How Trump’s immigration crackdown puts Americans’ healthcare at risk

Suddenly, Ali found himself in limbo, his whole livelihood in jeopardy.

Typically, people who have applied for a green card can remain in the country until their application is reviewed. But if the government doesn’t renew Ali’s visa status or approve his green card application this fall, when his current status expires, he will lose his job, even though he and his wife can legally stay in the US with their two children, who were born here.

The policy implemented by US Citizenship and Immigration Services, part of the Department of Homeland Security (DHS), to pause processing of applications for immigrants already in the US, has been met with a wave of legal challenges. The government recently lost in one major case where a judge ruled it had to start processing applications. But the Trump administration is appealing the decision, sowing further confusion and uncertainty.

A central promise of Donald Trump’s second term as US president has been the mass deportation of immigrants in the country illegally. Less publicized is the administration’s effort to strip people living here legally of their legal status – and what that means for people seeking medical care in the US, especially the neediest and most vulnerable Americans.

The USCIS pause is just one of many Trump administration policies making it harder for immigrants to legally enter or stay in this country – and straining a fragile multi-trillion dollar US healthcare system, as about one in six hospital workers directly involved in patient care is an immigrant, and an estimated 4% of hospital workers are not naturalized citizens.

The US has long been unable to recruit all the doctors it needs. According to the Association of American Medical Colleges, a non-profit organization representing physicians in North America, nearly one in four doctors in the country was trained abroad.Hospitals across the US are looking to people from other countries to fill their open positions. Hospitals in rural areas, where few American doctors want to move, are at a greater disadvantage. They have come to rely even more on immigrants. Ali and other foreign-born doctors have been part of the solution.

“We’re worried about the impact of the administration’s frequently changing immigration policies,” says Dr Jan Carney, president of the American College of Physicians, a national organization of internal medicine physicians. “[The physicians] are absolutely critical for the health of our communities, especially of our rural and under-served” residents.

‘My whole childhood was wars’

Ali’s typical day starts before most people are awake. At 5.30am, he begins a 35-minute drive through the lush, green mountains near his home to the internal medicine unit at the hospital. When he arrives, the morning moves fast. He starts to review one of dozens of patient charts while he drinks his coffee and eats his homemade omelette and avocado breakfast sandwich. Meanwhile, the three residents he is training are checking on patients, before Ali joins them on rounds. “They are very complicated patients,” Ali says, adding that some suffer from heart failure, liver diseases and other ailments at the same time.

He repeats his rounds throughout the day. Ali never knows what time he will be home, but he always tries to be there to play with his two kids before their bedtime. After they go to sleep, he studies and writes papers in preparation for a medical fellowship, which is in jeopardy because of the hold on immigration-related applications. Before he goes to bed, he often talks via FaceTime to his parents and sisters in Afghanistan.

Ali grew up in a small village north of Kabul, Afghanistan’s capital. “My whole childhood was wars,” he says. First the Afghan civil war, then the US invasion. “I remember during the Taliban era, there were no hospitals running properly, and doctors left the country.”

An infantryman with the 15th Marine Expeditionary Unit lugs shoulder-launched missiles while moving with his company to a security position after seizing a forward operating base 25 November 2001, beginning Operation Swift Freedom, in Afghanistan. Photograph: Joseph R Chenelly/DOD/AFP/Getty Images

His father was the only doctor in the village. “Kids would die from infections. My father tried his best, but he didn’t have all the resources that he needed,” Ali said. “As a child, I had a cataract in one of my eyes, and we couldn’t find an eye doctor in Kabul under the Taliban. My father took me to Pakistan for eye surgery, and that experience also reinforced my feeling at that time to become a doctor and help.” An international scholarship for people affected by the war in Afghanistan allowed him to attend medical school in the Middle East region.

Moving there for medical school was a shock. “I didn’t even know how to operate an elevator!” he says. “I worked hard because I felt like an impostor.” He first moved to the US in 2009 for a university research program in Pennsylvania, where he was part of a group of researchers who worked on a medication that was eventually approved by the US Food and Drug Administration (FDA). In 2013, he moved to a university in the midwest, where he researched cancer genetics. In 2020, he was able to upgrade his visa to an H-1B, which is used to hire high-skilled foreign workers and joined a rural hospital in West Virginia at the peak of the Covid-19 crisis. He later moved to the larger hospital where he now works.

Ali’s journey to rural America is common among foreign doctors. Many of them came to the US through programs that require foreign doctors to work in an underserved area for at least three years in exchange for the opportunity to stay in the US. Often, they never leave, says Dr Carney. “International medical graduates are more likely than US medical graduates to practice in rural areas.”

Like Ali, many of these foreign doctors have few connections in the US, but over time often become part of the community. Ali, his wife and children have settled happily into their area.

