0:00:00.750,0:00:04.500
Several years ago a young man[br]came to see me in my clinic.

0:00:05.917,0:00:08.000
He told me he was running for his life.

0:00:09.375,0:00:11.476
He said that he fled his home,

0:00:11.500,0:00:13.976
because there, homosexuality[br]wasn't just illegal,

0:00:14.000,0:00:16.292
in some cases it was punishable by death.

0:00:17.917,0:00:21.309
So when his sexual[br]orientation was exposed,

0:00:21.333,0:00:23.226
his family rejected him,

0:00:23.250,0:00:25.101
his boss fired him

0:00:25.125,0:00:28.458
and angry mobs repeatedly[br]attacked him in the streets.

0:00:29.583,0:00:33.684
And each time the police[br]arrived only to arrest him,

0:00:33.708,0:00:35.917
detain and torture him further.

0:00:36.958,0:00:40.643
And he knew that if he couldn't[br]escape the cycle of violence,

0:00:40.667,0:00:42.000
he would surely be killed.

0:00:43.292,0:00:45.851
So he had to do[br]what he needed to do to survive.

0:00:45.875,0:00:48.309
He left everything behind.

0:00:48.333,0:00:51.476
All of his friends,[br]his family, his career.

0:00:51.500,0:00:53.309
He fled his home,

0:00:53.333,0:00:55.893
he escaped to the United States

0:00:55.917,0:00:58.167
and here he applied for asylum.

0:00:59.458,0:01:02.059
But like many people[br]fleeing this kind of persecution,

0:01:02.083,0:01:03.351
he couldn't carry much.

0:01:03.375,0:01:04.851
He had some basic ID,

0:01:04.875,0:01:07.125
barely any money[br]and a few other belongings.

0:01:07.833,0:01:10.018
He certainly didn't bring[br]official documents

0:01:10.042,0:01:12.309
from the police who tortured him.

0:01:12.333,0:01:15.184
No videos from the mob[br]that tried to kill him.

0:01:15.208,0:01:18.250
He didn't have this kind of evidence[br]to help support his claims,

0:01:19.792,0:01:22.893
yet here he was, sitting in my clinic,

0:01:22.917,0:01:26.292
showing me some of the most powerful[br]evidence of his persecution.

0:01:27.917,0:01:31.292
That was the physical and psychological[br]scars that he brought with him.

0:01:32.792,0:01:35.458
You see, he suffered[br]from chronic, debilitating pain.

0:01:36.583,0:01:39.434
He had severe scars[br]scattered over his body,

0:01:39.458,0:01:42.333
poorly healing wounds[br]that got infected over and over again.

0:01:43.750,0:01:45.559
He suffered from severe depression

0:01:45.583,0:01:50.458
and continued to have regular, paralyzing[br]flashbacks and nightmares from PTSD.

0:01:52.542,0:01:54.101
So we continued our work.

0:01:54.125,0:01:56.309
We met regularly for months,

0:01:56.333,0:01:59.250
documenting each of these pieces[br]of medical evidence.

0:02:00.250,0:02:02.601
We went over the details of every attack,

0:02:02.625,0:02:04.018
photographed his scars,

0:02:04.042,0:02:06.434
documented his injuries and wounds,

0:02:06.458,0:02:10.893
and we were even able to start[br]chronicling his slow but steady recovery

0:02:10.917,0:02:12.208
while under our care.

0:02:13.625,0:02:15.809
Working closely with his lawyers,

0:02:15.833,0:02:18.101
I submitted a detailed affidavit,

0:02:18.125,0:02:21.643
including the findings[br]of this forensic medical evaluation,

0:02:21.667,0:02:24.768
and we included it as part[br]of his asylum application.

0:02:24.792,0:02:26.768
And then we waited

0:02:26.792,0:02:30.167
for several long years[br]while he navigated the courts.

0:02:31.208,0:02:33.208
And then one day I got an email from him.

0:02:34.875,0:02:37.167
It said that he was granted asylum.

0:02:38.000,0:02:40.851
And everyone in the clinic was overjoyed.

0:02:40.875,0:02:44.809
He said in his email[br]that this was the first time in years

0:02:44.833,0:02:48.809
that he didn't fear deportation and death.

