During the past year, I found it hard to explain, to family and friends, a strange truth. I was reporting on places where starvation and dehydration deaths had unfolded across a span of weeks or months—but these were not overseas famine zones or traditional theatres of war. Instead, they were sites of domestic lawlessness: American county jails. After meeting Carlin and Karina, I identified and scrutinized more than fifty cases of individuals who, in recent years, had starved to death, died of dehydration, or lost their lives to related medical crises in county jails. In some cases, hundreds of hours of abusive neglect were captured on video, relevant portions of which I reviewed. One lawyer, before sharing a confidential jail-death video, warned me, “It will stain your brain.” It did.

The victims were astoundingly diverse. Some, like Mary, were older. Some were teen-agers. Some were military veterans. Many were parents. In nearly all the cases I reviewed, the individuals were locked up pretrial, often on questionable charges. Many were being held in jail because they could not afford bail, or because their mental state made it hard for them to call family to express their need for it. (These jail deaths would not have occurred, several lawyers pointed out to me, in the absence of the cash-bail system.) Others were awaiting psychiatric evaluation or a court-mandated hospital bed. Often, the starvation victims were held in solitary confinement or other forms of isolation, which is well proved to deepen psychosis. Some were given no toilet and no functioning faucet, or were expected to sleep on mats on concrete floors, in rooms where the lights never turned off.