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"The United States is prepared to assist the Iraqi Army with additional unique capabilities to help them finish the job, including attack helicopters and accompanying advisers, if requested by Prime Minister Abadi," Carter said.

The idea of providing additional assistance with American pilots flying Apache helicopters or moving American advisers closer to the fight has been described before by Defense Department officials, but this is the first time that Carter has disclosed it as a proposal that could be requested by the Iraqi government.

American Apache helicopters have been in Iraq since last summer but only in a force-protection capacity, though last fall Apache helicopters assisted Iraqi ground troops fighting west of Baghdad.

In July, Iraqi security forces began a military operation to retake Ramadi which had been seized by ISIS earlier this year.

Since then, American military officials have grown frustrated by the slow pace of the Iraqi operation as Iraqi troops faced a tougher than expected ISIS defenses. About 10,000 Iraqi troops have encircled the center portion of the city where it is believed hundreds of ISIS fighters remain.

The brutal tactics, some experts say, may expose Al Qaeda to a Sunni backlash, much as in 2006 and 2007 when Sunni tribes aligned themselves with American forces against the Qaeda extremists.

Ayad Shaker, a police officer in Anbar, said that Al Qaeda had replenished its ranks with a series of prison breakouts, and that the group had also grown stronger because of the limited abilities of Iraqi forces, the conflict in Syria and tensions between Mr. Maliki and the Sunnis.

“I fought Al Qaeda,” he said. “I am sad today when I see them have the highest authority in Anbar, moving and working under the sun without deterrent.”

“If a patient comes to the urgent care clinic but is in need of emergency care, they will be stabilized and transferred to an emergency department at another facility for appropriate care,” he said.

The pandemic has exacerbated the Indian Health Service’s decades-long weaknesses and has contributed to disproportionately high infections and death rates among Native Americans. The Albuquerque service area has a seven-day rolling positivity rate of about 14 percent, compared with 7 percent for New Mexico and about 8 percent nationwide.

The office in the Albuquerque area is one of I.H.S.’s 12 service regions and serves 20 Pueblos, two Apache bands, three Navajo chapters and two Ute tribes across four southwest states. There are five hospitals, 11 health centers and 12 field clinics serving the residents of the area.Wendy Sarracino, 57, a community health representative for the Acoma people, said that when her son broke his leg, she had to stop at two hospitals before he could receive the care he needed.

“That was kind of our lifeline,” Ms. Sarracino said of the hospital. “We didn’t have to go very far for health care. An awareness needs to be made that people do live in rural New Mexico and we need health care.”

Dr. Thomas said the agency requested an extension of the removal of the tribe’s financial shares in the hospital given the pandemic but Laguna denied that request. “We’re doing everything we can to maintain all services for the tribal communities,” he said. “We take it very seriously and want to make sure we’re there for the patients.”

It has always been difficult for I.H.S. to attract doctors and nurses to its facilities, many of which are in isolated areas. In the Albuquerque area, the overall job vacancy rate of the health system is 25 percent for doctors and 38 percent for nurses.

“There’s already so much loss that we have to deal with in term of the unavailability of goods and services because we live on the reservation,” she said, “so basically we are fighting to keep whatever we can because at this point the health of our community isn’t great enough to sustain itself on it own.”