Nightmare on Peach Street: The Horrendous State of Georgia's Detention Centers
Located less than 10 miles outside the heart of Atlanta lies Clarkston, Georgia, a city celebrated for its ethnic diversity. Clarkston has been referred to as the “Ellis Island of the South,” and the “most diverse square mile in America.” It is a celebrated and welcoming reminder of progress. Yet, Clarkston lies in close proximity to some of the country’s most horrific immigration detention centers. Perhaps a reflection of the United States itself, the state of Georgia is home to a wide spectrum of beliefs, behaviors, and level of respect for human rights.
There exists a tension between Georgia's two histories: one of deeply rooted racism and oppressive policies and one of the civil rights movement forged by Dr. Martin Luther King Jr. that inspired change. The latter continues today by activists like John Lewis and Stacey Abrams. While “Black Lives Matter” and “Hate Has No Place Here” signs line the streets of metro Atlanta, the region serves as just one piece of a largely divided puzzle and is far from indicative of the attitudes of Georgians as a whole. It is within this complex landscape that we see the conditions of the Georgia detention centers intersecting not only with politics, but also economics, and, importantly, health care.
Follow the money and see where it goes...
Sprinkled throughout the state are six immigration detention facilities: Stewart Detention Center, North Georgia Detention Center (NGDC), Irwin County Detention Center, Folkston ICE Processing Center, Robert A. Deyton Detention Facility, and Atlanta City Detention Center (ACDC). By comparison, there are seven immigration detention centers in the entire state of California, which is not only more than 2.5 times larger than Georgia, but also shares a border with Mexico.
The Stewart, Irwin County, Folkston, Deyton, and North Georgia detention centers are run by private companies and remain fully operational today. Stewart Detention Center is the second largest male and trans-women detention center in the U.S. With 1,725 beds, it receives more transfers of individuals detained than almost any other facility and even some states. Called the “black hole of America's immigration system,” Stewart is located in Lumpkin, GA, a rural town located an hour outside of Atlanta with a population of 2,741, according to the 2010 census. By simple calculations, at full capacity, individuals detained at Stewart make up about 63% of Lumpkin’s population. Sadly, reporting after the 2010 census by Facing South found that immigrants were held in detention centers to be counted for the census before being deported out of the country. In 2012, Stewart County received 85 cents per inmate per day, which contributed to more than half of the county’s entire annual budget. Meanwhile, across the state, reporting in 2017 from the Atlanta Journal-Constitution showed that construction of the Folkston ICE Processing Center costs Georgian taxpayers $73.79 daily per bed, amounting to $116.7 million in expenses over the next five years. From a purely economic standpoint, the U.S. (already more than $23 trillion in debt) and, particularly, residents of Georgia cannot afford this expense. From a human rights perspective, we cannot afford to ignore these violations.
Health care, even if detained, is a human right
What the Georgia detention centers lack in fiscal responsibility, they make up for in immorality and indecency. A 2012 ACLU report on Georgia detention centers identifies a range of human rights violations at Stewart, Irwin, and ACDC, including, but not limited to, insufficient personal hygiene supplies, poor nutrition, and limited food options. In 2011, Stewart ran out of toothpaste and soap and had just three working showers for 58 individuals. The report is filled with accounts of sporadic and rushed mealtimes leaving many hungry and woefully malnutritioned. Meals at these facilities almost never contain any fruit and only rarely include green vegetables or protein. Many individuals detained lost large amounts of weight while in detention, including Grzegorz Kowalec, who lost an astonishing 68 pounds over the course of a year.
According to Freedom for Immigrants, the top complaint filed from individuals in immigration detention centers was medical neglect and abuse. In September 2011, the assistant warden at Stewart admitted that the medical unit had had no physician on staff since August 2011, and a follow up in December of that year revealed that one had still not been hired. In addition, the ACLU of Georgia was informed by ICE that Stewart had been without a physician since August 2009, a period of almost two and half years, which is significantly longer than the standard previously set by the private owner of the detention center, Corrections Corporation of America. Furthermore, individuals in ICE facilities reported that requests for medical care were severely delayed and, in some cases, ignored completely. Angela Kelley was detained at Irwin and resorted to a six-day hunger strike in order to see a nurse after filing multiple requests for over a month to see a medical professional. Even when medical staff are available, it is rare that they speak the language of the individual or have an interpreter present for the encounter.
