Immigration-enforcement operations — particularly large-scale raids by U.S. Immigration and Customs Enforcement (ICE) — have far-reaching consequences for community health, health care access, and clinicians’ ability to provide timely care. The fear that these operations generate extends beyond the targeted individuals, affecting mixed-status families, children, and entire communities. Current immigration enforcement is disrupting medical follow-up, exacerbating mental health symptoms, causing more patients to skip preventive care, and deepening mistrust in public institutions.1 In my clinical practice, I have seen sharp increases in anxiety, school absenteeism, deferred visits, and acute psychiatric symptoms after enforcement events. These effects are both predictable and preventable. Clinicians, health systems, and policymakers should recognize immigration enforcement as a social determinant of health currently implicated in a public health crisis and act accordingly.

Immigration enforcement extends far beyond workplace raids. Heightened surveillance, checkpoints, and the presence — real or rumored — of agents in community spaces create pervasive uncertainty. Even immigrants with legal status avoid seeking care because ICE actions are perceived as unpredictable and indiscriminate. These patterns affect many immigrant communities, each experiencing distinct forms of fear and disrupted care. Families alter daily routines in response not only to actual enforcement action but to the possibility of it; even the threat of such activity is associated with stress-related pregnancy complications and reduced health care utilization.

Nearly one in five U.S. residents are Hispanic, and in many regions — including where I work in Oregon — children commonly live in mixed-immigration-status households. In these families, one parent may be undocumented, the other may have Deferred Action for Childhood Arrivals (DACA) status or Temporary Protected Status (TPS), and the children are often U.S. citizens. The DACA program grants temporary protection from deportation and work authorization to certain immigrants who were brought to the United States as children. TPS provides similar temporary protection to immigrants from countries affected by conflict, natural disaster, or other crises. Because these programs depend on shifting federal policies and require renewal — DACA every 2 years and TPS sometimes every 6 months — families live in constant uncertainty, which amplifies the health effects of immigration enforcement.

In the days after such actions, clinics see increased no-show rates, canceled appointments, and interrupted treatment. Parents postpone well-child checks, and adults with diabetes, hypertension, or pregnancy complications avoid routine visits out of fear that seeking care could expose their families to risk. Immigration enforcement is associated with decreased health care seeking and reduced access to needed services.3 Patients also defer diagnostic testing, postponing imaging, laboratory monitoring, and specialty consultations that are essential for disease management. These delays often continue for weeks, worsening disease control and contributing to preventable complications.