A new report from the ACLU and Physicians for Human Rights details ICE’s abuse and retaliation against people who initiate hunger strikes in immigration detention.

On President Biden’s 100th day in office, Nilson Barahona-Marriaga joined demonstrators who greeted the president at a rally in Atlanta. “End detention now!” they chanted. “Communities are afraid!”

A 39-year-old immigrant from Honduras, Nilson had been recently released from Immigration and Customs Enforcement’s (ICE) Irwin County Detention Center in Ocilla, Georgia. The Irwin detention center, which remains open despite the Biden administration’s promise to end its contract with the facility, had most recently gained attention due to multiple allegations of involuntary hysterectomies performed on women at the facility.

When Nilson was detained at Irwin last year, he learned through his lawyer that coronavirus was present at the facility. ICE officials had failed to alert or protect staff and detainees. Facility staff regularly failed to wear masks and ensure disinfection.

Out of desperation, Nilson participated in a hunger strike with other detainees. Their group made common-sense demands that ICE follow public health guidelines, provide them with masks and cleaning supplies, and release medically vulnerable people from detention. Instead, facility officials threw Nilson and his fellow hunger strikers in solitary confinement. ICE cut off the water in their cells, so they could not drink, wash, or flush the toilets. Officials also restricted Nilson’s communications with his lawyer and family. Only nine days later, when Nilson realized that a person detained in the room next to his had COVID-19, did he end his hunger strike.

In the last year, hundreds of detained immigrants like Nilson have participated in a growing number of hunger strikes nationwide, seeking protection from COVID-19. ICE officials and detention staff have met these hunger strikes—protected speech under the First Amendment–with extreme measures, including increased use of force such as pepper spray, physical force, and rubber bullets. Today, detained immigrants are currently on hunger strike for the same reason at a number of facilities, including the Northwest Detention Center in Tacoma, Washington, and Bergen County Jail in New Jersey. After several months of declines, ICE has again begun to increase the number of detained people in custody. COVID-19 cases in ICE detention are again on the rise.

Our new report, Behind Closed Doors: Abuse and Retaliation Against Hunger Strikers in U.S. Immigration Detention, by the ACLU and Physicians for Human Rights, reveals that the scope and scale of ICE’s cruelty in response to such hunger strikes is much broader than previously known. Based on an assessment of over 10,000 pages of previously disclosed documents, the report analyzes hundreds of hunger strikes in ICE detention from 2013 to 2017, as well as the testimony of recent hunger strikers. The report finds that abuse and retaliation against hunger strikers is commonplace and dates back to President Biden’s time as vice president. ICE has responded to hunger strikes with involuntary medical procedures, solitary confinement, retaliatory deportation and transfer, and use of force — responses which are in violation of constitutional protections, international human rights law, and medical ethics.

Our report also shines a light on the many forms of day-to-day psychological coercion ICE employs to try to break hunger strikes, including denying access to basic privileges, restricting water access, and threatening prosecution.

Rather than safeguarding their patients’ health, medical professionals played a disturbing role in these abuses. During an August 2016 hunger strike of 22 mothers at the Berks County family detention center in Pennsylvania a family detention, an ICE physician sought to downplay the situation. The ICE physician also proposed family separation and force-feeding as responses to the hunger strike, noting that “If it appears they really are on a hunger strike, we will need to separate the mother and children – send mom to an IHSC facility to address the hunger strike.”

Doctors and nurses employed or contracted by ICE also violated medical ethics by supporting government motions for invasive and involuntary medical procedures, including force-feeding, forced hydration, forced urinary catherization, involuntary blood draws, and use of restraints. Our report identifies at least 14 separate ICE medical declarations supporting government motions for such involuntary procedures, in violation of physician’s ethical obligations to preserve the autonomy of mentally competent individuals, as well as international human rights law.

Our report reveals the lengths to which ICE will go to punish and deter hunger strikers rather than engage with their legitimate demands. Changing the response to hunger strikes will require addressing their underlying cause: an abusive and dangerous civil immigration detention system.

President Biden – who oversaw these abuses when Vice President – should reverse course and end the U.S. reliance on a mass immigration detention system and invest in community-based social services as alternatives to detention. Health professionals should refuse to participate in violations of medical ethics in their provision of care to detained immigrants, and government lawyers should refrain from pursuing cases for force feeding and other involuntary medical procedures.