In late May, the family attended their six-year-old son’s celebration for the end of the school year. The little boy bounced along to the Beach Boys’ Surfin’ USA, more or less in sync with his classmates. Ali filmed the choreography from the back of the small, brightly decorated school gym. Ali’s wife smiled as she held their toddler daughter, dressed in a Mickey Mouse T-shirt – her big eyes staring with some confusion at her brother’s antics.

At the end of the ceremony, the son trotted over with his Spider-Man backpack to hug his father. The boy and his sister only speak English. “They don’t know they are different. That’s the beauty of kids,” says Ali’s wife. One of the teachers approached the parents to ask whether the son will enroll in next year’s class, but Ali said he didn’t know. Come September, the family will have to move. If they are lucky, they will move closer to the city where he works for Ali’s fellowship. If not, they might have to leave the country. But go where? He said he fears going back to Afghanistan because he belongs to an ethnic group that opposes the Taliban and worked with the US during its time in Afghanistan. If he goes back, “the Taliban probably will kill me,” he said.

Foreign doctors fill need for physicians

Some of Ali’s patients make a long drive to his hospital from more remote parts of West Virginia, to get care they can’t receive at home. For example, in parts of McDowell county, thin roads cut through the Appalachian mountains for miles. Branches reach over some roads, creating a thick, green roof. Every now and then, the tree line breaks to reveal the wreckage of a train, a rusting school bus, or a somewhat dilapidated house, always with a porch, but rarely with anyone in it.

The county is in one of the state’s poorest regions. Some towns here have been without safe drinking water for two years.

“There’s so much poverty,” says Haven Walsh, a bartender at a popular tavern in one of the local towns. Behind her, friendly customers jump off their all-terrain vehicles, still dirty from the ride or their work in the mines. “The only jobs here are in coal or hospitals,” Walsh says. “And if you want to leave, you go into the military.” In his effort to escape the war in Afghanistan, Ali ended up in West Virginia, while many West Virginians left for military service in Afghanistan after the US invaded soon after the terrorist attacks of September 11 2001.

In the 1940s, McDowell county had more than 100,000 residents, and had bustling, prosperous towns, such as Welch, which was nicknamed “Little New York”. Today, the county has fewer than 17,000 people left. And McDowell is not an outlier. Many of West Virginia’s rural areas are depopulating at the same time that the health of the remaining residents is on the decline.

West Virginia has the second-highest cancer death rate in the US, with about one in eight adults being cancer survivors. It also has one of the lowest life expectancies in the US.

The setting sun illuminates a portion of the rural community of Iaeger in McDowell county, West Virginia, in 2020. Photograph: Lexi Browning for The Washington Post via Getty Images

Recruiting physicians in small towns can be especially hard. Some specialties in rural communities rely entirely on one doctor, said Jim Kaufman, president and CEO of the West Virginia Hospital Association, which represents 78 hospitals and healthcare systems in the state. “I know one hospital, they’ve been trying to recruit an OB-GYN for four years, and they’ve not had any luck.” Now, the obstetrics program is closing, “because they can’t get a physician”, he said.

Rural West Virginia’s healthcare problems are compounded by the fact that there are not many hospitals here. “Over 50% of our residents are in healthcare deserts,” says Dr April Vestal, referring to areas where people don’t have local access to basic medical care, doctors and pharmacists. Vestal heads an institute to improve rural health in the state. People like Vestal are coming up with creative solutions, like financial incentives for local medical students to stay, a mobile cancer screening unit, and even a fleet of helicopters to quickly provide people with medical care.

But foreign doctors like Ali remain part of the answer to the region’s needs.

Dr Kate Waldeck, a pediatrician who has worked in several hospitals across the state, said she filled in for a foreign doctor who was the only pediatrician in his clinic. He worked 50 weeks a year. “They asked me to come in so that he could have a week of vacation,” Waldeck says. In another place where she works regularly, “the only full-time physician is in his 60s, and he’s from Syria”, she says. “All of these places are anchored by international physicians.”

Hospitals risk losing doctors

The expansion of the Trump administration’s travel ban came after an incident that involved Ali’s native Afghanistan. In November 2025, two national guard members were shot in Washington DC and an Afghan national was charged.

“We are not going to put up with these kind of assaults on law and order by people who shouldn’t even be in our country,” Trump said in an address in the wake of the shooting.

The attacks rattled Ali. “Unfortunately, one of the guards was from West Virginia,” he said. “We from Afghanistan here in this community were on edge.” He said his wife wouldn’t leave the house for a month.

Intealth, an organization that helps bring international medical graduates to the United States, said some of the countries affected by the travel ban, such as Nigeria and Iran, were near the top of US hospitals’ recruiting lists.

Then came the move this January to pause various immigration applications for people from the banned countries.

USCIS said anything that would require the approval of the federal government was paused “to vet and screen aliens to the maximum degree possible”. Physicians who had been legally working in the US for years found themselves facing unemployment.

Ali’s job was at risk. He and many others affected by the policy sued the government.

