Caring for Families Affected by Immigration Enforcement

JM, a 42-year-old patient with type 2 diabetes, presents for a telehealth follow-up appointment after an emergency department visit for diabetic ketoacidosis. For the past year, JM was not receiving care and not taking prescribed medications because of concerns about insurance eligibility and cost. Fear of immigration enforcement and uncertainty about how their personal information might be used led them to avoid clinic visits. JM also describes psychosocial stress, including worry about potential detention or deportation and who would care for their children, which is contributing to poor sleep, anxiety, and difficulty managing chronic conditions. How can I best help JM manage their chronic conditions amid their stress surrounding immigration enforcement?

Immigration enforcement affects health. Policies that include mass deportation, detention of children and families, enforcement in sensitive locations, and changes to insurance and public benefits shape access to health care services and health outcomes.^1,2 Immigrants, spanning from undocumented individuals to naturalized citizens, report postponing or avoiding medical care due to fear and uncertainty.³ Additionally, immigrants, especially families with children, report chronic stress, anxiety, and avoidance of essential activities.⁴ These factors lead to exacerbations of chronic illness, more advanced disease presentations, and missed opportunities for preventive care and early intervention.

The US Immigration and Customs Enforcement's (ICE) sensitive areas policy, which limited immigration enforcement in schools, places of worship, and health care facilities, was rescinded in January 2025.⁵ Since then, with escalating enforcement across the country, more interactions between ICE and health care professionals have created growing tension regarding patient privacy, clinical autonomy, and law enforcement's role in medical decision-making. Clinicians are experiencing moral distress while caring for immigrants in this climate of fear and disruption, particularly when they perceive that the presence or actions of ICE may compromise trust, confidentiality, or the therapeutic relationship.⁶ Table 1 details resources for clinicians caring for patients affected by immigration enforcement.