As emergency medicine physicians, we are uniquely trained to examine and evaluate for both physical and psychiatric evidence of trauma. We examine and treat patients who present with injuries from both accidental and non-accidental trauma on daily basis. Our emergency departments often serve as the only access of care for individuals with psychiatric illness and, accordingly, we are skilled at recognizing signs and symptoms of depression, anxiety, and psychosis.
What is an asylum seeker?
Applicants who apply for asylum must prove that they have a “credible fear” of persecution or torture if they were to return to their home country. Applicants must demonstrate persecution on the basis of race, religion, nationality, political opinion, and/or membership in a particular social group, including that of sexual orientation and gender expression. While applicants have a right to a lawyer, the U.S. government is not obligated to provide one if the applicant is unable to afford one or find one pro bono. If applicants are fortunate enough to obtain legal representation, a vital component of the asylum application is the medical evaluation.
What is the medical evaluation?
The medical evaluation for asylum seekers consists of a physical and/or psychiatric exam to document manifestations of trauma and torture. While the medical evaluation is not a mandatory component of the asylum application, it can be incredibly valuable if performed appropriately. In a retrospective analysis, investigators found that the asylum grant rate among US asylum seekers who received medical evaluations was 89% compared to the national average of 37.5%. The study concluded that medical evaluations may be critical in the adjudications of asylum cases when maltreatment is alleged.
The burden of proving persecution can be quite difficult because many applicants have fled their homes in a rushed and chaotic whirlwind. Additionally, being able to locate and retrieve evidence once abroad and detached from relatives and neighbors is equally challenging. Thus, the claim for asylum often heavily depends upon the physical or psychological manifestations of trauma that applicants carry with them: the body becomes “the place that displays the evidence of truth.”
Importance of the Medical Evaluation
As the number of people being displaced due to violence and life-threatening conditions continues to rise, the U.S. has received an increasing number of asylum claims. In 2015, over 26,000 persons were granted asylum in the U.S. However, with a lack of resources allotted to respond to the global refugee crisis, there has been an enormous backlog at the US Citizenship and Immigration Services Asylum division and within the immigration courts. In fact, the average wait time for an initial asylum interview is over two years and it is predicted that there are over 600,000 asylum and removal cases pending in immigration courts.
While the individual physician may have little control over the administration’s inhumane and unprecedented anti-refugee and anti-immigration policies, backlog of asylum evaluations, the increased denial of requests by Trump-era ICE officials or the increased detainment of applicants awaiting hearings, their role in supporting an evaluation of those applicants lucky enough to have their cases heard in court is immense. A forensic medical and psychiatric examination by a trained clinician can offer corroborative support for an asylum seeker’s claim through written documentation of the physical and psychological sequelae of torture or other forms of persecution.
How to get involved
In order to perform credible forensic evaluations for asylum, physicians must be properly trained. Physicians for Human Rights (http://physiciansforhumanrights.org/) is the largest organization that leads and promotes training sessions for interested physicians. Many institutions have created student-run clinics, where interested medical students work with lawyers to match clients with trained physicians in their networks. The asylum evaluation serves as a unique opportunity for the emergency physician to exercise their medical expertise while also learning to appreciate the effects of trauma, persecution, and torture on the most vulnerable amongst us.
As emergency physicians, we constantly yearn for an opportunity to use our training and skills to save a life. The role of an asylum evaluator creates this opportunity to save a life in a different but equally important way.