critics denounced as unlawful and inhumane. Moreover, members of the current administration contend that Mr. Trump’s decision to freeze a portion of the aid to the region in 2019 ended up blunting the impact of the work being done to improve conditions there.

But experts say the reasons that years of aid have not curbed migration run far deeper than that. In particular, they note that much of the money is handed over to American companies, which swallow a lot of it for salaries, expenses and profits, often before any services are delivered.

Record numbers of Central American children and families were crossing, fleeing gang violence and widespread hunger.

independent studies have found.

“All activities funded with U.S.A.I.D.’s foreign assistance benefit countries and people overseas, even if managed through agreements with U.S.-based organizations,” said Mileydi Guilarte, a deputy assistant administrator at U.S.A.I.D. working on Latin America funding.

But the government’s own assessments don’t always agree. After evaluating five years of aid spending in Central America, the Government Accountability Office rendered a blunt assessment in 2019: “Limited information is available about how U.S. assistance improved prosperity, governance, and security.”

One U.S.A.I.D. evaluation of programs intended to help Guatemalan farmers found that from 2006 to 2011, incomes rose less in the places that benefited from U.S. aid than in similar areas where there was no intervention.

Mexico has pushed for a more radical approach, urging the United States to give cash directly to Central Americans affected by two brutal hurricanes last year. But there’s also a clear possibility — that some may simply use the money to pay a smuggler for the trip across the border.

The farmers of San Antonio Huista say they know quite well what will keep their children from migrating. Right now, the vast majority of people here make their money by selling green, unprocessed coffee beans to a few giant Guatemalan companies. This is a fine way to put food on the table — assuming the weather cooperates — but it doesn’t offer much more than subsistence living.

Farmers here have long dreamed of escaping that cycle by roasting their own coffee and selling brown beans in bags to American businesses and consumers, which brings in more money.

“Instead of sending my brother, my father, my son to the United States, why not send my coffee there, and get paid in dollars?” said Esteban Lara, the leader of a local coffee cooperative.

But when they begged a U.S. government program for funding to help develop such a business, Ms. Monzón said, they were told “the money is not designed to be invested in projects like that.”

These days, groups of her neighbors are leaving for the United States every month or two. So many workers have abandoned this town that farmers are scrambling to find laborers to harvest their coffee.

One of Ms. Monzón’s oldest employees, Javier López Pérez, left with his 14-year-old son in 2019, during the last big wave of Central American migration to the United States. Mr. López said he was scaling the border wall with his son when he fell and broke his ankle.

“My son screamed, ‘Papi, no!’ and I said to him, ‘Keep going, my son,’” Mr. López said. He said his son made it to the United States, while he returned to San Antonio Huista alone.

His family was then kicked out of their home, which Mr. López had given as collateral to the person who smuggled him to the border. The house they moved into was destroyed by the two hurricanes that hit Guatemala late last year.

Ms. Monzón put Mr. López in one of her relatives’ houses, then got the community to cobble together money to pay for enough cinder blocks to build the family a place to live.

While mixing cement to bind the blocks together, one of Mr. López’s sons, Vidal, 19, confessed that he had been talking to a smuggler about making the same journey that felled his father, who was realistic at the prospect.

“I told him, ‘Son, we suffered hunger and thirst along the way, and then look at what happened to me, look at what I lost,’” Mr. López said, touching his still-mangled ankle. “But I can’t tell him what to do with his life — he’s a man now.”

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Europe’s Dilemma: Take In ISIS Families, or Leave Them in Syria?

When Belgium said in March that it would repatriate some women who had joined the Islamic State, along with their children, Jessie Van Eetvelde welcomed the decision with relief — even though she knows it will likely mean time in prison.

She and her two children have been living for at least two years in detention camps in Syria. Her dream, she says, is to have her children, whose father fought for the Islamic State, attend school in Belgium. For that, she is ready to pay the price of having joined the militant group in 2014, if Belgium will take her back.

“Maybe they realized that those who want to go back are sorry and want a second chance,” Ms. Van Eetvelde, 43, said recently in a WhatsApp voice message.

