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Protecting Asylum-Seekers: Calling Attention to the Consequences of Electronic Ankle Monitoring

By Marie T. Mazzeo

Every day, refugees, asylum-seekers, and migrants leave the only homes they have ever known in search of a better life. These individuals face trauma at each stage of the migration process, and these experiences are associated with poor mental health outcomes, including PTSD, anxiety, and depression [1-2].Over the past few decades, there has been a tremendous shift in this country’s immigration policies and practices, leading experts to describe the past 25 years as “an unprecedented era of mass detention and deportation of immigrants” [3]. Detention, or holding an individual in custody, is a significant source of immigration-related trauma, and advocates have long demanded the closure of physical detention centers [1-3].

In 2004, U.S. Immigration and Customs Enforcement (ICE) began the Alternatives to Detention (ATD) program, which includes the Intensive Supervision Assistance Program (ISAP), to allow noncitizens to remain in their communities through the use of surveillance technology, including GPS-enabled electronic ankle monitors [4]. According to the Transactional Records Access Clearinghouse (TRAC) at Syracuse University, ICE’s ATD data reporting has had multiple significant errors [5]. TRAC uses the Freedom of Information Act to request ICE anonymized records and publishes publicly-available reports and online tools [6]. As of April 8th, 2023, there are 5,194 individuals in ATD with electronic ankle monitors; the average duration is 469 days [6]. Despite its intention, advocates argue that electronic monitoring through ATD is not an alternative but another form of incarceration deemed “E-Carceration” [3,7-8]. Many have called for discontinuing electronic ankle “shackles” due to these devices’ physical and psychological effects, a lack of supporting evidence for their efficacy or utility, a lack of consistency in the rules, regulations, and legal framework, and the associated costs [3,7-8].

Based on recent evidence, the expanded use of electronic ankle monitors does not appear to be a humane alternative to incarceration, and the effects of these devices require further investigation. In 2021, the Kathryn O. Greenberg Immigration Justice Clinic of Cardozo Law, Freedom for Immigrants, and Immigrant Defense Project published the first empirical study regarding electronic ankle monitors, entitled Immigration Cyber Prisons: Ending the Use of Electronic Ankle Shackles. This collaborative report called attention to the physical, psychological, financial, and social consequences that immigrants experience from ICE’s growing use of electronic ankle monitoring [3]. The report’s findings – based on a survey of 150 immigrants subjected to these devices and aggregated data from over 950 legal cases – demonstrate that electronic ankle monitoring threatens health and well-being [3]. 90% of survey participants reported that the monitors impacted their physical health; harms included: aches, pains, and cramps (74%), excessive heat (57%); numbness (55%), inflammation (45%), scarring (38%), cuts and bleeding (27%), and electrical shocks (22%) [3]. Additionally, 88% of survey participants reported that the monitors impacted their mental health; harms included: anxiety (80%), sleeplessness (73%), depression (71%), social isolation (61%), and suicidal thoughts (12%); 97% of participants reported social isolation [3]. Of note, immigrants who identified as Black were disproportionately subjected to ankle monitors [3].

The Cardozo report provides evidence demonstrating the detrimental effects of E-Carceration; however, these physical and mental health consequences should hardly come as a surprise, as immigrant detainees, legal professionals, and advocates have described them anecdotally for years. In 2017, the Washington Post published an exposé that called these devices’ use, and safety, into question. This article shared the experience of Leyli Martinez-Perez, a 25-year-old from El Salvador who burned her hand when the charger for her GPS monitor burst into flames – the company claimed that this incident resulted from faulty wiring, not the device [9]. It also described the experience of Jesus Escobar-Villalta, a 22-year-old from Honduras; doctors had to remove the device after the irritation resulted in an ankle blister and subsequent infection – one-week post-discharge, the company returned to put the device on his other ankle [9]. Further documentation of the harms and disadvantages of ankle monitors, including pain, immobility, stigma, and trauma, are detailed in Released into Shackles: The Rise of Immigrant E-Carceration, a report published in the California Law Review; this report argues against the use of ankle monitoring as an alternative to detention [8].

