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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 this 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 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?

261
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Now for some,

262
00:12:41,055 --> 00:12:42,299
when they hear these terms

263
00:12:42,299 --> 00:12:45,247
they immediately gravitate
towards wanting to build more walls,

264
00:12:45,247 --> 00:12:46,808
deploy more border patrol,

265
00:12:46,808 --> 00:12:48,278
deporting more people

266
00:12:48,278 --> 00:12:51,147
even if it means separating
children from their families,

267
00:12:51,147 --> 00:12:53,579
subjecting them to psychological torture

268
00:12:53,579 --> 00:12:56,461
or deporting them to places
where they might die.

269
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All the in the name of security.

270
00:12:59,754 --> 00:13:01,219
All in our name.

271
00:13:01,812 --> 00:13:05,091
But for me and for many others,

272
00:13:05,091 --> 00:13:06,493
when I think of these values,

273
00:13:06,493 --> 00:13:08,778
that pushes me
in an entirely new direction

274
00:13:08,778 --> 00:13:12,719
and renews my commitment to try
to meet the needs of these asylum seekers

275
00:13:12,719 --> 00:13:15,474
with every tool I have at my disposal.

276
00:13:15,969 --> 00:13:18,966
So that when we say that we
value life and liberty,

277
00:13:18,966 --> 00:13:22,298
we'll see these people who have
taken unimaginable risks

278
00:13:22,298 --> 00:13:24,558
to flee imminent danger and harm

279
00:13:24,558 --> 00:13:26,061
to try to find safety.

280
00:13:26,451 --> 00:13:27,933
We'll meet them where they are

281
00:13:27,933 --> 00:13:30,402
and provide food, water,
shelter, clothing.

282
00:13:30,552 --> 00:13:33,028
And we'll certainly meet
them with medical care

283
00:13:33,028 --> 00:13:35,559
and mental health care
that they so desperately need.

284
00:13:36,049 --> 00:13:38,534
When we say that we value the rule of law

285
00:13:38,534 --> 00:13:41,580
and not just the privileges
it provides a few

286
00:13:41,580 --> 00:13:44,669
but the responsibilities
it requires of all of us,

287
00:13:44,669 --> 00:13:47,605
we'll make sure that we have
a functioning immigration system.

288
00:13:47,605 --> 00:13:49,651
We'll make sure that we have
trained judges.

289
00:13:49,794 --> 00:13:54,412
We'll make sure that we're not
settling for the illusion of law and order

290
00:13:54,412 --> 00:13:57,879
that may be a tall wall
or a militarized border might provide us.

291
00:13:58,191 --> 00:13:59,760
We want the real thing.

292
00:14:00,059 --> 00:14:02,494
We want judges to be able
to evaluate the evidence,

293
00:14:02,494 --> 00:14:04,226
including the medical evidence,

294
00:14:04,226 --> 00:14:07,593
and we want them to administer justice ...

295
00:14:07,593 --> 00:14:08,772
fairly.

296
00:14:10,741 --> 00:14:13,407
When we say that we value
health and well-being,

297
00:14:13,407 --> 00:14:17,408
that we don't want to perpetuate harm,

298
00:14:17,408 --> 00:14:20,128
then we'll deploy
trauma-informed strategies

299
00:14:20,128 --> 00:14:22,040
at all levels of the immigration system.

300
00:14:22,040 --> 00:14:24,466
It might start with retraining
border patrol agents

301
00:14:24,466 --> 00:14:26,207
or immigration officials,

302
00:14:26,207 --> 00:14:29,720
but it needs more medical,
mental health and child welfare experts

303
00:14:29,720 --> 00:14:31,436
across the whole system.

304
00:14:33,766 --> 00:14:38,770
And when we say that we value justice,

305
00:14:38,770 --> 00:14:42,087
we won't let ourselves
be turned into the torturers

306
00:14:42,087 --> 00:14:45,245
that many of these children
and other people fled.

307
00:14:45,546 --> 00:14:48,449
We'll open up our detention
centers and our courts

308
00:14:48,449 --> 00:14:49,661
to experts and advocates

309
00:14:49,661 --> 00:14:51,546
to hold ourselves accountable.

310
00:14:52,524 --> 00:14:55,906
And we may find that we need
to shut down most of them

311
00:14:55,906 --> 00:14:57,580
and close these camps.

312
00:15:01,594 --> 00:15:04,299
I believe that by working
in effective partnerships

313
00:15:04,299 --> 00:15:07,248
with lawyers, doctors,
human rights advocates

314
00:15:07,248 --> 00:15:08,513
and many others,

315
00:15:08,513 --> 00:15:11,440
that we can work together
to meet these asylum seekers' needs,

316
00:15:11,440 --> 00:15:13,533
that we can meet our historical,

317
00:15:13,533 --> 00:15:14,567
humanitarian

318
00:15:14,567 --> 00:15:16,384
and legal obligations to them.

319
00:15:17,432 --> 00:15:18,431
And when we do,

320
00:15:18,431 --> 00:15:20,513
I think something powerful will unfold.

321
00:15:20,958 --> 00:15:22,813
Not only will these asylum seekers,

322
00:15:22,813 --> 00:15:25,814
like the man who came to my clinic
and won his asylum case,

323
00:15:25,814 --> 00:15:27,380
like the children in the study

324
00:15:27,380 --> 00:15:30,861
or the many thousands of others
seeking a new life,

325
00:15:30,861 --> 00:15:33,381
they'll be able to find
that safety and security.

326
00:15:33,781 --> 00:15:36,180
We'll recognize the abuses
that have occurred

327
00:15:36,180 --> 00:15:39,511
and we'll restore the rights
and protections that were lost.

328
00:15:40,547 --> 00:15:42,742
And I think that we'll be in wonder

329
00:15:42,742 --> 00:15:45,459
when we see them in the fullness
of their humanity.

330
00:15:46,047 --> 00:15:48,696
Not just their strengths and weaknesses,

331
00:15:48,696 --> 00:15:50,400
their hopes and joys,

332
00:15:50,400 --> 00:15:53,566
not just the trauma that we acknowledge,

333
00:15:53,566 --> 00:15:55,533
but we'll also stand with them

334
00:15:55,533 --> 00:15:57,743
and we'll be inspired by their resilience.

335
00:15:58,051 --> 00:15:59,455
They'll blossom

336
00:15:59,455 --> 00:16:02,084
and they'll add to the
richness of this nation.

337
00:16:02,679 --> 00:16:05,282
I think my staying true
to our fundamental values

338
00:16:05,282 --> 00:16:07,151
in the way that I've described,

339
00:16:07,151 --> 00:16:10,727
that's how we build a sane
and humane immigration system.

340
00:16:10,908 --> 00:16:14,610
That's how we remain the golden door.

341
00:16:15,129 --> 00:16:16,362
And that's how it happens

342
00:16:16,362 --> 00:16:19,232
that we remain the shining
light of the world.

343
00:16:19,706 --> 00:16:20,823
Thank you.

344
00:16:20,823 --> 00:16:23,108
(Applause)