This story is republished with permission of The Intercept. View the original version here.
Warning: This article contains graphic accounts of force-feeding.
Ajay Kumar set out from India in June 2018, eventually ending up at the U.S. border in California, where he declared his intention to seek political asylum. He was then taken into the custody of U.S. Immigration and Customs Enforcement, expecting to be released as he awaited his hearings. Instead, he languished in detention for nearly a year.
So he began a protest. In July 2019, along with three other Indian asylum-seekers, Kumar undertook a hunger strike, demanding release from ICE detention. The agency responded by transferring him to the El Paso Service Processing Center in Texas, an ICE jail operated by the firm Global Precision Systems.
With Kumar more than a month into the hunger strike, the government, using Justice Department lawyers, sought a judge’s order to force-feed him and the other three men. With the judge’s approval, contractors working at the detention center on ICE’s behalf began the process of making Kumar eat involuntarily in August 2019, 37 days since his last meal. The process was captured on video.
“I asked them to give me my freedom. If they had granted it at that time, there would have been no need for all of this,” Kumar said. “This is not humanity. This is totally against humanity.”
Historically, the federal government’s force-feeding procedures have been mired in secrecy, with even the court orders to carry it out frequently issued under seal. Video, court records and medical records reviewed by The Intercept in the case of the El Paso detention center provide a firsthand look at how the procedure is approved and executed — including the first publicly released video of force-feeding done under the auspices of the federal government. National and international medical organizations consider force-feeding hunger strikers a transgression of medical ethics; the process has been criticized as torture by international human rights organizations.
The video, nearly one hour long, shows five detention guards in riot gear, employed by Global Precision Systems, introduce themselves to the camera in preparation for their “calculated use of force” on Kumar. The guards enter the facility infirmary, where medical personnel explain the procedure to the asylum-seeker through a translator and begin their attempts to insert a nasogastric tube. Medical officials failed to correctly insert the tube two times before successfully beginning the force-feeding.
According to ICE’s Performance-Based National Detention Standards, whenever there is a “calculated use of force,” staff are required to use a handheld camera to record the incident. The Intercept, with Kumar’s consent, requested the video through the Freedom of Information Act. After ICE refused to turn over the footage, The Intercept filed a lawsuit and ICE subsequently agreed to turn over the footage, but the agency redacted the faces and names of everyone who appears in it, aside from Kumar. (ICE declined to comment for this story and Global Precision Systems did not respond to a request for comment.)
Kumar watched the video for the first time with The Intercept, which also showed the footage to four experts from universities and advocacy organizations that work on medicine and immigration detention.
“The process of watching this hourlong video was excruciating, knowing what Ajay was going through,” said Joanna Naples-Mitchell, research adviser for the U.S. at Physicians for Human Rights. “That was, perhaps, the most chilling thing about it: this kind of quiet, pernicious nature of the violence that was present throughout this video — and having these officers standing around him, and just this tremendous power imbalance and asymmetry between him and them.”
“You will be force-fed”
Kumar fled from India after receiving threats related to his political activism. The threats were very real: Later, as Kumar was in ICE detention, his father was killed in India, his immigration attorney said in court. From India, Kumar took a plane to Ethiopia and then another flight to Brazil and traveled north by car, bus, and foot, before ending up at the California border, according to records from an interview he gave to the U.S. border guards. After making his intention to declare asylum known, Kumar was placed in ICE custody and taken to the Otero County Processing Center in New Mexico — another privately run facility, in this case operated by Management and Training Corporation. (Management and Training Corporation did not provide a comment for this story.)
Asylum-seekers, when placed in ICE custody, are fighting civil immigration cases. Their legal right to request asylum, however, does not preclude detention. They are frequently placed in immigration detention centers. They sometimes stay under lock and key until their cases conclude, but in other instances they can argue for release to pursue their claim from the outside. Despite being placed in detention facilities while awaiting civil — not criminal — cases, conditions for asylum-seekers are identical to jails and prisons.
