ICE Detention Center Conditions: Medical Care, Access, and Grievances

Conditions inside an ICE detention center are governed by written standards that set minimum requirements for housing, medical care, food, legal access, discipline, and how staff must treat people in custody. Because immigration detention is civil rather than criminal, the rules aim for a non-punitive environment. The most detailed rulebook is the Performance-Based National Detention Standards (PBNDS) 2011, revised in December 2016, though the exact standards that apply depend on the facility’s contract with ICE.¹

Which Rulebook Applies to a Given Facility

Before measuring any facility against a standard, find out which standard it operates under. PBNDS 2011 governs most dedicated ICE detention facilities and sets the highest benchmarks. Local jails and other non-dedicated facilities holding ICE detainees under intergovernmental service agreements typically follow the National Detention Standards (NDS), most recently revised in 2025,² or the 2019 NDS for non-dedicated facilities.³

The differences matter. PBNDS 2011 covers more topics in greater detail, with higher requirements for recreation time and legal access. A facility operating under an older or shorter standard may lawfully provide fewer protections than a PBNDS facility down the road.

What Must Happen at Intake

Every newly arrived detainee goes through a medical screening, a property inventory, and an orientation. The medical screening uses a standardized form to flag urgent health conditions, infectious diseases, mental health concerns, and any history of self-harm. Staff are also expected to identify disabilities, pregnancies, and other vulnerabilities that affect housing placement and care.⁴

Orientation must tell the detainee how to request medical care, file grievances, contact legal services, and request religious diets. This information must be provided in a language or format the person can understand, using interpreters or translated materials for anyone with limited English proficiency.⁵

Housing, Hygiene, and Hold Room Limits

Housing units must provide adequate space, bedding, climate control, habitable temperatures, and lighting sufficient for reading. Sanitation requirements cover showers, cleaning supplies, and potable drinking water throughout the facility.

Hold rooms used for initial processing or temporary placement carry a strict cap: no one may be confined in a hold room for more than 12 hours.⁶ Bunks and cots are generally not allowed in hold rooms, with exceptions for people who are ill, minors, and pregnant individuals.²

Every detainee must receive a personal hygiene kit on arrival containing at minimum a bar of bath soap or equivalent, a comb, toothpaste and toothbrush, shampoo, and skin lotion. Female detainees must also receive sanitary pads or tampons and may be given soft-bristle brushes in place of combs.⁷ Bedding and clothing must be exchanged on a regular schedule.

Medical Care and the No-Charge Rule

Detention standards require access to medical, dental, and mental health care, both routine and emergency.⁸ Detainees must be told how to request care, and prescription medications must be available and administered as directed. Mental health screening at intake is required to identify people at risk of self-harm or in need of specialized treatment.

The PBNDS flatly prohibits charging detained individuals for any medical services, including medications dispensed by facility medical personnel.⁸ If a facility tries to bill for care, that is a violation worth reporting.

Anyone placed in segregation or restrictive housing must receive a medical evaluation before placement, or within 24 hours if that is not feasible, followed by daily face-to-face assessments by health care staff to confirm they remain suitable for continued confinement.⁸

Food, Diets, and Recreation

Detainees must receive three meals every day, at least two of them hot, with no more than 14 hours between the evening meal and breakfast. Menus must be nutritionally balanced, reviewed at least quarterly by food service staff and at least annually by a qualified nutritionist or dietitian.⁹

Religious diets are provided at no cost. Detainees whose beliefs require kosher, halal, or other religiously mandated food receive access to a common fare menu designed to accommodate multiple religious practices within the facility’s constraints.⁹ Medical diets and supplemental food must also be provided when a clinician prescribes them.

General population detainees must have at least one hour of physical exercise daily outside their living area, and outdoors when weather permits. Facilities at the optimal PBNDS level must offer at least four hours daily of outdoor recreation, seven days a week. People in administrative segregation get at least one hour daily, seven days a week; those in disciplinary segregation get at least one hour daily, five days a week.¹⁰

Legal Access, Phone Calls, and Visits

Detainees have the right to communicate confidentially with attorneys and authorized representatives. Legal visits must be available seven days a week, including holidays, for at least eight hours per day on business days and four hours on weekends and holidays. These visits take place in private consultation rooms and cannot be monitored.¹¹

Facilities must also provide unmonitored telephone access for calls to legal representatives and courts. Free calls are guaranteed to immigration courts, the Board of Immigration Appeals, consular officials, legal service providers on ICE’s free legal service provider list, the DHS Office of Inspector General, and, for asylum seekers, the UN High Commissioner for Refugees.¹² Access to law libraries, legal materials, and free photocopying of legal documents is also required.

