A man lay on the sidewalk in New York City, injured by a gunshot, holding his side.

Emily Bolgaard, a social worker providing supplies to the homeless through her nonprofit, discovered him and prepared to call 911. Nonetheless, the man pleaded with her not to make the call.

“No, no, no,” he insisted.

Bolgaard attempted to reassure him that federal law mandated hospitals to treat patients regardless of immigration status, but his fear was palpable.

“He expressed, ‘If I go to the emergency department, I’ll be on their radar,'” she recounted in an interview about the event.

Across the nation, healthcare professionals are increasingly worried that individuals with severe medical issues, including injuries and chronic illnesses, are forgoing treatment due to fears of arrest by immigration officials. After the Trump administration’s announcement of extensive deportation plans, the Biden administration’s strategy of safeguarding areas like hospitals and clinics has led to a noticeable increase in patient anxiety and a decrease in treatment uptake.

If this trend persists, healthcare professionals indicate that the consequences could be severe. Uncontrolled infectious diseases could spread, healthcare costs would rise due to untreated chronic conditions, and complications during childbirth may pose increased risks to women delaying care.

In a KFF survey, 31% of immigrants reported concerns that their status (or that of family members) could adversely affect their health. About 20% of all surveyed migrants shared struggles with diet and sleep, while 31% experienced increased stress and anxiety.

A White House representative did not respond to a request for comment. Following the announcement on January 21 to end protections at hospitals, a statement from the Department of Homeland Security indicated that the updated policy was “designed to enforce immigration laws and apprehend criminal foreigners.”

Research indicates that immigration enforcement actions are associated with deterioration in birth outcomes, negative mental health effects, decreased care access, and reduced public program utilization that alleviates illness and poverty.

“We are not only creating significant health risks, but also long-term economic risks for our nation,” stated Julie Linton, a pediatrician and member of the American Academy of Pediatrics’ Federal Committee. “These policies instill very real fear and uncertainty among people, drastically impacting their daily functioning.”

Chronic Conditions

Numerous immigrant communities grapple with a high prevalence of chronic diseases, including hypertension and diabetes. Without treatment, this can lead to serious complications like heart attacks and strokes.

Doctors express concern for patients like Maria, a 47-year-old pre-diabetic woman who has visited the same primary care clinic since arriving in the U.S. from El Salvador two decades ago. Even during the first Trump administration’s crackdown on immigrants, she sought medical care consistently. However, after protections around hospitals were lifted earlier this year, Maria canceled her appointment to check her blood sugar.

“We are in the clinic and deeply afraid of ICE arriving while we wait,” she said in Spanish.

Maria, who requested to remain anonymous, described herself as being in “continuous anguish.” She is formulating a plan to care for her American citizen child in the event she and her husband are deported.

One of her daughters, aged 15, is being treated for fatty liver disease, while another child requires care for developmental issues. Their eldest daughter has a doctor’s appointment scheduled for June. Maria and her husband wish to continue their child’s treatment but are apprehensive about attending appointments alone. “It’s very complicated,” Maria said. “I can risk myself for my child, but when it comes to my own health, I prefer to let it go.”

The repercussions of forgoing regular medical care can escalate quickly. Jim Manzia, president of St. John’s Community Health Network in Los Angeles, described a diabetic patient who ceased attending weekly diabetes education classes. Upon contacting her, the clinic staff discovered she was too terrified to even go grocery shopping and had subsisted on tortillas and coffee for days.

“We’re thankful we managed to reach her and that she came in,” Manzia noted. The network serves approximately 25,000 undocumented patients across more than 20 locations. Clinic exams indicated her blood sugar levels were dangerously elevated.

“This is becoming increasingly common,” Manzia lamented. “It breaks my heart to discuss these situations.”

Acute Care

In emergency care settings, doctors have noted several unusual indicators reflecting the impact of immigration enforcement. For instance, Dr. Amy Zidan, an emergency physician in Atlanta, reported a more than 60% decline in requests for Spanish interpretation in her hospital’s emergency department from January to February.

Theresa Cheng, an ER physician at Zuckerberg San Francisco General Hospital, recounted an incident where one of her residents cared for an immigrant patient who had sustained multiple facial fractures from an assault but hadn’t sought care for over two weeks. “There is an overwhelming sense of fear,” Dr. Cheng stated.

