Science
Migrants Are Skipping Medical Care, Fearing ICE, Doctors Say
A man lay on a New York City sidewalk with a gun shot wound, clutching his side.
Emily Borghard, a social worker who hands out supplies to the homeless through her nonprofit, found him and pulled out her phone, preparing to dial 911. But the man begged her not to make the call, she said.
“No, no, no,” he said, telling her in Spanish that he would be deported.
Ms. Borghard tried to explain that federal law required hospitals to treat him, regardless of his immigration status, but he was terrified.
“He said, ‘If I go to the emergency department, that will put me on their radar,’” she recalled in an interview recounting the incident.
Across the country, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, including injuries, chronic illnesses and high-risk pregnancies, are forgoing medical care out of fear of being apprehended by immigration officials. Since the Trump administration announced plans for mass deportations and rescinded a Biden-era policy that protected spaces like hospitals, medical clinics and churches from immigration enforcement, doctors said they have seen sharp increases in patient anxiety and appointment no-show rates.
If the trend continues, health care officials say, the list of consequences could be long: Infectious diseases circulating unnecessarily; worsening health care costs because of untreated chronic illnesses; and dangerous birth complications for women who wait too long to seek help, among others.
In a survey conducted by KFF, a health policy research organization, 31 percent of immigrants said that worries about immigration status — their own or that of a family member — was negatively affecting their health. About 20 percent of all immigrants surveyed said they were struggling with their eating and sleeping; 31 percent reported worsened stress and anxiety.
A White House spokesman did not respond to messages seeking comment. When the administration announced that it was ending protections at hospitals on Jan. 21, a statement from the Department of Homeland Security said the new policy was intended “to enforce our immigration laws and catch criminal aliens.”
Research has shown that immigration crackdowns are linked with poorer birth outcomes and mental health status, lapses in care, and fewer people accessing the types of public programs that reduce illness and poverty overall.
“We’re really creating not just very serious health risks, but economic risks in the long run for our country,” said Julie Linton, a pediatrician and member of the committee on federal government affairs for the American Academy of Pediatrics. “These policies are creating very real fear and uncertainty for people and have a tremendous impact on their ability to function on a day-to-day level.”
Chronic Conditions
Many immigrant communities suffer from high rates of chronic conditions such as high blood pressure and diabetes, which, if left untreated, can lead to heart attack, stroke and other grave complications.
That is why doctors worry about patients like Maria, a 47-year-old woman with pre-diabetes, who has been going to the same primary care clinic ever since she arrived in the United States from El Salvador 20 years ago. Even during the first Trump administration’s crackdown on immigration, she continued to seek medical care. But when the protections around hospitals and clinics were rescinded earlier this year, Maria canceled her appointment to have her blood sugar checked, a routine and crucial element of diabetes prevention in patients like her.
“We’re very scared of being in the clinic and having ICE arrive while waiting to be called,” she said in Spanish, referring to U.S. Immigration and Customs Enforcement.
Maria, who asked that her last name not be published, said that she is in a state of “constant anguish.” She said she avoids leaving the house and is working on a plan for the care of her children, who are American citizens, in case she and her husband are deported.
One of their daughters, who is 15, is being treated for fatty liver disease and the other, 11, needs therapy for a developmental condition. Their older daughter has another doctor’s appointment in June. Maria and her husband don’t want to interrupt her care, but they are worried about taking her there themselves. “It’s very complicated,” Maria said. “I can put myself at risk for my children. But if it’s for my own health, I prefer to let it go.”
The consequences of abandoning regular medical care can turn serious quickly, however. Jim Mangia, president of St. John’s Community Health Network in Los Angeles described one patient with diabetes who stopped showing up for a weekly diabetes education class. When a clinic staff member called the woman, they discovered she was afraid to even go to the grocery store, and had been subsisting for days on tortillas and coffee, he said.
“Thank God we reached her and she came in,” said Mr. Mangia, whose network serves an estimated 25,000 undocumented patients across more than 20 locations. Tests at the clinic showed that her blood sugar had become dangerously high.
“That’s what we’re going to see more and more of,” Mr. Mangia said. “It kind of breaks my heart to talk about it.”
