As the plastic feeding tube forced its way into John Otieno's nose, down his throat, and finally into his stomach, the East African asylum-seeker felt a wave of humiliation come over him.
The 28-year-old said he did his best to fight back against the six officers and three nurses who surrounded him, but he was sedated and handcuffed to a stretcher with his chest, arms, and legs in restraints.
"It was cruelty," Otieno told BuzzFeed News. "It's humiliating to me as a man when some other man can do as he wishes with my body."
The force-feeding by staff at GEO Group, one of the largest private prison companies in the US that ICE pays to detain immigrants, came at the end of Otieno's second hunger strike. The protests were a last resort to negotiate the release of asylum-seekers who are detained at Pine Prairie ICE Processing Center in Louisiana, said Otieno, who asked to use a pseudonym because he fears that speaking out will affect his asylum case.
Otieno is not the only person to be force-fed by US immigration authorities, according to a report published by the ACLU and Physicians for Human Rights on Wednesday that was first obtained by BuzzFeed News. The findings offer a wider glimpse that previously reported into how ICE force-fed detainees and tried to quell hunger strikes by threatening them with deportation, excessive force, or relocation to other facilities.
Court documents obtained by the ACLU show that ICE obtained court orders to force-feed or conduct other involuntary medical procedures on immigrants at least 15 times from August 2015 to August 2017. Although it's not known how many of the court orders were executed or if strikers began eating after they were threatened with force-feeding, the report states.
The documents also reveal at least one previously unknown case of a confirmed force-feeding via a nasogastric tube in January 2016, during the Obama administration. The report also found that attempts to force-feed detainees have been happening since at least 2012.
In a statement, ICE said it does not retaliate in any way against hunger strikers.
“For their health and safety, ICE carefully monitors the food and water intake of those detainees identified as being on a hunger strike,” the immigration enforcement agency said. “Additionally, ICE explains the negative health effects of not eating to its detainees, and they are under close medical observation by ICE or contract medical providers.”
In a statement, GEO Group, said they play any role in the decision to force-feed immigrants who are on hunger strike.
"All decisions pursuant to this ICE detention standard are made exclusively by medical professionals, ICE, a United States Attorney's Office, and a United States District Court," GEO Group said. "GEO staff never take action to intervene in the case of an individual engaged in a hunger strike without the express direction and authorization by ICE and a US District Court."
Joanna Naples-Mitchell, a US researcher for Physicians for Human Rights and one of the report’s lead authors, said it shows the scale of forced feeding inside ICE facilities, which started to garner national attention when news broke of a round of confirmed cases in 2019 at the El Paso Service Processing Center in Texas after a group of men went on a hunger strike to protest verbal abuse and threats about deportation.
In addition to force-feeding, ICE has performed other procedures to administer food, nutrients, or fluids to immigrants against their will, the report states. Among them was forced urinary catheterization in December 2015, which involves inserting a tube into the urethra to involuntarily collect vitals from people on a hunger strike, Naples-Mitchell said.
"Forced urinary catheterization is considered illegal under international law," Naples-Mitchell told BuzzFeed News. "It's cruel, degrading treatment, or torture."
Under ICE detention standards, the agency may place people on a hunger strike in medical observation cells, where they are isolated in a manner similar to solitary confinement, Naples-Mitchell said. Hunger strikers like Otieno were interviewed for the report and characterized the use of isolation as retaliation for their protests.
ICE also used coercive methods to try to end hunger strikes, including denying commissary privileges, limiting water access, and threatening prosecution, the report states. In one case, ICE reportedly brought in a Bangladeshi Consulate official to meet with asylum-seekers on a hunger strike who had fled persecution from their government.
Discussing a hunger strike in 2016 by 22 mothers at the Berks County Residential Center in Pennsylvania, Dr. Philip Farabaugh, an associate medical director at ICE, noted that the protests "look bad" and that they should look into separating the mothers from their children.
"Since this is a family facility, we don't want messaging going out that there is a hunger strike going on," Farabaugh said in an email on Aug. 17, 2016. “If it appears they really are on a hunger strike, we will need to separate the mother and children—send mom to an [ICE Health Service Corps] facility to address the hunger strike.”
