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Cosas del Estado: How Immigration Raids Lead to an Avoidance of Care

After an ICE sweep, undocumented immigrants become reticent of seeking all services — even local and state programs that don’t cooperate with federal immigration. How can the services pledged to protect them actually keep them safe?
(Photo: John Moore/Getty Images)

(Photo: John Moore/Getty Images)

Since Donald Trump took office on January 20th, 2017, communities throughout the United States have braced themselves for a surge in immigration law enforcement. Many fear this enforcement will include an increased number of immigration home raids conducted by Immigration and Customs Enforcement. Legal scholars have compiled reports of “typical” home raids: They occur in early morning or nighttime hours when those in the house are sleeping. Agents, with body armor and weapons drawn, surround the home; after entry, the agents corral the residents to a central location before requesting documents from anyone “suspected” of being undocumented. These arrests often include witnesses, many of whom are children.

Emerging public-health research has considered the ways in which fear of deportation shapes the health behaviors of undocumented immigrants and their communities. Fear of deportation can make one sick. There are at least two ways in which this happens. First, the perpetual stress of possible removal from one’s family and community detrimentally affects one’s mental and emotional health and exacerbates pre-existing medical conditions, even effecting the birth weight of one’s children. Second, fear of deportation also affects the ways in which undocumented immigrants accesshealth and government services.

Fear of arrest and deportation can result in avoidance or delay of a wide range of health care services. Undocumented patients were almost four times as likely to delay seeking health care for tuberculosis as immigrants with legal documents. Others avoided going to the hospital for fear they would be asked about immigration status upon entry. Some limited their time outside and remained close to their homes, decreasing access to grocery stores and other public spaces. When parents fear deportation, they may also avoid services to which their children — many of whom are U.S. citizens — may be entitled. These behavior changes also spill over to others in community, regardless of immigration status, as some fear they will have to disclose the locations of undocumented community members when accessing government services.

But what happens after immigration raids? Word of these raids, violent as they may be, spreads quickly throughout a community, and within hours community members know who was taken, which streets to avoid, and whose family will be in need of support. Do these raids change the use of health services among undocumented immigrants? If so, how? And how can advocates and communities prepare for these changes?

Guadalupe (not her real name) is an undocumented Mexican woman who walked across the border into Texas in 2007, when she was 19 years old. Since then, she has lived in the same place, a small town of about 20,000 in Southeast Michigan. Guadalupe has three children, Carlitos, Fatima, and Sofia. None of them are older than six; all of them were born in the U.S., and thus all are U.S. citizens.

On November 7th, 2013, Guadalupe and her sister-in law were in an upstairs apartment with their children when ICE and a local police department raided the apartment and the mechanic shop below it. Multiple men were arrested, detained, and later deported. Arrests throughout the day resulted in a reported detainment of around half a dozen men, all of whom were Latino.*

“I didn’t want to give my address, where I was, nothing. Even food stamps for the kids. I didn’t want to renew anything because I was so scared of everything.”

As Guadalupe saw these men cuffed, detained, and removed from her life, she began to rethink her relative safety in the U.S., and the repercussions her deportation would have on her Carlitos, Sofia, and Fatima.

Some things were clear: Guadalupe, as well as most everyone in her community, feared, avoided, and perhaps even loathed ICE. Most also feared police. Some avoided government services. But after the raid, these lines began to blur. Who was actually working with ICE? Who would actually deport you? Because the actual boot-to-the-door of Guadalupe’s apartment was a local police department — not ICE — the line between police and ICE virtually disappeared, despite the numerous efforts of the department to specifically take a pro-immigrant stance.

I first met Guadalupe while I was a public-health student writing a dissertation on the health effects of immigration raids on Latino communities. As it turned out, Guadalupe’s door was kicked in about three months into a five-month survey of the Latino community in the county. The Encuesta Buenos Vecinos — or Good Neighbors Survey — thus provided the opportunity for what researchers call a “natural experiment.” We could consider how health-related factors changed before and after an immigration raid.

Analyses of this data show that the raid predicted increases in day-to-day enforcement stress. That is, after the raid, community members felt their presence in the U.S. increasingly tenuous, and became more aware of the detrimental effects their deportations could have on their lives and that of others in their communities. Notably, having children in the home was related to fear of the consequences of deportation, limited contact with family and friends, and a fear of being reported by social services.

While this data suggests that an immigration enforcement action sowed fear through a community in its aftermath, it doesn’t explain how fear of a raid could lead to decreased use of health-care services. Conversations with Guadalupe partially addressed this.

As I sat at her kitchen table, Fatima running around next to us, Guadalupe described her fear of moving about her neighborhood: “When I’m driving and I see a police car, things like that from the state (as she calls them, “cosas del estado”), I get scared. I get scared that they are going to take away my children….” A bit later, she again describes the role of police as those with the power to separate her from her children: “The police are the ones who took away the father of my daughters, the ones who took away my brother. They are the ones who took away my family, who, if they detained me, would separate me from my kids.”

Two comments stand out to me from Guadalupe’s descriptions of the police above. First, she did not say that she feared ICE, but the police, not bothering to differentiate between those who exist to enforce immigration law and those whose goal is to “serve and protect” their communities. Then, Guadalupe went one step further and generalized from the police to “cosas del estado,” “things of the state,” government organizations — broadly stated — who may or may not be enforcing immigration law.

