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Several years ago a young man
came to see me in my clinic.
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He told me he was running for his life.
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He said that he fled his home
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because there, homosexuality
wasn't just illegal,
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in some cases it was punishable by death.
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So when his sexual
orientation was exposed,
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his family rejected him,
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his boss fired him
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and angry mobs repeatedly
attacked him in the streets.
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And each time the police
arrived only to arrest him,
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detain and torture him further.
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And he knew that if he couldn't
escape the cycle of violence,
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he would surely be killed.
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So he had to do what
he needed to do to survive.
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He left everything behind.
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All of his friends,
his family, his career.
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He fled his home,
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he escaped to the United States
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and here he applied for asylum.
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But like many people fleeing
this kind of persecution,
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he couldn't carry much.
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He had some basic ID,
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barely any money
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and a few other belongings.
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He certainly didn't bring
official documents
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from the police who tortured him.
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No videos from the mob
that tried to kill him.
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He didn't have this kind of evidence
to help support his claims,
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yet here he was,
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sitting in my clinic,
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showing me some of the most powerful
evidence of his persecution.
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That was the physical and psychological
scars that he brought with him.
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You see, he suffered
from chronic, debilitating pain.
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He had severe scars
scattered over his body,
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poorly healing wounds
that got infected over and over again.
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He suffered from severe depression
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and continued to have regular, paralyzing
flashbacks and nightmares from PTSD.
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So we continued our work.
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We met regularly for months,
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documenting each of these pieces
of medical evidence.
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We went over the details of every attack,
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photographed his scars,
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documented his injuries and wounds
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and we were even able to start
chronicling his slow but steady recovery
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while under our care.
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Working closely with his lawyers,
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I submitted a detailed affidavit,
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including the findings of this forensic
medical evaluation,
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and we included it as part
of his asylum application.
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And then we waited
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for several long years
while he navigated the courts.
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And then one day I got an email from him.
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It said that he was granted asylum.
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And everyone in the clinic was overjoyed.
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He said in his email that this was
the first time in years
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that he didn't fear deportation and death.
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It was the first time in years
that he truly felt safe,
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that he had the security
to rebuild his life all over again.
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And it was only through this medical
and legal advocacy
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that we were able to help restore
his legal status and his rights
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that he could do that,
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all through asylum.
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Now for many people fleeing persecution,
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they come to programs
and clinics like this
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telling unimaginable tales of violence
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and different reasons
they were persecuted.
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But one thing is always the same.
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The violence meted against them
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was done with complete impunity,
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sometimes by the hands of the state
directly through police
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or military officials.
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In other cases,
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the state just turns a blind eye
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and condones the acts
of paramilitary groups
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or even violent domestic partners.
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In other cases,
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state is completely powerless
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to protect the vulnerable
from powerful gangs.
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Now we know that social determinants
of health play a huge role
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in determining the health
and well-being of our patients:
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housing, income, education, race,
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social inclusion --
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but the same can be true
for equal protection in the law --
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due process.
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Especially in societies
for the most vulnerable,
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the marginalized
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and even those who are actively targeted,
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their access to these human
rights protections,
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that can mean the difference
between sickness and in health,
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and often it's the difference
between life and death.
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And for millions of people
who endure persecution and torture,
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the only way to heal
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is to acknowledge the human
rights abuses that have occurred
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and to help restore the rights
and protections that were so violated.
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After the atrocities of World War II,
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the asylum system was set up
as one pathway to that kind of relief.
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But these days it seems like that pathway
has turned into an obstacle course,
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setting people up to fail.
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Asylum seekers oftentimes
don't know how to start,
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let alone complete the process
that can drag on for years.
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They're not entitled to lawyers
so they don't know their rights.
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Increasingly, they're even being barred
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from setting foot in places
of potential refuge.
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They're arrested or prosecuted,
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even deported before they ever
get to see an asylum officer.
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And even if they do
make it through the process,
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asylum grant rates
can be as low as 20 percent,
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and far worse for some.
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It's almost like the system was designed
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to keep people from
exercising their right.
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But there is something that many
of these people can do.