Many European countries have balked at allowing the return of people linked to ISIS, yet some, like Belgium and Finland, are now heeding the advice of security experts and rights groups who say that repatriations are the safest option.

lost its last territorial foothold in Syria, more than 200 women from 11 European countries and their 650 children are living in two Syrian camps, Al Hol and Roj, according to figures compiled by Thomas Renard, a researcher at the Egmont Institute, a Brussels-based think tank.

Although the Europeans represent a small fraction of the 60,000 people being held in the camps, who are mostly Iraqis and Syrians, European governments are facing increasing pressure to bring the adults back to face trial amid an argument that the countries’ inaction violates their commitment to human rights.

Security experts, rights groups and lawyers of those who went to ISIS territories acknowledge that European governments face legitimate security concerns, along with political dynamics in countries fearful of terrorist attacks. But a growing number of government and intelligence officials say that leaving European citizens in Syria comes with greater risks, including that they could join terrorist groups that target Europe.

Kazakhstan and Turkey have repatriated many of their own citizens to prosecute them and, in some cases, reintegrate them into society.

The Kurdish leadership in the region that oversees the camps has not prosecuted the women, whose roles under ISIS’s rule often remain unclear. And because the administration is not internationally recognized, any prosecutions would still not get them out of their legal limbo.

Most European countries say that they have no legal obligation to help their citizens in the camps and that adults who joined ISIS should be prosecuted in Iraq and Syria.

Save the Children.

Reprieve says that many women in the camps were trafficked, raped and forced into marriage and domestic servitude.

Yet in several European countries, repatriations remain out of the question, said a French intelligence official who requested anonymity to discuss the topic. Part of the hesitancy, security analysts say, is that repatriated women could receive light or no prison sentences.

Britain has stripped British citizenship from nearly 20 women who joined ISIS, in some cases taking them to court to prevent their return. France has turned down numerous calls for repatriation, even as some of the women staged a monthlong hunger strike. The Netherlands and Sweden said that they might take in children, but without their mothers.

France reels from years of terrorist attacks, the government has opposed calls to repatriate people who left to wage jihad.

Although France has taken in 35 children from the camps on a case-by-case basis, 100 women with French citizenship and their 200 children remain mostly in the Roj camp, according to Jean-Charles Brisard, the director of the Paris-based Center for the Analysis of Terrorism.

France was due to repatriate at least 160 of them in early 2019, according to intelligence documents brought to light by the newspaper Libération that spring and seen by The Times this year. But the situation in the camps became too volatile, the French intelligence official said, and the plan was abandoned.

asked the International Criminal Court to consider whether the country’s policy makes President Emmanuel Macron complicit in war crimes.

A French woman who went on hunger strike in the Roj camp said that there was no running water and that many people there had respiratory problems. (The Times is not publishing her name, because she says she has received death threats from ISIS supporters who oppose their return to France.) “It’s very difficult to see doctors and dentists — there are no medicines,” she said, adding that the Frenchwomen wanted to return “to be tried, to be jailed.”

Jussi Tanner, a diplomat from Finland who is in charge of his country’s repatriations, said the women and children’s return was not a matter of “if, but of when and how.”

“Repatriating them as quickly as we can is better from a security point of view rather than pretending that the problem goes away when we look away,” he said. “You can leave them there, but they will return anyway.”

Claire Moses, Christopher F. Schuetze and Jasmina Nielsen contributed reporting.

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Japan Is Shaken After a Detainee, Wasting Away, Dies Alone in Her Cell

NAGOYA, Japan — First came a high fever. Then her face and limbs turned numb. Soon, she could keep down little more than water, sugar and bites of bread as she wasted away in her cell in a Japanese detention center.

By early March, Wishma Rathnayake — a migrant from Sri Lanka who was being held for overstaying her visa — could barely make a fist and was having trouble speaking, according to government records detailing her care. Yet week after week, as she begged to be released to a hospital for treatment, her jailers refused. She and her supporters believed the authorities had already made their own diagnosis: that she was faking her illness to avoid deportation.

On March 6, at the age of 33, Ms. Rathnayake died alone in her cell.

Her case has become a source of outrage for critics of Japan’s immigration system, who say that Ms. Rathnayake was the victim of an opaque and capricious bureaucracy that has nearly unchecked power over foreigners who run afoul of it.

