When Yazmin Juárez arrived at the South Texas Family Residential Center, in Dilley, Texas, in March, her 18-month-old daughter, Mariee, was a healthy toddler with plump cheeks who liked dancing and singing with her mother, and was blissfully unaware of her confinement. Yazmin, 20, had crossed the Rio Grande with her daughter in hopes of seeking asylum to escape the violence that had engulfed her home country of Guatemala.Yazmin and Mariee were apprehended on the U.S. side of the river by Customs and Border Protection. They were then transferred to Immigration and Customs Enforcement, or ICE, which sent them to the Dilley facility, the largest of three family detention centers for undocumented migrants in the country, with a capacity of 2,400.Haga clic para leer este artículo en españolOne week after arriving at Dilley, Mariee developed a cough, congestion, and a fever of over 104 degrees. During the next two weeks of her confinement, Yazmin felt powerless as her daughter got sicker, rebounded, and got sick again, battling a virus that started with a common cold.Six weeks after being released from the facility, relocated to New Jersey, and shuffled between three hospitals, Mariee was finally unhooked from a ventilator and died at Children's Hospital of Philadelphia. The cause of death, ultimately, was viral pneumonitis, according to hospital records.Mariee did not die in ICE confinement. One month into VICE News' investigation, false rumors about her death spread on social media, sparking outcry from immigration advocates who have long been concerned about conditions for children at Dilley. She died of a viral infection that can kill children anywhere, though doctors say that conditions at institutions like Dilley allow viruses to spread more easily and make it hard to recover.Yazmin is now pursuing legal action against ICE and also has concerns about her care after she left the facility. “I still don’t understand why this happened to me. After all I suffered, I only deserve happiness,” she said.Yazmin recently retained lawyers who now say that the Dilley facility “failed inexcusably” in caring for Yazmin and Mariee.
“Instead of offering safe harbor from the life-threatening violence they were fleeing, ICE detained Yazmin and her baby in a place with unsafe conditions, neglectful medical care, and inadequate supervision,” said R. Stanton Jones, a partner at Washington, D.C.-based Arnold & Porter law firm. “While there, Mariee contracted a respiratory infection that went woefully undertreated for nearly a month. After it became clear that Mariee was gravely ill, ICE simply discharged mother and daughter. Yazmin immediately sought medical care for her baby, but it was too late.”ICE declined to comment specifically on Mariee’s case but said the agency takes medical care seriously. “ICE is committed to ensuring the welfare of all those in the agency’s custody, including providing access to necessary and appropriate medical care. Comprehensive medical care is provided to all individuals in ICE custody,” a spokesperson said in an email.Five pediatricians who reviewed Mariee’s symptoms, vital signs, and doctor’s notes in ICE medical records from her time at Dilley, told VICE News that the course of treatment Mariee received was consistent with what they would do for a toddler presenting with those symptoms.But Mariee did ultimately die from an infection that was first detected at Dilley, which has a history of complaints of inadequate medical care for children. In July, two doctors contracted by the Department of Homeland Security released a review of care in facilities including Dilley over the last four years. The doctors found a host of problems and called the practice of family detention “an exploitation and an assault on the dignity and health of children and families.”
Crowded conditionsDoctors and health advocates have spent years arguing that the mass detention of children and families in prison-like facilities can cause stress, trauma, and health problems. Pediatricians who spoke to VICE News said these conditions can hurt a child’s ability to recover from a respiratory infection."Respiratory diseases, they flourish in the setting of crowding," said Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston. "Now you're adding this terrible level of psycho-social stress on kids, that could also impair their immune system, making them more susceptible to viruses and bacteria.”These facilities have become even more controversial in the wake of the Trump administration’s zero tolerance immigration policy that caused mass family separation earlier this year, and they are currently the only option for detaining adults who cross the border illegally with their children. The administration is planning to expand its capacity to hold migrant families by constructing more facilities like Dilley. In June, ICE requested space to hold 15,000 more people in family detention, cementing the policy into the future.VICE News was able to reconstruct the last two months of Mariee’s life through interviews and a review of medical records, with permission from Yazmin. Doctors say the virus Mariee contracted might have killed her even if she had initially received full hospital care rather than her treatment at Dilley.