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Something that can potentially
increase their chances of success
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to 90 percent or more.
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So what makes the difference?
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Getting a lawyer and having
a medical evaluation.
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It's as simple as that.
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The man who came to my clinic
and won his asylum case.
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Doctors and lawyers working together
to present all of the evidence,
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including the medical evidence,
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to the courts
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allows judges to make
informed and just decisions.
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And it's this kind
of medical-legal partnership
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that's now more important than ever
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because we live in a time
of epic, forced migration
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due to violence and conflict.
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In 2018 there were 70 million
people worldwide forcibly displaced
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due to war, conflict and persecution.
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It includes 40 million
internally displaced,
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25 million refugees
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and three million asylum seekers.
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Here in the United States,
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we see the impact of escalating violence
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in places like El Salvador,
Guatemala and Honduras,
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where murder rates can be high
as those in Syria and Afghanistan.
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Where police corruption
and gang violence are on the rise,
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where poverty and child abuse
are widespread and tolerated,
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where basic systems of governance --
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public safety,
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child protection --
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are ineffective.
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It's no surprise then that many
of the most vulnerable
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in some of these societies --
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children, women and other
targeted groups --
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they're growing increasingly desperate
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and fleeing in unprecedented numbers.
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Like over the past 10 years,
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the numbers of unaccompanied children
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trying to seek safety
at our Southwest border
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has increased 18-fold,
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from 3300 in 2009 to over
62,000 this past year.
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That's in addition to nearly half
a million people traveling as families.
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Men, women and children
trying to seek refuge at our borders,
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but who are stranded
in a humanitarian crisis.
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And what makes matters worse
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is that they're caught in this fog
of claims and counterclaims
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about who they are,
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what they've experienced,
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where the proof is
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and what they deserve.
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Do they deserve our help?
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Sometimes people make claims
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that they're not fleeing
human rights abuses
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but are simply economic migrants.
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Others say these children
are actually being exploited
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and trafficked by their parents.
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Others say they're
not even children at all;
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they're hardened criminals,
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they're gang members
trying to infiltrate our country.
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To cut through some of this fog,
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my colleagues and I conducted a study.
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We looked at data
from children seeking asylum
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who had medical evaluations.
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And this is what the evidence told us.
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80 percent of these children had evidence
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of exposure to repeated physical violence:
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assault and torture.
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60 percent of the girls
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and at least 10 percent of the boys
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had evidence of repeated
exposure to sexual violence.
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One young girl,
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telling a story
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and having corroborating evidence
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of being detained, beaten and raped
over the course of three years,
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trafficked to other men
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and even having the threats
of the murder of her entire family
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if she should ever escape
or try to seek help.
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90 percent of these children
had evidence of psychological harm
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from indirect violence,
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including such severe threats
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but also witnessing untold
atrocities with their very eyes.
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One young boy described
the terror and the grief
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and the utter fear
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of seeing the mutilated bodies
and faces of his younger brother,
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his aunt,
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his uncle,
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his cousin,
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all killed in a single gang attack
meant to send the community a message.
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And of course the psychological
toll is immense.
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19 percent of these children
had signs of anxiety disorder,
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41 percent, depression
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and 64 percent, PTSD.
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21 percent also had signs
of suicidality as children.
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To put this into some perspective,
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returning combat veterans,
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they have PTSD on the order
of 10 to 20 percent.
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These children at three-to-six times
more likely to have PTSD
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than a soldier returning from war.
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Now despite this burden
and despite this trauma,
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there are many others still.
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Children who come to seek safety
and enter into our immigration system
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only to find further abuse
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and even torture reminiscent
of the places that they fled.
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You might remember
some of those headlines,
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some of those images this past year.
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Children being ripped
from the arms of their parents.
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Toddlers, infants in cold
and unsanitary cages.
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The absence of food, water
clothing and even soap.
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There's also increasing reports
of medical negligence,
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preventable complications,
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child abuse,
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sexual abuse
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and even child deaths in US custody.
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Sadly, many of these abuses
and crimes aren't new.
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Some date back many years
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and even across administrations.
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But something's changed.
