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Asylum & Detention
Host a discussion: Case studies of asylum seekers The Refugee Protection Act of 2010
Creating an Asylum Clinic at Your School!
Physicians for Human Rights’ Asylum Network is a community of hundreds of health professionals who offer pro bono physical and psychological evaluations to document evidence of torture and persecution for men and women fleeing danger in their home countries. Survivors of human rights abuses are entitled to seek safe haven in the United States, but often find themselves immersed in lengthy and complex legal procedures that could ultimately result in deportation— resulting in further abuse, torture, and even death.
The Asylum Network at Physicians for Human Rights conducted 317 evaluations during academic year 2010-11. These evaluations aided survivors of female genital mutilation, LGBT persecution, gang violence, government sponsored torture, and a number of other forms of persecution. 10% of these evaluations were shadowed by medical students and residents through student run asylum clinics.
PHR has partnered with clinics at Mount Sinai, Cornell, UCSF, and University of Miami, and is now working with students to establish a new clinic at Tufts School of Medicine. These clinics offer not only direct medical training for students and residents, but provide much-needed forensic evaluations to survivors of egregious human rights abuses. Medical affidavits provide clear evidence of persecution, helping to secure legal status for survivors who deserve the chance to start their lives anew in the US.
PHR forensic evaluations are conducted by licensed physicians and residents, psychologists, and clinical social workers. However, medical students can play a very active role in conducting forensic evaluations. Asylum clinics run by students are a valuable resource, and PHR is always looking to expand to more medical schools.
Steps for medical students to establish an asylum clinic:
1. If your school has a free clinic, see if it can be reserved for a few hours a week [or month] for forensic evaluations.
2. Locate interested physicians who would be willing to conduct evaluations while teaching medical students. Professors, clinicians, mentors, and residents are all great resources for building a team for your clinic. Once identified, have the physicians join the PHR network  directly.
3. Identify a PHR-Student clinic point person. This student representative will be responsible for in-taking clients referred by PHR. When the clinic has openings for client evaluations, the point person will notify PHR, who will then send a list of pending clients.
Throughout the process, PHR will be available to answer any questions, provide training materials and example affidavits, and place you in touch with students and mentors from the already operating student clinics. Please see the example of the clinic at the University of Miami here. 
Student clinics are a wonderful way to gain valuable medical training, while directly helping clients in critical need of medical evaluations. Students who are involved in their asylum clinics can arrange training sessions for students and residents, host meetings to present their asylum work, and continue to get more students and licensed practitioners alike passionate and motivated about helping this vulnerable population.
If you are interested in establishing an asylum clinic at your school, please contact Kelly Holz, the Asylum Network Coordinator, at firstname.lastname@example.org . She will be available to answer any questions, and to provide all of the available resources.
The Asylum Network needs more forensic evaluators— and you can recruit them for us through establishing a student-run asylum clinic. Contact the Asylum Network today!
Creating an Asylum Clinic at Your School! Physicians for Human Rights’ Asylum Network is a community of hundreds of health professionals who offer pro bono physical and psychological evaluations to document evidence of torture and persecution for men and women … Continue reading
Hundreds of thousands of people around the world are threatened, persecuted and tortured because of who they are or what they believe. This includes members of opposition political parties in totalitarian nations, adherents of locally unpopular religions, and LGBT men and women who are ostracized by their communities.
Asylum and detention in the US
Asylum is a legal immigration status designed to offer safety to innocent victims like these. A person who fears future physical or psychological harm in his or her home country may be eligible to live and work as an asylee in the US.
Although asylum is meant to protect a victim’s human rights, the US process for granting asylum often undermines these rights. Many traumatized asylum seekers are incarcerated for months or even years in jail-like immigration detention centers . Their mental and physical health declines due to isolation, punitive treatment, substandard medical care and a host of other bad conditions. Even if released from custody, individuals may be subjected to stigmatizing and restrictive community monitoring that requires wearing an ankle bracelet or being visited at home regularly by the immigration equivalent of a probation officer. Asylum seekers are not provided with lawyers, work permits, social services, or medical care (except if incarcerated) while their cases are being decided. They are not able to earn a legal income. This lack of support pushes many to give up fighting their cases before receiving a decision, in spite of the danger they face upon deportation.
Asylum seekers in the US are confronted by a system that exacerbates the harm done by previous human rights abuses and imperils their health.
