Several years ago a young man came to see me in my clinic.
He told me he was running for his life.
He said that he fled his home
because there, homosexuality wasn't just illegal,
in some cases it was punishable by death.
So when his sexual orientation was exposed,
his family rejected him,
his boss fired him
and angry mobs repeatedly attacked him in the streets.
And each time the police arrived only to arrest him,
detain
and torture him further.
And he knew that if he couldn't escape the cycle of violence,
he would surely be killed.
So he had to do what he needed to do to survive.
He left everything behind.
All of his friends, his family, his career.
He fled his home,
he escaped to the United States
and here he applied for asylum.
But like many people fleeing this kind of persecution,
he couldn't carry much.
He had some basic ID,
barely any money
and a few other belongings.
He certainly didn't bring official documents
from the police who tortured him.
No videos from the mob that tried to kill him.
He didn't have this kind of evidence to help support his claims,
yet here he was,
sitting in my clinic,
showing me some of the most powerful evidence of his persecution.
That was the physical and psychological scars that he brought with him.
You see, he suffered from chronic, debilitating pain.
He had severe scars scattered over his body,
poorly healing wounds that got infected over and over again.
He suffered from severe depression
and continued to regular, paralyzing nightmares and flashbacks from PTSD.
So we continued our work.
We met regularly for months,
documenting each of these pieces of medical evidence.
We went over the details of every attack,
photographed his scars,
documented his injuries and wounds,
and we were even able to start chronicling his slow but steady recovery
while under our care.
Working closely with his lawyers,
I submitted a detailed affidavit,
including the findings of this forensic medical evaluation,
and we included it as part of his asylum application.
And then we waited
for several long years while he navigated the courts.
And then one day I got an email from him.
It said that he was granted asylum.
And everyone in the clinic was overjoyed.
He said in his email that this was the first time in years
that he didn't fear deportation and death.
It was the first time in years that he truly felt safe,
that he had the security to rebuild his life all over again.
And it was only through this medical and legal advocacy
that we were able to help restore his legal status and his rights
that he could do that,
all through asylum.
Now for many people fleeing persecution,
they come to programs and clinics like this
telling unimaginable tales of violence
and different reasons they were persecuted.
But one this is always the same.
The violence meted against them was met with complete impunity.
Sometimes by the hands of the state directly through police
of military officials.
In other cases,
the state just turns a blind eye
and condones the acts of paramilitary groups
or even violent domestic partners.
In other cases,
state is completely powerless
to protect the vulnerable from powerful gangs.
Now we know that social determinants of health play a huge role
in determining the health and well-being of our patients:
housing,
income,
education,
race,
social inclusion.
But the same can be true for equal protection in the law.
Due process.
Especially in societies for the most vulnerable,
the marginalized
and even those who are actively targeted,
their access to these human rights protections,
that can mean the difference between sickness and in health,
and often it's the difference between life and death.
And for millions of people who endure persecution and torture,
the only way to heal
is to acknowledge the human rights abuses that have occurred,
and to help restore the rights and protections that were so violated.
After the atrocities of World War II,
the asylum system was set up as one pathway to that kind of relief.
But these days it seems like that pathway has turned into an obstacle course,
setting people up to fail.
Asylum seekers oftentimes don't know how to start
let alone complete the process that can drag on for years.
They're not entitled to lawyers,
so they don't know their rights.
Increasingly, they're even being barred
from setting foot in places of potential refuge.
They're arrested or prosecuted,
even deported before they ever get to see an asylum officer.
And even if they do make through the process,
asylum grant rates can be as low as 20 percent,
and far worse for some.
It's almost like the system was designed
to keep people from exercising their right.
But there is something that many of these people can do.
Something that can potentially increase their chances of success
to 90 percent or more.
So what makes the difference?
Getting a lawyer and having a medical evaluation.
It's as simple as that.
The man who came to my clinic and won his asylum case.
Doctors and lawyers working together to present all of the evidence,
including the medical evidence,
to the courts
allows judges to make informed and just decisions.
And it's this kind of medical-legal partnership
that's now more important than ever.
Because we live in a time of epic forced migration
due to violence and conflict.
In 2018 there were 70 million people worldwide forcible displaced
due to war, conflict and persecution.
It includes 40 million internally displaced,
25 million refugees
and three million asylum seekers.
Here in the United States,
we see the impact of escalating violence in places like El Salvador,
Guatemala and Honduras,
where murder rates can be high as those in Syria and Afghanistan.