Los Angeles, California – Saturdays marked a weekly pilgrimage for Lucia Uribe. Every weekend, she would travel to the edge of California’s desert to visit her son, Ismael Ayala-Uribe, in detention.

Ismael was among the hundreds of thousands of people swept up in United States President Donald Trump’s immigration crackdown.

Born in Mexico and brought to the US as a child, he was arrested on August 17 while working at a car wash. Ever since, he had been in the custody of immigration authorities, first at a local jail and later at a detention centre for Immigration and Customs Enforcement (ICE) in Adelanto, California.

But one Saturday was different. Lucia remembers that Ismael’s hands looked paler, his eyes were bloodshot, and the fever he had was rising.

“Mom, I’m not going to make it,” Lucia recalls Ismael telling her. There was little she could do but reassure him.

“I told him, ‘Oh, my son, just hang in there as long as you can,’” Lucia said. “When I said goodbye to him, I felt something in my chest, a tightness, and it made me want to cry.”

It was the last time she would see her son alive. Lucia’s fears were confirmed by a knock at her door two days later, when police told her that her son had died at 2:32am on September 22, 2025.

Ismael was one of more than 50 people to die in ICE custody during the first 500 days of Trump’s second term.

A coroner’s report from the San Bernardino County Sheriff’s Department in southern California found that his death was caused by complications from an abscess in his pelvic region.

Ismael’s family, however, has argued that insufficient medical treatment in ICE facilities led a preventable infection to fester into a deadly condition.

For months, the Al Jazeera documentary series Fault Lines has spoken to people in ICE custody and the families of those who never made it out alive, to understand the conditions that could have led to deaths like Ismael’s.

What it found was that 2025, the year Ismael died, was the deadliest year in history for those in ICE custody. But experts fear 2026 is on track to match or surpass that record.

‘Not proportional’

The Trump administration has consistently denied reports that deaths in ICE custody are increasing.

In a social media post in June, the Department of Homeland Security, which oversees ICE, claimed that the death rate has remained “consistent with data over the last decade”.

“There has been NO spike in deaths,” the department wrote, pointing to the percentage of deaths relative to the overall population of ICE detainees.

But experts and watchdog organisations warn that ICE’s framing may be misleading.

“What has often been claimed is that the overall detained population is going up,” said Nicholas Cuneo, an expert in immigrant health with Physicians for Human Rights, an advocacy organisation.

But he pointed to statistics that show the death rate has nearly tripled. “That clearly is not proportional to the detained population,” Cuneo said.

In June, Human Rights Watch published a report revealing that, since Trump returned to office, immigrants in ICE custody are dying at a rate roughly three times higher than under his predecessor Joe Biden.

The annualised mortality rate during Biden’s four-year term was 2.24 for every 10,000 detainees. Since Trump began his second term, that proportion has risen to 6.38 deaths for every 10,000 people in custody.

In total, 33 people died in ICE custody last year, according to the agency’s own statistics. So far in 2026, at least 26 people have died.

Reagan Williams, a human rights lawyer and researcher who worked on the June report, said that the increase in overall detentions does not explain the spike in deaths.

“The administration has incarcerated record numbers of immigrants,” Williams said.

“And yet this rapid rise in detention does not fully account for the staggering increase in deaths. A higher percentage of detained immigrants are dying under this administration.”

While overcrowding at ICE facilities is a factor, experts at Physicians for Human Rights also found a pattern of delayed emergency care, understaffing and failure to provide adequate medical treatment.

Those factors have raised concerns that many ICE deaths may have been preventable, including Ismael’s.

‘A major failure’

A round-faced man with dark-rimmed glasses, a moustache and short-trimmed hair, Ismael came to the US when he was only five years old.

Southern California became his home, and as an adult, he qualified for the Deferred Action for Childhood Arrivals (DACA) programme, which offered temporary protection against deportation.

He lost his DACA status, however, in 2015 after a conviction for driving under the influence.

His family remembers him as a caring son and uncle, always willing to buy his niece and nephew new clothes or school supplies.

“Ismael was always looking after his siblings. He just had a big heart,” said his brother, Jose Miguel Ayala. “He was very protective of not just us, but my mum and dad too.”

He was 39 years old when he was brought to the Adelanto ICE Processing Center.

Two weeks after his arrival, Ismael told his family that he developed a high fever and a painful sore on his backside.

On September 18, 2025, workers at Adelanto initiated a Code Blue alert for Ismael, signalling a life-threatening medical emergency. Medical staff rushed him from his dorm to the infirmary in a wheelchair.

ICE documents show that Ismael was given pain medication, an ointment and a fibre supplement.

But according to Physicians for Human Rights’ Cuneo, who reviewed the case, Ismael should have received a physical examination and antibiotics.

“That is a major failure,” Cuneo said.

That weekend, hours after Lucia’s visit, Ismael’s condition worsened. Just after midnight on Sunday, ICE records say he was vomiting, shaking and sweating.