The tragedy has spurred a national reckoning. Japan, a country with a long history of hostility toward immigration, is now grappling with its at-times inhumane treatment of foreigners, especially people of color, and many are calling for change.

They point to a system in which most immigration decisions are made in secret, offering migrants little recourse to the courts. Those who overstay their visas or who have entered the country illegally can be held indefinitely, sometimes for years. And migrants who file asylum claims, as Ms. Rathnayake once did, are particularly unwelcome.

Japan, the world’s third-largest economy, settles less than 1 percent of applicants seeking asylum, including just 47 last year — a point of contention among other countries that have called on Tokyo to do more.

Immigration officials are “police, prosecutors, judges and jailers,” said Yoichi Kinoshita, who left the government’s immigration bureau over its lack of clear standards to guide its sometimes life-or-death decisions. He now runs an advocacy group focused on fixing the system.

On Tuesday, the Japanese government, facing growing pressure over Ms. Rathnayake’s death, made two major concessions.

The governing Liberal Democratic Party abandoned an effort to revise Japan’s immigration law, as opposition lawmakers said they would not start debate over the changes unless the government released video footage of Ms. Rathnayake taken in the detention center just before she died.

The government had argued that the revisions would improve treatment of detainees, in part by stopping lengthy detentions, which have drawn sharp criticism from human rights groups for decades. But critics took particular issue with changes that would have allowed Japan to forcefully repatriate asylum seekers, potentially returning them to dangerous situations in their home countries.

Also on Tuesday, the justice minister, Yoko Kamikawa, agreed to meet with Ms. Rathnayake’s two sisters in order to “express my condolence.” Ms. Kamikawa has repeatedly declined to address the specifics of Ms. Rathnayake’s death, whose cause has yet to be officially determined. She has said she will withhold comment until the immigration bureau has completed an inquiry into the case. The bureau, in a statement, reiterated her remarks.

Ms. Kamikawa announced the meeting as her ministry, which administers the immigration bureau, has come under regular attack in the news media for its role in Ms. Rathnayake’s death and its evasiveness about the causes. Protesters have gathered nearly every day in front of Parliament, and objections lodged by opposition lawmakers have been unusually fierce.

These lawmakers want to overhaul an immigration system in which the outcomes for those caught inside can be bleak. At least 24 detainees have died since 1997, according to the Japan Lawyers Network for Refugees. Activists have alleged government negligence in some cases, most recently the deaths in 2020 of an Indonesian man and in 2019 of a Nigerian man on a hunger strike. Official inquiries have not supported the accusations.

None of those cases have inspired the public anger engendered by the death of Ms. Rathnayake, a hopeful young woman who had come to Japan with dreams of teaching English.

In the summer of 2017, she began studying Japanese at a school in the Tokyo suburbs. On her Facebook page, she shared photos of trips to Buddhist temples and to the mountains, where she delighted in snow.

Around six months into her program, she began skipping class, said Yuhi Yokota, the school’s vice principal. Before long, she moved into an apartment with her boyfriend, another Sri Lankan student she met in Japan. The couple then disappeared, a development that school officials reported to immigration authorities, Mr. Yokota said.

Hoping to stay in Japan, Ms. Rathnayake applied for asylum status, but the government denied a request to renew her residence permit, and she withdrew her application. Officials soon lost track of her.

Then, last August, she appeared at a police station in Shizuoka, on the Pacific coast of central Japan, asking for protection from her boyfriend, who she said had abused her. She said she wanted to go home, but had less than $20 to her name.

The authorities were more interested in another problem: Her residence permit had expired and she was in Japan illegally. They sent her to a detention center in Nagoya, a few hours southwest of Tokyo, to await deportation.

Several months later, she received a letter from her ex-boyfriend. He knew that she had reported him to the police, he wrote, adding that he would seek revenge if she returned to Sri Lanka.

Ms. Rathnayake decided she would be safer in Japan. With the encouragement of a local nonprofit organization, START, she decided to try to stay.

The move irritated officials at the detention center, said Yasunori Matsui, the group’s adviser. They demanded that she change her mind, she told him during one of his frequent visits.

In late December, Ms. Rathnayake fell ill with a fever, and within weeks she was having trouble eating, according to the nonprofit.

