EL PASO, Texas — Olivia Ortega is not sure she’ll continue speaking Spanish with her three bilingual kids in public places in West Texas, after a gunman targeting “Mexicans” opened fire in an El Paso Walmart earlier this month.

In upstate New York, children living in a black Muslim enclave play an adaptation of tag. The name of a would-be anti-Muslim bomber, Robert Doggart, who was arrested in 2015 for plotting to destroy their community, serves as “it.”

And, at a Fort Worth, Texas, church that holds Sunday services in Korean, Burmese, Swahili, Spanish and other languages, the Rev. Will Aplicano has recently fielded calls from immigrants asking if it’s safe for them to gather together to pray.

For some Americans who are members of racial, ethnic and religious minority groups — long the targets of President Donald Trump’s rotating ire — the way that hate and violence can combine has moved from the realm of historical knowledge to known risk to, now, looming fear.

Immigrants, Muslims and people of color who spoke to NBC News say they’ve watched with growing alarm as racist rhetoric has become more commonplace, both on the internet and in their communities, leading to a rise in hate crimes three years in a row and a drop in their sense of security.

For some, catastrophic events like the El Paso shooting, which left 22 people dead, jolted them into the realities of America in 2019.

For others, particularly many racial, ethnic and religious minorities, it marked a sickening extension of the big and small insults, threats and injustices long a part of American life, even in a country that promises equality for all.

It’s that combination, what’s happening now and all that’s long happened, that raises the risk of debilitating trauma for those exposed to persistent reasons to fear, experts say.

“When we think about trauma, often we think about individual incidents — someone being raped or seeing combat — but in fact, trauma is cumulative,” said Monnica Williams, a psychologist who has researched the impact of racism on mental health at the University of Connecticut and developed the concept of racial trauma-induced post-traumatic stress disorder and the tests used by some clinicians to diagnose it.

“So the more traumatic events to which you have been exposed, the more likely to experience PTSD.”

Racism’s physical, emotional and financial toll can be so devastating that the American Academy of Pediatrics issued its first policy statement this week on its effect on the health of the nation’s children.

While long in the works, the warning of racism’s impact and recommendations for how doctors should respond seems particularly necessary now given the “cultural climate” and recent events, Dr. Jacqueline Dougé, a pediatrician who co-wrote the policy, said.

“Racism is not a new thing or a simple thing,” Dougé said. “It’s obviously incredibly complex but presenting differently at present.”

Almost six months before the gunman walked into that El Paso Walmart, surveyors with the Pew Research Center found that a substantial share of Americans said they have feared for their personal safety because of their race or ethnicity. About 43 percent of black respondents agreed, as did 30 percent of Latinos and 38 percent of white Americans.

Pew researchers did not ask additional questions to probe the reasons behind those safety concerns. But consider 2019.

In January, Oregon’s attorney general announced efforts to curb a 40 percent increase in hate crimes in the state, and Los Angeles reported the largest number of hate crimes in a decade. The following month, someone smashed the windows of a Brooklyn synagogue.

By April, a man opened fire in a California synagogue, killing one person and injuring three others. In May, a drone dropped leaflets over Sacramento bearing swastikas and referring to the press as the “enemy,” an idea repeatedly expressed by the president. The following month, armed neo-Nazis disrupted gay pride events.

And, last week, as grieving families held funerals for the El Paso mass shooting victims, police arrested a white man in Florida who authorities said appears to espouse white supremacist ideas online and who was accused of posting on social media, "3 more days of probation left then I get my AR-15 back. Don’t go to Walmart next week."

Madihha Ahussain, special counsel for anti-Muslim bigotry at Muslim Advocates, a national civil rights group, is among those who see a link between the president’s commentary, his policies and rising, if underreported, hate crimes. Trump has often referred to undocumented immigration as a type of “invasion,” the same word police say the El Paso gunman used in an anti-Hispanic screed posted online. And, as a New York Times analysis of Fox News broadcasts found, multiple administration officials and political allies of the president have used similar language repeatedly on that network.

“Yes, we have had hate crimes in the past,” said Ahussain, who fields calls from people afraid to report possible hate crimes and discrimination to authorities. “But now we have individuals in high office using the very same language and ideas and justifications as the people committing these crimes.”

Ortega, the El Paso mother, said all this has kept her on edge.

She didn’t appreciate Trump’s false running commentary on lawlessness in El Paso, her hometown, during and after the 2016 election.

Before the shooting, El Paso was actually one of the safest cities in the country.

