Libyan Dr. Faysal Alghoula needs to renew his green card to continue caring for roughly 1,000 patients in southwestern Indiana. But he hasn’t been able to do that since the Trump administration stopped reviewing applications for people from several dozen countries it deemed high-risk.

Alghoula has lived in the U.S. since 2016, and his current visa will expire in September if his application is denied.

But last week, Alghoula and doctors like him got a potential lifeline when the administration quietly made an exemption for physicians with pending visa or green card applications. It’s a move physicians, organizations and immigration attorneys had sought for months, citing widespread shortages and a high proportion of foreign-trained doctors, who disproportionately work in underserved areas, according to the National Library of Medicine.

The lack of doctors is top of mind for Alghoula, a pulmonologist and Intensive Care Unit doctor who serves a mostly rural population spanning parts of Indiana, Illinois and Kentucky.

“It is about four to five months wait to get the pulmonologist here,” he said.

Still, applicants and immigration attorneys say it’s unclear how big a difference the exemption will make. The change means doctors can have their cases reviewed, but it doesn’t guarantee their green cards or visas will be renewed. It is also unclear whether U.S. Citizenship and Immigration Services will be able to process those applications in time to meet immigration deadlines like Alghoula’s — especially as many doctors with pending applications still haven’t heard any updates from the federal government directly since the announcement was first made.

Despite his qualifications, Alghoula said he is still concerned about his upcoming appointment, given stories circulating about immigrants being detained at appointments to renew their paperwork.

“I’m still scared to go to my interview,” Alghoula said Wednesday. That uncertainty intensified on Friday when he learned that his interview, scheduled for early June, had been canceled without any explanation. He said he doesn’t know what that means for his application.

Meanwhile, the pause remains in effect for thousands of others, including researchers and entrepreneurs from 39 countries, including Iran, Afghanistan and Venezuela. While they’re on hold, many can’t legally work, get health insurance or a driver’s license. If they leave the U.S., they won’t be let back in.

Immigrants unable to work or see family

The Trump administration decided last year to stop reviewing green card and visa applications for people from a list of countries deemed high-risk and this year stopped reviewing visa applications for citizens of more than 75 countries over concerns they would seek public assistance. The moves came amid the U.S. government’s broader crackdown on immigrants.

The pause followed the shooting of two National Guard troops by an Afghan citizen, which the administration said highlighted “what a lack of screening, vetting, and prioritizing expedient adjudications can do to the American people.”

The Department of Homeland Security, which oversees immigration officials, didn’t answer questions about the pause or recent changes to exempt physicians but said in an email it wants to ensure applicants are properly screened after determining the prior administration failed to do so.

“There are lots of bans and lots of pauses that are happening right now,” said Greg Siskind, an immigration attorney based in Memphis, Tennessee. “It is all about making life miserable for people who are here legally so they will choose other countries.”

It isn’t clear how many doctors have been affected by the pause, according to a spokesperson for the American Academy of Family Physicians, who said several doctors have reached out to the organization asking for help.

Some doctors have already been denied

Before the exemption, many immigrants filed federal lawsuits demanding that the government issue decisions on their cases.

One of them was Iranian Dr. Zahra Shokri Varniab, who came to the United States three years ago to conduct radiology research. She was waiting for a green card to attend a residency program but her application got stuck in the pause. She filed a lawsuit demanding an answer to her application and a federal judge ordered immigration officials to review her case.

They did — and denied her. The 33-year-old doctor said she believes it was in retaliation for her lawsuit.

“I feel completely confused,” Shokri Varniab said.

In court filings, U.S. government lawyers wrote that Shokri Varniab’s application contained inconsistencies about whether she plans to become a practicing doctor or researcher. She said she plans to do both.

She said the exemption doesn’t appear to apply to her since her case was decided but is seeking relief in court.

Immigration policy compounding war abroad

Immigrants who hold prestigious jobs in science and technology said they currently can’t work due to the pause because they’re waiting on employment authorization documents. Some said they are running out of money for rent and groceries and worry their careers could be thwarted if they’re forced to leave the country.

Those from Iran are especially worried about returning home during the ongoing war with U.S. and Israeli forces. They said they can’t regularly reach family due to the Iranian government’s internet blackout or count on them for financial support.

Kaveh Javanshirjavid came to the United States from Iran seven years ago to study for his doctorate in agriculture. He was supposed to start a lab job in January but needs employment authorization and his application is on hold.