She tried to pass the time by watching television, but the commercials for food made her unbearably hungry.

Ms. Rathnayake was suffering from extreme anxiety, doctors found. A nurse suggested dealing with it by writing a diary with all of the things she was thankful for. In late January, a doctor prescribed her vitamins and painkillers. After they made her vomit, she resisted taking more.

Care was limited at the detention center’s medical facility, which was more like an infirmary than a clinic.

Officials said her problems were caused by “stress,” she wrote in a letter to Akemi Mano, a local activist, adding that “they don’t take me to the hospital.”

The authorities took Ms. Rathnayake to a gastroenterologist in early February. The exam was inconclusive, but if she could not keep down her medicine, she should be hospitalized, the doctor wrote in a medical report reviewed by The New York Times. The comment conflicts with the official government account of the visit, which says no recommendation for hospitalization was made.

Ms. Rathnayake was returned to the detention center. Soon, she could no longer walk. When she met with her representatives of START, she was rolled out in a wheelchair with a bucket in her lap.

She had filed for a provisional release in January, citing anxiety. Detention centers had already released hundreds of healthy detainees because of concerns about the coronavirus, but in mid-February, her application was denied without explanation. Soon after, she submitted a second one on medical grounds. She was so weak she could barely sign the form, Mr. Matsui said.

Despite the severity of her symptoms, officials waited until March 4 to take Ms. Rathnayake to a hospital. A psychiatrist who examined her wrote that her sponsors had told her that being sick would improve her chances of being released, according to a medical record reviewed by The Times and first reported by TBS, a Japanese broadcaster. START denies the allegation.

The cause of Ms. Rathnayake’s illness was unclear, the doctor noted. While it was possible that she was faking, he wrote, there would be no harm in granting her request for medical release, adding that “if you think about the patient’s benefit, that’s probably best.”

Two days later, Ms. Rathnayake was dead.

At the end of April, a group of opposition lawmakers held a video meeting with Ms. Rathnayake’s mother and sisters. One after another, they conveyed their deepest apologies and asked what they could do to help assuage the family’s grief.

“I want to know why they let her suffer,” her mother said. “Why didn’t they take her to the hospital as soon as possible?”

For now, the family can only speculate. An interim report on Ms. Rathnayake’s death, released by immigration officials last month, is filled with minute detail, like blood pressure and oxygen saturation readings during each checkup, the exact time she was administered medicine for her headaches or chest pain, every bite of food she ate or rejected.

But it omits the most important information: an answer for Ms. Rathnayake’s mother.

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Uruguay and Coronavirus: The World’s Highest Death Toll Per Capita

BUENOS AIRES — For most of the past year, Uruguay was held up as an example for keeping the coronavirus from spreading widely as neighboring countries grappled with soaring death tolls.

Uruguay’s good fortune has run out. In the last week, the small South American nation’s Covid-19 death rate per capita was the highest in the world, according to data compiled by The New York Times.

As of Wednesday, at least 3,252 people had died from Covid-19, according to the Uruguayan Health Ministry, and the daily death toll has been about 50 during the past week.

Six out of the 11 countries with the highest death rates per capita are in South America, a region where the pandemic is leaving a brutal toll of growing joblessness, poverty and hunger. For the most part, countries in the region have failed to acquire sufficient vaccines to inoculate their populations quickly.

a highly contagious variant first identified in Brazil last year.

“In Uruguay, it’s as if we had two pandemics, one until November 2020, when things were largely under control, and the other starting in November, with the arrival of the first wave to the country,” said José Luis Satdjian, the deputy secretary of the Health Ministry.

The country with the second-highest death rate per capita is nearby Paraguay, which also had relative success in containing the virus for much of last year but now finds itself in a worsening crisis.

Experts link the sharp rise in cases in Uruguay to the P.1 virus variant detected in Brazil.

“We have a new player in the system and it’s the Brazilian variant, which has penetrated our country so aggressively,” Mr. Satdjian said.

Uruguay closed its borders tightly at the beginning of the pandemic, but towns along the border with Brazil are effectively binational and have remained porous.

The outbreak has strained hospitals in Uruguay, which has a population of 3.5 million.

