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incarceration
Support the Human Rights Defenders Opposing Bukele’s State of Exception
Since the Salvadorian leader began his war on gangs, easily 25,000 (and likely many more) innocent people have been arrested and held under inhumane conditions, including extreme overcrowding.
Dec 10, 2024
Salvadoran President Nayib Bukele had a huge (though controversial) electoral victory in February 2024. But a small, stubborn legal movement is challenging his popular, indiscriminate war against gangs.
Even as the reduction of gang violence brings relief to many Salvadorans, many low-income people see their law-abiding neighbors being swept up arbitrarily in Bukele’s war. Understandably, they fear the so-called security forces.
During a November 2024 tour in the United States, attorneys Ingrid Escobar and Óscar Rosales of Socorro Jurídico Humanitario (SJH or Humanitarian Legal Aid ) were clear: They do not oppose the legal arrest and incarceration of gang members. But they’re resisting a suspension of constitutional rights that’s proven to be capricious in practice, cruel, dangerous, and deadly.
Institutionalizing Brutality
MS-13 killed 87 people during the last weekend of March 2022. At Bukele’s direction, the Legislative Assembly implemented Article 29, resulting in an extraordinary emergency measure called a “state of exception.” With it, “the rights to freedom of association and assembly, and privacy in communications, as well as some due process protections” were temporarily suspended. “Temporarily” has become long-term.
Of the 83,000 who have been detained during Bukele’s war against gangs, SJH estimates that only 40% are actually gang members, another 30% have collaborated with gangs (often unwillingly and sometimes under threat of death), and the remaining 30% (most of them also charged with collaboration) are actually innocent of any gang affiliation at all.
The denial of the presumption of innocence and a lack of access to legal representation and family are harrowing for detainees, as well as their loved ones.
So, easily 25,000 (and likely many more) innocent people have been arrested and held under inhumane conditions, including extreme overcrowding. Some released prisoners report 150 detainees sharing a single toilet, multiple people sharing a single bed, and those who can’t access a bed sleeping on floors with excrement.
In mid-November, Bukele stated that 8,000 state-of-exception prisoners had been released. But, according to Escobar, hundreds of release orders have been ignored. Former detainee Melvin Ortiz had received 24 such orders but was only released after his case was taken to the United Nations.
SJH claims there were at least 330 deaths in detention between April 27, 2022 and the end of October 2024. About half were due to violence, 40% to medical neglect, and 10% to terminal illness. Notably, 94% of those 330 decedents did not belong to gangs.
Considering the cumulative institutional brutality, these deaths aren’t surprising. Some released prisoners report “welcome beatings” by prison guards upon incarceration, extreme malnutrition, dehydration (prisoners receive four ounces of water to drink daily), torture, and a lack of medications or medical care.
There is psychological trauma, too. The denial of the presumption of innocence and a lack of access to legal representation and family are harrowing for detainees, as well as their loved ones.
Arbitrary and Political Arrests
One government official told Leslie Schuld, director of Centro de Intercambio y Solidaridad: “We are throwing out nets to capture gang members and then we will release the innocent people caught in the nets.” But statistics from the past 32 months show that, once imprisoned, it’s easier to become entangled in those metaphorical nets than be released.
In practice, anyone—but it’s usually people in low-income neighborhoods—can be arrested under the state of exception. SJH reports that police and military personnel arrest arbitrarily to fulfill quotas. Allegations against persons can be made anonymously—which has proven handy for unscrupulous people with grudges, unwelcome competitors, or even romantic rivals. People are arrested for their tattoos (one young man was detained for having a rose tattoo honoring his mother, Rosa), for haircuts or clothing deemed suspicious, for having an old criminal record, or for having been deported from the United States.
“The fear we have is that we’ll be the next ones he arrests despite never having broken the law.”
Sandra Leticia Hernández fits several of these categories. After serving a sentence in Ilopango prison, she returned to Isla El Espíritu Santo where she lived with her lesbian life partner. Business competitors resented her thriving motorcycle-taxi service as well as her sexual orientation. Sandra was arrested first—and then her partner, Eidi Roxana Claros de Zaldaña, was detained when she made inquiries about her. Sandra was released eventually, while Eidi remains incarcerated.
Young Salvadorans are deeply affected by state-of-exception injustices. Human Rights Watch has observed that many children in low-income barrios are doubly traumatized: once preyed upon by gangs, they are now targeted by the police and state security forces. Over 3,000 children have been arrested; detainees as young as 12 years old can receive prison sentences of up to 10 years.
Additionally, both SJH and Columbia University’s Center for Mexico and Central America claim that, in El Salvador, “an estimated 100,000 children and adolescents had been effectively orphaned” after their parents disappeared into detention. SJH reports that many of these children lack basic necessities and some of them experience one or more of the following: depression, weight loss, eating disorders, nightmares, hyperactivity, aggressiveness, and fear and anger toward the military and police.