Guadalupe went on to describe her experience renewing her application for the Washtenaw Health Plan, an insurance plan available for low-income residents of the county regardless of citizenship status. While she originally says she trusted the person with whom she was interacting, she then detailed the way in which the repercussions of her deportation, no matter how unlikely, were not even worth the risk of talking with those you trusted:

I asked when I went to renew my insurance, because of the raid, if there would be any problems. They told me no, I shouldn’t worry. Nothing will happen. The person helping with the application told me that all the information was confidential and that if I wanted anyone to know something I had to sign first to authorize it. The truth is that, in that moment, when they told me that my name would remain confidential, I thought it was a lie and I was scared. I had the address of a white U.S. citizen friend so that my bills could go there. I didn’t want to give my address, where I was, nothing. Even food stamps for the kids. I didn’t want to renew anything because I was so scared of everything.

I interviewed others who were in the apartment when it was raided, as well as those who were arrested during the daylong act of immigration enforcement. Interviewees who were involved in the raid, as well as those whose loved ones were detained, described a number of psychological and emotional repercussions, including nightmares, loss of appetite, and suicidality.

Many reference an intense distrust of police both for themselves and their children, with implications for community safety. Arturo, who was arrested as he drove away from the automobile shop below Guadalupe’s apartment, says, “If you see something wrong, like robbery or things like that, you’re not going to think to even call the police because it could completely go the other way around: ‘Oh yeah, who called?’ ‘Oh I did.’ ‘Show me your ID I just wanna see who you are.’ ‘Oh I don’t have one.’ ‘OK you know what, come in [to the station].’ So no.”

And like Guadalupe, others feared the use of government services could lead to their own deportation. Graciela, a known community organizer at a local Latino community based organizations, explains:

The kids can get food stamps but the mother is probably terrified. Do you think she is going to go out to [the Department of Health and Human Services] and apply for food stamps? She’s probably afraid the minute she walks in there, they’ll call immigration … and that’s a shame, cause the kids, kids are born here, they have a right to eat…. It’s just like this river of fear underneath the whole, everything.

These stories help to explain the primary finding of the Encuesta Buenos Vecinos survey that focused on a variable called “self rated health.” Self-rated health is a simple measure in which the researcher asks the participant to rate her health on a scale from one to five. Results show that the raid predicted lower self-rated health scores. While lower self-rated health scores after the raid may reflect participants literally feeling less healthy (because of increased stress over deportation, for example), another explanation is that participants have become aware of the tenuous links they have to health-preserving resources.

Prior to the raid, an undocumented immigrant may have thought: “I’m sick, but I’ll be OK, I can go to the doctor. I’m hungry, but I can get food stamps.” After the raid, when one feels the tension of immigration enforcement bearing down, the cosas del estado threatening to close in, avoiding the doctor and living with sickness may be preferable to possible deportation.

Guadalupe had traced her fear of deportation from ICE agents to police, and from police to the social service agencies that keep her and her children healthy. The repercussions of her deportation, which she described as the abandonment of her children, were simply not worth the risk of engaging with government services. What then, are immigrant advocates and health-care providers to do in the face of increasing immigration raids, and amid the deportation goals of the incoming administration? How do we keep our communities healthy when they fear contact with lascosas del estado?

One positive development has been the many local police departments that have taken firm stances against enforcing immigration law, which they see as the job of the Department of Homeland Security. The Washtenaw County Sherriff’s Office, for example, has stated that they “do not enforce immigration law,” and will not collaborate in raids (with some exceptions). Other local governments, Ypsilanti among them, have passed ordinances to restrict city officials from inquiring about immigration status.

Well-intentioned, but it may not be enough. While these collaborations contribute to a sense of safety around access to services and interactions with local police, they do nothing to address the activity of ICE in communities, who are not legally required to inform local police of enforcement activity. In the case of raids, ICE often relies on the element of surprise. Organizations have thus attempted to alert the community to ICE’s presence using programs like United We Dream’s Migra Watch, which shares a phone number to report ICE activity, or the RedadAlerts app to track and verify when ICE is reported in a community.

Other organizations have attempted to address that fear of leaving one’s home may result in deportation. Many undocumented immigrants fear that racial profiling will result in a request for an ID on a public sidewalk or when a passenger in a car. Prior to the passage of the REAL ID Act (HR 1268) of 2005, which was implemented in Michigan in 2008, undocumented immigrants were able to apply for driver’s licenses. After this time, however, a social security number is required to apply. Thus an expired license, according to many undocumented community members, is often interpreted as a sign that one is undocumented.

To address this, some local governments have begun granting community IDs to residents regardless of immigration status. Such programs have developed throughout the U.S., including in such major cities as Phoenix, Los Angeles, Oakland, Chicago, and New York City. The first two programs in the Midwest — the Washtenaw ID and the Johnson County ID — were established in 2014. As these IDs are adopted by undocumented and citizen residents alike, they are increasingly used as signs of community belonging, and not treated, as so often are expired driver’s licenses, as markers of immigration status. For citizens who continually ask, “what can we do?”, applying for a community ID, even when you already have a driver’s license, is a concrete step to support the immigrant community.

When we are done talking, Guadalupe leaves to pick up Sofía, taking Fatima with her. She invites me stay in her apartment, with her cell phone, and I talk to her brother, Santiago, the man who was the target of the raid. After Santiago was deported, his wife, Fernanda, took a bus down to Texas and walked across the border to Mexico to be with her husband. As I ask them about the raid over the static-y international phone line, I hear children crying in the background.

“And who is that crying?”, I ask Fernanda. “That’s my son. What happens is sometimes police drive by ... when he sees them, he starts to cry.”

*Update — September 3, 2017: A previous version of this article misidentified the date on which Guadalupe's apartment was raided by ICE as November 11th, 2013. The correct date of the raid was November 7th, 2013.