0:02:48.833,0:02:51.518
It was the first time in years[br]that he truly felt safe,

0:02:51.542,0:02:54.708
that he had the security[br]to rebuild his life all over again.

0:02:57.000,0:02:59.601
And it was only through this medical[br]and legal advocacy

0:02:59.625,0:03:03.059
that we were able to help restore[br]his legal status and his rights,

0:03:03.083,0:03:04.893
that he could do that,

0:03:04.917,0:03:06.333
all through asylum.

0:03:07.583,0:03:09.518
Now for many people fleeing persecution,

0:03:09.542,0:03:11.601
they come to programs[br]and clinics like this

0:03:11.625,0:03:13.518
telling unimaginable tales of violence

0:03:13.542,0:03:16.351
and different reasons[br]they were persecuted.

0:03:16.375,0:03:18.083
But one thing is always the same.

0:03:19.208,0:03:21.351
The violence meted against them

0:03:21.375,0:03:23.750
was done with complete impunity,

0:03:25.208,0:03:28.059
sometimes by the hands of the state[br]directly through police

0:03:28.083,0:03:29.809
or military officials.

0:03:29.833,0:03:33.351
In other cases,[br]the state just turns a blind eye

0:03:33.375,0:03:35.559
and condones the acts[br]of paramilitary groups

0:03:35.583,0:03:37.583
or even violent domestic partners.

0:03:39.208,0:03:41.518
In other cases,[br]state is completely powerless

0:03:41.542,0:03:43.958
to protect the vulnerable[br]from powerful gangs.

0:03:45.792,0:03:48.809
Now we know that social determinants[br]of health play a huge role

0:03:48.833,0:03:52.351
in determining the health[br]and well-being of our patients:

0:03:52.375,0:03:54.601
housing, income, education, race,

0:03:54.625,0:03:56.292
social inclusion.

0:03:57.375,0:04:01.101
But the same can be true[br]for equal protection in the law --

0:04:01.125,0:04:02.726
due process.

0:04:02.750,0:04:05.643
Especially in societies[br]for the most vulnerable,

0:04:05.667,0:04:06.976
the marginalized

0:04:07.000,0:04:09.684
and even those who are actively targeted,

0:04:09.708,0:04:12.476
their access to these[br]human rights protections

0:04:12.500,0:04:16.184
that can mean the difference[br]between sickness and health,

0:04:16.208,0:04:19.167
and often it's the difference[br]between life and death.

0:04:20.792,0:04:25.184
And for millions of people[br]who endure persecution and torture,

0:04:25.208,0:04:26.851
the only way to heal

0:04:26.875,0:04:30.934
is to acknowledge the human rights[br]abuses that have occurred

0:04:30.958,0:04:35.458
and to help restore the rights[br]and protections that were so violated.

0:04:36.542,0:04:38.684
After the atrocities of World War II,

0:04:38.708,0:04:43.101
the asylum system was set up[br]as one pathway to that kind of relief.

0:04:43.125,0:04:46.768
But these days it seems like that pathway[br]has turned into an obstacle course,

0:04:46.792,0:04:48.333
setting people up to fail.

0:04:49.833,0:04:52.226
Asylum seekers oftentimes[br]don't know how to start,

0:04:52.250,0:04:55.393
let alone complete the process[br]that can drag on for years.

0:04:55.417,0:04:58.583
They're not entitled to lawyers,[br]so they don't know their rights.

0:04:59.292,0:05:01.434
Increasingly, they're even being barred

0:05:01.458,0:05:04.292
from setting foot[br]in places of potential refuge.

0:05:05.458,0:05:07.018
They're arrested or prosecuted,

0:05:07.042,0:05:09.917
even deported before they ever[br]get to see an asylum officer.

0:05:11.000,0:05:13.292
And even if they do[br]make it through the process,

0:05:14.208,0:05:17.309
asylum grant rates[br]can be as low as 20 percent

0:05:17.333,0:05:19.434
and far worse for some.

0:05:19.458,0:05:22.018
It's almost like the system was designed

0:05:22.042,0:05:24.208
to keep people[br]from exercising their right.

0:05:26.875,0:05:30.309
But there is something[br]that many of these people can do.

0:05:30.333,0:05:33.893
Something that can potentially[br]increase their chances of success

0:05:33.917,0:05:35.976
to 90 percent or more.