"It's reasonable care," said Dr. Ewen Wang, associate director of pediatric emergency medicine at Stanford University Medical Center. “It didn't sound like she was in the best of health, but not something you anticipate dying from.”One doctor said he might have sent Mariee to a hospital for lab work, but the results likely wouldn’t have changed the outcome. All five doctors said that Mariee's recommended course of treatment would have been the same had she not been in ICE custody.Still, medical experts and advocates have long stressed that conditions in ICE facilities can be risky for sick children. Detention puts children at higher risk of contracting disease, and crowded, stressful conditions make it harder to recover.“Those stresses are real; they affect the child's abilities to fight an infection and illness and win,” said Brian Blaisch, a pediatrician in Oakland, California, who has experience working in immigrant detention centers.
“It didn't sound like she was in the best of health, but not something you anticipate dying from”
Arriving at DilleyYazmin was clutching copies of Mariee’s vaccination records when they were picked up by U.S. Border Patrol agents on the U.S. side of the Rio Grande on March 1. Agents took away their belongings. “They gave us a bag to put our stuff in, and we couldn't touch it anymore,” she said. “They put us in the cages in a very cold room, and the only thing they gave us was a gray blanket like the ones used to wrap a gift.”Timeline March 1
Yazmin and Mariee cross the Rio Grande into Texas, and are detained by U.S. Customs and Border Protection.
Yazmin and Mariee arrive at the South Texas Family Residential Center, in Dilley. Mariee passes medical exams.
Mariee shows first signs of contracting a cold.
Mariee is very sick with a 104-degree fever, cough, congestion, diarrhea, vomiting.After three days, they were moved into a cell at Dilley with six beds for six mothers and their children, including at least one other child who got sick while they were there. Yazmin and Mariee’s schedule was highly restricted. They could only go to the cafeteria during certain hours, and they often had to wait for most of the day to be seen by medical staff.Dilley was built by the Obama administration in 2014 and is operated by private prison giant CoreCivic (formerly Corrections Corporation of America) under a $1 billion contract. Dilley is the largest of three immigrant family detention centers in the U.S.After public outcry following the Obama administration’s ramp-up of family detention, the American Academy of Pediatrics sent a letter to DHS urging the agency to stop detaining families in facilities like Dilley: “Continued detainment of any children and mothers in the existing facilities puts them at greater risk for physical and mental health problems and unnecessarily exposes children and mothers to additional psychological trauma.”DHS conducted a review of conditions at family facilities in 2016 following more controversy and found that ICE standards didn’t properly address the immediate needs of sick children. “Parents and children should not have to wait 24 hours for treatment and should not have to wait for their healthcare needs to become urgent to receive quicker attention and treatment,” the report found.In a July review, two doctors and experts in detainee healthcare, Scott Allen and Pamela McPherson, who were contracted by DHS to conduct 10 investigations of ICE’s family detention centers over the past four years, documented unsafe conditions for children.
At Dilley, Allen and McPherson found detainees seeking medical care were held together in a gym because the facility lacked sufficient medical space. They also said Dilley had trouble keeping pediatricians on staff, did not hire a child psychiatrist, and sometimes placed toddlers and their parents in medical isolation for days as punishment for normal toddler misbehavior. On one occasion, a nurse mistakenly gave multiple children at Dilley adult doses of a vaccine, they found.“The placement of innocent children in confinement because of the action of a parent is unjust and places children in harm's way to advance a message of deterrence,” Allen and McPherson wrote.Mothers detained at Dilley over the past few years report similarly concerning conditions. Many, like Yazmin, said it wasn’t unusual to wait an entire day or even two days to see the medical staff. Yazmin said that in order to see a medical professional, she waited for hours in an over–air-conditioned room with 200 other patients.In one case, a mother said she waited several hours to be seen when her 4-year-old daughter had constant vomiting, diarrhea, and a fever, according to a sworn affidavit taken by her lawyer and reviewed by VICE News. She said the staff gave her daughter Vicks Vaporub, ibuprofen, and an allergy medication, but her symptoms continued and she lost 20 percent of her weight.“My daughter tells me she feels very weak; she does not want to get up in the morning, and she does not want to play,” she said in the affidavit. “She never had any of these symptoms or demonstrated any of these behaviors before coming here.”
