Elisha Waldman is incoming associate chief of the division of palliative care at Lurie Children’s Hospital of Chicago.
As a health-care provider, I find it an honor every time a parent allows me to play a part in their child’s care, even for something as simple as a check-up. This may sound like an exaggeration, but there is truly something sacred in parents bringing a child to a hospital or health clinic. This act is fundamentally an expression of faith in the system, of trust that the team will do everything possible to help their child.
But imagine having to choose between providing your child with essential health care and protecting the integrity of your family. This is the dilemma now facing thousands of undocumented immigrants living in the United States. Given the increasingly anti-immigrant rhetoric from our federal government — including bills passed Thursday in the House targeting undocumented immigrants and so-called sanctuary cities — and increasingly aggressive actions by agencies such as Immigration and Customs Enforcement, parents who are undocumented have to ask themselves whether bringing their children for even routine health care could trigger an alert and arrest.
Hospitals have long been among the “sensitive locations” generally protected from ICE actions. But there is no guarantee, in the current political climate, that this policy will continue. Even under the Obama administration, the country experienced newly aggressive immigration enforcement. This included arrests of children on their way to school, also traditionally considered sensitive locations.
The concept of sensitive locations was eroding even before the current heating-up. It comes as no surprise, then, that children’s hospitals and other pediatric health-care providers across the country have been reporting a decrease in use of health-care resources by undocumented immigrants in recent months. Actual numbers are difficult to obtain; most medical centers do not document parental immigration status. But within the field, there have been widespread anecdotal reports of reduced emergency department use, along with a drop in regular well-child visits.
This of course puts these individual children at risk, which should concern all of us for what it says about how we, as a society, care for the most vulnerable among us. But if that doesn’t move you, consider the broader public-health implications of such a trend. Fewer children brought in for routine health care means fewer children receiving the routine vaccinations of childhood, such as measles and meningitis. Fewer children brought in for treatment of illnesses means more children out in the community with untreated communicable diseases, such as tuberculosis. This reservoir of potential vectors of infectious disease affects everyone. Germs have no interest in immigration status.
This problem urgently needs to be addressed on two levels. First, we need ironclad assurances from elected officials and law enforcement that, barring true extenuating circumstances such as a serious criminal violation, health-care sites will remain sacred, safe spaces. Health-care workers should not have to worry about what they will do if an ICE agent shows up at their workplace demanding access to a family seeking treatment. Parents should not have to worry about being arrested while seeking proper care for their child.
Second, hospitals and clinics also need to take a stand, now, loudly and publicly. This is an issue that transcends politics; health care is a human right. Medical centers should educate patients and families. Hospitals should distribute materials informing families of their rights, as some have already started doing. We must reassure patients and families that they are in a safe space when they come to us — that they will be protected and nurtured while seeking care for their children, and have no need to fear being reported.
At the moment, thankfully, ICE raids on hospitals and medical clinics remain only a theoretical possibility. One hopes that the designation of such sites as sensitive locations will continue to be honored. For vulnerable communities, however, the threat feels all too real, and it is already affecting their health-care choices. For the children in those communities, and for the sake of the health and safety of all of us, health-care providers, officeholders and law enforcement must join to draw a clear line: In America, the sacred trust placed by parents in their child’s health-care provider is inviolate — now and forever.