Our patient had done everything right. After years of suffering from advanced liver disease, she had recovered and was caring for herself and her family. She had community support and regular medical care, and the last time we saw her in clinic, she expressed a cautious but real sense of optimism.
Then everything collapsed.
Her husband and teenage son were taken off the street by Immigration and Customs Enforcement. Within hours of their arrest, they were pressured into signing self-deportation papers; within days, they were deported. Amid this terrifying situation, our patient stopped taking her medication and her health rapidly deteriorated.
In November, just a few weeks after the deportations, a life-threatening bleed left her unconscious at home. She died in the intensive care unit, without her family.
In June, another patient, still recovering from a recent stroke, was taken by ICE outside his home, seized in front of his wife and toddler. His stroke left him physically incapable of fleeing, yet two plainclothes officers manhandled him into an unmarked van and took him into custody.
After several weeks in Moshannon Valley Processing Center in central Pennsylvania, he was released, thanks to the efforts of family, legal advocates and his medical providers. When he came back to clinic, he was soft-spoken and visibly shaken. In detention he had missed weeks of medication, and he continues to deal with the undertreated effects of his stroke, which make walking difficult and returning to work impossible. He told us he struggles to sleep through the night and often feels exhausted and depressed.
What happened to our patients are the inevitable consequences of ICE treating people and families as targets rather than as human beings, carrying out enforcement without any consideration of medical risk or family circumstances. Detention, deportation and family separation don’t merely cause social and legal harm; they also create profound medical stress that exacerbates chronic disease, worsens mental health and induces medical crises.
Between the three of us, we have worked with undocumented patients for years across many administrations. Our patients have always dealt with fear of deportation, limited access to care and a paltry safety net. But the past year has brought a shift: Immigration enforcement has moved from a largely targeted system to a highly visible, indiscriminate one. The paramilitary-style raids in city streets, racialized targeting of people perceived as nonwhite, expanded data sharing between health and immigration authorities, and removal of sanctuary protections that previously prevented ICE activity in health care settings have fundamentally altered risk calculations for immigrant communities.
The fact that our patient was unable to get medication in immigration detention is a travesty, but not surprising. Across the country, families describe loved ones who entered custody with treatable illnesses and came home much sicker, or never came home at all, as a result of inadequate or delayed health care.
At least 32 people died in ICE custody in 2025, the deadliest year in two decades. Another six people have died this year. And things are likely to get worse. In October, ICE halted payments to third party medical providers who treated patients in its facilities. Infections spread rapidly in crowded facilities unable to deliver basic care. At the end of January, a detention center in Dilley, Texas that houses children reported at least two cases of measles.
Spaces once understood as safe — clinics, churches, schools, courtrooms — are no longer trusted. One patient of ours is at extremely high risk of stroke. She was prescribed a blood-thinning medication that requires regular laboratory monitoring. If the drug level is too low, it fails to prevent a stroke. If it is too high, it can cause catastrophic internal bleeding. Yet this patient for months was too afraid to leave her home and risk encountering ICE at a clinic or lab. It’s a cruel calculus: seek essential medical care and risk detention, or stay home and risk her life. Our once-vibrant waiting room is full of empty chairs now. For those patients who have simply disappeared, we are left to wonder whether they are hiding at home, detained, deported or dead.
The impact extends beyond undocumented individuals; fear is contagious. Even immigrants with legal status are, for good reason, afraid of being targeted by enforcement actions. Our patients tell us they are keeping their U.S. citizen children home from school because of fear of ICE.
Immigration is a polarizing and politically fraught issue, and our health care system is riddled with inequities that leave many citizens struggling to get basic care. Immigration policies are often justified by the claim that undocumented people overwhelm the system and take resources from working-class Americans.
But making it dangerous to seek medical attention does not make anyone safer or healthier. When people are deterred from preventive care, treatable conditions worsen, emergency department utilization increases, and costs rise for everyone. Our citizen patients are not better off when detention centers become hot spots for infectious disease outbreaks. Nor are they better off when undocumented patients are too afraid to seek care, get taken into ICE custody, or die because the trauma of family separation made their suffering unbearable.
Congressional Democrats have refused to fund the Department of Homeland Security unless Republicans agree to basic limits on ICE’s conduct, including ending masked operations and banning enforcement at sensitive locations like medical facilities, churches, schools and courts. Democrats should hold the line: These demands are a bare minimum. ICE must also be barred from searching Medicaid databases to target patients, and detention facilities should be subject to regular, independent health inspections with swift corrective action to prevent infectious disease outbreaks, medical neglect and avoidable deaths. These steps are needed to protect public health, reduce preventable illness and save lives.
Instead, our patients are more frightened and sicker than ever, and health care providers are grappling with the moral injury of watching communities fracture and suffer in real time. Hippocrates, the physician of ancient Greece, instructs us to “do no harm.” Yet harm now seems to be woven into the very environment in which we practice.
Elizabeth Whidden is a fifth-year M.D./M.P.H. student. Robin Canada is a primary care physician. D. Daphne Owen is an emergency medicine physician.
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