In a prison population of roughly 400,000, someone is bound to die. But it doesn’t have to happen because of sheer indifference as a report released today found sometimes occurs in ICE detention. Advocacy groups Human Rights Watch (HRW) and Community Initiatives for Visiting Immigrants in Confinement (CIVIC) teamed up to take an in-depth look of medical records for eighteen deaths in ICE custody. The organizations tasked two independent experts with extensive experience in inmate medical care delivery with reviewing records of deaths from 2012 to 2015. Based on those analyses plus interviews with attorneys and formerly detained individuals, HRW and CIVIC concluded that systemic failures resulted in shoddy medical care that in some instances might have contributed to premature deaths.

Lelis Rodríguez entered an ICE contractor’s custody with high blood pressure. He had medication to control it, but it was locked up in his property bag, available to immigration prison staff. No one bothered to give it to him. When his right arm and leg started twitching, a nurse finally called an ambulance. He fell into a coma and died six days later. “This was an avoidable death,” concluded medical expert Dr. Marc Stern.

Tiombe Carlos was suicidal throughout her two-and-a-half years in ICE detention and attempted to take her life once before succeeding. Instead of implementing a care plan, officials at the York County Prison where she was held on ICE’s behalf put her in solitary confinement for at least nine months and dismissed her condition. One correctional officer concluded her unsuccessful suicide attempt was “done for attention” and a licensed professional counselor described it as a “suicidal gesture, not a suicide attempt, because she waited for officers to enter her cell before dropping from the stool.”

Sadly, deaths are not uncommon in ICE detention. From 2004 to 2014, at least 144 people lost their lives in or shortly upon release from detention. Like Lelis Rodríguez and Tiombe Carlos, seventy-four percent of deaths resulted from an identifiable medical problem and over thirteen percent died from suicide. Sometimes deaths happen inside facilities run by ICE. At other times poor medical care occurs in privately owned or operated prisons. In most instance, medical care is the responsibility of ICE’s Immigrant Health Services Corps, pointing to one challenge advocates face as they target private immigration prisons.

The future is foreboding. President Trump has announced an interest in expanding immigration imprisonment, including custody by or on behalf of ICE, while rolling back some of the precautions that are in place. Meanwhile, Congress continues its bipartisan track-record of funding immigration imprisonment. The budget that made its way through Congress last week gives DHS about $2.7 billion for ICE’s custody operations—enough money for 39,324 ICE beds per night. Unless the people locked up on suspicion of an immigration law violation come to be viewed as people with an inherent dignity that must be respected, an uptick in deaths seems likely.