The 41-year-old said he’s borrowing from friends to pay rent and relying on his wife’s doctorate stipend for basic necessities. But he doesn’t know how long that will last because she’s also Iranian and will need work authorization to get a job after graduating this summer.

“The whole of my life is on hold,” he said.

A nationwide campaign is underway to systematically dismantle Black political influence.

In Tennessee, Republicans are working to eliminate a congressional district that allows the majority-Black city of Memphis to choose its own representative.

In Florida, Republican Gov. Ron DeSantis signed off on a new map that eliminates a South Florida district, which had a near-majority Black electorate.

And in Louisiana, Republicans threw out thousands of votes that had already been cast so they could pass a new map that eliminates a congressional district that includes the majority-Black city of New Orleans.

Following the Supreme Court’s lead, Republican lawmakers have cast these as mere partisan exercises or even an attempt to be “race neutral.” But the pattern is not subtle, and Americans should not pretend otherwise.

At every turn, we are told this is not about race, that it’s just politics, that they’re just respecting the process.

Please. This is not some theoretical exercise being debated in a classroom. This is a threat to the multiracial democracy that our ancestors built over the last 250 years, often at great cost to them and the country.

I don’t think Americans fully understand the emergency of this moment.

The Voting Rights Act, which the Supreme Court gutted last week, was not some symbolic achievement. People bled and died for that law. Entire generations organized, marched and fought in courtrooms and legislative chambers so Black Americans could fully participate in democracy and wield real electoral power.

Now we are watching that progress get chipped away in real time, while some who should be on the frontlines protesting continue to debate whether it’s actually happening.

Trust me, it’s happening. And what frustrates me most is that America has seen this movie before.

After Reconstruction ended, the 14th and 15th amendments to guarantee basic rights for formerly enslaved people were still in place. Black Americans were still citizens. On paper, Black men still had the right to vote.

But then states stopped enforcing those rights. Courts weakened them. Governors aided and abetted the rollback. Business leaders looked away. And slowly, methodically, rights that existed in theory stopped existing in practice.

That is the part of American history people love to skip over.

The collapse of Reconstruction was not just about Klan terror and white lynch mobs. It was about institutions. It was about statehouses. It was about courts. It was about people in power deciding they’d had enough of multiracial democracy.

And for nearly 88 years, between the end of Reconstruction and the Voting Rights Act of 1965, Black Americans fought to claw back the electoral power that had been stripped away.

Eighty-eight years.

That should haunt all of us right now, because too many Americans have convinced themselves that democratic progress is permanent, that the arc of history, once it bends toward justice, cannot swing back.

But democracy is not a destination; it is a marathon with no finish line.

Rights are only as strong as the institutions willing to enforce them — and the people willing to defend them.

Section 2 of the Voting Rights Act still exists today, on paper. But states have moved with extraordinary speed to dilute the voting strength of Black communities, redraw districts and weaken the electoral influence Black voters built over generations. And too often, the courts have responded by insisting Americans should ignore the obvious.

Again: trust your eyes.

I grew up a Black woman and a Democrat in Nebraska, a red state many people in national politics would probably write off entirely. But thanks to a quirk in state lawmy congressional district delivered electors for Barack ObamaJoe Biden and Kamala Harris in the Electoral College. I know what can happen when voters are actually allowed to build coalitions and choose representatives responsive to them.

That is what democracy is supposed to do.

Voters deserve the opportunity to select representatives of their choice, even if the broader state leans one way or the other. Their voices should not be diluted because the people in power dislike the outcome.

Anyone who believes in multiracial democracy needs to understand where power is actually built in this country. State legislatures draw the maps. Governors sign the laws. State courts interpret voting rules. Secretaries of state oversee elections. America’s democracy is shaped in the states.

That is where this fight is being lost right now. And that is where it has to be won.

Because history tells us what happens when attacks on voting rights are treated like ordinary politics instead of what they actually are: an assault on who gets to wield power in America.

We have seen rights survive on paper while disappearing in practice before. We don’t have another 88 years to fix this.

Trust your eyes, then refuse to look away.

Don’t forget to subscribe to “MS NOW Presents: Clock It,” Symone Sanders Townsend’s new podcast series with Eugene Daniels on the latest political news, the catchiest cultural moments and how they converge. Listen to the latest episode here.