0:05:36.000,0:05:37.542
So what makes the difference?

0:05:38.458,0:05:42.268
Getting a lawyer[br]and having a medical evaluation.

0:05:42.292,0:05:43.875
It's as simple as that.

0:05:44.708,0:05:47.643
The man who came to my clinic[br]and won his asylum case.

0:05:47.667,0:05:51.726
Doctors and lawyers working together[br]to present all of the evidence,

0:05:51.750,0:05:53.268
including the medical evidence,

0:05:53.292,0:05:54.601
to the courts

0:05:54.625,0:05:57.500
allows judges to make[br]informed and just decisions.

0:05:58.792,0:06:01.518
And it's this kind[br]of medical-legal partnership

0:06:01.542,0:06:03.976
that's now more important than ever,

0:06:04.000,0:06:07.184
because we live in a time[br]of epic, forced migration

0:06:07.208,0:06:08.750
due to violence and conflict.

0:06:09.708,0:06:14.768
In 2018 there were 70 million[br]people worldwide forcibly displaced

0:06:14.792,0:06:17.518
due to war, conflict and persecution.

0:06:17.542,0:06:19.809
It includes 40 million[br]internally displaced,

0:06:19.833,0:06:23.042
25 million refugees[br]and three million asylum seekers.

0:06:24.417,0:06:27.643
Here in the United States,[br]we see the impact of escalating violence

0:06:27.667,0:06:30.226
in places like El Salvador,[br]Guatemala and Honduras,

0:06:30.250,0:06:33.708
where murder rates can be as high[br]as those in Syria and Afghanistan.

0:06:35.542,0:06:39.809
Where police corruption[br]and gang violence are on the rise,

0:06:39.833,0:06:44.101
where poverty and child abuse[br]are widespread and tolerated,

0:06:44.125,0:06:46.143
where basic systems of governance --

0:06:46.167,0:06:47.934
public safety,

0:06:47.958,0:06:49.268
child protection --

0:06:49.292,0:06:50.583
are ineffective.

0:06:51.833,0:06:54.684
It's no surprise then that many[br]of the most vulnerable

0:06:54.708,0:06:56.184
in some of these societies --

0:06:56.208,0:06:59.768
children, women[br]and other targeted groups --

0:06:59.792,0:07:01.643
they're growing increasingly desperate

0:07:01.667,0:07:04.292
and fleeing in unprecedented numbers.

0:07:05.167,0:07:06.559
Like over the past 10 years,

0:07:06.583,0:07:08.500
the numbers of unaccompanied children

0:07:09.792,0:07:11.976
trying to seek safety[br]at our southwest border

0:07:12.000,0:07:14.101
has increased 18-fold,

0:07:14.125,0:07:18.167
from 3,300 in 2009[br]to over 62,000 this past year.

0:07:20.250,0:07:24.333
That's in addition to nearly half[br]a million people traveling as families.

0:07:25.083,0:07:28.601
Men, women and children[br]trying to seek refuge at our borders,

0:07:28.625,0:07:31.625
but who are stranded[br]in a humanitarian crisis.

0:07:33.000,0:07:34.851
And what makes matters worse

0:07:34.875,0:07:38.018
is that they're caught in this fog[br]of claims and counterclaims

0:07:38.042,0:07:39.559
about who they are,

0:07:39.583,0:07:41.226
what they've experienced,

0:07:41.250,0:07:43.101
where the proof is

0:07:43.125,0:07:44.434
and what they deserve.

0:07:44.458,0:07:45.875
Do they deserve our help?

0:07:47.708,0:07:49.351
Sometimes people make claims

0:07:49.375,0:07:51.518
that they're not fleeing[br]human rights abuses

0:07:51.542,0:07:53.184
but are simply economic migrants.

0:07:53.208,0:07:55.809
Others say these children[br]are actually being exploited

0:07:55.833,0:07:57.417
and trafficked by their parents.

0:07:58.250,0:08:00.393
Others say they're[br]not even children at all;

0:08:00.417,0:08:01.768
they're hardened criminals,

0:08:01.792,0:08:04.375
they're gang members[br]trying to infiltrate our country.

0:08:05.125,0:08:06.726
To cut through some of this fog,

0:08:06.750,0:08:09.226
my colleagues and I conducted a study.