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The scope and scale
of these abuses and crimes,
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the systematic and seemingly purposeful
endangerment of asylum seekers
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and also the impunity
with which it's being done
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has raised the harm
to an entirely new level.
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It reminds me of one
of the girls in the study
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who told us how she pleaded
with one of her attackers,
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asking him to stop,
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asking why she was targeted.
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And do you what his response was?
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He says "we can do this because
there's no one here to protect you."
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We can't let this be true
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of children and other asylum seekers
trying to find help at our borders.
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But what do we do?
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As a physician,
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I'm often dealing with difficult decisions
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with some of my sickest
and most complex patients.
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Of course we want to keep
our focus on their health,
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their well-being,
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their quality of life,
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but sometimes it requires
a deeper exploration of their values
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to really understand how to move forward.
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In a similar way,
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our nation is facing a crisis
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with the increasing number
of asylum seekers at our borders
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and in our communities,
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and it compels us to re-examine
some of our own fundamental values.
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What does it mean when
we value health and safety?
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What does it mean when we value security,
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life,
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liberty,
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the life of children?
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What about this one --
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what does it mean when we say
we value law and order?
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Does that also include respecting
due process rights for an asylum seeker?
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Now for some,
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when they hear these terms
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they immediately gravitate
towards wanting to build more walls,
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deploy more border patrol,
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deporting more people
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even if it means separating
children from their families,
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subjecting them to psychological torture
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or deporting them to places
where they might die.
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All the in the name of security.
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All in our name.
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But for me and for many others,
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when I think of these values,
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that pushes me
in an entirely new direction
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and renews my commitment to try
to meet the needs of these asylum seekers
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with every tool I have at my disposal.
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So that when we say that we
value life and liberty,
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we'll see these people who have
taken unimaginable risks
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to flee imminent danger and harm
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to try to find safety.
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We'll meet them where they are
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and provide food, water,
shelter, clothing.
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And we'll certainly meet
them with medical care
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and mental health care
that they so desperately need.
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When we say that we value the rule of law
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and not just the privileges
it provides a few
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but the responsibilities
it requires of all of us,
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we'll make sure that we have
a functioning immigration system.
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We'll make sure that we have
trained judges.
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We'll make sure that we're not
settling for the illusion of law and order
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that maybe a tall wall
or a militarized border might provide us.
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We want the real thing.
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We want judges to be able
to evaluate the evidence,
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including the medical evidence,
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and we want them to administer justice ...
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fairly.
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When we say that we value
health and well-being,
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that we don't want to perpetuate harm,
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then we'll deploy
trauma-informed strategies
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at all levels of the immigration system.
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It might start with retraining
border patrol agents
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or immigration officials,
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but it needs more medical,
mental health and child welfare experts
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across the whole system.
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And when we say that we value justice,
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we won't let ourselves
be turned into the torturers
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that many of these children
and other people fled.
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We'll open up our detention
centers and our courts
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to experts and advocates
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to hold ourselves accountable.
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And we may find that we need
to shut down most of them
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and close these camps.
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I believe that by working
in effective partnerships
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with lawyers, doctors,
human rights advocates
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and many others,
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that we can work together
to meet these asylum seekers' needs,
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that we can meet our historical,
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humanitarian
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and legal obligations to them.
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And when we do,
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I think something powerful will unfold.
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Not only will these asylum seekers --
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like the man who came to my clinic
and won his asylum case,
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like the children in the study
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or the many thousands of others
seeking a new life,
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they'll be able to find
that safety and security.
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We'll recognize the abuses
that have occurred
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and we'll restore the rights
and protections that were lost.
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And I think that we'll be in wonder
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when we see them in the fullness
of their humanity.
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Not just their strengths and weaknesses,
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their hopes and joys,
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not just the trauma that we acknowledge,
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but we'll also stand with them
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and we'll be inspired by their resilience.
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They'll blossom
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and they'll add to the
richness of this nation.
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I think my staying true
to our fundamental values
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in the way that I've described,
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that's how we build a sane
and humane immigration system.
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That's how we remain the golden door.
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And that's how it happens
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that we remain the shining
light of the world.
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Thank you.
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(Applause)