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← How doctors can help fix the broken US asylum system

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Showing Revision 10 created 08/19/2020 by marialadias.

  1. Several years ago a young man
    came to see me in my clinic.
  2. He told me he was running for his life.
  3. He said that he fled his home,
  4. because there, homosexuality
    wasn't just illegal,
  5. in some cases it was punishable by death.
  6. So when his sexual
    orientation was exposed,
  7. his family rejected him,
  8. his boss fired him
  9. and angry mobs repeatedly
    attacked him in the streets.
  10. And each time the police
    arrived only to arrest him,
  11. detain and torture him further.
  12. And he knew that if he couldn't
    escape the cycle of violence,
  13. he would surely be killed.
  14. So he had to do
    what he needed to do to survive.

  15. He left everything behind.
  16. All of his friends,
    his family, his career.
  17. He fled his home,
  18. he escaped to the United States
  19. and here he applied for asylum.
  20. But like many people
    fleeing this kind of persecution,

  21. he couldn't carry much.
  22. He had some basic ID,
  23. barely any money
    and a few other belongings.
  24. He certainly didn't bring
    official documents
  25. from the police who tortured him.
  26. No videos from the mob
    that tried to kill him.
  27. He didn't have this kind of evidence
    to help support his claims,
  28. yet here he was, sitting in my clinic,
  29. showing me some of the most powerful
    evidence of his persecution.
  30. That was the physical and psychological
    scars that he brought with him.
  31. You see, he suffered
    from chronic, debilitating pain.
  32. He had severe scars
    scattered over his body,
  33. poorly healing wounds
    that got infected over and over again.
  34. He suffered from severe depression
  35. and continued to have regular, paralyzing
    flashbacks and nightmares from PTSD.
  36. So we continued our work.

  37. We met regularly for months,
  38. documenting each of these pieces
    of medical evidence.
  39. We went over the details of every attack,
  40. photographed his scars,
  41. documented his injuries and wounds,
  42. and we were even able to start
    chronicling his slow but steady recovery
  43. while under our care.
  44. Working closely with his lawyers,
  45. I submitted a detailed affidavit,
  46. including the findings
    of this forensic medical evaluation,
  47. and we included it as part
    of his asylum application.
  48. And then we waited
  49. for several long years
    while he navigated the courts.
  50. And then one day I got an email from him.

  51. It said that he was granted asylum.
  52. And everyone in the clinic was overjoyed.
  53. He said in his email
    that this was the first time in years
  54. that he didn't fear deportation and death.
  55. It was the first time in years
    that he truly felt safe,
  56. that he had the security
    to rebuild his life all over again.
  57. And it was only through this medical
    and legal advocacy
  58. that we were able to help restore
    his legal status and his rights,
  59. that he could do that,
  60. all through asylum.
  61. Now for many people fleeing persecution,

  62. they come to programs
    and clinics like this
  63. telling unimaginable tales of violence
  64. and different reasons
    they were persecuted.
  65. But one thing is always the same.
  66. The violence meted against them
  67. was done with complete impunity,
  68. sometimes by the hands of the state
    directly through police
  69. or military officials.
  70. In other cases,
    the state just turns a blind eye
  71. and condones the acts
    of paramilitary groups
  72. or even violent domestic partners.
  73. In other cases,
    state is completely powerless
  74. to protect the vulnerable
    from powerful gangs.
  75. Now we know that social determinants
    of health play a huge role

  76. in determining the health
    and well-being of our patients:
  77. housing, income, education, race,
  78. social inclusion.
  79. But the same can be true
    for equal protection in the law --
  80. due process.
  81. Especially in societies
    for the most vulnerable,
  82. the marginalized
  83. and even those who are actively targeted,
  84. their access to these
    human rights protections
  85. that can mean the difference
    between sickness and health,
  86. and often it's the difference
    between life and death.
  87. And for millions of people
    who endure persecution and torture,
  88. the only way to heal
  89. is to acknowledge the human rights
    abuses that have occurred
  90. and to help restore the rights
    and protections that were so violated.
  91. After the atrocities of World War II,

  92. the asylum system was set up
    as one pathway to that kind of relief.
  93. But these days it seems like that pathway
    has turned into an obstacle course,
  94. setting people up to fail.
  95. Asylum seekers oftentimes
    don't know how to start,
  96. let alone complete the process
    that can drag on for years.
  97. They're not entitled to lawyers,
    so they don't know their rights.
  98. Increasingly, they're even being barred
  99. from setting foot
    in places of potential refuge.
  100. They're arrested or prosecuted,
  101. even deported before they ever
    get to see an asylum officer.
  102. And even if they do
    make it through the process,
  103. asylum grant rates
    can be as low as 20 percent
  104. and far worse for some.
  105. It's almost like the system was designed
  106. to keep people
    from exercising their right.
  107. But there is something
    that many of these people can do.

