A death in a detention center north of Los Angeles in 2012 is one of more than 130 other deaths since 2003 in the 250 detention centers for immigrants. The causes of death range from asphyxia to cardiopulmonary arrest and drowning. More than 400,000 people pass through the national network of detention centers every year, and the industry is on the rise.

In 2012, more that 58,000 refugees were resettled in the United States. “These are truly survivors of war or survivors of torture, so in that case we see a high frequency of post-traumatic stress disorder and that are difficult to treat and at times also difficult to recognize,” said Marco Gemignani, who teaches psychology at Duquesne University and works with refugees at Catholic Charities Health Clinic.

The global suicide rate per 100,000 people is 16. The U.S. rate for the general population is 12.4. A study done last year found the Bhutanese rate is higher — 20.3 among refugees resettled in the U.S. and 20.7 among those in the refugee camps in Nepal. While there were suicide deaths reported among other refugee groups during that time, the numbers are not as high.

The first few months of a refugee’s life in the U.S. are filled with new experiences. And with doctor’s visits. All that initial care is covered by medical assistance. But when that coverage ends, refugees may still have outstanding health issues and no way to pay for them.

A few times a month, the Squirrel Hill Health Center’s Mobile Unit sets up in Pittsburgh’s Prospect Park, a neighborhood full of refugees. On board is a doctor, a medical assistant who is an Arabic-speaking Iraqi refugee — and someone who can handle all the paperwork. Also on board the bus is Praves Wagley, an ethnically Nepali, Bhutanese refugee who serves as a translator for many of the people who come for care. Trying to access health care without English language skills can often leave refugees in Pittsburgh lost in translation.