Fleeing persecution Hundreds of thousands of people around the world are threatened, persecuted and tortured because of who they are or what they believe. This includes members of opposition political parties in totalitarian nations, adherents of locally unpopular religions, and LGBT … Continue reading
In 2009, students, residents, and attendings at the University of Miami began working with PHR to plan a Human Rights Clinic. The intention was to enable asylum-seeking persons/victims of torture and abuse to obtain medial affidavits that document potential physical/psychological human rights violations on a consistent basis. The team drew on an existing academic model in operation at the Mt. Sinai School of Medicine in New York. The clinic provides a valuable service to the South Florida community while simultaneously providing education to medical students, residents, and fellows in this subject.
On Friday, October 29, 2010, the Human Rights Clinic of Miami  is officially opened its doors. Natascha Chida , a PGY-2, said, “Clients will mainly be persons who experienced torture/persecution and are seeking asylum in the United States. We will perform a history and physical that will result in a medical affidavit that the client’s legal representatives can use when advocating for asylum status. Our community partners will refer clients to us; these include Physicians for Human Rights, Catholic Charities, FIAC, and other local organizations. We will not be providing direct medical care, but clients may follow up at the San Juan Bosco Clinic for services. At this time PHR students (as the clinic is a project of PHR at UMMSM) and J Weiss residents will be volunteering with our clinic faculty, but as we grow we hope offer the experience to other residents and students.”
Here is an example of UMHRC’S structure  (PDF).
Here is an example of UMHRC’S algorithm  (PDF).
Here is an example of UMHRC’S Intake Form  (PDF).
Here is an example of UMHRC’S Initial Proposal  (PDF).
In 2009, students, residents, and attendings at the University of Miami began working with PHR to plan a Human Rights Clinic. The intention was to enable asylum-seeking persons/victims of torture and abuse to obtain medial affidavits that document potential physical/psychological … Continue reading
An interview with Natasha Chida.
What inspired the asylum clinic?
A combination of things led us to create our human rights clinic in Miami. I had worked with the Asylum Network on a few projects while serving on the PHR Student Advisory Board during medical school and had been speaking with Jenni Balde (the then Asylum Network Director) about doing a training in Miami in 2009. We then heard about Albert Einstein´s Human Rights Clinic and thought that a similar project may be needed in Miami (in addition to a one-time training). Miami has a large asylum-seeking population but at that time did not have a group of professionals who were consistently documenting, so the need was great.
At the same time that these things were occurring, Dr. Stephen Symes (program director of Jackson Memorial Hospital´s Internal Medicine Residency and also the director of the J Weiss Residency in Social Medicine and Global Health Equity) had been asked by local legal professionals in Miami to evaluate several immigrants who had been detained and were in need of medical care. Evaluations were thus being done prior to the creation of the HRC.
At this time (fall of 2009) we began speaking with PHR at the University of Miami Miller School of Medicine about starting a clinic; we essentially formed a coalition of students, residents, and faculty to work on the project. We then contacted the associated program directors of Albert Einstein’s program and they were kind enough to provide us with information about how the clinic is set up and run, etc. We then began contacting people in Miami who we thought would like to be involved.
What resources did you need to have?
Support from a key faculty member who was willing to serve as medical director (Dr. Symes), support from key medical school faculty, partnerships with local community organizations who deal with these issues, and a group of faculty, residents, and students who were willing to interview and document. We also made use of PHR´s sample affidavits and the training packet we received during the Miami Asylum Network Training. Lastly, we contacted other similar clinics in the country and obtained information from them. Dr. Ramin Asgary of the Mt. Sinai School of Medicine was particularly helpful. Based on all of this information we created the structure  (PDF). and algorithm  (PDF). of our clinic.
What is the first thing you should do when creating a system to provide evaluations for asylum seekers?
Always research what resources are already available to asylum seekers in your community. It is always a good idea to keep from replicating activities that already exist. In addition, it is preferable to partner with organizations who are already involved in the work you want to do. Have a good sense of what your community needs before starting a project (essentially, perform a needs assessment).
How much time did it take to start the clinic? What is the time commitment now?
In the beginning it probably took about 5 hours per week for a few months. This mainly involved contacting people, communicating (conference calls), meeting with people, creating documents for the clinic, etc. Now it really depends on how many evaluations we have. If there are none, then less than an hour a week on average. If there are, it is a bit different. Each eval takes at least 8 hours in total (including the interview, examination, and then writing the affidavit later) so the time commitment is variable. This is divided amongst members, however, so it isn´t too bad.