  108. Something that can potentially
    increase their chances of success
  109. to 90 percent or more.
  110. So what makes the difference?
  111. Getting a lawyer
    and having a medical evaluation.
  112. It's as simple as that.
  113. The man who came to my clinic
    and won his asylum case.
  114. Doctors and lawyers working together
    to present all of the evidence,
  115. including the medical evidence,
  116. to the courts
  117. allows judges to make
    informed and just decisions.
  118. And it's this kind
    of medical-legal partnership

  119. that's now more important than ever,
  120. because we live in a time
    of epic, forced migration
  121. due to violence and conflict.
  122. In 2018 there were 70 million
    people worldwide forcibly displaced
  123. due to war, conflict and persecution.
  124. It includes 40 million
    internally displaced,
  125. 25 million refugees
    and three million asylum seekers.
  126. Here in the United States,
    we see the impact of escalating violence
  127. in places like El Salvador,
    Guatemala and Honduras,
  128. where murder rates can be as high
    as those in Syria and Afghanistan.
  129. Where police corruption
    and gang violence are on the rise,
  130. where poverty and child abuse
    are widespread and tolerated,
  131. where basic systems of governance --
  132. public safety,
  133. child protection --
  134. are ineffective.
  135. It's no surprise then that many
    of the most vulnerable

  136. in some of these societies --
  137. children, women
    and other targeted groups --
  138. they're growing increasingly desperate
  139. and fleeing in unprecedented numbers.
  140. Like over the past 10 years,
  141. the numbers of unaccompanied children
  142. trying to seek safety
    at our southwest border
  143. has increased 18-fold,
  144. from 3,300 in 2009
    to over 62,000 this past year.
  145. That's in addition to nearly half
    a million people traveling as families.
  146. Men, women and children
    trying to seek refuge at our borders,
  147. but who are stranded
    in a humanitarian crisis.
  148. And what makes matters worse

  149. is that they're caught in this fog
    of claims and counterclaims
  150. about who they are,
  151. what they've experienced,
  152. where the proof is
  153. and what they deserve.
  154. Do they deserve our help?
  155. Sometimes people make claims
  156. that they're not fleeing
    human rights abuses
  157. but are simply economic migrants.
  158. Others say these children
    are actually being exploited
  159. and trafficked by their parents.
  160. Others say they're
    not even children at all;
  161. they're hardened criminals,
  162. they're gang members
    trying to infiltrate our country.
  163. To cut through some of this fog,

  164. my colleagues and I conducted a study.
  165. We looked at data
    from children seeking asylum
  166. who had medical evaluations.
  167. And this is what the evidence told us.
  168. 80 percent of these children had evidence
  169. of exposure to repeated physical violence:
  170. assault and torture.
  171. 60 percent of the girls
    and at least 10 percent of the boys
  172. had evidence of repeated
    exposure to sexual violence.
  173. One young girl, telling a story
  174. and having corroborating evidence
  175. of being detained, beaten and raped
    over the course of three years,
  176. trafficked to other men
  177. and even having the threats
    of the murder of her entire family
  178. if she should ever escape
    or try to seek help.
  179. 90 percent of these children
    had evidence of psychological harm
  180. from indirect violence,
  181. including such severe threats,
  182. but also witnessing untold
    atrocities with their very eyes.
  183. One young boy described
    the terror and the grief

  184. and the utter fear
  185. of seeing the mutilated bodies
    and faces of his younger brother,
  186. his aunt,
  187. his uncle, his cousin,
  188. all killed in a single gang attack
    meant to send the community a message.
  189. And of course the psychological
    toll is immense.

  190. 19 percent of these children
    had signs of anxiety disorder;
  191. 41 percent, depression
  192. and 64 percent, PTSD.
  193. 21 percent also had signs
    of suicidality as children.
  194. To put this into some perspective,
    returning combat veterans,
  195. they have PTSD on the order
    of 10 to 20 percent.
  196. These children at three to six times
    more likely to have PTSD
  197. than a soldier returning from war.
  198. Now despite this burden
    and despite this trauma,

  199. there are many others, still.
  200. Children who come to seek safety
    and enter into our immigration system
  201. only to find further abuse
  202. and even torture reminiscent
    of the places that they fled.
  203. You might remember
    some of those headlines,
  204. some of those images this past year.
  205. Children being ripped
    from the arms of their parents.
  206. Toddlers, infants
    in cold and unsanitary cages.
  207. The absence of food, water
    clothing and even soap.
  208. There's also increasing reports
    of medical negligence,
  209. preventable complications,
  210. child abuse,
  211. sexual abuse
  212. and even child deaths in US custody.
  213. Sadly, many of these abuses
    and crimes aren't new.
  214. Some date back many years
    and even across administrations.
  215. But something's changed.
  216. The scope and scale
    of these abuses and crimes,
  217. the systematic and seemingly purposeful
    endangerment of asylum seekers
  218. and also the impunity
    with which it's being done
  219. has raised the harm
    to an entirely new level.
  220. It reminds me of one
    of the girls in the study