Finally, troublesome critics of corporations and the government—such as union members denouncing corruption, social activists, and human-rights defenders—are targeted. That includes the SJH. At a press conference, Escobar talked about the scrutiny they’re under: “These [investigatory] actions include surveillance and monitoring of our homes, workplaces, and the facilities of the Humanitarian Legal Aid. We have confirmed [this] through license plates on vehicles that are used solely for police purposes.”
Thirsting for Justice
But SJH isn’t deterred. In addition to providing full legal accompaniment to 100 innocent clients, SJH is rendering habeas corpus services to another 2,600. And because many of its clients were sole breadwinners, SJH provides material support to their families. So far, SJH has secured the release of 50 innocents, after taking some of their cases to international courts.
Escobar declares on her X page: “Tengo sed, sed de #Justicia.” She is thirsty for justice—but it’s risky. Elsewhere she’s acknowledged, “The fear we have is that we’ll be the next ones he arrests despite never having broken the law.”
SJH has a loud collective voice that carries far. It regularly denounces the Bukele administration’s violations of human rights in national and international settings. Surely these defenders of El Salvador’s hard-won but vulnerable democratic rights deserve our moral, political, and monetary support.
Please call senators and representatives through the U.S. Capitol switchboard at (202) 224-3121.Ask that U.S. aid for the Salvadoran armed forces be withheld until all innocents have been released and the prisons investigated independently.
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To Ensure Health Equity, Congress Should Renew the Affordable Connectivity Program
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the program has been the essential linchpin for creating access to lifesaving medications for opioid use disorder.
Apr 03, 2024
In an ironic twist, people recovering from opioid addiction recently gained permanently expanded access to telemedicine services through a new federal policy—but many are likely to be among the 22 million low-income households losing access to affordable internet.
The Federal Communications Commission recently began to wind down the Affordable Connectivity Program, the country’s largest, most successful internet affordability program. This government-sponsored benefit program, introduced during the pandemic, provides low-income Americans with a one-time subsidy to purchase an internet-capable device and monthly subsidies for broadband services.
As a physician delivering telemedicine-based addiction care to rural and low-income communities, the Affordable Connectivity Program has been the essential linchpin for creating telemedicine access to lifesaving medications for opioid use disorder.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all.
Substance use disorders are life-threatening chronic conditions, but they’re treatable. More than 70% of people with substance use disorders transition into recovery. However, early recovery is fragile. When people are ready to engage in care, low-barrier, rapid access to care is vitally important to support treatment success, especially during reentry from incarceration when the overdose risk is up to 129 times greater than community-based populations. Nearly half of people using opioids in rural areas were recently incarcerated, emphasizing the need for expanded rural access to treatment.
Yet, in-person addiction care is disproportionately limited in rural communities, requiring long drive times to access care. This is simply not an option for most of my patients, particularly those in early recovery. Most are trying to rebuild their lives while confronting significant financial debts incurred during past periods of expensive, prolonged substance use and incarceration. Stigma locks them out of high-earning positions, effectively segregating them to low-wage positions with limited opportunities for advancement and usually no access to benefits like paid time off to engage in care.
Many of us can get a leg up during hard times from family or peers. However, most patients in early recovery are at the starting line of repairing social relationships weakened by trust lost during active substance use and prolonged absence during incarceration. Often, the social supports they can access are facing similar resource-limited circumstances, with minimal ability or bandwidth to help with transportation or finances.
Every day, my patients choose what they can afford from a menu of necessities.
What will you have today?
- Food
- Transportation to work
- Cellphone access
- Savings toward rent
- Fees to obtain a driver’s license
Rarely can they cover more than one or two at a time. How could expensive, time-intensive travel to distant healthcare ever compete?
It shouldn’t have to. And thanks to the relaxation of telemedicine rules and the Affordable Connectivity Program, it hasn’t had to.
While the Affordable Connectivity Program’s $30 monthly subsidy sounds inconsequential, the true value of costs saved is much higher, as the collateral costs (e.g., transportation, lost-wages) of in-person services are avoided. With reliable access to data plans, my patients attend their medical appointments from their worksites during their lunch breaks or easily negotiate alternative breaks with their bosses, who are more willing to be flexible because work can quickly resume when patients remain on-site. This has allowed patients to consistently receive addiction treatment without incurring lost wages and transportation costs during the two-to-four-hour long process of in-person care. With their financial distress tempered, my patients have more quickly transitioned from survival mode to future planning.
The Affordable Connectivity Program also enabled internet access to key social resources that promote health and stability. My patients have taken online classes, searched and prepared for jobs, and built healthy social connections with online recovery communities, the latter particularly key for rural patients with limited in-person social options.
