How doctors can help fix the broken US asylum system

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.