“The good news is that thanks to the Big Beautiful Bill that President Trump signed, we have an additional 12,000 ICE officers and agents on the ground across the country,” said Assistant Secretary Tricia McLaughlin. “That’s a 120% increase in our workforce. And that’s in just about four months.”

(Department of Homeland Security Press Release, January 3, 2026) 

Dear friends,

The acts of violence and harm by federal immigration agents in Minneapolis and throughout this country are a serious threat to human lives as well as to our democracy. We must take action now.

Four months ago, while we were in Portland, OR, we took an essential detour to the Immigration and Customs Enforcement detention center where Portlanders, despite volleys of tear gas and pepper spray from federal agents, had been protesting for weeks and were facing the threat of National Guard deployment. We went to bear witness to this grassroots stand against violence by federal agents, which had begun in our hometown of Los Angeles earlier that summer, and in nearby California counties over a year ago. We saw the people of Portland providing a shield to protect immigrant communities broadly, as well as to residents of the low-income apartment building just across the street.

We stood at the same intersection where just last Saturday, federal agents lobbed “tear gas, pepper balls, flash bang grenades and rubber bullets” at families with children during a daytime protest.

Threats to Democracy, Threats to Health

This is not only about ICE, and this is not only about Portland, or Minneapolis, or Los Angeles, or Chicago, or Maine, or any of the other numerous ICE operations in localities across the US. This is about a coordinated system of attacks intended to harm lives and erode our democracy. With a tripling of its budget in the past year, ICE now functions as a fulcrum of authoritarian power, and with it we see a staggering investment in carceral infrastructure among other coordinated strategies: targeting freedom of expression and assembly, undermining due process, attacking refugee and migrant rights, scapegoating populations and rolling back non-discrimination policies, using the military for domestic purposes and militarizing law enforcement, increasing surveillance capacity, and undermining international systems designed to protect human rights.

This interplay of individual harm and democratic erosion should compel health equity champions—and everyone committed to health care—to engage, because democracy is a determinant of health.

The recent killings of Minneapolis residents Alex Pretti and Renee Nicole Good represent only two of the eight people who have been killed by federal agents or died in ICE custody in the first month of 2026. The others are Luis Gustavo Núñes Cáceres, Geraldo Lunas Campos, Víctor Manuel Díaz, Parady La, Luis Beltrán Yáñez-Cruz, and Heber Sánchez Domínguez. At least 32 people died in ICE custody in 2025. Another 73,000, a record high, including children, are now held in immigration detention. More than half of the people detained have no criminal conviction, although crime was the dog whistle that enabled the expansion of ICE enforcement. On top of that, more than 328,000 people have been arrested, and nearly 327,000 people deported. It’s no surprise that recent data show that more immigrant adults, including those lawfully present, have skipped or postponed health care over the last year, with four in ten saying they have experienced negative health impacts because of immigration concerns.

From Retreat to Action

In 2025, we saw individuals and institutions, including many in health care, unprepared for the egregious federal assaults and threats to health. As a result, they retreated under an onslaught of harmful policies into their own isolated risk analyses. Champions of health equity lived the past year in cognitive dissonance—protesting on the weekends and being censored on the weekdays.

This year already, recent courageous actions across a diverse swath of society, from civilians on city streets to medical professionals in leadership to corporate CEOs, make plain that we will not be taking these harms to ourselves, our neighbors, our institutions, and our communities so readily. We have been steeled: the institutions who retreat will be fewer and the public outcry and support for leaders to uphold critical principles will be greater. A groundswell of action to protect human life and dignity and preserve democracy is rising, partly because we learned quickly over the past year and partly because time is running out: the infrastructural investments in this system will be hard to unwind once established.

Our Strategic Response

Through our Mobilization Network, HealthBegins helps equip individuals and organizations to take broader action together. In those trainings and convenings, we help our members understand and navigate the various levers of power that we each have access to, as members of a community, institutions, and a society.

Below are some of the resources and strategies we share in our Mobilization Network spaces—actions you can take in your setting starting now. Our next convening on February 20 will highlight learning and problem-solving strategies and tactics to address ICE enforcement. You can register to join here.

Actions to take in your role as a community member:

• Learn how to protect your neighbors by attending a training on community supports like neighborhood watches and adopting a day labor corner.

• Join Rapid Response trainings in your state, like this upcoming one in Washington.

Actions to take in your role as an institutional leader or player:

• Protect the people you serve. These social media cards created by HealthBegins, with contributions by Mobilization Network members, provide immediate steps that healthcare institutions can take to protect patients, staff, and communities.

• Protect the people who serve you. Around one in six U.S. hospital workers was born in another country, and many more have immigrant family members. Institutions can offer flexible virtual/hybrid attendance policies (modeled on the current K-12 school response) for the safety of staff in households including immigrants. Healthcare and social-service organizations within communities can also create a pool of emergency funds for legal aid and essential services.

• Be knowledgeable about and prepared for ICE raids at workplaces, not only for your own workplaces but for the communities you serve.

• Use and analyze available data to better understand and respond to local impacts of ICE enforcement.

Actions to take in your role in civic life:

• Stay up to date and engage with recent ICE-related legislation. This site provides an easy-to-read rundown as well as contact information and scripts for contacting your elected representatives.

• Sign this action to let your Congressional members know that you don’t want your tax dollars invested in ICE until the violence, abuses, and deaths in American communities and immigration detention centers stop.

• Find opportunities to mitigate the other threats that enable ICE, such as asking your city council to remove surveillance equipment such as flock cameras in your community.

In Portland, we were greeted by a large, smiling man with a booming voice as we approached the protest zone. It turned out that he was a chaplain from a local hospital, who told us he had been a frequent presence at the site after work hours. Perhaps it was not a coincidence that we were all connected to healthcare, finding each other at one of the current frontlines for democracy. Our role in health care comes with a commitment to do no harm. That commitment calls on us to act now, with urgency, to protect human life, community well-being and the principles of a healthy democracy, with all of our available powers.

Best,

Rishi Manchanda, MD, MPH                                                Sadena Thevarajah, JD