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Hospitals must remain sanctuaries: Why ICE has no place in health-care spaces

Fear of deportation, language barriers, and systemic inequities will delay or prevent critical medical care, leading to devastating consequences.

A 5-year-old child receives a COVID-19 vaccine at Hartford Hospital in Hartford, Conn., in 2021. Fear of deportation has already kept many patients from in-person visits at health clinics, write the authors.
A 5-year-old child receives a COVID-19 vaccine at Hartford Hospital in Hartford, Conn., in 2021. Fear of deportation has already kept many patients from in-person visits at health clinics, write the authors.Read moreJoseph Prezioso / MCT

On Jan. 20, President Donald Trump issued an executive order titled “Protecting the American People Against Invasion,” which repeals previous policies that limited immigration enforcement in sensitive locations such as health-care facilities, schools, and places of worship.

This policy change permits Immigration and Customs Enforcement (ICE) agents to conduct enforcement actions within these previously protected spaces, leading undocumented people to avoid essential and potentially lifesaving medical care.

As a fourth-year medical and public health student with experience in immigration case management and an emergency room physician who has dedicated more than a decade to caring for undocumented immigrants, we know firsthand what will happen next. Fear of deportation, language barriers, and systemic inequities will delay or prevent critical medical care, leading to devastating consequences.

It is with a sense of urgency that we feel compelled to speak out against the erosion of sanctuary in our health system.

The immigrant community is both substantial and integral to the city’s fabric. As of 2022, 15.7% of Philadelphia’s population was born outside the U.S., marking the highest share in eight decades. It is estimated that more than 50,000 undocumented people live in Philadelphia, contributing to industries such as construction, food services, and domestic work.

» READ MORE: Allowing ICE to arrest people in ‘sensitive locations’ would violate faith traditions and sacred spaces | Opinion

These workers are essential to the city’s economy, providing labor that supports infrastructure, local businesses, and households. Nationally, undocumented workers also pay billions of dollars annually in state, local, and federal taxes. Yet, despite their economic contributions, they remain excluded from essential social services, including health insurance.

Recent policy changes that allow ICE to enter health-care spaces shatter the trust and safety required for effective care. These changes will drive undocumented people further into the shadows, away from hospitals and emergency rooms, places where they should be met with compassion — not hostility.

Fear-driven delays in seeking care will also undermine the broader health and safety of our communities.

Further, allowing immigration raids in health-care settings erodes the image of these centers as places of refuge and respite for healing, and will make many patients feel less safe, immigrant or not.

Even in the short time since the inauguration, we have seen a notable decline in the visibility of immigrants in our city, including patients who are unwilling to come for in-person visits at our health clinic. Fear of deportation has already kept many of our patients from seeking care until their conditions have declined, resulting in unnecessary sickness and death.

For example, a 27-year-old patient recently died from widespread thyroid cancer — a disease that might have been treatable had he not delayed seeking care for months out of fear his undocumented status would be discovered. By the time he presented, we could only offer him comfort care as he faced the end of his life.

Similarly, we recently treated a 44-year-old patient who delayed seeking care for vision and gait difficulties due to similar fear of exposure of his immigration status. He ultimately suffered a stroke that left him unable to work or walk, but which also may have been prevented had he accessed prompt care. Fear of exposure also sacrificed his family’s livelihood.

» READ MORE: Our neighbors are being targeted by ICE. Who is stepping up to protect them? | In Conversation

Earlier this week, a patient of ours delayed presenting to the emergency room for symptoms that ended up being heart failure because he had heard ICE was outside the hospital. This rumor was later dispelled, but the fact that it could have been a reality led to very consequential delays in care. When we visited him in the hospital recently, he was overwhelmed by intense fear of ICE, in addition to already battling significant health challenges and experiencing anxiety about his upcoming surgery.

These stories are not isolated. They are the disturbing effects of a system that forces people to choose between health and safety.

Fear-driven delays in seeking care will also undermine the broader health and safety of our communities.

When people avoid health-care settings, their untreated illnesses spread, straining hospitals and overwhelming emergency response systems. Delays in care lead to more advanced disease states, requiring more intensive and costly treatments, and ultimately worsen health outcomes across the board.

Moreover, avoiding timely medical intervention increases the vulnerability of our community to the spread of infectious diseases, as preventable illnesses remain untreated and potentially transmissible. Public health systems, already stretched thin, must contend with the consequences of delayed care. Physicians, bound by the Hippocratic oath to do no harm, are placed in impossible ethical conflicts, unable to provide care without worrying about the potential consequences for their patients.

A hospital is not a place to enforce immigration policies. It is a sanctuary where care is determined by medical need, not by nationality, citizenship, or ability to pay.

Policies must reinforce, not erode, the principle that health is a human right. Ensuring health-care facilities remain safe and accessible for all, especially during public health emergencies, is not just an act of compassion, it is a moral and practical imperative.

The dignity and well-being of our patients — and the integrity of our health system — depend on it.

Elizabeth Whidden is a fourth-year student studying medicine and public health at the University of Pennsylvania and has worked and volunteered in community health clinics serving immigrants for the past five years. D. Daphne Owen is an assistant professor of emergency medicine at the University of Pennsylvania and has worked in nonprofit clinical settings serving uninsured people and immigrants for 15 years.