In the lobby of a downtown New Orleans hotel, 30 doctors and med students sprawled across a marble floor. The September 10 die-in was targeting the Immigration and Customs Enforcement (ICE) field office, covering five southern states, which is housed in the same building as the Hyatt; more specifically, it was a last-minute attempt to prevent the deportation of Yoel Leal, a 51-year-old with serious health issues, who came to the U.S. a year ago to request asylum after being assaulted by police in his native Cuba.
In 2016, before Donald Trump took office, ICE released 75 percent of eligible asylum seekers in the Deep South, but today ICE keeps the vast majority in detention while their cases are processed. Rather than being released to his wife, a legal Florida resident, Leal remained in ICE custody for 11 months after making his asylum claim. According to the advocacy group Congreso de Jornaleros, he was moved from the Mexican border to Louisiana to Mississippi to Alabama. (New Orleans-based ICE spokesperson Bryan Cox said Leal was held the first five months to await trial, which is standard procedure.) In February, he received an order of deportation and, per Cox, would have been viewed by the agency as a flight risk—even though in detention his legs grew so swollen from gout, a condition that he had previously been able to manage, that he couldn't walk and other detainees had to help him to the cafeteria and showers.
In May, Leal was taken to an emergency room with pneumonia. An X-ray showed a mass that indicated a more worrisome issue than gout. The radiologist told Leal it was probably cancer. Leal never received a biopsy, even as his shortness of breath worsened.
Three doctors reviewed his medical records and wrote multiple letters to ICE officers and Congress on Leal's behalf, stating that he should have received an immediate biopsy. "NSCLC [non-small cell lung cancer] is treatable when discovered at early stages," internist Catherine Jones wrote in a letter dated September 6. "Allowing months to pass, knowing malignancy is likely and not pursuing even diagnosis, much less treatment, ensures that the cancer will have progressed during this time. There is a significant possibility it will have progressed to a stage where treatment is not an option, causing premature and preventable death."
Leal is one of 15 plaintiffs in a class action lawsuit filed by the Southern Poverty Law Center. According to the suit, detainees have experienced delayed or absent treatment for anaphylactic shock from food allergies, a brain parasite, diabetes, cerebral palsy, and other illnesses. "All persons in ICE custody receive comprehensive medical care," said Cox. According to Cox, ICE could have used "prosecutorial discretion" to halt a deportation order based on "mitigating circumstances," but the agency chose to go forward with Leal's removal.
Cases like Leal's have inspired opposition from a host of activist organizations, including Congreso, part of the New Orleans Workers' Center for Racial Justice, which organized a rally in front of the Hyatt for Leal the day before his die-in. But this opposition also comes from medical professionals, who increasingly view ICE's alleged mistreatment of detainees as a stain on their profession. Doctors have acted as whistleblowers, discouraged their colleagues from taking staff positions in ICE facilities, and marched in the streets.
Historically, doctors have skewed politically conservative and some have participated in racist atrocities, such as forced sterilization and the infamous Tuskegee experiment, in which doctors didn't treat Black men for syphilis in order to observe the disease progression. But in recent years many doctors have embraced left-of-center causes that intersect with their profession, including gun control, government-funded healthcare, and, most regularly and frequently, the right of detained migrants to obtain medical care.
"I think there's a sea shift in people going into medicine," said Kiersta Kurtz-Burke, a rehab physician in practice for 16 years, who participated in protests in New Orleans. "If you're 22 and you want to make a lot of money, you're going into tech. You're not going to go through a 10-year training program that puts you in a massive amount of debt. Now medicine is more self-selected for people who really want to help."
Keith Chappel, a Massachusetts-based ER physician, once considered himself a Republican, but Trump has caused him to reassess. "As a physician, my political ideology always takes a back seat to my Hippocratic Oath… to do no harm to patients," he said. "For many doctors, these current detention camps run against the commitment to this oath."
Other medical professionals feel their jobs give them a form of privilege they should utilize to advocate for patients, even if those patients aren't their own. Sarah Talia Himmelfarb, 35, a third-year resident, was one of a group of protesters who blocked traffic in a Congreso-led protest outside of the Hyatt. Frustrated drivers yelled and blared horns. One SUV drove through the line, slamming hard against a protestor, who was rattled but uninjured. Himmelfarb worried that an arrest would lead to her being fired from her clinical position at a local teaching hospital. But she knew she wanted to be there.
"I do have this kind of prestige as a doctor, and I have people who would want to get me out of jail," she said.
