ICE Detention Is an Infectious Disease Crisis Waiting to Get Worse

The conditions inside Immigration and Customs Enforcement detention facilities are now producing the kind of infectious disease outbreaks that public health practitioners spend their careers trying to prevent, and the federal government is responding by planning to make those facilities larger. In the past several weeks alone, Legionella bacteria has been detected in the water system of a Baltimore federal building that houses an ICE regional office and detention holding rooms, measles has spread through the largest ICE detention facility in the country, and tuberculosis cases have been documented at ICE sites across at least six states. None of this is an accident, and none of it is a surprise to anyone who has spent time thinking about how respiratory and waterborne pathogens move through crowded congregate settings.

What is actually happening inside these facilities

In Maryland, two U.S. senators and seven House members recently sent a letter to the General Services Administration warning that Legionella bacteria has persisted in the water system of the George H. Fallon Federal Building in downtown Baltimore despite hyperchlorination treatment. The letter notes that detainees are being held in overcrowded conditions for far longer than temporary holding rooms were ever designed to accommodate. Legionella thrives in poorly maintained plumbing and ventilation systems and causes a severe pneumonia, known as Legionnaires’ disease, that can be fatal for older adults and immunocompromised individuals; the same pathogen drove a large 2025 outbreak in New York City that killed multiple residents.

In El Paso, ICE confirmed in early March that there had been at least 14 cases of measles at Camp East Montana, a tent city on the Fort Bliss Army base that is currently the largest detention facility in the system, with an additional 112 people quarantined or isolated and four further cases diagnosed in the surrounding community. Tuberculosis has appeared at facilities in Alaska, California, Arizona, Colorado, Washington, and New York over the past year. Both diseases spread through the air, and both flourish under exactly the conditions ICE facilities create: crowding, poor ventilation, and incomplete screening on intake.

The evidence has been clear for years

Federal standards require that detainees be screened for tuberculosis within twelve hours of intake, but government investigators have found that this standard is not consistently met. When detainees do screen positive, they are often moved to solitary confinement rooms that lack the negative-pressure ventilation and air filtration needed to prevent measles virus or TB bacteria from spreading beyond a single space. Solitary confinement is not infection control; it is a punitive practice being used as a substitute for the engineering controls that any modern hospital ward would consider routine.

The published evidence on this is not new. A 2021 study in JAMA Network Open documented more than 2,600 cases of influenza, chickenpox, and mumps between 2017 and 2020 across 22 ICE facilities, including one site where a varicella outbreak ran for thirty-three consecutive months. A more recent study published last October analyzed twenty ICE facilities from 2019 to 2023 and identified 2,035 influenza cases, 486 hepatitis A cases, and 252 mumps cases across 128 separate outbreaks. The recommendations in both papers were not novel, expensive, or technically demanding: reduce crowding, vaccinate detainees and staff against preventable infections, and improve infection control through better air filtration and ventilation. These are the same interventions that work in child care settings, the same interventions that work in hospitals, and the same interventions that work in nursing homes. They have not been implemented because they have not been prioritized.

The system is being scaled up, not fixed

The detained population has grown from roughly 39,000 at the end of the previous administration to more than 75,000 today, and the conditions for outbreaks have worsened proportionally. Crowding intensifies transmission, and frequent transfers between facilities seed pathogens across the system. The administration’s “Detention Reengineering Initiative” now calls for consolidating hundreds of existing sites into roughly 34 regional mega-centers. One planned facility in Social Circle, Georgia; a small city whose population would nearly triple as a result; would hold between 7,500 and 10,000 detainees for stays of approximately sixty days. The math on this is straightforward. As the size of these facilities grows, the probability of severe outbreaks grows with it, and so does the probability that pathogens will move from inside the facility into the surrounding community, as already happened with measles in El Paso.

Public health has known how to prevent these outbreaks for a long time. The fact that they are happening anyway is a policy choice, and the choice to make the facilities even larger without first fixing the underlying conditions is a decision to accept a predictable rise in preventable illness and death. I have spent enough years inside outbreak responses to know what comes next when a system is built this way, and I am not optimistic that the lessons of the past few years will be applied before the next mega-facility opens its doors.