by Dr. Arcelita Imasa
Hawaii has long been a haven for migrants. From the plantation era to today’s diverse communities, people have come here from around the world seeking safety, work, and a better future.
Migrants from the Philippines, Micronesia, Latin America, and elsewhere are now an essential part of island life—caring for our kupuna, working in hotels and farms, and enriching the culture that makes Hawaii unique.
But along with these contributions come health challenges that too often remain invisible.
Many migrants in Hawaii struggle to see a doctor or dentist. Some don’t have health insurance, while others fear high medical bills. Language barriers and long wait times add to the stress.
For Micronesian families under COFA (Compact of Free Association), shifting healthcare policies have also created confusion about what services they receive are covered.
Migrant workers are the backbone of Hawaii’s industries, like caregiving, agriculture, and hospitality. Yet these jobs are physically demanding and sometimes unsafe.
Long hours, exposure to chemicals, and heavy lifting lead to injuries and chronic health problems. Too often, workers push through pain rather than risk missing work or losing income.
Being far from home adds another layer of strain. Many migrants live with the stress of separation from loved ones, the pressure to send money back home, or the uncertainty of immigration status. This takes a toll on mental health, leading to anxiety, depression, or loneliness. Unfortunately, culturally appropriate mental health services remain scarce, and stigma persists.
Migrants’ right to health is no different from anyone else’s: access to medical care, insurance coverage, and social supports like food assistance.
But as migrants, they face added vulnerabilities—Hawaii’s high cost of living, job insecurity, layoffs in healthcare and other sectors, and the responsibility of sending remittances to family overseas.
A Climate of Fear
In recent months, the vulnerabilities of migrants have deepened. The passage of the One Big Beautiful Act threatens to restrict healthcare access for many.
ICE agents have become more visible near hospitals, schools, and community spaces. Reports of immigration raids on farms have already endangered lives and livelihoods.
Two of my patients, who are both low-wage workers, have “self-deported” out of fear that they would be arrested and find themselves without support.
Immigration lawyers report soaring caseloads as arrests, detentions, and deportations increase. On Oahu, detention facilities are taking in more detainees transferred from the mainland.
The full extent of ICE activity in Hawaii is hard to capture, but its chilling effects are undeniable.
It is only a matter of time before we learn collectively that migrants are delaying or avoiding care, cancelling appointments, or skipping the ER, even in emergencies, because they fear being detained. This is not only a humanitarian crisis; it should be considered a public health threat.
Hospitals’ Role and Responsibility
As a healthcare worker, I have been told by administrators to “not interfere with ICE” and “not get in the way” when agents show up.
These directives are framed as safety precautions. Staff safety is important, but this policy is incomplete. It leaves a huge ethical gap.
It is frightening that, while no ICE arrests inside Hawaii healthcare facilities have been documented so far, these sites are only considered “sensitive locations,” where enforcement is supposed to be limited but not prohibited.
Photos of ICE vehicles on hospital grounds, shared through community tracking networks, remind us that the threat is real. If hospitals limit their response to passive observation, this does little to ease our fears or protect vulnerable patients.
Hospitals should not stop at non-interference. Non-interference is not neutrality; it abandons our duty of care. If ICE can intimidate patients on hospital grounds, then hospitals are complicit in driving people away from lifesaving treatment.
We can and must go further. We must train our people to require judicial warrants before ICE can enter patient care areas. We must train staff on immigrants’ rights and ICE tactics.
We must adopt “safe zone” or sanctuary policies to reassure patients that hospitals are places of healing, not surveillance. We must equip the front desk and security staff to properly handle ICE requests.
Even small steps, like checking for warrants, can make immigrant patients feel safer.
Beyond the Hospital Walls
Oahu urgently needs a stronger migrant support system involving immigrant rights groups, rapid response networks, and legal aid organizations.
Community members can help by building relationships with migrants, sharing hotlines and resources, and standing ready to respond when ICE appears at hospitals or elsewhere.
We must also acknowledge the harsh realities of detention. Across the country, overcrowded centers fail basic hygiene standards. Food is unhealthy, nutrition is neglected, and medical care is delayed or denied. Detained migrants face family separation, trauma, and depression; their children often require therapy.
People die in detention—many from preventable causes. This is what happens when health is ignored in the name of enforcement.
An Attack on All of Us
The ongoing attack against migrants is an attack on all of us. Legal status, “doing it the right way,” or years of loyalty to this country offer no protection under policies designed to punish and exclude the migrants.
We must demand a healthier society—one where everyone, regardless of immigration status, can live with dignity.
Migrants are not just workers; they are our neighbors, caregivers, coworkers, classmates, and friends. When we safeguard their health, we strengthen the health of the entire community.
Here in Hawaii, we know that aloha means caring for everyone as part of one ohana. Caring for migrants’ health is caring for Hawaii itself.
DR. ARCELITA IMASA is a practicing family physician and the secretary of the Hawaii Workers Center’s Executive Committee of the Board. She grew up in the Philippines before migrating to Hawaii with her family more than a decade ago.
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