How do asylum seekers find your clinic?
Dr. Symes had already formed good relationships with local community organizations such as the Florida Immigrant Advocacy Coalition and Catholic Charities prior to the creation of the HRC. Both of these organizations have legal wings that serve asylum seeking clients. These organizations contact Dr. Symes directly to ask for evaluations. In addition, we also had pre-existing connections with PHR, through which we are also referred clients. Lastly, we did some research (via the internet and phone calls) on organizations in the state of Florida who serve asylum seekers; we have contacted them and they will also send us clients in the future.
How do you cover your costs?
At this time we do not have costs, but in the future we may apply for grant funding if necessary.
How do you recruit new MDs and med students? What skills do they need to have?
The student Chapter of PHR officially runs the clinic. We recruited residents through the J Weiss Residency. Once we have more clients we may open it up to other residents, but for now we are focusing on the Social Medicine Residents. In terms of attendings, we have a group of core faculty. We essentially knew people who would be interested and contacted them personally. UM as a human rights community is pretty close-knit so we already had relationships with people who we knew would be interested.
When we need more attendings in the future we´ll send out emails to other people who we know are interested in these issues but also ask our existing members to contact people directly. In terms of skills, students and residents need commitment and an interest in this type of work. Attendings need to be able to perform a thorough history and physical/psychological exam. It isn’t absolutely necessary for students/residents/attendings to have attended a PHR Asylum Network Training, but it is very helpful. Everyone should at least read PHR’s handbook on documenting for asylum seekers. People really become experts at doing the evaluations with practice.
It was a bit easier for us to find faculty to be involved because we already knew several people who would be interested because we’ve been involved with Miami’s human rights community for some time. If students who are new to a med school are seeking faculty, the best thing to do is always meet with a few key players on campus and get names of people who have an interest in human rights. Once you have the names you can directly contact them.
An interview with Natasha Chida. What inspired the asylum clinic? A combination of things led us to create our human rights clinic in Miami. I had worked with the Asylum Network on a few projects while serving on the PHR … Continue reading
What is asylum?
Asylum is the process by which a person fleeing persecution in his or her country of origin can seek protection in another country. Every year, thousands of individuals who have suffered violence, injustice, and torture, seek asylum in the United States. When granted, asylum within the US can eventually lead to permanent residency. This legal status also allows an asylee to work legally, to apply to bring family members into the country, and to enter and exit the country freely.
Who can apply for asylum?
Those who flee their country of origin and reach the United States can apply for protection in the form of asylum due to persecution based on race, religion, nationality, political opinion, or membership in a particular social group. The US also recognizes women who have undergone forced abortion, involuntary sterilization, and who have suffered persecution for resistance to a forced birth control program, as eligible for asylum.
For those whose experiences may not fit the stringent requirements for asylum, the following forms of relief from deportation are also available:
- The Violence Against Women Act (VAWA): This 1994 US Federal Law can serve as a basis of protection for victims of domestic violence.
- Withholding of Removal: Often applied for simultaneously with the asylum application, this process prevents deportation in the case that a person is “more likely than not” to face persecution if forced to return to his or her home country.
- Convention Against Torture (CAT): Although more difficult to obtain than asylum, CAT status allows those who fear torture that is not necessarily based on race, religion, nationality, membership in a particular social group, or political opinion, to apply to remain in the US.
- U-Visa: A U-Visa gives up to four years of legal status and work eligibility to victims of certain crimes who cooperate with law enforcement.
- T-Visa: A T-Visa allows certain human trafficking victims to remain in the US if they agree to testify against perpetrators.
What happens when a person applies for asylum?
The process of seeking asylum is controlled by complex US immigration law. It has become increasingly difficult to gain asylum since the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. Among other things, this law established requirements for the expedited removal and detention of any asylum seeker who arrives in the US without valid permission to enter the country, and has led to the detention of many asylum seekers who have no criminal record.
The detention system is based on the punitive model of criminal incarceration, and many asylum seekers suffer poor living conditions, high psychological stress, and inadequate access to health services while in detention. The lack of appropriate mental health and other health services has led to an unacceptable number of avoidable deaths within the detention system. Being incarcerated makes it extremely difficult for individuals to seek evidence, correspond with attorneys, and otherwise prepare successful asylum applications. Additional barriers to successful asylum petitions include language differences between asylum seekers and immigration officials, the lack of social and financial resources, and a general lack of understanding of how to seek asylum.
