As arrests by U.S. Immigration and Customs Enforcement rose in 2025, demand spiked for health care personnel to staff rapidly expanded detention sites. Nearly 400 U.S. Public Health Service (USPHS) officers — nurses, physicians, pharmacists and other clinicians — have completed monthlong tours at ICE facilities across the country in the past year, according to a USPHS employee who reviewed deployment rosters.
A growing number of those officers say the assignments produced intense moral distress. They describe life‑threatening delays in getting medications and medical attention to detainees, group screenings that breached confidentiality, severe overcrowding and inadequate staffing, and other practices they believe enable inhumane conditions. Some officers have resigned; others remain but report deep ethical conflict.
Rebekah Stewart, a nurse practitioner who left the corps in October, said she had previously deployed to the Southwest border in 2019 after migrant child deaths and felt like a witness rather than a clinician. When asked to deploy again in June, she chose to resign rather than participate in operations she saw as harmful.
The USPHS is a uniformed, noncombatant corps of roughly 5,000 officers who work in federal agencies such as the Indian Health Service, the Food and Drug Administration and the Centers for Disease Control and Prevention, and who respond to public health emergencies. While emergency deployments are an expected part of the job, recent assignments in ICE facilities have produced unusually widespread moral conflict among officers.
ICE detention levels climbed to near two‑decade highs. The agency reported about 71,000 people held at 225 facilities nationwide as of Feb. 2, 2025, including local jails, federal prisons, military bases and privately run “soft‑sided” centers. Media investigations, rights groups and a Senate inquiry have documented overcrowding, inadequate basic care and other abuses. An NPR count found 32 deaths in ICE custody in 2025, one of the deadliest years in recent memory.
USPHS clinicians sometimes fill gaps when ICE’s own health corps or contracted providers are insufficient. Officers who deployed describe tensions between ICE operational priorities — particularly speeding case processing and deportations — and clinicians’ obligations to provide appropriate care and follow medical ethics.
One nurse who worked in El Paso reported a facility operating at roughly three times its intended capacity with too few staff. She said teams were pressured to perform “batch” medical screenings, asking 20 to 30 detainees the same personal questions in group settings, which violated confidentiality norms. Delays obtaining medications, including anti‑epileptics and insulin, were linked to seizures and dangerously elevated blood sugars, she said.
At Bureau of Prisons facilities where some USPHS officers were deployed, two officers reported major delays in accessing critical resources and a pervasive staff distrust of detainees that impeded care. A physician recalled cases in which hospital transfers for a kidney stone and a broken bone were postponed while detention staff reviewed camera footage to verify injuries.
Officers also recounted meaningful clinical encounters: men transferred from abusive local centers describing sleeping on bare floors, sharing a single toilet with dozens of people, and food being mishandled or thrown. Clinicians called those encounters important and humane, yet many still plan to leave the corps because they fear future assignments will force them into ethically compromising roles.
Hilary Mabel, a bioethicist at Emory University, said moral distress arises when clinicians are prevented from making ethically sound choices, lack resources to deliver adequate care, or feel complicit in wrongdoing. That distress often prompts job changes or exits from the profession. Losing staff who are most committed to ethical practice, she warned, further weakens institutional quality of care.
The departures are already significant: roughly 340 USPHS officers left service last year — about 290 retired with pensions and roughly 50 departed before qualifying for retirement benefits. That attrition worsens staffing shortages across federal health agencies and reduces surge capacity for future public‑health responses; USPHS officers are distinct from typical civil‑service employees and often provide continuity during shutdowns and staffing gaps.
Admiral Brian Christine, Assistant Secretary for Health, defended the deployments, saying the corps’ mission is to care for people where need is greatest and that officers must provide humane care with professionalism and compassion. He cautioned against prioritizing individual moral judgments over delivering services to vulnerable people in need.
Former USPHS commander Jonathan White, who spent 20 years as a crisis response manager, warned that the corps faces a morale crisis that leadership choices may exacerbate. He and others argue that individual clinical acts can feel hollow when the larger system produces lasting harm, and that no amount of professional care can fully mitigate the health effects of mass deportation policies.
Many officers now question whether remaining in the corps is the best way to help detainees. Some say public dissent against harmful policies could do more to protect detainee health than quietly participating in problematic assignments. Others worry the officers who stay will be less likely to challenge deployments, leaving the organization with fewer ethically vigilant clinicians.
Critics say losing officers who leave on moral grounds undermines the nation’s long‑term public health readiness. A physician who worked in a prison facility told NPR that the service needs people who will question deployments and insist on ethical practice when rebuilding public health capacity.
NPR spoke with 12 current or former USPHS officers; six said they planned to leave or already had resigned largely because of ICE deployments. Two agreed to speak on the record; the rest requested anonymity for fear of professional repercussions.
ICE did not immediately respond to NPR’s request for comment about health care quality in detention. The agency has previously said it is recruiting more medical staff but did not provide an update on hiring. Ximena Bustillo contributed reporting to this story.