Himmelfarb and eight other activists were charged with obstructing traffic and spent several hours in jail. Later Himmelfarb received a letter from the state medical licensing board, asking her to write a statement about her arrest. It's a process she will have to repeat throughout her career.
"I felt like I was doing my work," she said. "I was advocating for somebody's health."
"Maybe this will close some doors, but maybe it will open some doors," said Kurtz-Burke. "Or maybe you don't want to be in a program where they're not comfortable with you taking a stand on this."
Himmelfarb and a few other doctors and advocates spent the entire night of September 11, the day before Leal's scheduled deportation, contacting the Federal Aviation Authority, Delta Airlines, and the Atlanta airport to alert all parties that it was risky—and possibly lethal—for someone with compromised lung capacity to fly. (The reduced oxygen and increased pressure could cause Leal's blood oxygen to plunge to a dangerous level.) Ultimately they found a security guard willing to intervene, but by the time the guard arrived at the gate, the plane was gone. It had taken off four minutes early. (He is still alive in Cuba and seeking treatment.)
Himmelfarb didn't cry until the plane was halfway to Cuba. Then, as the adrenaline subsided, she began to think about Leal trying to breathe, in what would be excruciating conditions. She felt her own chest tighten. She had treated patients during asthma attacks, or with pneumonia, heart failure, lung cancer or COPD. She had seen people gasp, desperate for air.
Some of the doctors advocating for immigrants are seasoned organizers. Lara Jirmanus, the founder of Boston's Health and Law Immigrant Solidarity Network, a lobbying and educational organization, came to medicine as a second career, to better serve those she had been advocating for in her previous role as an organizer. So did Ian Kim, the founder of the Sacramento Chapter of Doctors for Camp Closure (D4CC). Others, including many of the doctors participating in the New Orleans-based die-in for Leal, had never demonstrated before. For many, it was the clinical details of a particular case or general media reports about conditions inside detention facilities that spurred them to action.
In July 2018, a psychiatrist and an internist working for the Department of Homeland Security wrote a joint letter to the leaders of the Senate Whistleblower Protection Caucus. In the detention centers, they had seen a one-year-old lose 30 percent of his body weight in 10 days and a four-week-old with an intracranial bleed that had been missed by staff. They saw children vaccinated with adult doses and multiple fingers crushed in spring-loaded doors.
By this August, the CDC had reported 931 cases of mumps in detention centers. There have also been outbreaks of measles and chickenpox. A team of Johns Hopkins physicians reviewed the autopsy reports of three children who died in Customs and Border Patrol custody*, documenting that a contributing cause of death was influenza. They sent their findings to Congressional leaders in a letter on August 1. After the report, CBP reiterated that it has no plans to vaccinate detainees for the flu.
The conditions at CBP and ICE facilities have provoked widespread outrage, and many have criticized the large corporations that continue to work with those government agencies. But medical professionals have perhaps a more personal stake in the issue than many protesters. Some of the doctors who have become activists work with vulnerable immigrant populations. Others simply know what it means to detainees and to overall public health when migrants don't get proper treatment.
A July job posting for a lead physician in a privately run ICE facility in Louisiana was removed from the Journal of the American Medical Association after doctors alerted media to problematic wording. The listed $400,000 salary is roughly four times the expected pay for a doctor with two years of experience. The job didn't require board certification, but it did require the candidate to be "philosophically committed to the objectives of this facility."
According to Jones, the New Orleans doctor who wrote a letter for Leal, the posting "asks doctors to put loyalty to ICE over loyalty to their patient. Medical standards prohibit dual loyalty"—placing the wellbeing of an ideal or institution before that of a patient.
Kate Sugarman, 58, spearheads a group of doctors who write letters to support asylum cases. Because her Washington, D.C. clinic primarily serves immigrants, she has close ties to the Ethiopian community and is regularly invited to their family events. Since 2005, Sugarman has been documenting torture scars to support the cases of asylum applicants, but she had never publicly demonstrated. Trump's family separation policy and the highly publicized prolonged detention of asylum seekers enraged her. She began demonstrating and canvassing, working to flip Virginia districts for Democratic candidates.
"As a Jew, I know what happens when people are put in camps," she said, "and it doesn't end well."
Kurtz-Burke, who has participated in protests in New Orleans and D.C., had similarly personal motivations. One of her former patients was a 10-year-old Honduran boy who was shot while asleep in the back of his family car while riding through his neighborhood. The bullet severed his spine, paralyzing him from the neck down. In Honduras, his family was told he would die, so they came to the U.S. seeking treatment.
