Occupying Hospitals

Moments before Alex Pretti was executed by ICE agents last month, the thirty-seven-year-old registered ICU nurse at a Veterans Affairs hospital in Minneapolis had come to the aid of a woman shoved to the ground. His horrific death, caught on camera as agents shot at him ten times, has not only shaken the country, igniting massive protests and drawing unlikely condemnation even from some Trump supporters. It has also struck a nerve in the health care community in particular, not just as a tragic loss of one of their own but as emblematic of the dangers facing workers and the moral basis of medicine itself.

The National Nurses United (NNU), the largest registered nurses’ union in the United States, blasted the shooting as “cold-blooded murder” and renewed its call for the abolition of ICE, arguing that such enforcement operations threaten public safety and health. In condemning the murder, other nursing associations underscored the alarming rise of workplace violence and interference with patient-care environments. A doctor who witnessed Pretti’s shooting and rushed to help testified that ICE agents initially prevented him from providing aid. When he was finally allowed through, the officers who surrounded Pretti “appeared to be counting his bullet wounds” instead of checking a pulse or starting resuscitation.

Doctors described ICE agents entering hospitals and clinics, lingering outside emergency departments, patients delaying or avoiding care altogether.

A few days before Pretti’s murder, physicians from across specialties had gathered for an extraordinary press conference at the Minnesota State Capitol to issue a collective warning: immigration enforcement was actively undermining medical care in Minnesota. Doctors described ICE agents entering hospitals and clinics, lingering outside emergency departments, refusing to leave patient rooms, and obstructing clinical care. Clinicians reported that patients were delaying or avoiding care altogether, describing a litany of harms: missed prenatal visits, unmanaged diabetes, untreated infections, ruptured appendices, sepsis, cancer patients disappearing mid-treatment after being detained. Pediatricians spoke of children traumatized by arrests near schools and hospitals, infants brought in critically ill because parents waited until roads felt “clear,” and families forced to weigh a child’s health against the risk of detention. Obstetricians reported patients refusing hospital transfers, laboring alone, or seeking unsafe home births out of fear. Family physicians spoke of widespread food insecurity, medication rationing, and clinics experiencing cancellation rates as high as 60 percent.

Dr. Lisa Mattson, president of the 10,000-strong Minnesota Medical Association, invoked the Emergency Medical Treatment and Active Labor Act to argue that ICE’s presence in hospitals undermines a settled baseline of U.S. law: the emergency room as a public guarantee, the hospital as a private and safe space for the patient, regardless of immigration status. Congress passed the bill in 1986, requiring emergency departments to evaluate and stabilize anyone who presents for care regardless of citizenship, legal status, or ability to pay. This was a federal response to “patient dumping,” as physicians from Chicago’s Cook County Hospital had called the commodification of life that allowed hospitals to refuse the uninsured. Mattson added that ICE presence violates patient privacy, undermines clinical judgment, and breaches long-standing norms governing law enforcement in health care settings. 

Matt Klein, a state senator and practicing internal medicine physician at Mayo Clinic, invoked the Hippocratic Oath to frame the crisis as an ethical, indeed moral rupture. He revealed that Renée Good still had a pulse minutes after being shot in the head by an ICE agent in January while a physician on the scene was reportedly prevented from administering aid, just as in Pretti’s case. This denial of care, Klein said, “stirs the blood” of physicians because it violates a core tenet of medical ethics: the duty to treat the injured and the vulnerable, regardless of circumstance or background. By making it impossible to honor that oath, ICE is undermining the very foundations of medicine, he underscored.

Physicians at the press conference warned of a collapse of trust: hospitals conceived as places of care are increasingly becoming sites of surveillance, accessible only to those whose visibility poses no risk. They spoke of deepening “moral injury” among clinicians, urging immediate action to keep ICE out of medical spaces and insisting that safeguarding access to care is not a partisan demand but a bedrock moral and public health imperative.

Though ICE’s intrusion into hospitals marks an unprecedented escalation of attacks on medicine in the United States, the denial of health care is certainly not new. Nor is the United States unique in what it is now experiencing; intrusive state power and violence in hospitals have long been lived realities in conflict, war-torn, occupied, and apartheid settings. At the same time, American medicine has long clung to the convenient fiction that politics and care can be separated, even as social medicine has shown that the two are co-constitutive. To insist that this is “not political” is itself a politics, indeed a refusal to name what is happening to medicine and the conditions under which care takes place.

---

Over the last few decades, the concept of moral injury as originally introduced by psychiatrist Jonathan Shay has traveled from U.S. veterans, who used it to name the ethical wound of betrayal and coerced wrongdoing, to U.S. clinicians facing COVID-19, describing care under scarcity and profit-driven institutional constraints, to besieged health care workers in humanitarian and global health settings, where it captures a lesser-recognized toll of practicing medicine amid violence, genocide, and other systematic harm. The use of the term by health care workers in Minnesota resonates in this latter context: it is not just the Hippocratic Oath that is being violated, but also the expanded imperative in humanitarian medicine to bear witness to atrocities, to speak, and to insist on accountability.

