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In February 2017, Zeresenay Testfatsion arrived at the Texas border to seek asylum in the United States, after making the lengthy trek from his native Eritrea.

Upon his arrival, Testfatsion was arrested by U.S. Immigration and Customs Enforcement agents at the border for “unlawfully” entering the country, and held in detention centers around the country until his hearing was scheduled for October. Despite Testfatsion’s claim that he feared returning to his home country in northeast Africa, a judge ordered his deportation — back to a country rife with violence, where those who try to migrate elsewhere face imprisonment and torture, according to the United Nations. After 90 more days in detainment, Testfatsion filed a petition to be released. Instead, he ended up in limbo, eventually being held in an ICE detention center inside Cairo International Airport in Egypt.

On June 6, after 16 months in ICE detention, Testfatsion was found dead in a shower at the Cairo facility from an apparent suicide, according to a press release by ICE.

Just weeks earlier, an immigrant from Mexico who was detained by ICE officials in Texas killed himself in custody, according to NBC News. Marco Antonio Muñoz was taken into custody May 11, and was found dead on May 13. The Washington Post reported that Muñoz, 39, suffered a breakdown after he was separated from his wife and 3-year-old son.

The two recent deaths shed light on some of the most tragic outcomes for immigrants held in detention, those suffering from mental health issues or those who fear being deported.

Court records showed Testfatsion feared returning to his country, which suggests his suicide might have been due to believing his life was in danger, since asylum seekers are considered traitors in Eritrea, according to the Associated Press. ICE did not immediately return requests for comment from Mic.

Testfatsion also may have had an underlying mental health condition, which did not receive attention and could have been exasperated while in detention, according to research by the Human Rights Watch, which said such a scenario is all too common.

Clara Long, a senior researcher with HRW, said the organization’s examination of immigration detention centers across the U.S. over the last seven years revealed systemic deficits in both medical and mental health in detention centers, where eight inmate suicides have been recorded since 2010. In all, more than 180 detainees have died in custody since 2003. In 2017, JeanCarlo Jimenez Joseph died by suicide after being given only a fraction of the anti-psychotic medicine he took outside of detention, according to an investigation by the website Capital & Main.

“There is a pattern of people with psycho-social disabilities being inappropriately placed in isolation, not receiving adequate mental health care, and dying by suicide,” Long said.

Beyond a lack of mental health services, Long said that being detained itself is incredibly stressful.

“People are being placed in desperate positions, and that in itself has enormous health consequences,” she said.

Anne Slanina, a clinical psychologist that works for the Center for Victims of Torture in St. Paul, Minnesota, said that clients she has worked with who have been detained at the border have reported that they experience associative flashbacks. Being detained triggers memories of their own torture.

“I heard several clients refer to their treatment at that time as worse than their torture in their home country,” she said. Particularly grueling for these asylum seekers is ICE’s method of using the “ICE box,” or very cold temperatures, Slanina said.

Indeed, treatment in ICE detention centers can be sometimes so traumatic — especially when they spend months detained without access to a lawyer — that some asylum seekers have given up and returned to their home countries. LGBTQ asylum seekers self-deported for this reason, according to Denise Bell, a researcher with Amnesty International. This was also confirmed in a report from the organization.

“People fled horrific violence and ended up going back because they couldn’t stand the conditions after being held in no man’s land in the U.S.,” she said.

Jonathan Jayes-Green, co-founder and director of UndocuBlack, a national organization that advocates for black undocumented immigrants and refugees as well as TPS holders and DACA recipients, said that too often, the mental health of people being put in detention centers is overlooked.

“We never think about the mental health of the people that we put in detention cages when they arrive at our borders,” Jayes-Green said. “Usually crossing borders… can cause and trigger a lot of old trauma, but also trigger new trauma. Once you put folks who have all that as a background, in cages… that compounds the entire matter.”

According to Jerome Kroll, a University of Minnesota psychiatrist who treats many refugee and immigrant patients at a University-run clinic in Minneapolis, the PTSD that some refugees experience can lay dormant for years before being triggered.

“Research demonstrates that when PTSD is quiescent— when life is quiet — they are calm, but when new things happen that are unrelated to the PTSD other than it’s stressful and it raises anxiety, then the old flashbacks and reliving the experience and anxiety and avoidance come back too,” Kroll said.

There’s also an issue of the care refugees and immigrants receive when they do seek help. Poet, healer and culture worker Lula Saleh, who is Eritrean and Ethiopian, said that part of the problem is that there is not a shared language between the East African immigrant groups and the institutions — including the care providers and nonprofit service organizations they encounter. Often, she said, health providers lack the knowledge of what refugees and immigrants have gone through, and don’t always know how to navigate cultural nuance.

So for example, if a person seeking health service gets asked if they are having thoughts of suicide, it can be a very triggering question.

“That’s the worse thing you could ask someone in our culture, just because that’s not something you would ask. There’s this idea culturally that you would never kill yourself. There’s a shame or taboo to even bring up the subject of suicide,” Saleh said.

Even as a native English speaker who has been in the U.S. a long time and has attended college, “I don’t feel comfortable navigating the health care system,” Saleh said. “I’m very particular with who I might want to meet with or talk to.”

Newer immigrants, meanwhile don’t have the same community support as those who have been in the country for longer.

“Zeresenay’s suicide is shocking and disturbing, but it points to a larger problem,” she said. “A lot of younger people are leaving Eritrea without families and without systems of support.”

That’s one of the reasons UndocuBlack has internal supports for the network of undocumented black immigrants in their network. “We created a program that encourages people to connect with each other,” said Gabrielle Jackson, the organization’s wellness director.

For Jayes-Green, the way the current administration has been carrying out their immigration policy has been effective in instilling fear.

“It increases our anxiety. It’s meant to make it very clear to us that we are at risk,” he said. The recent crackdown on non-citizens “makes it very clear the goal is to continue to implement their white supremacist agenda to people like me, and Ze, who came to the border two years ago in 2016, as disposable.”