For Kumar, days passed, then weeks, without any indication of when he would be released from detention. The conditions and treatment, he said, were abysmal. It was “the worst experience I had over there, the worst,” he told The Intercept. “I did not expect that these people would treat us like this.” Kumar said he would speak up for himself and others. The complaints Kumar said he lodged included a request for the staff to respect Hindi detainees’ religious observations, including a request that their food not be cross-contaminated with beef, which is prohibited in the Hindu religion. In response, he said, Otero correctional staff would send him to solitary confinement. (In some cases, records indicate he was segregated for “insolence.” In one case, the documents say the segregation order was related to claims of a hunger strike.)
Advocates for migrants have lodged a raft of complaints against the Otero County Processing Center, including over its use of solitary confinement. In 2021, Advocate Visitors with Immigrants in Detention, or AVID, and Innovation Law Lab, released a report co-written by Nathan Craig, a professor at New Mexico State University who has worked on Kumar’s case, that drew on more than 200 complaints of alleged abuse at the facility. They included claims of unsanitary conditions, inadequate medical care, harassment by staff and prolonged use of solitary confinement. Recently, the Department of Homeland Security’s Office for Civil Rights and Civil Liberties wrote a recommendations memo to ICE highlighting concerns and best practices to be improved in terms of detainee treatment.
“The private contractors’ aim is to cut costs and try to extract profit out of this situation. These lead to dangerously bad conditions,” Craig said. “There’s poor sanitation, poor medical care. The conditions are very unpleasant, partly by design, partly by the extraction of profit."
Even as he fought for better conditions, Kumar requested to be released on bond. ICE, though, kept him confined. He decided something drastic needed to be done: After nearly a year in ICE detention, Kumar ate his last meal on July 8, 2019, and began his hunger strike.
“For the first few days my body was demanding food all the time, all the time. But after 10 to 12 days, my hunger stopped permanently,” Kumar said. “And as the days passed, the weakness increased gradually.”
Other men in the facility also began hunger strikes. Kumar said they were all threatened with force-feeding: “The guards who were there before the transfer were threatening me: ‘Now you will go to El Paso and tubes will be inserted inside you. You will be force-fed.’”
A force-feeding hub
The El Paso Service Processing Center is a hub of federal government force-feeding. Kumar was far from the first detainee to be force-fed there. A report from the American Civil Liberties Union and Physicians for Human Rights shows that as early as 2016, there was a court order for a forced hydration in the facility.
Additional ICE records reviewed by The Intercept show that, in 2018, there were a total of 25 hunger strikes, six of which were met by “involuntary administration of fluids.” One ICE detainee was flown from New Jersey to El Paso to be force-fed in November 2018. In early 2019, the Associated Press reported that nine men were simultaneously being force-fed at the facility. That year there were 40 hunger strikes in the facility, according to an ICE facility report, with Kumar’s case brining the reported total to 13 known force-feedings.
The practice of force-feeding incarcerated hunger strikers is widespread in federal facilities, spanning Democratic and Republican administrations alike. While the Pentagon’s force-feedings of Guantánamo Bay detainees by the Department of Defense made global headlines in 2013, other government agencies — both at the federal and state levels — also engage in the practice, albeit with less fanfare.
As in Kumar’s case, the Department of Homeland Security force-feeds detainees at several immigration jails. The Justice Department’s Bureau of Prisons has also conducted force-feedings, which typically require an order by a judge. Though contractors running and working at detention facilities do not typically initiate the court proceedings that result in judicial orders for force-feedings — in Kumar’s case, the government was itself the sole petitioner — contractors do, as in Kumar’s case, sometimes carry out the procedure.
Though advocates, journalists and lawyers have continually fought to get videos of federal force-feedings, none had been made public. In 2014, a judge ordered the release of the Guantánamo Bay videos, but after the Obama administration appealed, a panel of three federal judges overturned the previous ruling.