Acute Care
For doctors working in urgent care settings, a drop-off in immigrants has become apparent through some unusual metrics. For example, Dr. Amy Zeidan, an emergency room physician in Atlanta, said that requests for Spanish-language interpretation in her hospital’s emergency department had fallen more than 60 percent from January to February.
Theresa Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center, said one of her residents had seen an immigrant patient who had suffered multiple facial fractures from an assault, but had not sought care for more than two weeks. “There is tremendous fear,” Dr. Cheng said.
In late January, Dr. Cheng said, she saw a patient who arrived with severely untreated diabetes. The patient, an undocumented woman, said she had waited to receive help because she was scared. She died that day.
Dr. Carolina Miranda, a family physician in the Bronx, spoke of a patient who had been granted asylum but, fearful of ICE, had failed to show up for a doctor’s appointment about a possible brain tumor.
Similar delays or cancellations are arising among pregnant women and new mothers, according to obstetrician-gynecologists around the country. Dr. Caitlin Bernard, an obstetrician in Indiana, said a patient had skipped her postpartum visit, explaining that she would no longer be leaving her house. On an obstetrics floor in a San Diego hospital, multiple staff members said they had seen an overnight drop-off following the inauguration in the number of immigrant women coming in with acute issues during their pregnancies.
“Obviously those women still exist,” said one doctor, who asked not to be identified because her employer forbade her from speaking publicly on the matter. “I fear it’s going to increase maternal mortality over time. ”
Children’s Health
Many of the children of immigrant parents who have skipped appointments or left medications unfilled are American citizens. But in mixed-status families, parents who are at risk of deportation are often unwilling to take the risk of going to the clinic or pharmacy.
A pediatrician at a health center that cares for underserved populations on the central coast of California reported a 30 percent increase in no-shows for pediatric appointments. Many of those who do bring their children, and are referred elsewhere for specialty care, such as speech therapy, or an autism evaluation, refuse, saying they are too frightened, said the pediatrician, who asked to be unidentified because he wasn’t authorized to speak publicly.
Dr. Tania Caballero, a pediatrician at Johns Hopkins who sees patients at a health center for underserved groups called Baltimore Medical System, said she had encountered parents who had not wanted to go with their babies to the emergency room out of fear, and parents of children with chronic conditions like cerebral palsy, asthma, and Type 1 diabetes who had told her they have stopped getting vital care.
“I tell patients, ‘I can’t control what happens outside of my space, and I can’t control if somebody comes into my space, But you know me. I have the tools, and I want to help you navigate this journey and do it together,’” she said.
Some parents of children in other dire situations — such as those receiving cancer treatment — are hoping that their child’s condition might actually protect them. Some have asked pediatricians for letters explaining their child’s medical requirements, in hopes that immigration officials who detain them might be convinced that the child needs to stay in the United States to survive.
Dr. Lisa Gwynn, a pediatrician in South Florida who serves families from across the Caribbean and South America, said that her plummeting patient attendance rate is particularly worrisome because patients are missing out on childhood vaccines necessary for preventing diseases like measles, pneumonia and whooping cough.
Dr. Gwynn also worries that without coming to see her, children who have experienced severe trauma before coming to the United States aren’t being connected to social workers or psychologists who can help.
“Imagine your children living in a home where everyone’s scared, and they’ve come to this country to not feel scared anymore,” she said. “We know that stress does not fare well for health. Period. Kids don’t perform as well in school, they have mental health issues, depression, anxiety. ”
A Dilemma for Hospitals
Some medical facilities have said they will comply with immigration officials. NYU Langone, in New York City, sent a memo to employees warning them not to try to protect illegal migrants. But many other health centers and organizations are finding ways to take a stand, telling staff to display “Know Your Rights” information on the walls and to never record their immigration status in a patient’s medical records. ”
Last week, the New England Journal of Medicine published an article by two doctors and a lawyer detailing how physicians can continue to provide health care and lawfully push back in the face of some ICE requests.
