A shocking Department of Homeland Security memo obtained by BuzzFeed News reveals how inadequate medical care contributed to the deaths of at least four immigrants in the custody of Immigration and Customs Enforcement, or ICE. The memo includes revelations from an ICE whistleblower about how one man died from meningitis after “grossly negligent” care. The whistleblower also said official reports on one of the four deaths were “very misleading.”

The DHS memo also includes reports of immigrants being administered incorrect medication or being given such grossly inadequate medical care that they had to have preventable surgeries. One of the victims of medical neglect was an 8-year-old child whose rare infection inside his skull was misdiagnosed as an ear infection. He was given only ear drops. A few weeks later, after the infection spread, the child had to have his frontal bone surgically removed.