What is likely the first video of a force-feeding being carried out by authorities was published in 2016 by Wisconsin Watch, a nonprofit investigative news organization. The state government in Wisconsin carried out the procedure: The video shows a person incarcerated at Waupun Correctional Institution, a state prison, being force-fed by Department of Corrections staff. The man, Cesar DeLeon, was on hunger strike to protest prolonged solitary confinement.
The practice has been condemned by medical experts and ethicists. The American Medical Association says force-feeding violates the “core ethical values of the medical profession.” The World Medical Association and the International Committee of the Red Cross have also condemned the practice. And, before Kumar ever arrived in El Paso, the United Nations said that ICE’s force-feeding of previous detainees could be violating the U.N. Convention Against Torture.
“If someone has capacity — they’re legally competent to make their own medical decisions — you cannot force-feed them,” said Dr. Matt Wynia, director of the Center for Bioethics and Humanities at the University of Colorado and the former head of the American Medical Association’s Institute for Ethics. “It’s a law enforcement intervention, and doctors do not have a place to use their skills and knowledge to be agents of the state for purposes of law enforcement, or for purposes of maintaining control of the prison population, or to try and break the hunger strike.”
Last year, the ACLU and Physicians for Human Rights released a report about hunger strikers and ICE’s response in immigration detention. The authors, Eunice Cho of the ACLU and Naples-Mitchell of Physicians for Human Rights, relied on over 10,000 pages of documents, studying the cases of nearly 1,400 people.
“Although some detained people, on occasion, are able to bring outside attention to their hunger strikes,” the report reads, “very little is known of ICE’s systemic response to hunger striking detainees.”
The report found that ICE began seeking and executing judicial orders for involuntary medical procedures since 2012, including a previously unknown force-feeding case from 2016 under the Obama administration. It also found that in many cases, ICE failed to consider alternatives to force-feeding, including addressing the conditions the hunger strikes were protesting. In multiple cases, the report found, documents and internal emails revealed ICE officials attempted to hide or manipulate information about in-custody hunger strikes in order to avoid public pressure.
Warning: The video below contains graphic footage of a force-feeding.
“We have to remember how coercive and how abusive the detention system actually is in the first place,” said Cho, a senior staff attorney at the ACLU National Prison Project. “In the context of that, it may be that people have tried to do everything else possible, but it sometimes becomes an option of last resort because there is simply nothing else to do in terms of controlling one’s own bodily autonomy.”
Force-feedings have taken place at other jails, not just the El Paso facility. In 2020, immigrants detained at twoseparate Louisiana detention centers were subjected to force-feeding. Just this year, in February, ICE force-fed a Yemeni man detained in Arizona. That process went so badly that “one of the guards in the room thought the man was having a stroke,” according to a report from the Daily Beast.
“This is a practice that has clearly been accepted by multiple administrations, regardless of political party,” said Naples-Mitchell from Physicians for Human Rights. “It’s routinized within ICE policies and practices. And even though it’s clearly accepted, there’s also this veil of secrecy around how often it’s being used.”
A legal fight
About a week after he had started the hunger strike, the transfer order that guards had threatened him with was issued; Kumar was taken to the El Paso Service Processing Center. Government lawyers then sought a court order from a federal district judge for ICE to force-feed him. Kumar had lost just over 20 pounds during the hunger strike, dropping from 139 pounds to 118.
After the federal judge’s order came, a social worker concluded Kumar was “fully competent” to make decisions over his own medical care, according to court records reviewed by The Intercept.
On August 14 at 3:45 p.m., the U.S. government began the process of force-feeding Kumar. The video obtained by The Intercept shows the infirmary, where the three other hunger strikers are seen in the beds, also with their faces blurred, watching Kumar be force-fed.