Funding for the Affordable Connectivity Program is projected to run out in April unless Congress acts quickly to renew funding. Amidst the Affordable Connectivity Program’s wind down, my team has begun switching patients to the remaining alternative telecommunication benefits for low-income households, like the Lifeline program. However, this inferior program provides only $9.95 monthly toward internet service—insufficient to cover the entire cost of a plan—and limited options of qualifying service providers. For my patients battling homelessness living in tents, cars, and motel room rentals while working tireless hours to survive and endeavor toward stable thriving, a $20 increase in monthly expenses is insurmountable.
The communities with significantly limited internet access—rural, low-income, Black—are also disproportionately impacted by the opioid crisis and low access to in-person treatment. Their precarious internet access falsely positions the internet as a luxury, rather than an essential resource for healthcare, education, employment, transportation, and social belonging. Internet access is a health equity issue.
I urge Congress to renew funding for the Affordable Connectivity Program and pursue legislative pathways to permanently expand internet access to all. Without swift action, I fear that losing the Affordable Connectivity Program will lead to more lives lost to treatable substance use disorders.
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California Flooding Highlights the Risks of Extreme Weather on People Behind Bars
State and federal government entities are not equipped or prepared to protect the 1.9 million people in our nation’s jails, prisons, and detention facilities during more frequent and severe weather disasters.
Mar 24, 2024
In February, California faced a “monster storm.” This storm was the second atmospheric river storm to hit the state within a week, leaving nine confirmed dead in its wake. While this storm was record breaking, California saw similar weather patterns and severe flooding last year, and we can only expect these occurrences to continue and increase in intensity as climate change fuels a rise in extreme weather events.
In 2023, a series of storms created Tulare Lake in a previously dry basin near Corcoran, California. Protected only by a levee in need of repairs, the highest concentration of incarcerated people in the state were left at risk of flooding. Last spring, flooding caused by storms affected visitors’ access to the Substance Abuse Treatment Facility and State Prison at Corcoran and forced the California Department of Corrections and Rehabilitation to stop accepting transfers.
Despite no news yet on the effects of California’s most recent storm on people in carceral facilities, it is only a matter of time before these stories come to light. California’s disaster response plans fail to account for its incarcerated population. Over and over again across the country, weather-related disasters have threatened the lives and well-being of people behind bars. Still, this problem remains unmitigated—state and federal government entities are not equipped or prepared to protect the 1.9 million people in our nation’s jails, prisons, and detention facilities during these disasters.
As medical professionals, we implore lawmakers and prison administrators to take proactive measures to prevent the health risks of freezing winters and scorching summers from becoming recurring nightmares in the years ahead.
These extreme weather incidents extend beyond just flooding in California. During the 2023 summer of record-breaking heat, states and the federal government put hundreds of thousands of lives at risk by confining people to carceral facilities that lack universal air conditioning and air filtration equipment—we saw extreme heatwaves and raging wildfires in Canada cause widespread panic and lethal ramifications for people behind bars, including reports of at least 41 heat-related deaths in the Texas summer alone. Over 30% of California’s wildland firefighting crews are made up of incarcerated people, putting them directly in harm’s way. Increasing frigid winter temperatures have also caused suffering and death in facilities ill-equipped with adequate heating systems. During the brutal winter storm Uri of 2021, people incarcerated in Texas prisons faced freezing temperatures and power blackouts, described by one person as “being in a meat locker.”
Correctional facilities are often situated in geographically vulnerable areas, susceptible to a gamut of natural disasters, from floods and hurricanes to blizzards and wildfires. And incarcerated people, devoid of the agency to evacuate, are left unprotected. The impacts of the catastrophic Hurricane Katrina in 2005 serve as a stark reminder of these consequences. Major flooding left prisons under water and without food and water for days due to a lack of coordination to plan and evacuate facilities, highlighting the critical need for including prisons in emergency preparedness planning. Yet almost two decades later, states still rarely incorporate jails and prisons into their emergency disaster response plans, rendering incarcerated individuals an afterthought even under emergency evacuation orders. They are often left stranded in dire circumstances, used as free labor, and denied access to critical medical treatment for weeks, if not months, during these emergency events.
As medical professionals, we implore lawmakers and prison administrators to take proactive measures to prevent the health risks of freezing winters and scorching summers from becoming recurring nightmares in the years ahead. We call upon them to develop comprehensive strategies for the threat of extreme weather, such as creating evacuation plans and implementing temperature reporting and standards for indoor temperatures—planning ahead for the weather extremes that will certainly occur can save lives.
With predictions of increasingly frequent and severe temperatures and natural disasters on the horizon, safeguarding one of society’s most vulnerable and rapidly-aging populations must be a paramount concern.
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