It’s a city that’s more than 80 percent Latino, where cross-border interactions are common, and which at times could feel like a bubble, insulated from the ethnocentrism sweeping the country. But the Walmart shooting, immediately followed by the arrests of hundreds of people in Mississippi immigration raids, has raised Ortega’s concerns about Trump’s rhetoric to the level of fear.

In particular, Ortega worries about her youngest daughter, 3, who arrived in the world with skin that’s a bit darker than her siblings, who are 9 and 7.

Ortega has wondered if the girls’ skin could attract the attention of federal agents (who legally can set up checkpoints within 100 miles of the border). In Ortega’s post-shooting nightmare scenario, her daughter, an American citizen, could wind up wrongly separated from the family, on the other side of a Trump border wall, if Ortega can’t immediately produce the child’s birth certificate.

“I’m getting scared something will happen to them,” Ortega said of her children, “about the way they talk, the way they look, the color of their skin.”

At the University of Connecticut, Williams and her colleagues have treated what she describes as a growing number of people of color who have endured the daily indignities of co-workers bristling at their ideas and business owners questioning their presence in ways that seem to mirror Trump’s assaults on the intelligence and belonging of any person of color who questions him.

Williams, who is set to begin new research soon at the University of Ottawa in Canada, has also recently heard more stories from people who describe what felt to them like dangerous encounters with police, neighbors and strangers who seem emboldened to say offensive things.

The people with PTSD whom Williams has treated are often hypervigilant, meaning they may be jumpy when tapped on the shoulder from behind, or obsess about possibilities that seem unlikely to others. And they experience physical symptoms, including high blood pressure and insomnia.

“The idea of racial trauma, mass, wide-scale racial trauma, not only should not be dismissed,” Williams said, “but the impulse to do so ultimately reveals something about anyone inclined to do so quickly.”

Among young adults, the onslaught of horrible racial news headlines can drive a sense of despair, said the Rev. Kevin Cosby, the president of Simmons College of Kentucky, a historically black university, and the pastor of St. Stephen Church, a predominantly black congregation in Louisville.

“I think there are a lot of young people, in particular, millennials who are struggling with the reality that this is what our country has always been and always will be absent some sort of reset,” said Cosby, who co-founded the Angela Project, an effort to connect black and white Christians, four years ago.

“And I think many of them feel both vulnerable — emotionally and economically — and guilty about what injustices are occurring in our names, right now.”

At Fort Worth’s Bethesda Community Church — where Sunday services are held in six languages in addition to English — news of the El Paso shooting stirred a lot of fear among refugee and immigrant congregants, Aplicano, the pastor who leads the church’s language ministries, said.

“There were people who asked, can we go out on the street?” Aplicano, who immigrated to the United States from Honduras, said. “Is it safe? Should we come to church on Sunday? Is gathering a good idea? Some of them were saying, you know, right now I think it’s better if I stay home. Should I go to Walmart? The answers here, again, aren’t easy. We can’t pretend that evil does not exist … but you cannot stop living. You cannot surrender to fear.”

Aplicano’s congregants are not alone in their safety concerns. In fiscal year 2015, 715 nonprofit organizations applied for Department of Homeland Security grants for groups at “high risk” of an attack. Most were religious institutions in need of help making their facilities more secure. In fiscal year 2019, 2,037 organizations applied, the agency told NBC News.

Black Americans and Muslim Americans have long ranked among the most freqent victims of hate crimes.

Both realities do not have to be explained to Tahirah Amatul-Wadud. She’s one of two lawyers who represent a community of about 200 people called Islamberg, about 45 minutes west of Binghamton, New York. Several of Amatul-Wadud’s siblings, nieces and nephews also live in the community, founded by black Muslim families four decades ago when several decided to leave Brooklyn.

The community has been the target of multiple plots, including by Doggart, who was recorded by the FBI as saying, “I don’t want to have to kill children, but there’s always collateral damage.” The most recent threat came this year, when a group of white teens from a nearby town were found with homemade explosives and a plan to destroy Islamberg.

“The abnormal has become so normal, so much a part of life,” Amatul-Wadud said.

In the years since Doggart’s arrest, residents have formed a neighborhood watch to monitor the community’s entrance. Women in Islamberg have committed to a buddy system that means never leaving the property alone. And while most continue to wear hijabs, few wear the colorful ankle-length abayas that had been customary off the property.

“Nothing about our lives has, since 2015, been easy,” Amatul-Wadud said. “It’s not an easy decision, muting who you are, trying to be less easily identifiable and hoping that will provide safety.”

Janell Ross reported from New York and Suzanne Gamboa reported from El Paso