The Legal Orientation Program, which for over two decades provided group presentations explaining immigration law and court procedures, was terminated by the Department of Justice effective April 16, 2025, along with the Immigration Court Helpdesk and the Counsel for Children Initiative. Detainees no longer have access to these orientation services, which puts more weight on independently reaching a lawyer or a provider from the free legal service list.

For personal visits, facilities must allow visits during set hours on Saturdays, Sundays, and holidays, and are encouraged to offer weekday and evening hours as well. Each visit must last at least one hour. Immediate family, other relatives, friends, and associates are all eligible, and there is no cap on the number of visitors per detainee beyond what the visiting room can physically hold.¹¹ Facilities with restrictions on minor visitors must still allow a detainee’s request for a visit with a minor child within 30 days.

Each facility must provide at least one working telephone for every 25 detainees during established waking hours. Indigent detainees may request free calls to immediate family during emergencies or on an as-needed basis. When a detainee requests a call, staff must provide access within 24 hours and typically within eight waking hours; longer delays must be documented and reported to ICE.¹² Paid call rates are capped by the FCC under the Martha Wright-Reed Act.¹³

Protections for Detainees With Disabilities

Facilities must proactively identify detainees with disabilities during intake or through observation, rather than waiting for a request. Each facility is required to designate a Disability Compliance Coordinator with enough authority to ensure the facility meets federal, state, and local accessibility laws.⁴

Detainees with disabilities must be housed in the least restrictive setting possible and given equal access to programs and activities. Assistive devices such as canes and crutches generally must remain with the detainee at all times, including in general population. A disability alone cannot justify placement in restrictive housing. Facilities must provide auxiliary aids for detainees with vision, hearing, speech, or manual impairments, and the detainee’s own preference for the type of aid carries significant weight.⁴

Protections During Pregnancy

Under the 2025 National Detention Standards, pregnant detainees and those recovering from delivery may not be restrained except in truly extraordinary circumstances documented by a supervisor and directed by on-site medical authority. Restraints are never permitted on anyone in active labor or delivery. Even where extraordinary circumstances justify restraints, handcuffing must be in front to allow the person to break a fall, and face-down or four-point restraints are prohibited.²

If a pregnant detainee is placed in segregation for any reason, the facility must notify ICE in writing within 72 hours of the initial placement.²

Protections for Transgender and Intersex Detainees

Housing and classification decisions for transgender and intersex detainees must account for the individual’s gender self-identification and an assessment of how placement would affect their health and safety. Placement cannot be based solely on identity documents or physical anatomy. A medical or mental health professional must be consulted as soon as practicable, and each placement must be reassessed at least twice per year.¹⁴

Facilities may not search or physically examine a detainee solely to determine genital characteristics. Security staff must be trained in proper procedures for cross-gender pat searches and searches of transgender and intersex individuals.¹⁴

Sexual Abuse Prevention

ICE maintains a zero-tolerance policy for all forms of sexual abuse and assault, as well as for retaliation against anyone who reports an incident. Under DHS regulations implementing the Prison Rape Elimination Act (PREA), facilities must adopt written policies covering screening, training, reporting, response protocols, medical care for victims, and investigations. Each facility must designate a PREA Compliance Manager.¹⁵

Detainees, attorneys, family members, and third parties can report sexual abuse confidentially and anonymously to:

ICE Office of Professional Responsibility at 1-833-4ICE-OPR or ICEOPRIntake@ice.dhs.gov
The Detention, Removals, and Information Line at 888-351-4024
The DHS Office of Inspector General at 1-800-323-8603

Discipline and Segregation

When a detainee faces disciplinary charges, the PBNDS requires written notification of the charges in a language they understand at every step, with translation and interpretation as needed. Anyone appearing before a disciplinary panel may request a staff representative, and representation is automatic if the person is illiterate, has limited English, or otherwise needs assistance.¹⁶

Detainees must receive copies of all reports, exhibits, and documents used at the hearing unless disclosure would create a specific safety threat. Decisions can be appealed through a formal grievance process, and no staff member may retaliate against a detainee for filing a complaint or an appeal.¹⁶