  221. who told us how she pleaded
    with one of her attackers,
  222. asking him to stop,
  223. asking why she was targeted.
  224. And do you what his response was?
  225. He says, "We can do this, because
    there's no one here to protect you."
  226. We can't let this be true

  227. of children and other asylum seekers
    trying to find help at our borders.
  228. But what do we do?
  229. As a physician,
  230. I'm often dealing with difficult decisions
  231. with some of my sickest
    and most complex patients.
  232. Of course we want to keep
    our focus on their health,
  233. their well-being, their quality of life,
  234. but sometimes it requires
    a deeper exploration of their values
  235. to really understand how to move forward.
  236. In a similar way,
  237. our nation is facing a crisis
  238. with the increasing number
    of asylum seekers at our borders
  239. and in our communities,
  240. and it compels us to re-examine
    some of our own fundamental values.
  241. What does it mean
    when we value health and safety?

  242. What does it mean when we value security,
  243. life, liberty,
  244. the life of children?
  245. What about this one --
  246. what does it mean when we say
    we value law and order?
  247. Does that also include respecting
    due process rights for an asylum seeker?
  248. Now for some, when they hear these terms

  249. they immediately gravitate
    towards wanting to build more walls,
  250. deploying more border patrol,
  251. deporting more people
  252. even if it means separating
    children from their families,
  253. subjecting them to psychological torture
  254. or deporting them to places
    where they might die.
  255. All in the name of security.
  256. All in our name.
  257. But for me and for many others,

  258. when I think of these values,
  259. that pushes me
    in an entirely new direction
  260. and renews my commitment to try
    to meet the needs of these asylum seekers
  261. with every tool I have at my disposal.
  262. So that when we say
    that we value life and liberty,
  263. we'll see these people
    who have taken unimaginable risks
  264. to flee imminent danger and harm
  265. to try to find safety.
  266. We'll meet them where they are
  267. and provide food, water,
    shelter, clothing.
  268. And we'll certainly
    meet them with medical care
  269. and mental health care
    that they so desperately need.
  270. When we say that we value the rule of law,
  271. and not just the privileges
    it provides a few
  272. but the responsibilities
    it requires of all of us,
  273. we'll make sure that we have
    a functioning immigration system.
  274. We'll make sure that we have
    trained judges.
  275. We'll make sure that we're not
    settling for the illusion of law and order
  276. that maybe a tall wall
    or a militarized border might provide us.
  277. We want the real thing.
  278. We want judges to be able
    to evaluate the evidence,
  279. including the medical evidence,
  280. and we want them to administer justice ...
  281. fairly.
  282. When we say that we value
    health and well-being,

  283. that we don't want to perpetuate harm,
  284. then we'll deploy
    trauma-informed strategies
  285. at all levels of the immigration system.
  286. It might start with retraining
    border patrol agents
  287. or immigration officials,
  288. but it needs more medical,
    mental health and child welfare experts
  289. across the whole system.
  290. And when we say that we value justice,

  291. we won't let ourselves
    be turned into the torturers
  292. that many of these children
    and other people fled.
  293. We'll open up our detention
    centers and our courts
  294. to experts and advocates
  295. to hold ourselves accountable.
  296. And we may find that we need
    to shut down most of them
  297. and close these camps.
  298. I believe that by working
    in effective partnerships

  299. with lawyers, doctors,
    human rights advocates
  300. and many others,
  301. that we can work together
    to meet these asylum seekers' needs,
  302. that we can meet our historical,
  303. humanitarian
  304. and legal obligations to them.
  305. And when we do,
  306. I think something powerful will unfold.
  307. Not only will these asylum seekers --
  308. like the man who came to my clinic
    and won his asylum case,
  309. like the children in the study
  310. or the many thousands of others
    seeking a new life,
  311. they'll be able to find
    that safety and security.
  312. We'll recognize the abuses
    that have occurred,
  313. and we'll restore the rights
    and protections that were lost.
  314. And I think that we'll be in wonder
  315. when we see them in the fullness
    of their humanity.
  316. Not just their strengths and weaknesses,
  317. their hopes and joys,
  318. not just the trauma that we acknowledge,
  319. but we'll also stand with them
  320. and we'll be inspired by their resilience.
  321. They'll blossom,
  322. and they'll add
    to the richness of this nation.
  323. I think by staying true
    to our fundamental values

  324. in the way that I've described,
  325. that's how we build a sane
    and humane immigration system.
  326. That's how we remain the golden door.
  327. And that's how it happens
  328. that we remain the shining
    light of the world.
  329. Thank you.

  330. (Applause)