Although legal professionals and immigration advocates have documented the significant physical and psychological effects of electronic ankle monitoring without ambiguity, the medical community has thus far largely neglected to document these effects and adequately advocate for these individuals' well-being. While a legal and media review generates much information regarding this topic, a review of the medical literature yields two recent case reports. The first describes the only documented case of malleolar bursitis in a patient with an electronic ankle monitor [10]. The second describes how an ankle monitor complicated the care of an unstable gynecological patient with profuse vaginal bleeding [11]. This report also describes the necessity for formal protections related to the removal of these devices in medical emergencies and for guidance, education, and training for the removal of these devices in non-urgent cases [11].

These reports and accounts raise many questions that require investigation by the medical community: Are the ‘electric shocks,’ described in the Cardozo report, extrinsically caused by malfunctioning devices or a manifestation of nerve dysfunction? How do self-reported mental health effects compare to clinically validated measurements? What are the long-term psychological and physical impacts of these devices? What injury patterns are typical of these devices? Which pre-existing conditions, if any, should be considered contraindications to these devices?

The silence within the medical community regarding this issue is detrimental to public health. The absence of medical documentation allows the manufacturers and distributors of electronic ankle monitors to claim that these devices cause no harm. The physical and psychological trauma from these devices decreases the quality of life of individuals forced to wear them, and the blanket denial of any harm caused by these monitors is inaccurate. To help address this significant threat to a vulnerable population’s health and human rights, we must elicit and document the physical and psychological toll of E-Carceration.

Marie Mazzeo is an MS4 at NYU Grossman School of Medicine, Silverstein Scholar, and Gold Humanism Honor Society Member. She is also a graduate of Macaulay Honors College at Hunter College, where she earned a Certificate in Public Policy. Marie plans to pursue her passions for service, medical education, and advancing health equity through a career in PM&R.


  1. Cleary SD, Snead R, Dietz-Chavez D, Rivera I, Edberg MC. Immigrant Trauma and Mental Health Outcomes Among Latino Youth. J Immigr Minor Health. 2018;20(5):1053-1059. doi:10.1007/s10903-017-0673-6

  2. Sangalang, C. C., Becerra, D., Mitchell, F. M., Lechuga-Peña, S., Lopez, K., & Kim, I. (2019). Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States. Journal of immigrant and minority health, 21(5), 909–919.

  3. Giustini, Tosca; Greisman, Sarah; Markowitz, Peter L.; Rosen, Ariel; Ross, Zachary; Whitfield, Alisa; Fialho, Christina; Castle, Brittany; and Kang, Leila, "Immigration Cyber Prisons: Ending the Use of Electronic Ankle Shackles" (2021). Online Publications.

  4. U.S. Immigration and Customs Enforcement, Intensive Supervision Appearance Program: Fiscal Year 2020 Report to Congress 1–12 (n.d.).

  5. Syracuse University. (2022, September 20). ICE’s Sloppy Public Data Releases Undermine Congress’s Transparency Mandate. TRAC Immigration. Retrieved April 17, 2023, from

  6. The Transactional Records Access Clearinghouse. (n.d.). (rep.). TRAC Immigration: Alternatives to Detention (ATD). Retrieved April 17, 2023, from

  7. Kilgore, J., Sanders, E., & Hayes, M. (n.d.). No More Shackles Why We Must End the Use of Electronic Monitors for People on Parole. The Center for Media Justice and The Urbana-Champaign Independent Media Center.

  8. Pittman, J. (2020). Released into Shackles: The Rise of Immigrant E-Carceration. California Law Review, 108(2), 587–618.

  9. Miller, M., 2017. This company is making millions from America’s broken immigration system. Washington Post, [online] Available at: <> [Accessed 17 April 2023].

  10. Besinger, B., & Ryckman, S. (2021). Septic Malleolar Bursitis in a Patient with an Ankle Electronic Monitoring Device: A Case Report. Clinical practice and cases in emergency medicine, 5(1), 97–100.

  11. Pancheshnikov, A., Boddu, R., Rubenstein, L. S., & Cuneo, C. N. (2022). Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement's Alternatives to Detention programme in the healthcare setting. BMJ case reports, 15(6), e246515.


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