Medical organizations such as the American Medical Association (AMA) and the American College of Physicians (ACP) wrote letters to USCIS requesting an exemption for physicians. Doctors challenged the administration’s pause in federal court.

The government later updated its website to say that following an internal review process, holds were lifted on several groups of people including “medical physicians”. USCIS told the Guardian that it was “processing certain applications associated with medical physicians”, but did not say when pending cases would be resolved.

Just days ago, a federal court ruled that USCIS can no longer suspend the processing of immigration benefits for nationals of 39 countries, adding that the policy reveals “anti-immigrant sentiments that it is forbidden from letting influence its decision-making”. USCIS is appealing the decision, but in the meantime, the agency said it would comply with the court ruling.

In response to questions to the DHS about the ruling, James Percival, DHS’s general counsel, said in an emailed statement that “the Left” has been using arguments about racial “animus” to go after “virtually every Trump-era Department of Homeland Security policy”. He called it “sabotage dressed in legal clothing”.

It’s not clear what will happen in the many relevant lawsuits following the national ruling. Curtis Morrison, an attorney representing Ali and dozens of other physicians from countries affected by the travel ban and subsequent USCIS pause, said in his experience he has only seen the agency processing applications of plaintiffs in the lawsuits. He is concerned USCIS is “slow-walking the implementation of the order”.

So far, only one of the 21 doctors the Guardian interviewed for this story had their application processed. Ali and the other 19 are still waiting.

People participate in a protest on the first day of the Trump administration’s full ban against travel from 12 countries and a partial ban on seven others, at Los Angeles International Airport on 9 June 2025 in Los Angeles, California. Photograph: David McNew/Getty Images

All this is leaving hospital directors reeling in communities like the one where Ali works. “In healthcare, we always have to adapt. So we’ll keep up. But it’s getting more and more challenging,” says the vice-president of the hospital where Ali works, whose identity the Guardian is also withholding as a precaution because the hospital receives some federal funding.

Other immigration policy changes are compounding the problems for hospitals.

The Trump administration also imposed a $100,000 fee on H-1B visas for people applying for them from abroad. Before, the cost was about $2,000 to $5,000.

“We have one [doctor] right now that we’re actually processing the $100,000 [fee for],” the hospital executive said, adding that they were desperate. The effects are already visible. “If we were able to do 150 kidneys last year, right now, because of limited physicians, we’re only able [to do] maybe 80 [transplants]. That’s 70 people who are not going to get a kidney this year,” he said.

On 8 June, a different federal judge struck down the $100,000 fee. The government has also appealed that ruling.

‘I’m not even allowed to continue working at my free clinic’

West Virginia offers an especially stark example of a difficult situation, but similar cases can be found across the country. Many of the doctors interviewed for this article, all from countries impacted by the travel ban and the USCIS pause, perform jobs for which there are severe shortages or which serve communities with tremendous needs. They all are anxious about their future in the US.

“I was at the forefront of the Covid pandemic. I took care of veterans for six years. And the only reason for this [situation] is where I was born,” says a Sudanese doctor who is a cardiology fellow in the upper midwest. His wife, a pediatric cardiologist, is expecting their second child soon. “Since we cannot be employed, we won’t have health insurance. So my wife will be vulnerable during a very critical time,” her husband said, requesting that their identities be withheld.

If her application is not approved soon, she will also lose her job in a specialty where there are not enough doctors in the US. According to her husband, the hospital that offered her a job had been looking for someone in her specialty for four years.

Dr Faysal Al Ghoula, 38, is working in another specialty with severe shortages. He is a pulmonologist and intensive care unit physician from Libya, now serving patients in an underserved part of Indiana. “My hospital has been trying to recruit for a long time now, and we’ve been unable to find coverage,” he says, adding that if he leaves, it will be a struggle for the hospital to hire and train a new doctor.

Another Sudanese doctor elsewhere in the upper midwest, who worked at a jail, had to stop working earlier this year because his application for a work permit was still on hold. He trained two nurse practitioners to take over his role, he told the Guardian. A jail official had lobbied for him to be able to renew his permit because recruiting another physician would be extremely difficult, he said.

Outside of his work at the jail, he volunteered his time at a free clinic but said he believed all the uncertainty around the countries affected by the travel ban would affect that as well. “What’s been especially difficult is that, legally, I’m not even allowed to continue working at my free clinic, even though I volunteer there without pay. That part has honestly been heartbreaking,” he says, citing advice from his attorney. When the Guardian interviewed him, he had spent most of the day calling more than 36 patients from his clinic to tell them they had to find a new physician – and still had more calls to make. Many of these patients have serious medical conditions. Seven called him back saying they had been unable to find timely follow-up care.

Ali, too, is worried about the people he has been treating for the last several years. But he’s also concerned about his family and his future: “You do everything by the book, abide by the laws, and you end up in this deadlock,” he said.

Fatima Khan contributed to this report

This story was produced in a partnership between Columbia Journalism Investigations and the Guardian