0:08:09.250,0:08:12.684
We looked at data[br]from children seeking asylum

0:08:12.708,0:08:14.292
who had medical evaluations.

0:08:15.708,0:08:18.250
And this is what the evidence told us.

0:08:19.542,0:08:22.309
80 percent of these children had evidence

0:08:22.333,0:08:24.643
of exposure to repeated physical violence:

0:08:24.667,0:08:25.958
assault and torture.

0:08:27.333,0:08:30.434
60 percent of the girls[br]and at least 10 percent of the boys

0:08:30.458,0:08:33.851
had evidence of repeated[br]exposure to sexual violence.

0:08:33.875,0:08:35.809
One young girl, telling a story

0:08:35.833,0:08:37.476
and having corroborating evidence

0:08:37.500,0:08:40.809
of being detained, beaten and raped[br]over the course of three years,

0:08:40.833,0:08:42.643
trafficked to other men

0:08:42.667,0:08:46.143
and even having the threats[br]of the murder of her entire family

0:08:46.167,0:08:48.542
if she should ever escape[br]or try to seek help.

0:08:50.833,0:08:54.851
90 percent of these children[br]had evidence of psychological harm

0:08:54.875,0:08:56.143
from indirect violence,

0:08:56.167,0:08:57.643
including such severe threats,

0:08:57.667,0:09:02.417
but also witnessing untold[br]atrocities with their very eyes.

0:09:04.375,0:09:09.750
One young boy described[br]the terror and the grief

0:09:10.750,0:09:12.059
and the utter fear

0:09:12.083,0:09:16.059
of seeing the mutilated bodies[br]and faces of his younger brother,

0:09:16.083,0:09:17.351
his aunt,

0:09:17.375,0:09:19.643
his uncle, his cousin,

0:09:19.667,0:09:24.542
all killed in a single gang attack[br]meant to send the community a message.

0:09:28.042,0:09:31.351
And of course the psychological[br]toll is immense.

0:09:31.375,0:09:34.934
19 percent of these children[br]had signs of anxiety disorder;

0:09:34.958,0:09:36.726
41 percent, depression

0:09:36.750,0:09:39.125
and 64 percent, PTSD.

0:09:40.250,0:09:43.875
21 percent also had signs[br]of suicidality as children.

0:09:45.750,0:09:48.684
To put this into some perspective,[br]returning combat veterans,

0:09:48.708,0:09:51.292
they have PTSD on the order[br]of 10 to 20 percent.

0:09:52.167,0:09:55.351
These children at three to six times[br]more likely to have PTSD

0:09:55.375,0:09:57.625
than a soldier returning from war.

0:10:01.375,0:10:04.518
Now despite this burden[br]and despite this trauma,

0:10:04.542,0:10:06.601
there are many others, still.

0:10:06.625,0:10:10.809
Children who come to seek safety[br]and enter into our immigration system

0:10:10.833,0:10:12.351
only to find further abuse

0:10:12.375,0:10:15.125
and even torture reminiscent[br]of the places that they fled.

0:10:16.875,0:10:18.934
You might remember[br]some of those headlines,

0:10:18.958,0:10:20.750
some of those images this past year.

0:10:21.917,0:10:25.309
Children being ripped[br]from the arms of their parents.

0:10:25.333,0:10:29.268
Toddlers, infants[br]in cold and unsanitary cages.

0:10:29.292,0:10:32.375
The absence of food, water[br]clothing and even soap.

0:10:34.083,0:10:36.893
There's also increasing reports[br]of medical negligence,

0:10:36.917,0:10:38.934
preventable complications,

0:10:38.958,0:10:40.309
child abuse,

0:10:40.333,0:10:41.601
sexual abuse

0:10:41.625,0:10:44.667
and even child deaths in US custody.

0:10:47.167,0:10:49.684
Sadly, many of these abuses[br]and crimes aren't new.

0:10:49.708,0:10:52.976
Some date back many years[br]and even across administrations.

0:10:53.000,0:10:54.292
But something's changed.

0:10:55.375,0:10:57.917
The scope and scale[br]of these abuses and crimes,

0:10:59.708,0:11:04.643
the systematic and seemingly purposeful[br]endangerment of asylum seekers

0:11:04.667,0:11:08.393
and also the impunity[br]with which it's being done

0:11:08.417,0:11:10.667
has raised the harm[br]to an entirely new level.