On March 1, Uruguay had 76 Covid-19 patients in intensive care units. This week, medical professionals were caring for more than 530, according to Dr. Julio Pontet, president of the Uruguayan Society of Intensive Care Medicine who heads the intensive care department at the Pasteur Hospital in Montevideo, the capital.

That number is slightly lower than the peak in early May, but experts have yet to see a steady decline that could indicate a trend.

“It is still too early to reach the conclusion that we’ve already started to improve, we’re in a high plateau of cases,” Dr. Pontet said.

Despite the continuing high number of cases, there is optimism that the country will be able to get the situation under control soon because it is one of the few in the region that has been able to make quick progress on its vaccination campaign. About a quarter of the population has been fully immunized.

“We expect the number of serious cases to begin decreasing at the end of May,” Dr. Pontet said.

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Uruguay Death Toll Soars as Virus Slams South America

BUENOS AIRES — For most of the past year, Uruguay was held up as an example for keeping the coronavirus from spreading widely as neighboring countries grappled with soaring death tolls.

Uruguay’s good fortune has run out. In the last week, the small South American nation’s Covid-19 death rate per capita was the highest in the world, according to data compiled by The New York Times.

As of Wednesday, at least 3,252 people had died from Covid-19, according to the Uruguayan Health Ministry, and the daily death toll has been about 50 during the past week.

Six out of the 11 countries with the highest death rates per capita are in South America, a region where the pandemic is leaving a brutal toll of growing joblessness, poverty and hunger. For the most part, countries in the region have failed to acquire sufficient vaccines to inoculate their populations quickly.

a highly contagious variant first identified in Brazil last year.

“In Uruguay, it’s as if we had two pandemics, one until November 2020, when things were largely under control, and the other starting in November, with the arrival of the first wave to the country,” said José Luis Satdjian, the deputy secretary of the Health Ministry.

The country with the second-highest death rate per capita is nearby Paraguay, which also had relative success in containing the virus for much of last year but now finds itself in a worsening crisis.

Experts link the sharp rise in cases in Uruguay to the P.1 virus variant from Brazil.

“We have a new player in the system and it’s the Brazilian variant, which has penetrated our country so aggressively,” Mr. Satdjian said.

Uruguay closed its borders tightly at the beginning of the pandemic, but towns along the border with Brazil are effectively binational and have remained porous.

The outbreak has strained hospitals in Uruguay, which has a population of 3.5 million.

On March 1, Uruguay had 76 Covid-19 patients in intensive care units. This week, medical professionals were caring for more than 530, according to Dr. Julio Pontet, president of the Uruguayan Society of Intensive Care Medicine who heads the intensive care department at the Pasteur Hospital in Montevideo, the capital.

That number is slightly lower than the peak in early May, but experts have yet to see a steady decline that could indicate a trend.

“It is still too early to reach the conclusion that we’ve already started to improve, we’re in a high plateau of cases,” Dr. Pontet said.

Despite the continuing high number of cases, there is optimism that the country will be able to get the situation under control soon because it is one of the few in the region that has been able to make quick progress on its vaccination campaign. About a quarter of the population has been fully immunized.

“We expect the number of serious cases to begin decreasing at the end of May,” Dr. Pontet said.

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Guantánamo Detainee Agrees to Drop Call for C.I.A. Testimony

WASHINGTON — A detainee at Guantánamo Bay has agreed to a deal intended to lead to his release in the next few years in return for giving up the right to question the C.I.A. in court about its torture program, United States government officials said.

The deal, negotiated by the Pentagon official who oversees the military commissions that serve as a court for some detainees, was reached in recent weeks, and comes as a number of those who have been charged at Guantánamo are seeking to cite their abuse at the hands of the C.I.A. as part of their defense.

Under the deal, the prisoner, Majid Khan, 41, who has pleaded guilty to serving as a courier for Al Qaeda, would complete his prison sentence as early as next year and no later than 2025 and then could be released to another country, assuming one will take him, according to people who have seen the terms or are familiar with its details.

In exchange, Mr. Khan will not use his sentencing proceedings to invoke a landmark war court decision that allowed him to call witnesses from the C.I.A.’s secret prison network to testify about his torture.