“If they wanted, they could have taken me to another room,” Kumar said. He alleged that officials force-fed him in front of the others to encourage them to break their own strikes after watching him undergo the procedure. (A news report suggests that one of those three men was taken to the hospital the following day and diagnosed with ileus, a lack of muscle contractions of the intestines that can lead to a life-threatening blockage. That man was later returned to ICE custody and force-fed.)
“Our responsibilities are to pin the detainee, control the head, and if a weapon is produced, secure the weapon,” says one of the correctional officers dressed in riot gear, whose face was blurred in ICE’s video.
As correctional officers began to tighten the restraints on Kumar, someone behind the camera instructs the lead security officer to remove the restraints and use their hands.
“He was obviously so weak and so thin,” said Dr. Parveen Parmar, an associate professor of clinical emergency medicine at the University of Southern California, who reviewed the video. In 2019, Parmar filed an affidavit after reviewing hundreds of Kumar’s medical records during the court process to force-feed him. “As a physician, it was really viscerally hard to watch the use of force,” she told The Intercept. “I can clearly state it was medically unnecessary.”
Michelle Iglesias, a doctor with whom ICE contracts, oversaw Kumar’s force-feeding to verify the tube’s placement, according to medical records and court testimony reviewed by The Intercept. When Kumar’s attorneys attempted to stop the procedure from continuing, Iglesias defended the practice in federal court, though the doctor did concede that that force-feeding violates medical standards “in the private world.” The doctor suggested that “because this is a detainee in custody,” there is “a different policy.” (Iglesias declined to comment.)
Experts that spoke with The Intercept rejected Iglesias’s argument. “In medicine, we fight against that pretty regularly, for, I think, obvious reasons,” said Wynia, the former American Medical Association ethicist. “In our history, we have seen that is a very dark path to go down, where doctors are using their medical knowledge and skills to serve the interests of the state and of the court system.”
Private prison firms running ICE detention centers sometimes require doctors to declare that they are aligned with ICE’s mission. In a 2019 posting for a $400,000-a-year job as lead physician at an ICE facility in Louisiana, unrelated to the Texas facility, the private prison firm GEO Group said candidates must be “philosophically committed to the objectives of the facility.”
In the video, before the force-feeding begins, a woman who identifies herself as a “doctor” is present to oversee the procedure. Kumar identified her to The Intercept as Iglesias.
A painful process
Kumar is given one last chance to avert the force-feeding. In the video, the doctor tells a translator to deliver a message to Kumar: “Up until this point, he still has the opportunity to drink the protein supplement, as opposed to using the tube in his nose.”
Kumar refuses, saying through the translator: “You guys know the only thing I want: my freedom.” The guards dressed in riot gear then hold Kumar down.
In the video, two nurses wearing U.S. Public Health Service uniforms perform the force-feeding. Health care in the facility is overseen by ICE’s Health Service Corps, which includes Public Health Service employees, but in ICE’s sprawling network of detention centers, the ground-level providers can also be contracted private providers. At times, medical personnel from multiple organizations are in the same facility.
In the video, one nurse begins inserting the tube through his left nostril, having Kumar sip water to facilitate the insertion. Kumar complies with instructions.
“At first I got scared seeing that tube — the tube that was almost as thick as my pinky finger, which they were going to put in my nose,” Kumar later said. The tube was about 6 millimeters thick, according to notes written by a nurse involved in the procedure. By comparison, the tubes used to force-feed Guantánamo detainees were between 3.3 and 4 millimeters, according to Guantánamo force-feeding documents obtained by Al Jazeera in 2013.
As the tube is inserted, Kumar is in visible pain, his back arching as the officers hold him in position.
“Right then, my mind stopped working,” Kumar said. “I was only thinking that I wish this tube would flip and go into my brain and the story ended there. I felt as if it was going through the throat, tearing the flesh. And blood started coming from the mouth and nose.”
Kumar is then guided to a wheelchair and taken for an X-ray to verify the tube’s correct placement, though he has trouble standing up. The insertion was found to be “unsuccessful,” according to the medical notes and video. The doctor overseeing the procedure later testified in court that the tube had coiled in Kumar’s esophagus. Kumar then returns to the bed, where a nurse removes the tube.
