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Rebekah Stewart, a nurse at the U.S. Public Health Service, got a call last April that brought her to tears. She had been selected for deployment to the Trump administration’s new immigration detention operation at Guantánamo Bay, Cuba.
This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the torture and inhumane treatment of men suspected of terrorism in the wake of 9/11.
“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.
Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom KFF Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.
Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.
The Trump administration’s mass arrests to curb immigration have created a new type of health emergency as the number of people detained reaches record highs. About 71,000 immigrants are currently imprisoned, according to Immigration and Customs Enforcement data, which shows that most have no criminal record.
Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, several news organizations have reported that many of the men shipped to the base had no criminal convictions. As many as 90% of them were described as “low-risk” in a May progress report from ICE.
In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, according to The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the United States or deported.
While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the United States. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.
“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.
Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.
“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”
One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.
“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”
Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told KFF Health News.
“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.
“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”
The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.
“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, said in an emailed statement to KFF Health News.
Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: Say “Yes Sir!,’ salute smartly, and execute the mission: Show up, provide humane care, and protect health.” Christine is a recent appointee who, until recently, was a urologist specializing in testosterone and male fertility issues.
“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”
Into the unknown: PHS officers’ questions unanswered
In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.
“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”
Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.
Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?
Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.
But PHS officers who were deployed to the base told KFF Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.
Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.
The consequences of insufficient preparation can be severe. In 2014, the Navy threatened to court-martial one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol was brutal: A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.
“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”
The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was guided by professional ethics. After a year, the military dropped the charges.
A uniformed doctor or nurse’s power tends to depend on their rank, their supervisor, and chains of command, Xenakis said. He helped put an end to some inhumane practices at Guantánamo more than a decade ago, when he and other retired generals and admirals publicly objected to certain interrogation techniques, such as one called “walling,” in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to torture.
Torture hasn’t been reported from Guantánamo’s immigration operation, but ICE shift reports obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.
“Welfare checks with potential hunger strike IA’s,” short for illegal aliens, says an April 30 note from a contractor working with ICE. “In case of a hunger strike or other emergencies,” the report adds, the PHS and ICE are “coordinating policies and procedures.”
“De-escalation of potential pod wide hunger strike/potential riot,” says an entry from July 8. “Speak with alien on suicide watch regarding well-being.”
Inmates and investigations have reported delayed medical care at immigration detention facilities and dangerous conditions, including overcrowding and a lack of sanitation. Thirty-two people died in ICE custody in 2025, making it the deadliest year in two decades.
“They are arresting and detaining more people than their facilities can support,” one PHS officer told KFF Health News. The most prevalent problem the officer saw among imprisoned immigrants was psychological. They worried about never seeing their families again or being sent back to a country where they feared they’d be killed. “People are scared out of their minds,” the officer said.
No sunlight in high-security Camp 6
The PHS officers who were at Guantánamo told KFF Health News that the men they saw were detained in either low-security barracks, with a handful of people per room, or in Camp 6, a dark, high-security facility without natural light. The ICE shift reports describe the two stations by their position on the island, Leeward for the barracks and Windward for Camp 6. About 50 Cuban men sent to Guantánamo in December and January have languished at Camp 6.
A Navy hospital on the base mainly serves the military and other residents who aren’t locked up — and in any case, its capabilities are limited, the officers said. To reduce the chance of expensive medical evacuations back to the United States to see specialists quickly, they said, the immigrants were screened before being shipped to Guantánamo. People over age 60 or who needed daily drugs to manage diabetes and high blood pressure, for example, were generally excluded. Still, the officers said, some detainees have had to be evacuated back to Florida.
PHS nurses and doctors said they screened immigrants again when they arrived and provided ongoing care, fielding complaints including about gastrointestinal distress and depression. One ICE monthly progress report says, “The USPHS psychologist started an exercise group” for detainees.
Doctors’ requests for lab work were often turned down because of logistical hurdles, partly due to the number of agencies working together on the base, the officers said. Even a routine test, a complete blood count, took weeks to process, versus hours in the United States.
DHS and the Department of Defense, which have coordinated on the Guantánamo immigration operation, did not respond to requests for comment about their work there.
One PHS officer who helped medically screen new detainees said they were often surprised to learn they were at Guantánamo.
“I’d tell them, ‘I’m sorry you are here,’” the officer said. “No one freaked out. It was like the ten-millionth time they had been transferred.” Some of the men had been detained in various facilities for five or six months and said they wanted to return to their home countries, according to the officer. Health workers had neither an answer nor a fix.
Unlike ICE detention facilities in the United States, Guantánamo hasn’t been overcrowded. “I have never been so not busy at work,” one officer said. A military base on a tropical island, Guantánamo offers activities such as snorkeling, paddleboard yoga, and kickboxing to those who aren’t imprisoned. Even so, the officer said they would rather be home than on this assignment on the taxpayer’s dime.
Transporting staff and supplies to the island and maintaining them on-base is enormously expensive. The government paid an estimated $16,500 per day, per detainee at Guantánamo, to hold those accused of terrorism, according to a 2025 Washington Post analysis of DOD data. (The average cost to detain immigrants in ICE facilities in the United States is $157 a day.)
Even so, the funding has skyrocketed: Congress granted ICE a record $78 billion for fiscal year 2026, a staggering increase from $9.9 billion in 2024 and $6.5 billion nearly a decade ago.
Last year, the Trump administration also diverted more than $2 billion from the national defense budget to immigration operations, according to a report from congressional Democrats. About $60 million of it went to Guantánamo.
“Detaining noncitizens at Guantanamo is far more costly and logistically burdensome than holding them in ICE detention facilities within the United States,” wrote Deborah Fleischaker, a former assistant director at ICE, in a declaration submitted as part of a lawsuit brought by the American Civil Liberties Union early last year. In December, a federal judge rejected the Trump administration’s request to dismiss a separate ACLU case questioning the legality of detaining immigrants outside the United States.
Anne Schuchat, who served with the PHS for 30 years before retiring in 2018, said PHS deployments to detention centers may cost the nation in terms of security, too. “A key concern has always been to have enough of these officers available for public health emergencies,” she said.
Andrew Nixon, an HHS spokesperson, said the immigration deployments don’t affect the public health service’s potential response to other emergencies.
In the past, PHS officers have stood up medical shelters during hurricanes in Louisiana and Texas, rolled out Covid testing in the earliest months of the pandemic, and provided crisis support after the deadly shooting at Sandy Hook Elementary School and the Boston Marathon bombing.
“It’s important for the public to be aware of how many government resources are being used so that the current administration can carry out this one agenda,” said Stewart, one of the nurses who resigned. “This one thing that’s probably turning us into the types of countries we have fought wars against.”
Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.
