On a Wednesday morning earlier this month, Jane*, the coordinator for a mobile clinic at a temporary housing campus in Downey, just southeast ofLos Angeles, was weaving through the line of patients, helping them fill out routine forms.
Everything was normal, she recalled, until she glimpsed, from the corner of her eye, the facility’s security guard whisk away the cone that had been propping open the gate for the clinic, letting it swing shut. What had welcomed care now suddenly threatened capture.
Outside, a convoy of unmarked white SUVs rolled toward the entrance. Spotting the armed, masked men and out-of-state plates, Jane knew they were agents of US Immigration and Customs Enforcement (Ice) and so did her patients. As she tried to keep everyone calm, the clinic’s driver and security guard asked to see the agents’ warrant. But they didn’t have one,Jane said.
After a tense few minutes, the SUVs pulled off. The clinic stood its ground, and no one was hauled off – yet the fear lingered. AsIce raids sweep LA county, fixtures of normal life –school,workand now even the doctor’s office – have become hunting grounds cloaked in fear for the region’s immigrant residents.
“The clinic should be a safe place where people don’t have to think about anything but their health,” says Dr Bukola Olusanya, family nurse practitioner and regional medical director at St John’s CommunityHealth.
But the raids challenge that promise. “Everybody’s life has been put on pause because of this fear,” said Jane. And that pause threatens community health in LA.
In fact, the “pause in life” is quite literal. Since the raids started,St John’s Community Health, the network of community health centers across LA that Jane’s mobile clinic is part of, has seen its no-show rate jump from under 10% to over 30%, CEO Jim Mangia said. “People are too afraid to go to school or work, let alone come into the clinic,” he added.
The consequences can be disastrous, he warned. “One patient was too afraid to go to the grocery store, so she was eating tortillas and drinking coffee for five days,” he says. “When we went to her home, her blood sugar level was through the roof – she was on the verge of a diabetic coma.”
Sacrificing basic needs for a sense of safety has become a frighteningly common tradeoff. Since the start of the raids, Alice*, a 53-year-old undocumented mother of two, says her world has been confined to the walls of her home. “I am so nervous, I can’t even sleep,” she said through a translator. “I don’t go to the grocery store, to the laundromat, to the clinic. My house is like a little jail.” Her isolation has also suspended the livelihood she once earned from cleaning houses and selling Tupperware, she said.
And her health has suffered as a result. Prior to the raids, Alice never missed her hypertension appointments and consistently attended monthly health-education meetings. “She is one of the community members that really participates,” Ana Ruth, her community health worker, said. But Alice has missed her last two appointments, and her blood pressure has spiked – likely from stress and lack of medical attention.
St John’s has worked hard to reach these patients through their “Healthcare Without Fear” program, which “[sends] doctors and nurses to people’s homes to do their physical appointment in the home where they’re safe”, Mangia, the CEO, explains. But the home visits receive no state or federal reimbursement – so on top of the revenue lost from “a third of our patients not coming in because they’re afraid of Ice,” clinic finances take a double hit, Mangia says.
The financial shock will force St Johns to close some of its newly opened clinics and lay off staff, Mangia warns. “That’s going to cut access to healthcare for all our patients, not just our undocumented ones.”
And St John’s isn’t just in a tough financial spot – the clinic faces a fundamental contradiction in creed. “On the one hand, by law, we’re required to serve everyone regardless of ability to pay, race, creed, color, national origin or immigration status,” Mangia says. “But on the other hand, the president is threatening to take away funding for any state that serves the undocumented.”
DHS did not respond to a request for comment.
It’s a catch-22 health workers in cities across the US fear they’ll soon confront too. Springfield, Ohio, became a political flashpoint in the national immigration debate as theTrump-Vance campaign amplified false claimsabout its growing Haitian community, the majority of whom arrived underTemporary Protected Status (TPS)– a federal program granting temporary legal residence to migrants from crisis-hit countries.
That protectionends on 3 Augustfor Haitians, and Springfield is bracing for an ensuing enforcement blitz, like the one now shaking LA, that could leave its safety-net health systems especially worried.
Over the past few years, they’ve adapted to care for the newcomers, investing millions into interpretive services, training and outreach, said Ben Merick, vice-president of operations at Springfield Regional Medical Center. “At first, it was a strain, no doubt,” said Laura,* a local community health leader. “But now we’ve gotten really good at it.”
But if the scenes unfolding in LA replay in Springfield, “it [will be] terrible for everything our community has been able to build”, she said. The vast majority of Springfield’s Haitian residents work steady jobs, and thus “almost everybody’s covered with some sort of insurance”, Laura said. But once TPS ends, many will lose their jobs and health coverage, entering a legal and logistical limbo. With children enrolled in local schools and having put down roots in their new community, they are unlikely to leave immediately, Laura explains. As such, they will still need care – without any way to pay for it and under threat of immigration enforcement.
“At the end of the day, it doesn’t matter who they are, where they come from, what their payers are, if they have insurance – we will provide care,” Merick says. Though the commitment is unwavering andbacked by law, it will place heavy stress on a community that spent years integrating Haitian residents – now avital part of its economy– only to see them targeted for removal, Laura says.
As Ice raids spread, communities across the US face the same devastating calculus. “The collateral damage that’s being done to the American people is that healthcare is going to become much more expensive, less accessible and less availablefor everyone,” Mangia concludes. “It’s kind of a perfect storm.”
Several people in this story are identified through pseudonyms over fears of their safety and the safety of their families, to not jeopardize their immigration status and over concerns speaking out may threaten funding for their organizations