0:11:13.500,0:11:15.750
It reminds me of one[br]of the girls in the study

0:11:16.917,0:11:19.976
who told us how she pleaded[br]with one of her attackers,

0:11:20.000,0:11:21.268
asking him to stop,

0:11:21.292,0:11:22.708
asking why she was targeted.

0:11:23.875,0:11:25.958
And do you what his response was?

0:11:27.042,0:11:30.792
He says, "We can do this, because[br]there's no one here to protect you."

0:11:36.000,0:11:37.768
We can't let this be true

0:11:37.792,0:11:41.292
of children and other asylum seekers[br]trying to find help at our borders.

0:11:43.042,0:11:44.333
But what do we do?

0:11:46.042,0:11:47.309
As a physician,

0:11:47.333,0:11:49.393
I'm often dealing with difficult decisions

0:11:49.417,0:11:52.518
with some of my sickest[br]and most complex patients.

0:11:52.542,0:11:55.018
Of course we want to keep[br]our focus on their health,

0:11:55.042,0:11:57.018
their well-being, their quality of life,

0:11:57.042,0:12:00.500
but sometimes it requires[br]a deeper exploration of their values

0:12:01.583,0:12:03.917
to really understand how to move forward.

0:12:05.125,0:12:06.393
In a similar way,

0:12:06.417,0:12:08.559
our nation is facing a crisis

0:12:08.583,0:12:11.434
with the increasing number[br]of asylum seekers at our borders

0:12:11.458,0:12:12.809
and in our communities,

0:12:12.833,0:12:17.125
and it compels us to re-examine[br]some of our own fundamental values.

0:12:18.500,0:12:22.059
What does it mean[br]when we value health and safety?

0:12:22.083,0:12:24.042
What does it mean when we value security,

0:12:25.958,0:12:28.101
life, liberty,

0:12:28.125,0:12:29.809
the life of children?

0:12:29.833,0:12:31.143
What about this one --

0:12:31.167,0:12:33.958
what does it mean when we say[br]we value law and order?

0:12:34.583,0:12:38.417
Does that also include respecting[br]due process rights for an asylum seeker?

0:12:40.000,0:12:41.976
Now for some, when they hear these terms

0:12:42.000,0:12:45.018
they immediately gravitate[br]towards wanting to build more walls,

0:12:45.042,0:12:46.476
deploying more border patrol,

0:12:46.500,0:12:47.976
deporting more people

0:12:48.000,0:12:51.018
even if it means separating[br]children from their families,

0:12:51.042,0:12:53.476
subjecting them to psychological torture

0:12:53.500,0:12:56.125
or deporting them to places[br]where they might die.

0:12:57.333,0:12:59.601
All in the name of security.

0:12:59.625,0:13:00.917
All in our name.

0:13:01.667,0:13:03.292
But for me and for many others,

0:13:05.000,0:13:06.476
when I think of these values,

0:13:06.500,0:13:08.601
that pushes me[br]in an entirely new direction

0:13:08.625,0:13:12.518
and renews my commitment to try[br]to meet the needs of these asylum seekers

0:13:12.542,0:13:15.684
with every tool I have at my disposal.

0:13:15.708,0:13:18.809
So that when we say[br]that we value life and liberty,

0:13:18.833,0:13:22.184
we'll see these people[br]who have taken unimaginable risks

0:13:22.208,0:13:24.518
to flee imminent danger and harm

0:13:24.542,0:13:26.351
to try to find safety.

0:13:26.375,0:13:27.893
We'll meet them where they are

0:13:27.917,0:13:30.518
and provide food, water,[br]shelter, clothing.

0:13:30.542,0:13:32.809
And we'll certainly[br]meet them with medical care

0:13:32.833,0:13:35.458
and mental health care[br]that they so desperately need.

0:13:36.000,0:13:38.434
When we say that we value the rule of law,

0:13:38.458,0:13:42.059
and not just the privileges[br]it provides a few

0:13:42.083,0:13:44.643
but the responsibilities[br]it requires of all of us,

0:13:44.667,0:13:47.643
we'll make sure that we have[br]a functioning immigration system.