The St. John’s clinic network in Los Angeles recently launched an ambitious home visitation program in which a doctor, nurse and medical assistant visit patients’ where they live to perform exams and deliver medications. They aim to inform all 25,000 of their undocumented patients of this option.
In the New York area, a hospital association suggested designating a “hospital liaison” who can be paged to quickly usher an agent into a private office, and then ask to see a signed warrant, which would then be reviewed by in-house counsel.
At the emergency room of University Hospital, a safety net facility in Newark, staff members hand out cards, in Spanish and other languages, reminding patients of their rights. “You have the right to refuse consent for immigration or the police to search yourself, your car or your home,” the cards state.
But even there, the fear is palpable. Annalee M. Baker, an emergency physician, said she had seen a young woman who said her partner had beaten her until she was unconscious. Covered in welts and bruises, she had waited hours to come in. The reason given: she was terrified that her partner would be deported.
Dr. Baker also treated a minor who had been stabbed; she had needed his parents’ consent to treat him, but the boy had been skittish about providing any details about them, out of fear they might be caught in the immigration dragnet.
Still, it is the people who never come in at all that haunt Dr. Baker the most.
“The tragic message to these people is: Be a shadow and hope that you do not die.”
Sarah Kliffcontributed reporting.
Archaeologists working in Egypt have discovered a remarkable combination of Homeric epic and Egyptian ritual: a 2,000-year-old mummy with a papyrus fragment of the “Iliad” sealed in a clay packet outside its wrappings.
It is the first time a literary work has been found playing a functional, spiritual role in the mummification process. And it suggests that for a Roman-era Egyptian, the “Iliad” — specifically some lines from Book 2’s “Catalogue of Ships” — was perhaps as crucial for navigating the afterlife as a magical spell.
“The find is incredibly significant, primarily for the discovery of such a papyrus with Greek literary text in its original context,” said Foy Scalf, an Egyptologist at the University of Chicago. “We have evidence that such Greek literary texts could be used as magical amulets and that Homer was frequently cited in such amulets, as well as in the large handbooks now known as ‘The Greco-Egyptian Formularies.’ The new find directly supports that indirect knowledge.”
The mummy, a nonroyal male, was unearthed by the Mission of the University of Barcelona at a burial site known as Oxyrhynchus, as part of a project directed by Ignasi-Xavier Adiego of the university’s Institute of Ancient Near East. Leah Mascia, a specialist in the written and material culture of Greco-Roman and Late Antique Egypt at the Free University of Berlin, coordinated the collaborative breakthrough that finally brought the damaged text to light.
Recognizing that the heavily degraded papyrus required careful analysis, Dr. Mascia worked with a conservator, Margalida Munar, to stabilize the artifact, and Dr. Adiego, an authority on the Carian language, to study the text. Together, their combined expertise in preservation and linguistics allowed them to identify and read the document.
After six years of painstakingly reconstructing tomb fragments, Dr. Mascia uncovered a rare moment of cultural alchemy: Roman Egypt, where foreign and local customs merged. Her analysis, which identified embalmer seals and folding patterns of the papyrus packet, suggests that classical Greek epics were not merely read but physically repurposed.
Traditionally, mummified bodies were buried with sepulchral texts like the “Book of the Dead” and “The Book of Breathing,” formulaic manuals intended to protect and guide the deceased through the underworld. Yet, by the early Roman period, a major shift emerged: the introduction of sealed papyrus packets placed upon the dead.
These new packets contained a surprising mix of texts, including Greco-Egyptian magic, documentary records and even literary works like the “Iliad,” indicating a personalized, alternative funerary practice.
Out of the dumps
The Oxyrhynchus necropolis, located near the modern village of El-Bahnasa about 120 miles south of Cairo, is not just a burial site but an archaeological mother lode. Located on the banks of the Bahr Yussef canal, the area is speckled with ancient garbage dumps that managed to preserve everything from wedding invitations and tax records to horoscopes and early Christian gospels.
The ruins of Oxyrhynchus were initially documented by Vivant Denon, a scholar during Napoleon’s 1798 Egyptian campaign. But they held a secret that remained buried for an additional century, until 1896, when British archaeologists dug up more than 400,000 fragments of papyri from the ancient trash heaps. The discoveries ultimately included lost masterworks by poets and playwrights like Sappho and Euripides, transforming millenniums-old refuse into a cornerstone of classical literature.