“Those stresses are real, they affect the child's abilities to fight an infection and illness and win”
Katy Murdza, advocacy coordinator at the Dilley Pro Bono Project, said even healthy kids regress in detention to wet the bed, misbehave, and turn into people their parents don’t recognize. Murdza said she hears medical concerns from parents about their children constantly. She estimates that once a day she flags a medical case to ICE, and about once a week recommends that ICE release a detainee to get medical help elsewhere.While CoreCivic operates Dilley, the company told VICE News it does not provide any of the medical or mental healthcare staff or service, which are provided by ICE’s Health Service Corps. “We have deep sympathy for the family for their tragic loss,” the company said. CoreCivic staff “do not make medical or mental health treatment determinations and are trained to refer all detainee health or medical concerns, whether routine or acute, to facility medical staff for evaluation, triage and treatment.”
“My daughter tells me she feels very weak; she does not want to get up in the morning, and she does not want to play”
Mariee gets sickerWhen she arrived at Dilley, Mariee was given a full medical screening by a registered nurse who listened to her lungs and heart, inspected her skin and abdomen, checked her vitals, and tested her for TB. The nurse determined that she was healthy and cleared her to stay at Dilley.Timeline March 14
Yazmin has her credible fear interview with an immigration officer.
Mariee’s condition improves.
Yazmin passes credible fear interview. Mariee’s condition worsens. She has fever, cough, and congestion. Doctor hears wheezing in her lungs.Yazmin was pleasantly surprised that school and other activities for the kids were available at the facility. She befriended two other mothers from Guatemala, and Mariee played with the other kids the way she used to at a plaza by their house in Guatemala, Yazmin said. As they posed for their identification card photo, Yazmin smiled, wrapping her arms around Mariee. She had tied up Mariee’s hair in a bun style matching her own.But six days after arriving, Mariee wasn’t playing anymore, and was clearly coming down with a cold. A physician assistant prescribed Tylenol and honey to soothe the cough, but the next day Mariee was worse, with a temperature of 104.2 degrees, a cough, diarrhea, and a rapid heart rate, according to medical records obtained by VICE News. A physician’s assistant diagnosed her with bronchiolitis and an ear infection, and gave her the antibiotic Augmentin, Tylenol, and Pedialyte.On March 14, Yazmin had her credible fear interview with an asylum officer, the first hurdle in order to move forward in the asylum process. If a family passes, they’re allowed to leave detention and wait for their next immigration hearing in the U.S. If a family fails, they’re likely sent back to their home country.Rather than leave Mariee in daycare with other sick kids, she held her in her arms while she told her story of the violence in Guatemala that had motivated her to seek refuge in the United States. Mariee was visibly sick at this point, and Yazmin said the officer asked what was wrong with her. Yazmin burst into tears, explaining that she wasn’t able to get Mariee the medical attention she thought she needed.Growing desperate, Yazmin called her mother in New Jersey, who wired her money to buy tea and lemon at the commissary for Mariee. “I was desperate because of my daughter,” Yazmin said. “I would cry to my mother like crazy."
The day after the interview, Yazmin made her third visit to medical staff to seek treatment for Mariee. She’d lost two pounds since they arrived at Dilley and was still coughing and had a runny nose. A physician assistant continued her course of treatment with Pedialyte, Augmentin, Tylenol, and a probiotic.The following week, Mariee’s condition improved. At a mental health appointment, a social worker wrote in an evaluation, “Mother notes that daughter has felt much better after being sick last week and is happy.” Notes from that appointment say Mariee was “over her cold.”More good news came two days later, when Yazmin learned she had passed her credible fear interview and would be released from Dilley. She was relieved that she would soon be able to take Mariee to see a doctor outside the facility.That afternoon, however, Yazmin told the Dilley medical staff Mariee wasn’t able to finish the Augmentin because she couldn’t keep it down. Mariee had gained some of the weight back, but her fever had spiked again to 103.3, and the medical staff heard her lungs make a wheezing sound. A pediatrician at the facility prescribed ibuprofen, Vicks Vaporub and Zyrtec, an allergy medication. None of it seemed to work.At that point, Yazmin was thinking about all options to get care for Mariee. She begged supervisors at Dilley to send her and Mariee back to Guatemala, where despite the danger at least she knew she could take her to a hospital.Following advice from her detention roommates, Yazmin said, she snuck salt from the cafeteria to rub on Mariee’s belly. As she left the cafeteria, she curled her wrists into 90-degree angles to keep the packets in her sleeves from falling to the ground. Two days later, Yazmin took Mariee back to the medical area because she was still not better. The registered nurse’s notes say “a referral would be made for her to see a provider.”