According to ICE documents, he was later sent to an intensive care unit, where he went into cardiac arrest within minutes of his arrival and subsequently died.

“I believe Ismael’s death could have fully been prevented by timely care,” Cuneo said. “It was a simple abscess that was not treated in a timely manner.”

Fault Lines obtained a coroner’s investigation that reveals Ismael was critically ill when he first arrived at the hospital, a fact that was left out of ICE’s public report on his death.

The coroner’s report also contradicts ICE’s timeline for Ismael’s death. It indicates Ismael went into cardiac arrest early on September 21, nearly a full day before he passed away. Medical staff, however, managed to restore his heartbeat after intubating him.

That conflicts with ICE’s report, which only notes his pulse stopping once: shortly before his death was announced on the morning of September 22. ICE described his condition on September 21 as “calm and cooperative”, but it signalled no heart problems.

“If they had given him the medical care and what he needed, maybe he would be here with us,” Lucia said.

In a statement about Ismael’s death, ICE said detainees receive “comprehensive medical care” throughout their time in custody.

But California’s Attorney General Rob Bonta told Fault Lines that his office found “the exact opposite” during its inspections of the state’s detention centres.

“We’ve gone to these facilities. We’ve gone into Adelanto. We have done our own physical inspections,” Bonta explained.

“If what the ICE spokesperson said was true, Mr Ayala-Uribe would be with us today.”

An internal mortality review committee also found that the care provided to Ismael at Adelanto “deviated beyond safe limits of practice”, according to a document obtained by US media earlier this year.

It also suggests that medical staff delayed responding to calls about Ismael’s declining health in the days leading up to his death.

‘We want to go outside alive, not dead’

Fault Lines spoke to current detainees in the Adelanto detention centre who say they, too, fear the conditions could be harmful to their health.

Many described inadequate medical care, mouldy food and retaliation for protesting against the subpar conditions.

Some are part of a class-action lawsuit, filed in January, accusing the US government of “inhumane and illegal conditions” at Adelanto.

“They don’t take things seriously,” one detainee, Kurt Campbell, said of the Adelanto staff.

“They think everyone’s a liar. So when you’re going through something and you express what you’re going through, they act like you’re lying. We do want to go outside, but we want to go outside alive, not dead.”

Four men have died in Adelanto between September 2025 and March 2026, including Ismael. Campbell, who is originally from Jamaica, said he knew one of the detainees who passed away.

“His last days were spent in confinement and in Adelanto instead of being with his family,” Campbell said. “He didn’t kill anyone. He didn’t hurt anyone. His crime was coming over the border.”

Guadalupe Moreno Cristin, another detainee in Adelanto, recalls experiencing rectal bleeding for more than a week, in addition to heart issues.

When he was taken to the infirmary, the only treatment he said he was given was Tylenol and a serum. His health has continued to deteriorate.

“I haven’t had a bath for, like, eight days now because I can’t lift my hands up,” Cristin said. “I can’t change myself on my own. I can’t stand for long, and I can’t walk much.”

Detainee Jesus Jacobo Ortiz Ruiz estimated that, for every 320 people in ICE custody, there is only one doctor. “You’ve got to be literally dying in here for you to get sent to the hospital,” Ruiz added.

Fault Lines spoke to US Representative Judy Chu, who represents a congressional district near Adelanto. For the past decade, she has been conducting oversight visits at the facility.

“I’ve seen firsthand for over a decade how they’ve cut corners, how they don’t want to spend money on food, and most importantly, they don’t want to spend money on medical care,” Chu said.

To push for change, roughly 150 detainees signed a petition and went on hunger strike earlier this year to denounce the “unbearable and inhuman” conditions at Adelanto.

Campbell said he was placed into solitary confinement for 30 days for participating in the hunger strike. Other detainees reported receiving physical retaliation, including Ashraf Abujama.

“They just enjoy using force on me,” Abujama said. “They want to just use me as an example to all the detainees, that ‘(this is) what we can do’.”

‘An emptiness that wasn’t there before’

In recent weeks, changes have been under way at Adelanto.

The facility, formerly owned by the private prison firm Geo Group, has been sold to the Department of Homeland Security for $950m, as the federal government seeks to acquire more detention centres.

Critics, however, warn that the switch to federal ownership could make conditions inside Adelanto more opaque, limiting the ability of state and local authorities to exercise their oversight roles.

It is a change that concerns families of detainees like Ismael. Where once his mother Lucia visited him at Adelanto, she now spends her weekends with a new ritual: visiting his grave on Sundays.

Jose, Ismael’s brother, often joins her, along with his sister and her two kids.

Their father often stays behind. “My dad still has a hard time going,” Jose explained.

More than a year has passed, but the entire family is still grappling with the loss.

“There’s a time where I just feel like he’s just going to walk in,” Jose said. “There’s just an emptiness that wasn’t there before.”