Naples-Mitchell said she also saw documents in which ICE was planning to transfer immigrants on a hunger strike to Krome Service Processing Center in Miami, where force-feeding was more likely to be administered and the detainees could be deported as scheduled. ICE couldn't deport the immigrants if they were on a hunger strike, Naples-Mitchell said.
"This need to meet this deportation timeline is really driving the abuses," Naples-Mitchell said.
Eunice Cho, a senior staff attorney with the ACLU and one of the report’s lead authors, said that while medical professionals and organizations have deemed force-feeding to be unethical, it is not necessarily unlawful if ICE is able to obtain a court order to do so. However, the process is marked with significant legal issues because people on a hunger strike often have to plead their case on their own, Cho said.
The government, Cho noted, has to show how the hunger strike is posing a danger to an immigrant's safety, and the motions should include specific information as to why force-feeding is necessary under the law. Yet many of the motions and declarations submitted by ICE attorneys and medical professionals have very little information about an immigrant's health that would justify force-feeding.
"The government is bringing the barest of evidence in these motions for force-feeding, and we see in many cases these federal courts rubber-stamp them," Cho said.
Ironically, instead of addressing the issues that immigrants on a hunger strike are protesting, ICE subjects them to even worse abuses by placing them in medical isolation and forcing unwanted medical procedures, Cho said.
A hunger strike is usually a last resort for people in ICE detention, and it’s an autonomous decision that should be respected, said Dr. Ranit Mishori, a professor of family medicine at Georgetown University School of Medicine.
“They feel this is their last option to protest the conditions in detention or other issues. It is a decision they make willfully knowing exactly what the outcomes could be,” said Mishori, a contributing writer of the report and senior adviser to Physicians for Human Rights.
She added that there are ways of negotiating with people on a hunger strike, including using an independent medical team with no government affiliation to assess if the situation becomes so dire that an agreement on hydrating the protesters can be reached.
“It is not this or that, and it is never a binary option. There is room to negotiate these things,” Mishori said.
It was an attempt to negotiate his release that led Otieno to start a hunger strike. After requesting asylum at the US–Mexico border, he was moved around to different ICE facilities. He said he realized he was never going to be able to fight his case outside of detention, especially at his location, because the ICE field office was known to deny requests for parole, a form of release for asylum-seekers.
In early 2020, Otieno decided he would rather seek asylum in another country. He sent ICE letters that he would pay his own way if he were released, but he never got a response. Then he did some research on ICE protocols and learned that if he refused to eat for three days, local agency officials would have to report it to their superiors. Otieno hoped that by doing this he would be able to make his case for release.
"It was the only option I had," he said. "I needed my freedom. I needed to move on with my life — because at that point, I was stuck in one place with no hope, only doom."
After day four of the hunger strike in March 2020, Otieno was sent to solitary confinement and threatened with forced feeding on day six. After 12 days, he met with an ICE supervisor who agreed to look into his case if he ate, and Otieno relented.
Nothing came of it. Otieno went on a second hunger strike in July 2020 along with 28 other detainees. The group was pushing for better conditions inside ICE facilities and the opportunity to be released on parole.
"If I was deported, I'd be dead. And I would rather die in dignity, fighting, than just sit down and wait to be shipped to the slaughterhouse back home," Otieno said.
ICE guards told him that going on a hunger strike would negatively affect his asylum case and those of the other detainees. On the third day, guards escorted protesters to solitary confinement in riot gear, which Otieno viewed as an intimidation tactic. On the ninth day, he and two other men collapsed. They were all taken to a local hospital to be examined. It was there, Otieno said, that he was told by an ICE officer that the agency had a court order to force-feed him. But the staffers at the hospital refused to do it, so ICE took Otieno back to the Pine Prairie ICE Processing Center, where the tube was inserted the next day.
"You feel hopeless," he said, "like a piece of trash."
Hamed Aleaziz contributed reporting to this story.