The public health costs of allowing ICE in hospitals

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The public health costs of allowing ICE in hospitals

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The Trump administration moved this week to end longstanding protections barring Immigration and Customs Enforcement (ICE) from conducting raids in hospitals and medical clinics. This decision is not only cruel; it is a public health catastrophe in the making.

Hospitals are meant to be sanctuaries — places where people seek care without fear. If people without documentation fear that stepping into a hospital will expose them to ICE, many will avoid medical care altogether. This fear will lead to preventable suffering and death, not only among undocumented immigrants but also within the broader community. Infectious diseases will spread unnecessarily, chronic illnesses will worsen, and emergency situations that could have been easily treated will become fatal for those too afraid to seek help. Children with undocumented parents will suffer. Women may avoid prenatal care and attempt to give birth at home without proper support, leading to increased preventable complications and both infant and maternal mortality. The ripple effects will endanger public health as a whole and further undermine the ethical credibility and morale of the U.S. health care field.

Undocumented workers are also essential to the very functioning of our health care systems. From home health aides to nurses, janitors, and food service staff, undocumented people play critical roles in hospitals, clinics, and care teams. They are often the ones ensuring that patients receive basic daily care, that facilities are clean and safe, and that the behind-the-scenes work necessary for medical institutions to operate smoothly is done. By harming these workers, either because they themselves are targeted or because their families and communities are under siege, the health care system will face wide-ranging disruptions, particularly in underserved and rural areas where labor shortages and understaffing are already acute. Targeting undocumented workers and their communities with mass arrests and deportation directly threatens the very systems we rely on to care for the sick and vulnerable.

Health care workers are on the front lines of this crisis, and what we choose to do in response to it will either worsen suffering or alleviate it. We must rise to meet this moment with courage and clarity. As doctors, nurses, hospital administrators, and allied health professionals, we have a fundamental duty to provide care to everyone who walks through our doors. That duty is incompatible with cooperation with ICE. Effective care requires trust, and trust is impossible if patients believe their health care providers are embroiled with policing systems and deportation threats.

To protect our patients and uphold our ethical obligations, health care workers must prepare ourselves and one another to respond to ICE incursions into our workplaces. This begins with understanding our rights and responsibilities. First and foremost, under protections ensured by the Fourth Amendment, ICE agents cannot enter the private spaces of a clinic or hospital without a proper warrant. All patient care areas are private spaces. If ICE shows up, health care workers should immediately verify whether the agents possess a valid warrant. A proper warrant must be issued by a U.S. district court or state court and will display this information clearly on its letterhead. If ICE cannot produce such a warrant upon request, staff should respectfully but firmly request that they leave the premises.

According to the Immigration Defense Project, ICE agents may misrepresent themselves as local police in order to trick people into giving them information, allowing them into private spaces, or to lure people out into public spaces. But ICE agents do not have the same authority as police officers. Unless authorized by specific agreements, ICE agents only have enforcement power over immigration-related violations; they do not have authority to enforce other laws, nor do they have authority — like police do — to bypass requirements for judicial warrants to enter private spaces under exigent circumstances, such as imminent danger. Unless a judicial warrant specifically requires it, health care workers are not obligated to share any information with ICE about themselves, their patients, or their co-workers. It is within our legal rights, and our professional ethical obligations, to refuse to hand over identification or documents simply because ICE asks for them. The law can protect us, but only if we know and exercise the rights that it still affords us (for now).

In addition to knowing the law, which should include reviewing “Know Your Rights” materials from organizations like the National Immigration Law Center and Interrupting Criminalization (which offers a consult service for health workers and organizations), health care workers must develop clear protocols for responding to ICE. These protocols should include:

  1. Alerting all co-workers immediately: If ICE agents are spotted, staff should quickly inform their colleagues and activate a pre-established response plan.
  2. Documenting the encounter: Record the names and badge numbers of the agents, as well as any actions they take. Use phones to record video footage, which can serve as evidence in case of rights violations.
  3. Refusing ICE agents entry unless they present a valid warrant that lists specific areas of your clinic or hospital and the persons or things to be seized.
  4. Staying silent: Exercise the right to remain silent and encourage others to do the same. Refrain from providing any information to ICE agents.
  5. Avoiding physical obstruction: While it is essential to protect patients and co-workers, physically obstructing ICE agents or providing false information can lead to prosecution. Instead, use lawful methods to ensure agents act within lawful limits.

Health care institutions must also take collective action. Administrators should publicly affirm their commitment to protecting patients from ICE and implement comprehensive training for all staff on how to handle such situations. Hospitals and clinics must build partnerships with legal advocates, immigrant rights organizations, and community groups to ensure robust support systems are in place. In the end, although we should avail ourselves of every possible legal resource, it is only through mutual aid, strategic preparation, and everyday practices of solidarity that we can protect one another from the threat of state violence.

ICE incursions into hospitals are a direct attack on the foundational principles of medical ethics and public health. We cannot stand by and allow fear to undermine our duty to care for those in need.

Eric Reinhart is a social psychiatrist, psychoanalytic clinician, and political anthropologist based in Chicago.


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