Placement in a Special Management Unit (segregation) can be administrative, for safety or security, or disciplinary, as a sanction. Disciplinary segregation placements must be reviewed every seven days. When any detainee reaches 14 consecutive days in segregation, or 14 days within a 21-day period, the facility must notify the ICE Field Office Director. The same notification is required within 72 hours for any detainee with a mental illness, serious medical condition, physical disability, or pregnancy.²

What Must Happen During a Transfer

Immediately before a transfer, the sending facility must tell the detainee, in a language they understand, that they are being moved and provide the name, address, and phone number of the destination facility in writing.¹⁷

The detainee’s attorney of record must be notified as soon as practicable, but no later than 24 hours after the transfer. On arrival at the new facility, the detainee must be offered a free domestic phone call of at least three minutes to notify family. The offer of that call must be documented and signed by both staff and the detainee.¹⁷

Transfers often happen with little warning, and the 24-hour attorney notification window means a lawyer may only learn of a move after it has happened. Keeping an attorney’s current contact information on file with the facility helps close that gap.

How to File a Grievance or Report a Violation

The PBNDS establishes a formal grievance system meant to resolve complaints at the facility level. Most issues are expected to be handled informally, but every detainee has the right to file a written grievance.¹⁸

Medical grievances must reach the facility’s health authority within 24 hours or the next business day, with a response from medical staff within five working days when practicable. Emergency medical grievances follow a separate fast-track procedure. The facility must offer at least one level of internal appeal reviewed by someone not involved in the original decision, and unsatisfied detainees or those who fear retaliation can appeal directly to ICE’s Enforcement and Removal Operations. No detainee may be disciplined, harassed, or punished for filing a grievance.¹⁸

For staff misconduct, physical abuse, sexual abuse, or civil rights violations, detainees and their families can bypass the internal system and report directly to the DHS Office of Inspector General at 1-800-323-8603 or by writing to DHS Office of Inspector General/MAIL STOP 0305, Attn: Office of Investigations – Hotline, 245 Murray Lane SW, Washington, DC 20528-0305.¹⁹

Civil rights complaints can also be filed with the DHS Office for Civil Rights and Civil Liberties (CRCL) through an online portal at dhs.gov. CRCL reviews allegations of rights violations in detention, discrimination, due process problems, and physical abuse. CRCL does not provide legal remedies directly but uses complaint data to identify and address systemic problems in DHS programs.²⁰ Reports from government watchdogs and civil rights groups have repeatedly documented gaps between the written standards and actual facility conditions, particularly around medical care, grievance responsiveness, and use of segregation, so documenting problems in writing and escalating them outside the facility is often the practical route to a response.

1
U.S. Immigration and Customs Enforcement. 2011 Operations Manual ICE Performance-Based National Detention Standards
2
U.S. Immigration and Customs Enforcement. 2025 National Detention Standards
3
U.S. Immigration and Customs Enforcement. 2019 National Detention Standards for Non-Dedicated Facilities
4
U.S. Immigration and Customs Enforcement. Disability Identification, Assessment, and Accommodation
5
U.S. Immigration and Customs Enforcement. Religious Practices – PBNDS 2011
6
U.S. Immigration and Customs Enforcement. Hold Rooms in Detention Facilities – PBNDS 2011
7
U.S. Immigration and Customs Enforcement. ICE Detention Standard – Personal Hygiene
8
U.S. Immigration and Customs Enforcement. ICE Performance-Based National Detention Standards 2011 – 4.3 Medical Care
9
U.S. Immigration and Customs Enforcement. Food Service – PBNDS 2011
10
U.S. Immigration and Customs Enforcement. Recreation – PBNDS 2011
11
U.S. Immigration and Customs Enforcement. Visitation – PBNDS 2011
12
U.S. Immigration and Customs Enforcement. Telephone Access – PBNDS 2011
13
Federal Register. Implementation of the Martha Wright-Reed Act – Rates for Interstate and Intrastate Incarcerated Peoples Communications Services
14
U.S. Immigration and Customs Enforcement. PBNDS 2011 Revised 2016
15
U.S. Immigration and Customs Enforcement. ICE Sexual Abuse and Assault Prevention and Intervention Program
16
U.S. Immigration and Customs Enforcement. Detention Standard 3.1 – Disciplinary System
17
U.S. Immigration and Customs Enforcement. Detainee Transfers – PBNDS 2011
18
U.S. Immigration and Customs Enforcement. Performance-Based National Detention Standards 2011 – Grievance System
19
Office of Inspector General, Department of Homeland Security. Hotline
20
Homeland Security. Make a Civil Rights Complaint