"He can live a good life with proper care," she said. "When you have that experience with someone, it's really hard to have a hardened heart. But when all you're doing is watching Fox News, where they present it as huge groups of people streaming over the border, it's easier to cut off that compassionate part of yourself."
For the most recent doctor-led demonstration, Luz Contreras Arroyo, a family medicine doctor and psychiatrist from Sacramento, flew to D.C. for less than 48 hours. She couldn't get more than a day off work but thought it was critical that she join the other doctors in lobbying and protesting. "I came here illegally when I was four-years-old with my mom, who was seven and a half months pregnant," she said.
When they migrated in 1989, Arroyo's mother hid under California scrubs, her hand clasped over her daughter's mouth, while Border Patrol helicopters hovered low. "There are these internal, hippocampal emotions that come up when I hear of kids suffering in camps and kids that die in the river with their fathers," she said. "If we'd come 30 years later, I would have been separated from my mom."
Arroyo's medical training adds an additional layer to her story. "I understand what trauma does to children and how this has long-term ramifications… not just psychological but physical consequences. And then, the knowledge of how that leads to intergenerational trauma," she said. "It's not just that these kids are going to be screwed-up adults. It's their kids and their grandkids. It's just cruel, inhumane, and evil."
This weekend, an 18,000-member, D.C.-based group of physician citizen-lobbyists, Doctors for America, is holding a national conference. The panels include "Immigrant Health and Rights" and "Why Doctors Must Organize."
Doctors joke about white coats ("I only ever wear one when I protest," Kurtz-Burke said), but they know it's a powerful symbol. People these days may be inclined to distrust the media and politicians, but medical professionals still have a kind of prestige.
"People listen to doctors," Sugarman said. "They do what we tell them to do. It's our obligation to use that privilege to speak out."
Over the past three months, there have been at least four medical-led demonstrations, either on behalf of undocumented immigrants or in demand of an end to migrant detention. The Bay Area Do No Harm Coalition, Public Health Justice Collective, WhiteCoats4BlackLives, and Medicine for Migration organized an anti-detention demonstration in front of the San Francisco ICE Office in August.
In September, the California Nurses Association organized a 250-person demonstration in front of UCSF Benioff Children's Hospital on behalf of Isabel Bueso, a 24-year-old Guatemalan with a rare genetic disease. Bueso came to California at age seven, invited by doctors eager to study her condition. She has received weekly life-saving treatments through an Obama-era humanitarian program, but in August, the Trump administration announced that it was effectively ending the program.
On October 19, Kurtz-Burke, Sugarman, Arroyo and hundreds of other doctors marched the few blocks from the Navy Plaza to the Trump International Washington Hotel for a die-in organized by a three-month-old, 2,000 member collective of healthcare providers, Doctors For Camp Closure. As they approached, hotel employees tugged metal barriers in place.
Dozens of doctors clustered the sidewalks, while seven doctors lay on the ground in front of the barriers. Two doctors read out the names, nationalities, and causes of death of each of the 37 detainees who had died in ICE or CBP custody since April 2018, when "zero tolerance" (Trump's policy that separating families at the border) was broadly enacted. After each name, the doctors observed a minute of silence. These minutes were repeatedly interrupted by groups of tourists trying to go inside the Trump Hotel. Afterwards, the doctors marched to the White House, where roughly 40 doctors staged another die-in. They were joined on the ground by a handful of Hispanic kids who had come down with a New York youth organization to support the doctors' protest.
"With any kind of direct action, probably the two most important things that come out of it are publicity, having people know there are physicians who are morally opposed to this, but also, really strengthening our bonds as a collective group," said Kurtz-Burke. She returned from D.C. energized and mobilized, ready to collaborate with a contact she met to create a telehealth psych program for Louisiana-based asylum seekers.
Two days after the D.C. rally, D4CC put out a call for doctors willing to start local chapters. Within 24 hours, doctors in 10 states responded, including Texas and Louisiana—the states with the largest number of immigrant detainees.
"This is a human rights issue," said Marie DeLuca, a 29-year-old ER physician and a D4CC founder. "Despite the fact that it's become a partisan topic, doctors should be able to unite across the political perspectives and say we're not OK with what's going on at the camps and we're going to ask that they be closed."
Correction 11/5: An earlier version of this article incorrectly stated that the Johns Hopkins doctors performed autopsies of children who died in ICE custody. In fact, the doctors only reviewed autopsy reports. VICE regrets the error.