To evaluate an affirmative asylum case, an asylum officer will conduct a detailed interview in which the asylum seeker must demonstrate that he or she cannot return to his or her country of origin due to past persecution or a reasonable fear of future persecution. If an asylum seeker already has an order to appear before an immigration judge, they must prepare a defensive asylum application, which means a judge will hear the case in an adversarial setting. The interview and court proceedings are often extremely difficult and traumatizing for the asylum seeker, as they are forced to recount the details of experiences which may include torture and other severe forms of persecution.
The medical documentation of an asylee’s suffering is hugely influential; in some cases medical professionals who have conducted forensic evaluations may be brought in to testify on the asylum seeker’s behalf so that their findings can have maximum impact on decision-makers. Although 90% of asylum cases with a medical evaluation are approved, the lack of qualified volunteer physicians means that the majority of asylum seekers do not receive this important, potentially life-saving, assistance.
Eventually, the asylum seeker will receive a decision on his or her case, and depending on the circumstances, might have a few legal options left, or may be immediately ordered back to his or her country of origin. Those who receive asylum can immediately begin work and petition to bring their family members into the country.
How long does it take to be granted asylum?
With few exceptions, the 1996 Law requires that applications for asylum be filed within one year of arrival within the United States. However, detained asylum seekers can remain in detention anywhere from months to years while they await decisions on their cases.
What is asylum? Asylum is the process by which a person fleeing persecution in his or her country of origin can seek protection in another country. Every year, thousands of individuals who have suffered violence, injustice, and torture, seek asylum … Continue reading
- How To Contribute To The Asylum Network 
- The University of Miami Human Rights Clinic: A Model 
How To Contribute To The Asylum Network The University of Miami Human Rights Clinic: A Model
US Immigration Detention and Alternatives: An Overview
Why are Noncitizens in Immigration Detention?
Those without US citizenship, even green card holders, may be deported from the US under certain circumstances. In most cases, deportation requires a judge’s order. Deportation hearings take place in immigration courts, where immigrants do not have the same protections afforded to criminal defendants. A lawyer is not provided by the government, even if a person is unable to understand or participate in legal proceedings, and impartial determinations of mental capacity are unavailable.
Immigration detention was formerly used only for those with the most serious criminal convictions or those who posed national security concerns. However, strict immigration laws passed in 1996 drastically expanded the list of crimes that warrant detention, and also implemented mandatory detention for most people caught arriving in the US without valid permission to enter. Any noncitizen accused of being deportable or under a deportation order may be held in a prison, jail, or jail-like detention center until the case is decided.
As a result, immigration detainees are today the fastest growing segment of the incarcerated population in the US.
Detention of Asylum Seekers in the US
Asylum seekers very often flee their homes in acute danger and try to avoid official detection until they reach a country where they hope to find refuge. Because many asylum seekers escape from their countries hastily, many arrive in the US with without adequate identification and are therefore particularly likely to find themselves subject to mandatory immigration detention while awaiting resolution of their cases.
Detention is severely damaging to the health and well-being of Asylum Seekers
United Nations treaties and international laws strongly advise against detaining asylum seekers because detention damages the physical and mental well being of asylees who may have experienced severe persecution or torture. The US government’s plan for health care of detainees has historically focused on “mak[ing] sure [detainees] are medically able to travel and medically able to return to their country,”  as opposed to maintaining or improving health.
In a landmark 2003 survey by PHR and the Bellevue/NYU Program for Survivors of Torture, many respondents reported that they had significant difficulty in accessing care while in detention, and nearly half reported that their physical health had declined while in detention. The survey also found that 90% percent of asylum seekers in detention suffered one or more of the conditions of anxiety, depression, and PTSD, and more than 90% of these individuals reported that detention had substantially contributed to worsening their mental health. There is significant variation between different detention facilities, and a lack of comprehensive oversight. Although conditions in some detention facilities have improved since 2003, poor conditions and human rights violations continue in many others due to the lack of standardization and oversight of detention facilities. Between October 2003 and January 2010, a shocking 107 detainees died in immigration detention, many due to documented substandard care or severe neglect of their medical conditions.