2014 Senate investigation. He was also sleep deprived, kept naked and hung by his wrists, and hooded, to the point of hallucinations.

Mr. Khan was transferred to Guantánamo Bay in 2006 and saw a lawyer for the first time in his fourth year of detention. In 2012, he pleaded guilty to terrorism-related charges stemming from his work for Al Qaeda after the Sept. 11 attacks, and agreed to postpone his sentencing while he cooperated with government prosecutors.

On April 16, he and his lawyers reached agreement with the overseer of military commissions for a sentence that would end sometime between early next year and March 1, 2025.

The agreement itself is under seal, at least until a judge questions Mr. Khan on whether he voluntarily entered into it. But several people, speaking on the condition of anonymity to describe details of the deal, said that it has a sentencing range of 11 to 14 years, applied starting with his guilty plea in 2012.

prosecutors failed to disclose certain evidence. Colonel Watkins retires from the Army on Aug. 1 and was replaced on the case Wednesday by an Air Force judge, Col. Mark W. Milam.

The agreement is the first involving a Guantánamo detainee that the Biden administration has reached since taking office. It was made by Jeffrey D. Wood, a National Guard colonel who was appointed by the Trump administration to the civilian role of convening authority for military commissions.

had actually seen Mr. Khan in C.I.A. detention.

The issue had been simmering but had not come to a head because travel restrictions during the coronavirus pandemic brought most military commission hearings to a standstill for the last year.

The question of whether Mr. Khan could receive a reduction in his sentence because of his torture was also a potential model for the defense in the capital conspiracy case against Khalid Shaikh Mohammed and four other men accused of plotting the Sept. 11 attacks. Defense lawyers for all five defendants say there is evidence that each was systematically tortured in the black sites, and they want a judge or jury to hear graphic details about it to avert a death sentence when the long-delayed case eventually proceeds.

Two contract psychologists who devised the C.I.A.’s interrogation program, James Mitchell and John Bruce Jessen, have been publicly identified. But the identities of the people who interrogated Mr. Khan, and in which countries where they did it, are still classified at the court, which operates under rules that the government says are intended to balance state secrets and fair trial rights.

Prosecutors argued that anonymous, in-person testimony about Mr. Khan’s treatment, whether in a classified session or in public, risked exposing covert U.S. government employees, and said it was not possible to take them to Guantánamo Bay. That left the possibility of the judge ordering their appearances, prosecutors refusing to bring them and as a remedy, the judge reducing Mr. Khan’s sentence.

filing on April 22, Mr. Khan’s lawyers will also ask the judge after sentencing to void the June 2020 ruling that found credit for pretrial punishment is an available remedy at a military commission — undercutting its potential use in the Sept. 11 case.

Mr. Khan has been kept apart from the other former C.I.A. prisoners at Guantánamo since he pleaded guilty. At that time, he became a government informant, and has been debriefed on demand although prosecutors have yet to hold a trial where his testimony would be needed.

In pleading guilty he admitted to delivering $50,000 from Mr. Mohammed to militants in Indonesia that was used to finance the bombing of a Marriott hotel in Jakarta, Indonesia, in 2003, killing 11 people. Three men at Guantánamo have been charged in that plot, but have yet to be arraigned and have no trial date.

During the Trump administration, Mr. Khan was also listed as a government witness in a planned federal prosecution of another Pakistani man, Uzair Paracha. Mr. Paracha was convicted in 2005 in New York of federal terrorism-related offenses, but the conviction was overturned. Rather than retry him last year, federal prosecutors dropped the case in exchange for Mr. Paracha voluntarily giving up his U.S. residency and returning to Pakistan, after 17 years of incarceration.

For Mr. Khan, the path out of Guantánamo may be more complex. Successive U.S. administrations have argued that a convicted war criminal who completes his sentence may still be held at Guantánamo in the quasi-prisoner of war status of a detainee, as long as the United States considers itself to be at war with Al Qaeda and other terrorist groups.

Also, it is unclear where Mr. Khan would go. He was born in Saudi Arabia, lived as a child in Pakistan but went to high school in suburban Baltimore and had asylum in the United States before he returned to Pakistan after the Sept. 11 attacks. By law, he cannot be sent to the United States.

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