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

‘Ali’, from Afghanistan, is a ‘stellar’ doctor caring for patients in under-served West Virginia – but like many other foreign medics, his US future is now in peril

I n a state plagued by high rates of cancer and low life expectancies, Ali’s colleagues say he’s exactly the kind of doctor West Virginia needs. Ali, who comes from Afghanistan, moved to the state in 2020 with a visa status that requires him to work in communities or hospitals without enough doctors.

“I realized there is a shortage of physicians in general,” said Ali, who is in his late 30s and one day hopes to become a specialist and treat patients with cancers and other diseases in his adopted home, where the rolling hills remind him of rural Afghanistan. For now, he cares for patients at a large hospital in a coalfield region of the state.

Last year, he treated more than 1,600 patients, more than 80% of whom are on Medicare or Medicaid, the US government health insurance schemes that largely serve older and low-income patients. Many live in rural areas shaped by the mixed legacy of a declining coal mining industry. Patients sometimes travel up to two hours to receive care at the hospital where he works because they have limited access to doctors and, particularly, specialists.

Ali is a pseudonym and the Guardian is also withholding his location as a precaution in his immigration case. He routinely treats people with liver diseases, often caused by heavy drinking, and manages the complications of obesity-driven diabetes, both widespread health problems in the state.

“He’s a stellar caregiver … with great foundational knowledge and ability to take care of West Virginians,” said a senior colleague who works with Ali, whose identity the Guardian is also withholding because of the sensitivity of the situation. “He’s been dedicated to taking care of folks here.”

But Ali may not be able to continue to work in the US. Still on a visa, he has applied for a green card but has not yet been approved. Last year, the Trump administration banned entry for people from more than a dozen countries and later expanded the restrictions to 39 nations, including Afghanistan. The administration gave a range of reasons for why these countries were subject to the ban, including that they do not have internal systems in place to properly issue identity documents or vet people who may pose national security threats, or that they don’t accept deportees being returned.

Then in January of this year, the administration paused applications filed by immigrants from those same countries who were already in the United States and seeking green cards and other immigration benefits.

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.”

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.

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”.