I first learned to fear the police when I was just nine years old. I had recently come to the U.S. from Mexico without legal documents. I quickly realized that uniforms and sirens could change a family’s life in an instant. I learned to avoid certain streets and to keep quiet, as fear became a part of my everyday life.
After years of challenges, I finally obtained a work permit through DACA and became a U.S. citizen in 2019. Today, I am a family medicine doctor in rural North Carolina, serving a mostly Spanish-speaking community. This area lacks adequate maternity care, so I train future doctors to continue this important work.
I don’t share my background with patients to build trust. Instead, trust develops through thoughtful explanations and respecting their hesitations. I understand what it’s like to navigate systems that weren’t designed for people like me.
Fear greatly affects whether individuals seek medical care. Recent reports of civilian deaths during immigration enforcement operations are alarming. We often view immigration enforcement as a legal or political issue, but it also deeply influences who accesses healthcare and when.
In my clinic, fear shows up in missed prenatal appointments and patients who delay seeking help until symptoms worsen. Pregnant women may hesitate to go to hospitals due to the risks they perceive during transit. After childbirth, follow-up care is crucial, but silence and fear can have deadly consequences.
Trust in a physician can’t erase the fear tied to immigration enforcement. Even patients with deep trust hesitate at times. Research shows that increased immigration enforcement leads to a decrease in healthcare usage, affecting even U.S. citizen children in mixed-status families. Families become hesitant to seek preventive or emergency care, leading to worse health outcomes. Fear spreads beyond legal status to envelop entire communities.
Pregnancy adds another layer of risk. The U.S. has one of the highest maternal mortality rates in high-income countries, with women of color and those in rural areas facing the highest risks. A frequent cause of these deaths is missed warning signs or delayed follow-up. Continuity of care saves lives, yet that continuity is disrupted by fear.
Historically, periods of stricter immigration enforcement, from the Chinese Exclusion Act to post-9/11 measures, repeatedly push immigrants to the fringes of society. This not only damages community health but also creates long-lasting harm. Other countries show similar patterns. In parts of Europe, aggressive enforcement has driven marginalized groups away from essential services, worsening health disparities.
Today, immigration enforcement is closely tied to a healthcare system already in distress. Many rural hospitals are closing, and maternity services are disappearing. In this environment, enforcement not only intimidates individuals but also jeopardizes entire healthcare systems. Trust in clinics erodes, leading to late presentations and more severe health issues.
As a physician, I witness this not as an ideological issue but as a breakdown of the system. A healthy healthcare system depends on predictability and trust. When patients fear seeking help, it leads to a domino effect: increased emergency room visits, advanced illness at diagnosis, and worse maternal outcomes, all putting extra pressure on an already stretched system.
We don’t need to disregard immigration law entirely. We need to recognize that healthcare and immigration enforcement cannot coexist safely. Health settings should have protections against enforcement activities, ensuring families can seek medical attention without fear. Countries that separate health services from immigration enforcement tend to see better health outcomes.
While my life may be labeled as an immigrant success story, the more pressing narrative is how fear restricts access to care. When fear infuses healthcare settings, the entire system suffers. If lawmakers continue to separate immigration policies from healthcare, we risk ignoring the bigger picture and continuing to see preventable illnesses and deaths.
The real question is whether our healthcare system can effectively function while fear acts as a barrier to care.
Jesus Ruiz, M.D., is a family physician and clinical assistant professor in North Carolina, focusing on rural maternity care and immigrant health.
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patients,Physicians,public health,reproductive health