On occasion, the medical neglect far exceeds limited access to medical care and constitutes medical abuse:
"I feel like I'm going crazy....When I get upset, they just give me more medicine. I can't tell them I'm really upset or they just put me in a helmet and handcuffs for a few days. That's torture! I don't see anybody. I don't really care about anything. I just want to get out and get into a program that will help me." - Ermis Calderone, former detainee at Stewart Detention Center
“The first six months I took the [HIV] medicine in Nigeria it didn’t work, but for the past three years with treatment my viral load was undetectable and my CD4 count was healthy. I spent one week here without medicine. In the second week, the lab drew blood and said my CD4 had dropped to 400 and my viral load was up. In the third week, the doctor asked questions about my medical history. In the fourth week, the lab did another blood test, but they didn’t answer anything I asked them, and I still had no medicine...A lot of people here are very sick and they still won’t take them to the hospital...I’m scared of what can happen to me...I’ve seen people die.” - Robert, former detainee at Atlanta City Detention Center.
This kind of abuse and neglect resulted in 178 reported deaths in immigration centers between 2003 and 2018, three of which occurred in Georgia detention centers in 2018 alone. In more recent times, two detainees have died of COVID-19 while in ICE custody in Georgia as of March 2020, with alarming reports of failure to comply with any meaningful COVID-19 mandates. In September 2020, a whistleblower reported involuntary hysterectomies of women detained in Irwin County Detention Center. The shocking report of alleged forced sterilization follows a long history of unsafe, irresponsible, and abusive health care. We are quantitatively able to measure the death toll at the detention centers; however, we must also remember the rates of human suffering and long-term mental and physical health outcomes that former detainees must live with are just as important. These individuals are not just statistics - they are our neighbors, our patients, and our peers.
It’s not all bad news! Well, maybe it is…
Even so-called “wins” within the Georgia immigration landscape present their own challenges. In 2018, the city of Atlanta broke its contract with ICE, and the last individual detained was removed from ACDC. In 2019, Atlanta Mayor Keisha Bottom, signed historic legislation to re-purpose the ACDC site located in the heart of Atlanta. The Equity Center will replace the former state-run immigration detention center with the mission of “advancing racial and economic equity, promoting restorative justice, and investing in the well-being of individuals, families, and communities.”
While the city taking a stand by removing its affiliation with a maligned ICE facility was a well-intentioned success (you can read more about human rights violations at ACDC in this Project South report), the word choice is important here: the individuals once at ACDC were removed, not released. Likely, they were removed to another detention center - one that is privately run, with potentially worse conditions, and farther from family, urban areas, and media hubs. Additionally, many detainees rely on nonprofits and organizations that can provide pro-bono resources to help them navigate the immigration landscape in Georgia. Unsurprisingly, the majority of these resources are located in and around metro Atlanta - far from the rural detention centers where they were likely moved it.
So what?
Although it is often medical neglect and abuse in the Georgia detention centers that remain at the forefront of our minds as healthcare providers, it is clear that the inhumane treatment does not stop at medical neglect. There is very little, if anything, about the centers that could be called “acceptable”, including the very fact that in this country we subject people to forced detention under the guise of preventing illegal immigration. The very nature of these facilities is criminal.
While some may argue that the state of Georgia’s detention centers is solely an issue for politicians or lawyers to combat and that we, as healthcare providers, should “stay in our lane,” the terrible conditions and consequent negative health outcomes faced by those in detention are a violation of medical rights and, thus, human rights. As medical students and physicians, we are advocates, and the human beings in these detention centers are our patients—this is our lane.
Nicole Lue is a second-year medical student at Emory University School of Medicine.