Not long after Immigration and Customs Enforcement (ICE) agents descended on Chicago in September, CommunityHealth, a volunteer-run clinic serving immigrant communities, went into lockdown.

For weeks, federal agents lingered outside nearby medical centers but had not come to CommunityHealth. Then on a crisp October day, ICE agents gathered a block away from the clinic in the predominantly Latino neighborhood of Little Village.

The clinic’s decision to not allow anyone in or out of the building for several hours was intended primarily to protect patients, but the fear and stress extended to the over 50 staff members and volunteers who had been forced to consider their safety since ICE arrived in Chicago.

Staff were “very scared that they will be at the wrong place at the wrong time and get arrested even though they are here legally and documented,” said Emily Hendel, a family nurse practitioner who is the director of clinical services at CommunityHealth.

Because of the many challenges faced by immigrants, clinicians who treat these patients have long had to play roles that went beyond just medical care: helping patients and their families navigate living in the US, such as assisting with school enrollment or helping to translate documents.

As thousands of ICE agents are deployed across the US, physicians, nurses, and clinic staff often become trusted figures for families who rely on them through births, deaths, and illness, and sometimes trauma. Clinicians say they are helping families prepare for the possibility that one or both caregivers may be detained. And they are advising patients on when diagnostic tests can wait while offering practical solutions, such as pharmacy delivery.

“Visits take longer when people are upset and tearful and stressed,” Hendel said. “You can’t focus on being efficient; you have to really give space for them to share how they are doing emotionally.”

Strained Providers

More than 60% of patients at St John’s Community Health Center in Los Angeles are Latino. In the first 6 months of 2025, more than 90% of people detained by ICE were Latino, according to a report from the University of California, Los Angeles.

Carlos Sermeno, MD, pediatrician at St John’s Community Health, has seen the impact of the immigration crackdown and how detention and deportation shake up families. While completing his residency in 2019 in the Bronx, New York, Sermeno regularly cared for children who had been separated from their parents at the border and put into the foster care system.

“I would get questions from the kids asking where their mother was; they didn’t have any news for months,” Sermeno said.

For months during his residency, Sermeno endured the mental strain of navigating these questions. When he moved to Los Angeles, Sermeno continued to work primarily with immigrants but said the last few years have been relatively normal. Now, he is once again navigating a precarious situation with his patients who come from immigrant families. 

“I have experiences now that bring me back to that time in New York,” he said.

In recent weeks, Sermeno has treated children presenting with sleep disturbances driven by fear that their parents may be taken away during the night. In many cases, older siblings accompany patients to appointments to minimize the risk associated with caregivers leaving the home. These circumstances often complicate the collection of accurate medical histories, as young patients and their siblings are limited in their ability to provide complete information. In several cases, patients’ primary caregivers have already been deported.

“There have been times where I’ve had to go to the bathroom to take a deep breath for a couple of seconds, calm my mind, and then go out and see the next patient,” he said.

Sural Shah, MD, chair of the Council on Immigrant and Family Health at the American Academy of Pediatrics, said pediatricians’ requests for guidance on how to navigate moral distress in their job have led the group to discuss drafting guidelines to create more resources for clinicians.

“They want kids to have circumstances that will support their health and well-being, and it’s really hard to see families scared, being separated from each other, and skipping health appointments out of fear,” said Shah, a pediatric primary care physician who practices in Los Angeles. “It’s very, very difficult to be a pediatrician or any provider on the frontlines.”

‘Do You Have a Plan?’

Even before ICE agents entered cities in 2025, healthcare clinicians reported an increase in patients not showing up for appointments, mainly because of fear that the Trump Administration would enforce actions on immigration. Once the raids started, clinicians in Los Angeles and Chicago said their no-shows increased drastically. At St John’s Community Health, 50% of patients did not come to appointments in June. Sermano said more patients were also not following up for appointments with specialists.

In Chicago, CommunityHealth patients cancelled appointments or switched them to telehealth. These virtual appointments increased by 730% from October 2024. The clinic also saw new patient registrations drop by 50% compared with the same month the previous year, and no-shows increased by 20%.

Patients were “afraid of leaving their homes,” Hendel said.

Tania Caballero, MD, a pediatrician at Baltimore Medical System in Baltimore, helps families prepare for the event that one or both caregivers are detained. She wrote a long checklist to go over during each visit: What happens to their child that is left behind? Do caregivers have a list of their child’s medications at home? Have they talked to the school and given another adult permission to pick their kids up?

“Years ago, we were hearing about separation of families on the border, but we had not been hearing about parents being separated from kids in our community, especially not in this way, where parents are taken away from their kids in public and abruptly,” Caballero said. “This is every child’s nightmare.”

Her patients also call her when a family member gets detained. 

“Kids see one of their parents aggressively detained in front of them. They won’t eat, they can’t sleep, the remaining parent is traumatized, and one source of income is lost, so they call us,” she said. “Often, we are providing some therapeutic guidance for parents over the phone or telehealth. I provide guidance on providing routines for their child and predictability in their regular days.”

Practical Solutions

In Chicago, CommunityHealth began automatically offering patients the option to change their appointment to telehealth within appointment reminders.

But “people are still forgoing critical things,” including vaccines, lab work, and mammograms, Hendel said.

Shah said many patients will not come in for diagnostic tests for conditions like diabetes or for medication monitoring. And she has written letters for patients whose cases are moving through immigration court, detailing the impact a deportation would have on a child with complex health needs such as cancer, congenital heart issues, or asthma. She refers families to pro bono immigration lawyers.

Shah said about 75% of her patients who are immigrants have switched their appointments to telehealth since ICE raids began. Sermeno, of St John’s Community Health, said he dedicates 1 day per week to telehealth visits and that his virtual appointments are up 60% from 2024.

Both CommunityHealth and St John’s Community Health have partnered with pharmacies that deliver medications to patients’ homes for little or no additional cost.

And in March, before ICE agents began raids in Los Angeles, St. John’s Community Health also expanded their home visit service and, in some cases, delivered groceries to patients who were afraid to leave their homes.

Sermeno has changed the way he refers patients to specialists. 

“We are making different decisions with medical care now, factoring in whether it’s safe for them to leave their homes,” he said. “For some, I tell the parents, ‘I’m going to make these referrals for these treatments, but this is not something that is urgent, so try to stay safe at home, and if you need to do something urgently, I will let you know.”

Kaitlin Sullivan is a journalist living in Colorado.