Her mother carried her on her back across mountains and through cold streams. Her daughter, school-age at the time, could not walk or feed herself. She had to trickle milk into her daughter’s mouth using a small spoon. After trekking through three countries, they arrived at the border to seek asylum from domestic violence. Upon arrival, mother and daughter were detained for weeks while awaiting a court date for asylum. During that time, the girl received minimal medical care and became even sicker following an influenza infection.

Her mother told us, “That place made her worse — I lost the child I knew.”

This is one of thousands of stories that go unheard. We are four pediatricians who care for children across Utah and the Intermountain West. We have seen firsthand that immigration policy is not abstract. It shapes whether children come in for vaccines, whether parents seek care when a child is sick and whether families feel safe enough to walk through our hospital doors.

The American Academy of Pediatrics has been clear: All children — regardless of immigration status — deserve access to preventive care, adequate nutrition, safe housing and freedom from toxic stress.

Utah has made efforts to align with those values. In 2024, our state launched a capped, state-funded health insurance program covering children regardless of immigration status. The program exists for a simple reason: to reduce fear and keep children on track for immunizations, prescriptions, dental visits and well-child care.

But recent policy proposals have pointed us in a very different direction. Legislation like HB88 would have required agencies and nonprofits to verify immigration status for services long protected under federal public health law — vaccinations, food and housing assistance, support for survivors of domestic violence, and testing and treatment of infectious diseases.

Supporters of such measures often argue they are needed to deter migration. But decades of research on the so-called “welfare magnet” theory show that migration decisions are driven far more by jobs, wages, family ties, and conditions in home countries than by access to local health or nutrition programs.

When policies restrict access to care, families delay treatment until sickness worsens — often ending up in emergency rooms, the most expensive and least effective setting for care. Utah‑based data show that preventable emergency visits rise when people lack coverage, transportation or access to primary care — the very barriers such policies would intensify.

When policy deliberately weaponizes hardship to force people out, the result is predictable: more fear, less care-seeking and worse health outcomes.

Good policy follows public health reality. Vaccine-preventable diseases do not check immigration status. As our region confronts a growing measles outbreak, keeping doors open to immunizations and disease testing is essential. That is why federal law has long protected access to emergency and public health services — and why similar restrictions elsewhere are now facing legal challenges.

Against this backdrop, the proposed ICE detention facility in Salt Lake County raises profound concerns.

Detention settings are, by their nature, high-risk environments for health. The Department of Homeland Security has documented widespread failures in existing facilities, including lapses in medical care, overcrowding, inadequate staffing and unsafe environments with poor sanitation.

These conditions are not just uncomfortable — they are dangerous. Crowding and poor sanitation dramatically increase the spread of infectious diseases. Outbreaks of influenza, COVID-19, mumps, hepatitis A, tuberculosis — and more recently, measles — have all been documented in detention facilities. These illnesses do not remain behind facility walls; staff and contractors move between detention centers and the broader community, creating pathways for transmission.

Facilities of this scale also place strain on local health and water systems. Federal oversight reports from the Government Accountability Office and the DHS Inspector General find that detention facilities frequently rely on ambulance transport and outside emergency departments for medical care. In communities where emergency resources are already stretched, this added burden can delay care for everyone. Furthermore, at a time of shrinking snowpack and water restrictions, committing millions of gallons a day to an ICE facility would divert water needed to protect our Great Salt Lake and clean our air for all children’s health.

A robust body of research shows that detention — especially prolonged detention — has severe mental health consequences for children. Rates of depression, anxiety, post-traumatic stress disorder and developmental delays are significantly higher among children with detained family members, and even higher for those detained themselves. Even the threat of detention or family separation creates what we call “toxic stress” — a chronic activation of the stress response that disrupts brain development and increases the risk of lifelong health problems.

The harm does not stop with those detained. The presence of a detention facility in our community will ripple outward, instilling fear in families who may avoid seeking care, pull children out of school or withdraw from community life altogether. This erosion of trust makes it harder for health care workers, educators and public health professionals to do our jobs.

Some, like Rep. Trevor Lee, argue that “compassion stops at the door of responsibility.”

As physicians, we cannot agree.

Compassion and responsibility are not competing values. Fear-based policies create a false choice between the two. In reality, the well-being of vulnerable groups and the health of the broader community are deeply connected. The proposed detention facility represents a cruel and unnecessary step backward.

As pediatricians, our responsibility is clear. We are obligated to speak when we see policies that will harm children.

We urge our leaders — and our neighbors — to do the same.

Dr. Erin Avondet is a pediatric hospitalist in Salt Lake City. She is passionate about health policy, public health issues, community advocacy, and caring for children with medical complexity.

Dr. Katie Gradick is a pediatric palliative care and hospice physician in Salt Lake City with interests in language justice and expanding global access to compassionate health care for all children, and especially those with life-limiting illness.

Dr. Sarah Schear is a pediatric palliative care and hospice physician in Salt Lake City. She takes care of children with serious illness and their families. She cares about ensuring a healthy environment for kids and future generations.

Dr. Reena Tam is a pediatric hospitalist in Salt Lake City. She is dedicated to creating a culturally-informed and resilient pediatric healthcare workforce and workplace to improve the lives of all children and their families they serve.

The views expressed in this op-ed are the authors’ and do not reflect any official stance from their employer.

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