TB is spreading in ICE detention centers. So what’s the agency’s responsibility?

Several Immigration and Customs Enforcement (ICE) detention facilities have reported issues with tuberculosis or TB. The deadly but treatable and preventable infectious disease has already killed at least one detainee.

Tuberculosis outbreaks

A 45-year-old Ethiopian man named Serawit Dejene died on Jan. 28 after contracting TB at a facility in Arizona. He’d been in ICE custody for roughly three months when he died.

One detainee in Alaska tested positive, something discovered by the detainee’s lawyer. That lawyer reportedly said his client missed two video appointments and then found he had TB by calling area hospitals.

Meanwhile, some detainees at a facility in Southern California also tested positive, and a lawsuit also showed detainees were exposed at a Denver holding facility. There are suspected cases at a center in Washington state.

“The Immigration and Customs Enforcement Agency is obligated to provide for the health care needs of anyone who is detained,” César Cuauhtémoc García Hernández, law professor at Ohio State University and Gregory Williams chair in civil rights and civil liberties, told Straight Arrow News. “These are obviously not people who can go and seek medical care on their own.”

ICE didn’t offer a response to a request for comment in time for publication. 

Dangers of tuberculosis

Tuberculosis is the world’s top infectious killer and kills 1 1/2 million people every year. The type of infection has been around since the days of ancient Egypt.

“TB has been around forever,” Dr. Joanne Flynn, distinguished professor and chair of microbiology and molecular genetics at the University of Pittsburgh School of Medicine, told Straight Arrow News. “I mean, since people were around, right? It’s a very old disease. It is a bacterial infection. It is spread through the air, by coughing, breathing, sneezing, singing, a lot of things.”

TB is preventable with a vaccine known as the Bacille Calmette-Guérin (BCG) vaccine. It’s given to infants in many countries, with around 100 million doses administered each year.

“It’s not a great vaccine,” Flynn said. “I would say that most people who die of TB were probably vaccinated, but they were vaccinated as a baby.”

The vaccine is rarely used in the U.S. for several reasons.  For example, America saw fewer than 11,000 cases in 2024.

“TB is a disease of poor people, to be honest,” Flynn said. “And so, as the socioeconomic status of a country goes up, the TB rates go down. And so here we never vaccinated, at least not regularly with BCG.”

Where America does try to fight TB is with treatment. There is medication to treat the disease, although that treatment can take months.

People with TB are also typically quarantined until they can get treatment. Without treatment, TB can take a terrible turn. “If they are not treated, it’s about a 50% fatality rate,” Flynn said. “So that’s a lot. But you can treat it, and it works.”

Responsibilities of ICE

The conditions inside immigration detention facilities are often a perfect place for a condition like TB to thrive.

“One of the major risk factors for developing [or] for being infected with mycobacterium tuberculosis is being close to somebody who’s infectious,” Flynn said. “So, jails, prisons, any shelters for people who are unhoused, situations where people are in very close contact, absolutely is a major, major risk factor.”

ICE has its own health unit called ICE Health Service Corps (IHSC).

“IHSC supports ICE’s mission to protect national security and public safety, upholds health care standards across ICE-owned and contracted facilities, and ensures the provision of required health care delivery for detained aliens,” Dr. Stewart D. Smith, IHSC assistant director, said about his agency.

However, Hernández said the agency and ICE itself do not have a lot of external oversight.

“I think that there’s a question about whether ICE is complying with its own detention standards,” Hernández said. “That in and of itself might give rise to a viable lawsuit. I wouldn’t hold my breath for that. Again, the standard is so low, courts have been very reluctant to exert much oversight.”

Washington state recently passed a law intended to boost oversight and improve conditions at the state’s only private prison facility. The company running that facility filed a lawsuit to prevent that law from taking effect.

“They are adamant that they do not want this kind of external oversight,” Hernández said. “And as a result, we’re mostly left to individual lawyers who are representing clients who are detained in these facilities to raise a red flag when they see that their clients are not getting the care that they need.”

When detainees do get sick or, in the case of Serawit Dejene, die in custody, there’s only a limited amount that can be done to hold anyone accountable. Family members can file lawsuits, but that’s a tough claim to prove in court.

“There are multiple layers of immunity that the agency can point to and that the individual medical providers themselves can also point to,” Hernández said. “And so that’s not typically a very fruitful avenue. Most of the time, the best that can come from a tragedy like a death is publicity that changes practices to try to make sure that this kind of thing doesn’t happen again.”

While TB isn’t much of an American issue, it’s not Americans who are ending up in these facilities. People from other countries could already be infected with no symptoms or issues.

“If somebody who is from another country and maybe is detained or jailed, the stress or whatever other chronic conditions they have could lead to this reactivation if they are latently infected,” Flynn said.