“When they dragged the tube out, it seemed like everything in the stomach was going to come out along with the tube,” Kumar said. “It was just as painful as inserting the tube.”
A nurse and then a doctor asks if Kumar would like to break his hunger strike and drink the protein supplement. He refuses.
A second nurse begins to perform the same procedure, inserting the tube.
“As soon as they started the second time, it was more painful than the first time, because my nose was already injured and the tube was going inside, tearing it again,” Kumar said. “So the second time was more painful than the first.”
Once again, the X-ray showed the tube coiled in his esophagus, according to the doctor’s court testimony. After nurses remove the tube for the second time, Kumar can be seen on the video bending over a container.
“When they took it out, I had a lot of blood in my throat, which is why I had to vomit, and they brought the trash can for me to spit out the blood,” Kumar said.
It wasn’t until the third attempt — in his right nostril this time, since, according to Kumar, the doctors told him his left nostril was too swollen from the previous attempts — that the second nurse was able to reach his stomach with the tube.
“If you use a thinner, more flexible tube, you’re lubricating adequately, or providing adequate anesthesia, you’re much more likely to get it right the first time and not result in having to do it three different times,” said Parmar, the University of Southern California professor. “It’s incredibly painful. I’m not surprised he was vomiting blood because it’s traumatic. It is traumatic to the nares and to the esophagus when you put in the tube, particularly multiple times — particularly if it’s a larger, more rigid tube.”
One of the nurses then begins the drip of nutritional shake through the tube.
“The other thing that was very disturbing was the fact that this was happening in full view of other people who had also participated in a hunger strike,” said Cho, the ACLU attorney, who reviewed the video. “It does not seem like an accident that ICE intended to show in full view this remarkably invasive and torturous medical procedure to other people who are also participating in this hunger strike with him. It was, frankly, very disturbing.”
45 pounds lost
As ICE was trying to quietly continue force-feeding Kumar and the three other Indian asylum-seekers through sealed court filings and closed proceedings, public pressure began to mount. On Sept. 5, with his health condition improving, ICE paused Kumar’s force-feeding and removed the tube, according to court records.
Kumar, though, kept up his hunger strike and his health declined. Once again, ICE and U.S. attorneys sought a judge’s approval to reinsert the tube and commence force-feeding.
“We tried to work with Ajay and other men to have the opportunity of some legal representation to oppose this order, because the hunger strike is a protest, it’s not a medical condition — it is a political protest,” said Craig, the New Mexico-based professor and immigration advocate. “The orders are temporary. So, if they want to continue force feeding this person, they have to return to the court a second time.”
During the court battles between Kumar’s attorneys and the government, Parmar filed a court affidavit after reviewing nearly 500 pages of records. In the affidavit, she reported that his health was declining and warned that the medical care he was receiving in ICE custody was “putting his life at risk.”
“I was so disturbed by the instability of his vital signs and how clearly he was getting progressively much more ill. I was very concerned he was going to lose his life,” Parmar told The Intercept. “He wasn’t getting a basic standard of care for somebody as ill as he was. This just wasn’t the setting for somebody this ill.”
The federal judge, though, once again approved the procedure on Sept. 12. Kumar was taken to a hospital, where medical personnel inserted another tube — this time a much thinner one — and began to force-feed him.
After continued protests and complaints by Kumar, his attorneys and migrant advocates, ICE reached a deal with Kumar a week later and finally released him on Sept. 26. Kumar’s hunger strike had lasted 76 days. In total, he lost 45 pounds.
In the first few months after his release, Kumar had recurring nightmares about solitary confinement, the hunger strike and being subjected to force-feeding.
“I asked them just for freedom, from the first day until the date they released me,” Kumar told The Intercept. “I didn’t have any other demand.”
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