HOUSTON (AP) — A whistleblower report provided to BuzzFeed News alleges U.S. Immigration and Customs Enforcement has “systematically provided inadequate medical and mental health care” to detained migrants, leading to complications that included the removal of part of an 8-year-old boy’s forehead.

The report published Thursday says poor medical care contributed to two preventable surgeries and contributed to four deaths in detention. It renewed harsh criticism from migrant advocates and Democrats of President Donald Trump’s immigration crackdown, during which there have been reports of squalid conditions in packed cells and crying children left to fend for themselves after being taken from their parents.

At the Stewart Detention Center in Lumpkin, Georgia, a man who was bleeding through his skin continued to receive aspirin even though he had extremely thin blood. The man was eventually taken to a hospital in critical condition and not expected to survive, according to a report summarizing the complaint that was delivered to ICE leadership in March.

In Arizona, a detainee at the Eloy Federal Contract Facility had “worsening psychosis-related symptoms, but the psychiatrist failed to treat him,” the report says.