In 2025, as immigrant arrests by U.S. Immigration and Customs Enforcement surged, so did the demand for health care providers to staff hastily constructed detention centers. Nearly 400 U.S. Public Health Service (USPHS) officers — nurses, doctors, pharmacists and other clinicians — have done monthlong tours at ICE facilities nationwide in the past year, according to a USPHS employee who reviewed deployment rosters.
A growing number of officers say these assignments have caused severe moral distress. They report life‑threatening delays getting medicines and care to detainees, chaotic and confidentiality‑violating screenings, overcrowded and understaffed conditions, and other practices they view as facilitating inhumane operations. Some have resigned from the service; others remain but feel deeply conflicted.
“We have been tasked with protecting and promoting health, and instead, we are being asked to facilitate inhumane operations,” said Rebekah Stewart, a nurse practitioner who left the service in October. Stewart, who had previously deployed in 2019 to the Southwest border after migrant child deaths in Border Patrol custody, said she felt like a witness more than a clinician and could not reconcile participating in a system she sees as harmful. When called to deploy to an ICE facility in June, she resigned.
Many Americans are unfamiliar with the USPHS. It comprises about 5,000 uniformed, non‑combatant officers who serve in federal agencies such as the Indian Health Service, FDA and CDC and deploy to public health emergencies. While those missions are generally accepted as part of the job, recent ICE deployments have prompted unusual levels of moral conflict.
ICE detention has risen to the highest volumes in nearly two decades. ICE reported about 71,000 people held at 225 facilities nationwide as of Feb. 2, 2025, including local jails, federal prisons, military bases and privately owned “soft‑sided” facilities. Media reports, human rights organizations and a Senate investigation have documented overcrowding, insufficient basic health care, and other abuses. NPR’s tally found 32 deaths in ICE custody in 2025, one of the deadliest years in decades.
USPHS officers sometimes fill gaps when ICE’s own health service corps and other providers are insufficient. But officers who deploy describe institutional tensions: ICE priorities to expedite deportations can conflict with clinicians’ duty to ensure appropriate care and follow medical ethics. One nurse who deployed to El Paso described a facility at roughly three times capacity that was similarly understaffed. She said teams were pressured to conduct “batch” medical screenings — asking 20–30 detainees personal medical questions in groups — violating confidentiality norms. Delays in accessing medications, including anti‑epileptics and insulin, led to seizures and dangerously high blood sugars, she said.
At Bureau of Prisons–operated facilities, two USPHS officers reported major delays accessing critical resources and a culture of staff distrust toward detainees that impeded care. One physician recalled a patient with a kidney stone and another with a broken bone whose hospital transfers were delayed while detention staff reviewed camera footage to verify injuries.
Some officers described meaningful clinical encounters with individual detainees — calls from men transferred from notoriously abusive local centers who described sleeping on floors, sharing one toilet with 40 others, and having food thrown at them. Clinicians who provided care to those individuals called the work important but said they still planned to leave the USPHS, fearing future ethically compromising assignments.
Hilary Mabel, a bioethicist at Emory University, said moral distress occurs when clinicians are prevented from making ethically sound choices, lack resources to provide adequate care, or feel complicit in wrongdoing. The result is often job changes or leaving the profession. As conflicted employees depart, institutions risk losing those most committed to ethical practice, further undermining quality of care.
The exodus is already significant: roughly 340 USPHS officers left the service last year — about 290 retiring with pension and 50 departing before qualifying for retirement benefits. That loss compounds existing staffing shortages at federal health agencies and weakens capacity for future public health responses; USPHS officers are less easy to lay off than civil servants and often sustain work through shutdowns and staffing gaps.
Admiral Brian Christine, Assistant Secretary for Health, defended the deployments in response to questions about departures: “The mission of the U.S. Public Health Service Commissioned Corps is to care for people where the need is greatest. In pursuit of subjective morality or public displays of virtue, we risk abandoning the very individuals we pledged to serve. Our duty is clear: say ‘Yes Sir!’, salute smartly, and execute the mission: show up, provide humane care, and protect health with professionalism and compassion.”
Former USPHS commander Jonathan White, a clinical social worker who retired after 20 years as a crisis response manager, warned the service is facing a morale crisis exacerbated by leadership that has publicly disparaged scientific consensus. He and others say even clinically meaningful encounters can feel hollow if the broader system causes lasting harm: “No amount of professionalism and care from USPHS officers, or other health care professionals, can make a mass deportation system not be harmful to people’s health,” White said.
Many officers questioned whether remaining in the corps is the best way to help detainees. Some argued speaking out against inhumane policies could do more good than quietly participating. Others worried that those who stay may be the least likely to question deployments, leaving an organization with fewer ethically vigilant clinicians.
Losing officers who leave out of moral conviction undermines the nation’s long‑term ability to respond to public health crises, according to critics. “We want people in the USPHS who have high moral and ethical standards when we’re able to rebuild public health,” a physician who worked in a prison facility told NPR. “People who question deployments and say, ‘Is this the right thing to be doing?’ — we want people like that in the corps.”
NPR spoke with 12 current or former USPHS officers; six said they planned to leave or had already tendered resignations largely because of recent or impending ICE deployments. Two spoke on the record; others requested anonymity for fear of job loss.
ICE did not immediately respond to NPR’s request for comment about detainee health care quality. The agency has previously said it is recruiting more medical staff but declined to provide an update on hiring.
NPR’s Ximena Bustillo contributed to this report.