In the 1990s, the Mission of the University of Barcelona and the University of Cairo began a joint project largely funded by the Spanish Ministry of Culture and the Egyptian Ministry of Tourism and Antiquities. This ongoing mission, directed by Maite Mascort i Roca and Esther Pons Mellado and staffed by archaeologists, epigraphists and papyrologists, focuses on various sectors of the necropolis, including No. 22, where experts are reconstructing the elaborate social and religious life of residents during the transition from the Ptolemaic to the Roman era.
Researchers exploring the multichambered burial site have exhumed a remarkable trove of treasures, among them mummies adorned with golden tongues — gold foil placed over the mouth — and at least one with copper, ritualistic additions that may have ensured that the dead could confidently speak their case to Osiris, the god of death and resurrection, before judgment.
A separate, distinct area of the necropolis — Sector 42 — has yielded large jars containing cremated remains. One vessel held the bones of an adult, an infant and a feline, along with fabric fragments. While these individuals most likely date to a slightly different period from the “Iliad” mummy, the immense complexity of these rites implies a wealthy, status-conscious class, providing fresh insight into the spiritual anxieties of the Roman-era community.
A cultural passport
Recovered in December from Tomb 65, the fragmentary papyrus packet contains a passage from the 2,800-year-old “Iliad” that functions as a detailed inventory of the Achaean army’s naval strength and regional origins, describing the forces arrayed against Troy to retrieve Helen. The text mentions specific commanders, such as Guneus, who arrived with “two and twenty ships from Cyphus,” and Tlepolemus, a “son of Hercules” who brought nine ships from Rhodes.
Dr. Mascia’s findings reveal a deliberate, intimate act: a document prepared in a mummification workshop and placed directly upon the body of the deceased. “These sealed papyrus packets may have been regarded as part of an alternative funerary procedure,” she said, adding that further studies were essential to prove this hypothesis.
This spiritual first-aid follows a long tradition. Dr. Scalf noted that “The Greco-Egyptian Formularies” even suggests the “Iliad” doubled as a literal medical kit. For a bed-bound patient shivering with malaria, the prescription was simple: Brace your head against a papyrus scroll of Book 4 to break the fever.
For residents navigating the complex, vibrant crossroads of Roman Egypt, Greek literary papyri may have functioned as a crucial cultural passport, said Anna Dolganov, a historian at the Austrian Archaeological Institute. In Egypt, being Hellenic connoted an exclusive social status and financial privilege — and had to be meticulously documented through genealogies going back across several centuries.
Buried with the dead, the “Iliad” perhaps served as a cheat code for a more comfortable afterlife. Dr. Dolganov wonders if carrying the epic poem was a deliberate strategy to secure entry into the Greek underworld, effectively sidestepping the torturous trials of Egyptian mythology. For these individuals, a Hellenic identity wasn’t just for this world — it was an eternal upgrade, offering a smoother path and higher status in the great beyond.
Science
Ten times worse than benzene — California updates its science on two chemicals in everyday air
Two toxic contaminants present in California’s ambient air appear to be much stronger carcinogens than previously known, state environmental health officials announced Thursday.
The draft finding from the state’s Office of Environmental Health Hazard Assessment finds that acrolein and ethylene oxide may pose an estimated cancer risk more than 10 times higher than benzene, a serious carcinogen linked to leukemia and other cancers.
It is the first step in a review process before final risk values are adopted, and it arrives at a time federal air-quality regulations are being reined in.
“If the early air monitoring results bear out, and if the draft cancer values developed are close to what eventually becomes final, then each air contaminant poses an unacceptable cancer risk,” said Kris Thayer, OEHHA’s director.
The update reflects the state’s evolving understanding of its most dangerous pollutants, which has shifted over the decades from visible pollutants, such as smog, to more invisible ones that cause cancer, heart disease and other health harms.