0:13:47.667,0:13:49.809
We'll make sure that we have[br]trained judges.

0:13:49.833,0:13:54.268
We'll make sure that we're not[br]settling for the illusion of law and order

0:13:54.292,0:13:58.101
that maybe a tall wall[br]or a militarized border might provide us.

0:13:58.125,0:14:00.018
We want the real thing.

0:14:00.042,0:14:02.518
We want judges to be able[br]to evaluate the evidence,

0:14:02.542,0:14:04.101
including the medical evidence,

0:14:04.125,0:14:07.393
and we want them to administer justice ...

0:14:07.417,0:14:08.708
fairly.

0:14:10.708,0:14:13.226
When we say that we value[br]health and well-being,

0:14:13.250,0:14:15.417
that we don't want to perpetuate harm,

0:14:17.333,0:14:19.934
then we'll deploy[br]trauma-informed strategies

0:14:19.958,0:14:21.934
at all levels of the immigration system.

0:14:21.958,0:14:24.434
It might start with retraining[br]border patrol agents

0:14:24.458,0:14:26.059
or immigration officials,

0:14:26.083,0:14:29.684
but it needs more medical,[br]mental health and child welfare experts

0:14:29.708,0:14:31.208
across the whole system.

0:14:33.625,0:14:37.125
And when we say that we value justice,

0:14:38.625,0:14:41.893
we won't let ourselves[br]be turned into the torturers

0:14:41.917,0:14:45.518
that many of these children[br]and other people fled.

0:14:45.542,0:14:48.393
We'll open up our detention[br]centers and our courts

0:14:48.417,0:14:49.684
to experts and advocates

0:14:49.708,0:14:51.542
to hold ourselves accountable.

0:14:52.417,0:14:55.768
And we may find that we need[br]to shut down most of them

0:14:55.792,0:14:57.333
and close these camps.

0:15:01.500,0:15:04.018
I believe that by working[br]in effective partnerships

0:15:04.042,0:15:07.101
with lawyers, doctors,[br]human rights advocates

0:15:07.125,0:15:08.393
and many others,

0:15:08.417,0:15:11.393
that we can work together[br]to meet these asylum seekers' needs,

0:15:11.417,0:15:13.393
that we can meet our historical,

0:15:13.417,0:15:14.684
humanitarian

0:15:14.708,0:15:16.583
and legal obligations to them.

0:15:17.417,0:15:18.684
And when we do,

0:15:18.708,0:15:20.934
I think something powerful will unfold.

0:15:20.958,0:15:22.809
Not only will these asylum seekers --

0:15:22.833,0:15:25.726
like the man who came to my clinic[br]and won his asylum case,

0:15:25.750,0:15:27.268
like the children in the study

0:15:27.292,0:15:30.726
or the many thousands of others[br]seeking a new life,

0:15:30.750,0:15:33.643
they'll be able to find[br]that safety and security.

0:15:33.667,0:15:35.934
We'll recognize the abuses[br]that have occurred,

0:15:35.958,0:15:39.042
and we'll restore the rights[br]and protections that were lost.

0:15:40.417,0:15:42.601
And I think that we'll be in wonder

0:15:42.625,0:15:45.083
when we see them in the fullness[br]of their humanity.

0:15:45.958,0:15:48.684
Not just their strengths and weaknesses,

0:15:48.708,0:15:50.393
their hopes and joys,

0:15:50.417,0:15:53.434
not just the trauma that we acknowledge,

0:15:53.458,0:15:55.434
but we'll also stand with them

0:15:55.458,0:15:57.893
and we'll be inspired by their resilience.

0:15:57.917,0:15:59.268
They'll blossom,

0:15:59.292,0:16:01.500
and they'll add[br]to the richness of this nation.

0:16:02.542,0:16:05.143
I think by staying true[br]to our fundamental values

0:16:05.167,0:16:07.059
in the way that I've described,

0:16:07.083,0:16:10.809
that's how we build a sane[br]and humane immigration system.

0:16:10.833,0:16:15.018
That's how we remain the golden door.

0:16:15.042,0:16:16.351
And that's how it happens

0:16:16.375,0:16:18.667
that we remain the shining[br]light of the world.

0:16:19.542,0:16:20.809
Thank you.

0:16:20.833,0:16:23.125
(Applause)