In late January, Dr. Cheng treated a patient with severely untreated diabetes. The undocumented woman shared her terror and had been waiting for assistance. Tragically, she passed away that same day.

Dr. Carolina Miranda, a family physician in the Bronx, discussed a patient granted legal asylum, yet fearing ICE, who missed an appointment regarding a potential brain tumor.

Similar delays and cancellations have been observed among pregnant women and new mothers nationwide. Dr. Caitlyn Bernard, an obstetrician in Indiana, noted a patient who skipped a postnatal visit, indicating she no longer felt safe leaving her house. Staff on the obstetrics floor of a San Diego hospital reported a significant drop in immigrant women experiencing acute pregnancy-related issues following the administration change.

“These women undeniably still exist,” a doctor, choosing to remain anonymous due to institutional restrictions on public statements, expressed. “I fear this will drive up maternal mortality rates over time.”

Children’s Health

Many children of immigrant parents who skip appointments or leave prescriptions unfilled are American citizens. In mixed-status families, parents facing deportation often hesitate to bring their children to clinics or pharmacies.

Pediatricians serving underserved populations in Central Coast California reported a 30% increase in missed child appointments. Many families who sought professional care for their children, including evaluations for speech therapy and autism, cited fear as a barrier, with some wishing to remain anonymous due to the sensitive nature of their situations.

Dr. Tania Caballero, a pediatrician at Johns Hopkins, has encountered parents reluctant to visit emergency rooms, including those with children suffering from chronic conditions such as cerebral palsy, asthma, and diabetes.

“I tell my patients, ‘I cannot control what happens outside of my clinic. I can’t ensure against an ICE visit, but you know me, and I possess the resources to help you navigate this journey together,'” she explained.

Some parents facing dire circumstances, like those of children undergoing cancer treatment, believed their child’s medical conditions might shield them. They sought letters from pediatricians outlining their child’s medical needs, hoping this information would convince immigration authorities to allow them to remain in the U.S. for survival.

Dr. Lisa Gwyn, a pediatrician in South Florida, reported alarming drops in patient attendance as families from the Caribbean and South America miss essential pediatric vaccinations needed to prevent illnesses like measles, pneumonia, and whooping cough.

Dr. Gwyn also expressed concern for children who have endured significant trauma before arriving in the U.S. and who are not connected with social workers or psychologists for needed support.

“Imagine a child living in a home filled with fear. They came to this country hoping to find safety, only to feel afraid again,” she said. “We understand that prolonged stress negatively impacts health. Children who are stressed perform poorly in school and often battle mental health issues, including anxiety and depression.”

Hospital Dilemma

Some medical facilities have stated they will comply with immigration authorities. NYU Langone has issued warnings to employees cautioning against attempting to shield undocumented patients. However, many other health centers and organizations are finding ways to protect their patients by displaying “Know Your Rights” information and advising staff not to log immigration status in patients’ medical records.

Last week, the New England Journal of Medicine published an article detailing how physicians continue to provide healthcare while legally distancing themselves from ICE requests.

The St. John’s Clinic Network in Los Angeles recently instituted an ambitious home visit initiative where doctors, nurses, and medical assistants conduct examinations and deliver medication, working to inform all undocumented patients of this service.

The New York Regional Hospital Association proposed designating a “hospital contact” to quickly guide law enforcement to private offices, emphasizing the necessity of viewing signed warrants.

In the emergency department at University Hospital, a safety-net facility in Newark, staff distribute cards in Spanish and other languages to remind patients of their rights, stating, “You have the right to refuse consent to searches of yourself, your car, or your home.”

Yet, fear remains palpable. Dr. Annaly M. Baker, an emergency physician, recounted witnessing a young woman who had been beaten unconscious waiting for hours to receive care.

Dr. Baker also attended to a minor who had been stabbed but required parental consent for treatment. The boy was reluctant to provide details, fearing that his parents might be caught in immigration enforcement.

What troubles Dr. Baker most is the number of people who never seek treatment at all.

“The tragic message to these individuals is to remain hidden, and I hope you don’t die,” she remarked.

Sarah Cliff contributed to this report.