It comes only two months after the Trump administration’s Environmental Protection Agency moved to roll back standards on ethylene oxide, or EtO, in an effort to save millions of dollars in compliance costs for facilities that use the chemical for medical sterilization. The administration said it acted to “safeguard the supply of essential medical equipment,” but experts said the move will also expose more people to health risks.
It also follows a new national report from the American Lung Assn. that found 82% of Californians live in counties with unhealthful air, nearly double the national average.
“This is an important step to better understanding the harms of pollutants impacting Californians’ health,” said Will Barrett, assistant vice president for nationwide clean air policy at the American Lung Assn., who reviewed the state’s findings for The Times. “Following the latest available health science to determine risk is crucial to protecting health.”
Ethylene oxide is a colorless gas often used in the sterilization of medical devices, particularly those that can’t be cleaned using steam or radiation.
Acrolein can be formed when materials burn, such as cigarettes, e-cigarettes and vapes, wood, plastics and gasoline for cars, trucks, ships and aircraft. It can also be released by cooking fats and oils at high temperatures, and has been found in water produced by oil and gas operations and is an ingredient in some pesticides used in irrigation canals.
People can take steps to protect themselves from acrolein exposure in everyday life by avoiding smoking tobacco or using e-cigarettes and vaping products, avoiding smoke from fires or exhaust from diesel and gasoline vehicles and equipment — much of which can also help reduce exposure to ethylene oxide, officials said. When cooking with oils or fats, people should avoid very high temperatures and use a range hood fan when possible.
While both chemicals have been present in the state’s air for years, the new assessments from OEHHA are based on the latest science on health risks, officials said. Both acrolein and ethylene oxide were found to pose an estimated cancer risk exceeding 800 in 1 million — on par with the cancer risk that diesel exhaust was estimated to pose when it first emerged as a major public health concern in the 1990s, the agency said.
In response to the findings, Gov. Gavin Newsom’s May budget revision, released Thursday, includes $2.5 million in funding for the California Air Resources Board and OEHHA in support of research to help reduce people’s exposure to acrolein and ethylene oxide. The funding will help the state identify and track major sources of the chemicals and turn the findings into public health policy outcomes, officials said.
OEHHA’s assessment provides the first cancer risk value for acrolein since it was classified as probably cancer-causing to humans by the International Agency for Research on Cancer in 2020. Ethylene oxide was already identified as a carcinogen by the state, but the new assessment updates its risk levels based on the new research. The risk calculations are based on air monitoring data, which vary across the state depending on location, nearby sources and other factors.
Officials said the findings underscore the state’s efforts to strengthen environmental protection measures for residents at a moment when federal officials seek to loosen them.
“Especially in light of some of the national rollbacks we’re seeing on protections for public health, it really underscores how important the work that we’re doing here in California is,” said Courtney Smith, principal deputy executive officer with the Air Resources Board. “Not only for protecting the health of Californians, but also to ensure that there is rigorous, solid science available to other entities as well who may want to pursue additional protections.”
Short-term exposure to EtO by inhalation can cause headaches, dizziness, nausea, fatigue respiratory irritation and other adverse health effects, according to the federal Agency for Toxic Substances and Disease Registry. Longer-term exposure increases the risk of cancers of the white blood cells, such as non-Hodgkin’s lymphoma, as well as breast cancer.
Inhaling acrolein can cause nose and throat irritation and a decreased breathing rate. Chronic exposure, such as through cigarette smoke, has been linked to the development of asthma, chronic obstructive pulmonary disease and respiratory cancers.
The findings also come as California continues to receive poor grades on air quality. The American Lung Assn. annual State of the Air report found that the five U.S. counties with the worst smog pollution are all in California. Bakersfield was the metropolitan area with the worst level of year-round particle pollution for the seventh year in a row, while Los Angeles was the city with the worst ozone pollution, as it has been for 26 of the last 27 years.
“Californians face the most significant smog and soot challenges in the nation, but our air agencies have followed the science to build policies and programs to make real headway,” Barrett said. The state’s latest assessment “speaks to the need for ongoing local efforts while the federal government ignores the science and opens the door for more pollution. California must continue to invest in things like cleaning up truck fleets, broader public education and the underlying science to guide policies to protect health.”
