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She handed Rodolfo a checklist, assembled by the Immigrant Legal Resource Center, on how to prepare for a possible deportation: Decide who can care for your children. Write down their medications and important phone numbers. Tell your family whom to call if you are detained.

Providers at these federally qualified health centers, which receive some government funds to serve the uninsured and underinsured, do not ask patients about their citizenship status. Instead, the patients, who are required to pay a modest clinic fee, must show proof of residence and income.

For decades, these clinics have been safe havens. When police officers parked in the Carrboro clinics lot for a coffee break, a doctor chased them off because she didnt want patients to be frightened.

But that was a year ago.

Now some insulin-dependent patients have been no-shows at appointments. Diabetes patients, who must exercise, have told doctors here they will not even walk around the block, skittish about the cruising police cars even though a few departments have announced they will not check immigration status.

Dr. Ashkin has built up relationships with many uninsured immigrants over the years. But recently a longtime patient, pregnant but having first-trimester bleeding, refused to take his advice to go for an ultrasound at the university medical center at Chapel Hill.

She was fearful that immigration agents might be waiting. Fortunately, the bleeding stopped.

Referring to the dread among his patients, Dr. Ashkin said, Their trust in us is breaking down.

This is not the first time that fear has kept undocumented patients away. Researchers found that in the wake of expanded immigration enforcement in Arizona in 2010, illegal immigrants used health services less frequently, according to a study published in The American Journal of Public Health.

After a large federal immigration raid in 2008 in Postville, Iowa, babies born to Latinas had a 24 percent higher risk of low birth weight than those born a year earlier, according to a study published this year in The International Journal of Epidemiology.

The effects of deferred health care will be felt in many ways, experts said. Hospitals and emergency departments, exponentially more expensive than primary care, will treat more sick patients, said Dr. Joshua M. Sharfstein of the Johns Hopkins Bloomberg School of Public Health. School systems will feel the impact of more students with a range of health-related challenges.

Researchers have also looked at the question of federal benefits for illegal immigrants.

Many are paid off the books in cash. But certainly not all. Between 2000 and 2011, immigrants not authorized to work here contributed between $2.2 billion and $3.8 billion a year more to Medicare than they withdrew, according to a 2016 study.

Jos, 42, works year-round for a tobacco grower; his wife, Irma, 44, picks tobacco and also works at a local steakhouse, wiping down tables and mopping floors. They do not have Social Security numbers because they are here illegally.

But we pay taxes! Irma declared, responding to the argument that taxpayer-funded clinics should serve only legal citizens.

Their paycheck deductions are taken with individual tax identification numbers. But, she noted, neither is eligible for the programs those taxes fund, including Social Security, Medicare and Medicaid.

Siler City is a town of about 8,000 an hour southwest of Durham. The road there runs past tobacco fields, a derelict former chicken-processing factory and trailer parks into a downtown lined with storefront Pentecostal churches. A sign in an art gallery window warns: No Weapons Allowed.

In a ranch house with chipped gray-blue siding is a branch of El Futuro, Dr. Smiths mental health clinic. Post-traumatic stress disorder is prevalent among patients, said Karla Siu, the clinical program director.

A 9-year-old recalls sleeping in the desert, awakening to a snake. Women quake from memories of being raped on the road. Men seethe, mortified, less from having been stiffed of a days wages than from being too afraid to file a complaint.

As stories of raids churn through rumor mills, therapy sessions have become especially tense. Clinicians report that some patients conclude sessions with ever more elaborate farewells.

The client is grieving the possibility of not seeing the therapist again, Ms. Siu said. So saying goodbye with hugs and tears each time is a form of control, because its on their own terms.

El Futuro has waiting lists of people who want help. But in a survey of patients, the clinic found that some people are afraid to come in. Elizabeth, 27 and here illegally, is among them.

With great reluctance she showed up at the clinic for an interview with a reporter, arriving late, uneasy. Apologizing, she said she leaves her apartment these days only to go to the grocery store and to her job as a hotel maid.

She has no one who will care for her two young children if she is deported, she explained haltingly, tears welling up.

And in Mexico, another danger awaits: her ex-boyfriend. Years ago, when the couple arrived in North Carolina, she said, he began to beat her so badly that she finally called the police. They arrested him and had him deported.

Now, fearful for her children and for her own safety, Elizabeth is consumed by anxiety. Her nightmares from that violent period are back.

After recounting her story, Elizabeth walked toward El Futuros reception area, clutching her 5-year-old daughters hand. Even if she cleared the clinics wait list, she said, it just seemed too risky to come back.

A version of this article appears in print on June 27, 2017, on Page D1 of the New York edition with the headline: Sick With Worry.

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Unauthorized Immigrants Steer Clear of Medical Care - New York Times