“I was desperate because of my daughter”
Yazmin and Mariee are releasedAfter passing her credible fear interview, Yazmin knew she would have the chance to get Mariee to a hospital. She just hoped it wouldn’t be too late. On March 25, the day they were released, a licensed vocational nurse cleared Mariee as healthy enough to travel, but there is no record that anyone took Mariee’s vital signs that day.Timeline March 25
ICE clears Yazmin and Mariee for release, and they fly to Newark, New Jersey.
Yazmin takes Mariee to local pediatrician, who prescribes a nebulizer and instructs her to take Mariee into the E.R. if her condition worsens. Later that day, Mariee is admitted to JFK Medical Center.
Mariee is transferred to the ICU.Yazmin and Mariee boarded a plane to New Jersey, where they looked forward to joining Yazmin’s mother and brothers, who would all be meeting Mariee for the first time, Yazmin felt a sense of relief, even though it was her first time flying. Now that she had complete control over Mariee’s care, she believed her daughter would recover.The next day, Yazmin and her mother immediately took Mariee to a local pediatrician, who gave Mariee an antibiotic to fight any bacterial infection, another to fight inflammation, and albuterol nebulizer treatment to calm her breathing. She told Yazmin to take her to the ER if her breathing got worse.Within a few hours, Yazmin said, Mariee was having trouble breathing again. She took Mariee to the ER at John F. Kennedy Medical Center in Edison, New Jersey. Two days later, doctors there diagnosed her with pneumonia and transferred her to the ICU. “I would tell her, ‘I know you’ll get better; you’ve always been a strong girl, a brave girl, and I know you’ll get better,’” Yazmin said.Doctors put Mariee in a medically induced coma and gave her a breathing tube. She would spend the last few weeks of her life at hospitals in New Jersey and Philadelphia.“She couldn’t wake up,” Yazmin said. “I couldn’t touch her, because I could damage her with the tubes she had. She had, like, 20 little bags injected into her. She was in really bad shape.”
After three weeks in intensive care, doctors told Yazmin that Mariee’s only chance of survival was a special life support machine called ECMO at Children’s Hospital of Philadelphia. She had to sign off on a helicopter transfer for Mariee and her breathing equipment — there wasn’t room for Yazmin in the helicopter.On the morning of May 10, Yazmin was in Mariee’s room, scrolling through the Bible on her phone and writing her favorite verses on a yellow hospital legal pad. A chaplain visited and prayed with her, then she shared photos of Mariee, and told the chaplain how she loved to dance and was starting to learn the songs Yazmin would sing to her.Yazmin remembers hearing one machine start to make a noise, and then more and more noise. She asked the doctors what was going on, and they said not to worry, but she could see Mariee getting swollen. Later she learned Mariee was suffering from internal bleeding.By 7 a.m., the doctors had resuscitated Mariee several times. Yazmin watched Mariee’s skin turn from purple to black. The doctors told Yazmin that Mariee would not survive, and asked if they could take her off the ventilator.Timeline March 30
“She had, like, 20 little bags injected into her. She was in really bad shape”
JFK Medical Center transfers Mariee to Jersey Shore University Medical Center.
Mariee is sedated and intubated with breathing tube.
Mariee is transferred by helicopter to Children’s Hospital of Philadelphia.
Mariee put on ECMO breathing machine.
Mariee dies from viral pneumonitis.“It was the most difficult decision of my life,” Yazmin said. Mariee died at 9:26 a.m.JFK Medical Center, Jersey Shore Medical Center, and Children’s Hospital of Philadelphia declined to comment on Mariee, citing patient confidentiality.Yazmin decided to send Mariee’s body to Guatemala — alone — to be buried with her relatives.“I had the illusion of making a new life with her, because my life in Guatemala was unbearable,” she said. “I wanted to live happily with her, to go to the park with her and to work hard for her. She was everything to me, but unfortunately that didn’t happen.”Now, Yazmin is going to school and working at a restaurant in New Jersey, and lives in a house with her mother and three brothers. Yazmin’s room is full of pictures of Mariee. On the floor is a big box of medical bills, some addressed to Mariee. She wonders how she’ll deal with the more than $2 million in medical fees she now owes from Mariee’s care after she left ICE facilities. Her asylum case is still pending, and Texas child welfare officials are investigating Mariee’s death.“I don’t know if they’ll send me back,” Yazmin said. “Being here will help me to excel myself and to continue my studies to have a decent life. I do it for my daughter because that’s what I wanted for her.”Photos: Family photos of Mariee and Yazmin in Guatemala, courtesy of Yazmin Juárez.Cover illustration: Leslie Xia