst the COVID-19 pandemic. Noting the lack of public data on detainees with chronic health needs, they identified a 2013-2014 survey of 565 detainees in four California facilities — three jails and one private prison.
Researchers found 42.5% of respondents had at least one diagnosed medical condition and 15.5% had multiple chronic conditions. About 28% of detainees reported a combination of heart disease and Type 2 diabetes, about 17% had neuropsychiatric conditions and nearly 9% reported lung disease.
Of the individuals with known health conditions and treatment, about 21% experienced disruption in care upon entering detention, as did nearly 32% of individuals with two or more conditions.
In January 2025, across a pair of peer-reviewed journals — the Journal of the American Medical Association and the Journal of Migration and Health — Saadi and her colleagues again warned about the health dangers of migrant detention, concluding: “The most effective harm-reduction policy would be to end the use of incarceration in immigration legal proceedings.”
Healing at home
It will take more attention to research like Saadi’s and the stories of detained immigrants like de Paz for the public to understand the degree of medical harm resulting from Trump-era raids and arrests, to ensure it doesn’t happen again.
Meanwhile, de Paz has said she does not want to speak to reporters about her experience. When she returned home in October, the Los Angeles Times noted a tremor in her hands that hadn’t been there before her detention.
“She’s gone through a lot of trauma, and she’s asked to take a break while she heals,” explained Jimenez.
She has since made progress. For Thanksgiving de Paz returned to the Home Depot parking lot where she had been detained. She gave plates of homemade turkey in pipián, a traditional Guatemalan dish, to the day laborers there.
This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.