Thursday’s announcement kicks off a 45-day public comment period, after which the draft assessments may be revised before undergoing additional public comment, peer review by the state’s Scientific Review Panel on Toxic Air Contaminants, and eventual adoption.
In a scrubby forest an hour outside the Lithuanian capital on a recent day this spring, excavators were digging ditches and tree harvesters were whirring in an effort to restore a waterlogged, mosquito-infested ecosystem that was drained in the Soviet era.
The reason is twofold: to help the climate and to defend the country from invasion.
The area was once a vast peat bog, and peat bogs are highly efficient at storing planet-warming carbon dioxide. They also happen to be very good at stopping tanks, because the spongy soil can’t support the weight of armored vehicles. The tanks get stuck and sink, often permanently.
Tomas Godliauskas, the Lithuanian vice minister of defense, said the bogs would form “an integral defensive line” when combined with other military tactics. The project also has the advantage of being relatively cheap compared with other measures like tank ditches and minefields, he added.
Lithuania isn’t the only European Union country using bogs to deter a Russian invasion. Latvia and Finland, for example, are also seeking to restore bogs for both environmental and defense purposes. And Ukrainian bogs helped to delay Russian troops in a failed push toward Kyiv in 2022.
Richard Hooker, a former director at the National Security Council who’s now a senior fellow at the Atlantic Council, a research organization based in Washington that focuses on international security, said peatland restoration could play an important role in Lithuania’s defense against an invasion from the east.
He noted that only one major highway runs from Minsk, in Byelorussia, to the Lithuanian capital, Vilnius, and that the Russian Army is heavily mechanized, without the kind of light infantry units that the U.S. Army has. That means restored, impassible peat bogs would force invading troops onto roads and trails, where they would be more vulnerable.
“The idea that you can use natural obstacles to tie in with man-made obstacles to slow down an attacker is an excellent one,” Mr. Hooker said. “A lot more could be done than has been done, but the early signs anyway are promising.”
The hazards of the bogs were illustrated in March last year, when a 70-ton M88 armored recovery vehicle from the U.S. Army sank during a training exercise near Pabrade, a city in eastern Lithuania near the border with Belarus. Four crew members died.
The bog restoration project is part of Lithuania’s total defense doctrine, a security strategy mobilizing the military, civilian and private sectors to be prepared in case of Russian aggression. The country is looking to restore 6,000 hectares of peatlands, Mr. Godliauskas said.
But it’s about more than just defending the border. It’s also about carbon capture.
Peat bogs form when oxygen-poor conditions in wetlands prevent bacteria and fungi from fully breaking down organic matter like plants and dead animals. In Lithuania, some of the resulting peat was extracted by the Soviet authorities to burn in power plants and to expand agriculture.
The restoration effort is a priority across multiple agencies in the government, said Aira Paliukenaite, Lithuania’s vice minister of the environment. The ministry is planning for restoration to continue for the next 30 years as a part of its policy of aligning with the European Union’s Nature Restoration Law.
That measure requires every country in the bloc to implement a plan, with targets, to mitigate carbon emissions and restore biodiversity and habitats in the coming decades.
Lithuania appears to be in a good starting position. The country still has large quantities of undisturbed peat underground. By rewetting it, officials said they could transform the land back into a what’s known as a carbon sink, or storage system, because peat can lock away carbon for much longer than forests can.
It’s not a simple process, though. The technical planning and site preparation can take years. The projects are still in the early stages, especially those along the border, but they are starting to work with nongovernmental groups like the Foundation for Peatland Restoration and Conservation.
While some in the country are skeptical about the restoration process and its efficacy, others are welcoming the plan.
Albertas Lakstauskas, 52, a teacher and politician, has lived his whole life in Zasliai, a small town near one of the foundation’s projects, the restoration of about 150 acres of drained land where peat was extracted to supply energy to the Soviet Union.
Mr. Lakstauskas said he, like some others in the town, was doubtful that peat bogs alone could stop a Russian invasion, but he said he thought supporting the environment was a matter of national pride.
“If we can do some things to do better, I think that’s a good opportunity,” he said. “And I choose to participate.”
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