It is worth recalling that, in the shadow of Nazi medical atrocities, the newly formed World Medical Association—now the world’s largest such organization, with 10 million physicians—moved to codify modern medical ethics by updating the traditional Hippocratic injunction to “do no harm,” understood in its older, paternalistic sense. The association’s centerpiece, the Declaration of Geneva (1948), was explicitly framed as a “modern Hippocratic oath”: a pledge to serve humanity and, crucially, not to use medical knowledge to violate human rights and civil liberties, even under threat. In other words, it set an ethical line against complicity—against becoming the instrument of state violence, whether by action or acquiescence. That is the reasoning that physicians in Minnesota were invoking. In his Nobel Peace Prize address in 1999, then-director of Médecins Sans Frontières, Dr. James Orbinski, expressed it this way: “to seek to relieve suffering, to seek to restore autonomy, to witness to the truth of injustice and to insist on political responsibility.”

But although they adopted the language of political neutrality by emphasizing medical duty, Minnesota physicians were in fact insisting on political as well as moral responsibility. That is clear in three ways. They named state action as the source of harm. They framed advocacy as a professional obligation. And they made a concrete demand for change: calling for an immediate end to the violence and trauma inflicted by ICE. When harm is produced by policy, “duty” cannot remain apolitical: to name the injury is already to challenge the authority that legitimizes it and to reframe care as a public responsibility rather than a private virtue.

Overshadowing all of this is a cruder rupture: the United States has now completed its withdrawal from the World Health Organization, retreating from an institution built on the claim that health is a basic human right. When that premise is betrayed, when humanitarian norms are criminalized or disregarded and the language of human rights gives way to raison d’état and raw power, clinicians from the United States, from Gaza, from Tehran and beyond describe the same fracture: the ideals they trained under and looked up to are openly and brutally violated as their profession is increasingly captured by a corporate–political–security logic that both demands and normalizes depravity.

More than two years ago now, in the wake of Israel’s first assault on Al-Shifa Hospital, Gaza’s largest tertiary-care hospital, I wrote in these pages of the emerging “war on hospitals”—Israel’s systematic, unprecedented, genocidal obliteration of Gaza’s health care system and the basic infrastructure of life itself through the targeting of hospitals, physicians, nurses, and patients—as well as the near-total silence of American physicians and health care organizations in response to these crimes. The double standards long applied to Gaza and made brutally transparent since 2023 were opening onto a dark horizon: a future of medicine increasingly in shambles.

What happens once the destruction of hospitals can be argued for—rationalized, narrated, managed—as legally and morally sanctioned “necessity”? What happens when the weaponization of health becomes ordinary? And what happens when the medical community treats this as none of its concern? This is precisely what motivated my article with Allan Brandt on the striking silence of the New England Journal of Medicine—one of the world’s most influential medical journals and a central forum for professional debate—throughout the Holocaust. In retrospect, we should have argued that the erosion of medical neutrality—the protection owed to physicians, patients, and medical facilities—was an early warning of Auschwitz.

The lesson is that once the moral grammar that protects medical spaces begins to erode in one place, its dismantling proceeds elsewhere. Minnesota is not Gaza, of course. Yet the press conference at the state capitol struck me as a smaller, domestic register of the same unraveling: the transformation of care into a site of violence, control, fear, and death. It is this continuum that physician colleagues and I at the American University of Beirut have named healthocide.

What happens once the destruction of hospitals can be argued for—rationalized, narrated, managed—as legally and morally sanctioned “necessity”?

While we coined the term in the context of war and genocide, the phenomenon is not isolated to catastrophic settings; it does not require bombardment, invasion, mass murder, and drone killing. There is also gradual healthocide, the smaller-scale, less spectacular assault on health and health care that often gets condoned as politically legitimate. It takes shape wherever the conditions of health and well-being are systematically undermined: where the land is chemically scorched and rendered unviable; where clean water is unavailable; where livelihoods are shattered by climate-driven floods and ruined harvests; where reproductive rights and clinical care are banned by the state; where chronic illness becomes unmanageable because people are too frightened to seek care; where a clinic is treated as a tactical zone; where surveillance replaces refuge—a form of violence that kills the very possibility of health, slowly, bureaucratically, and in plain sight.

The point of placing Minnesota alongside Gaza is not to collapse contexts or draw equivalences. It is to trace a dangerously traveling logic and to name a rupture the world is now witnessing: the intensifying unraveling of humanitarian ethics, as health care is increasingly treated as legitimate terrain for state (and non-state) power—whether bombs, apartheid, occupation, or militarized policing—and patients learn that even the hospital and the clinic aren’t safe. Stripped of whatever protective power it once had, medicine becomes another vehicle of complicity in the apparatus of violence.

Recognition too often arrives tragically late, only when harm becomes legible to those who imagined themselves insulated from it. Now masses of such people are starting to register the dissonance between what we already know and what we continue to tolerate: the predictable trauma of family separation and mass deportation; the violence on our streets and at our doors; the quieter violence of silence and complicity through institutional denial, censorship, and the policing of speech. What is newly shocking is not the fact of brutality but its proximity and undeniability. Since time immemorial healing spaces have served as spiritual spaces, in many cases literal sanctuaries. Now even this space, this last space where life ought to be preserved and protected from brute force and coercion, is being thoroughly desacralized. Humankind cannot—and will not—bear this reality.

Independent and nonprofit, Boston Review relies on reader funding. To support work like this, please donate here.

The post Occupying Hospitals appeared first on Boston Review.