Alternatives to Detention
Programs that offer alternatives to detention have proven successful both in ensuring that asylum seekers appear for immigration hearings, and in avoiding incarceration of innocent individuals. In the late 1990’s the Vera Institute of Justice created a pilot program called the Appearance Assistance Program (AAP). Immigrants selected by the government were diverted from detention, received help with establishing community ties and finding “sponsors,” and were required to meet regularly with program staff about their rights and duties in the legal process. Ninety three percent of formerly detained asylum seekers in AAP appeared for all of their hearings, compared to 78% of a control group who received no special services. Detention is justified only when an individual is determined through individualized review to pose a danger to the community. Otherwise, asylum seekers should be released into effective alternative community supervision plans.
  Caitlin Weber, “ICE Officials’ Testimony on Detainee Medical Care Called into Question,” CQ Politics , June 16, 2008, (accessed February 25, 2009).
US Immigration Detention and Alternatives: An Overview Why are Noncitizens in Immigration Detention? Those without US citizenship, even green card holders, may be deported from the US under certain circumstances. In most cases, deportation requires a judge’s order. Deportation hearings … Continue reading
How asylum and detention affect health and human rights.
- An Introduction To Asylum 
- An Introduction To Immigration Detention 
- Dual Loyalty: Should Physicians Always Prioritize The Patient? 
- Conditions Of Detention: The Use Of Isolation And Segregation 
- Respect Medical Neutrality 
How asylum and detention affect health and human rights. An Introduction To Asylum An Introduction To Immigration Detention Dual Loyalty: Should Physicians Always Prioritize The Patient? Conditions Of Detention: The Use Of Isolation And Segregation Respect Medical Neutrality
To help people develop an understanding of the range of reasons that asylum seekers request sanctuary in the U.S., you may host a discussion these case studies. Participants may wish to read these cases ahead of time, or the discussion facilitator may read the profiles one at a time.
Politically persecuted, detained and tortured
This case is for a man in his 30s from Cameroon. The client is seeking a physical and psychological evaluation. In Cameroon, he was arrested and detained on three occasions for his political opinion and association with the Southern Cameroons National Council and human rights activities. His reported physical scars include scars on his head, as well as on his legs and feet from beatings in detention. In addition, he has reported difficulty sleeping, nightmares, nervousness/anxiety, and headaches. He speaks English. The attorney is seeking a completed affidavit by December and will also be requesting oral testimony in January.
Subjected to FGC, forced into marriage, and abused
This case is for a woman in her 20s from Burkina Faso. The client is seeking a psychological evaluation. She is seeking asylum because she was subjected to FGC when she was 5 years old and still suffers from physical pain and emotional trauma from the procedure. When she was 20 she was forced into a marriage by her stepfather, during which she was systematically raped. She is now legally married in the US and has a baby, but fears that if she returns to Burkina Faso she will be forced to return to her marriage, where she will once again be raped. She also fears her daughter will have to undergo FGC.
Gay, HIV positive, and threatened
This case is for a man in his 40s from Jamaica. The client is seeking a psychological evaluation. In Jamaica, his life was threatened because of his sexual orientation and HIV positive status. He and his friends were attacked for being gay. He was forced to be closeted his entire life, and was also in an abusive relationship. His attorney also believes he suffers other non-obvious psychological issues, including extreme anxiety, shyness and panic attacks.
Fleeing domestic violence
This case is for a woman in her late 20s from El Salvador. The client is seeking a psychological evaluation. She has suffered extreme abuse by her common law husband and father of her two children. Since becoming pregnant with her first child, she was subjected to beatings and rapes. He threatened her and told her if she ever left him that he would kill her, also threatening to take away her children. He took one daughter from her and did not return her until the client agreed to go back to him. He was an alcoholic and a drug abuser and would hurt her often when he was drunk or high. The client fled to the US after he beat her one night in front of his friends. She left her children with her mother in El Salvador.
Seeking treatment and dignity
This case is for a woman in her 30s from Nepal. The client suffers from a rare and deadly skin disease, which renders her unable to tolerate sunlight. She suffers from chronic tumors, which are surgically removed on a monthly basis, resulting in massive scarring and the complete loss of her nose. As a result of cultural stigma associated with disability, she was denied schooling at an early age, and she and her siblings (also afflicted) were victims of ridicule and violence. Due to a lack of sophisticated medical care in Nepal, she has only received effective care in the U.S. She has lost one brother to depression, and fears she will fall victim to the same fate is she is returned to Nepal. She speaks Nepali and some Hindi.
To help people develop an understanding of the range of reasons that asylum seekers request sanctuary in the U.S., you may host a discussion these case studies. Participants may wish to read these cases ahead of time, or the discussion … Continue reading