Learning How to Evaluate People Seeking Asylum

The half-day session featured talks by Jacobs School students and faculty physicians that explained HRI’s work, its relevance to global human rights work and to medical education. Attendees also heard from a staff attorney at Journey’s End Refugee Services, who discussed the asylum process from a legal perspective

Established in 2014, HRI works with physician volunteers at UB and in the community to document medical evidence of torture in immigrants seeking asylum in the U.S. A student chapter of the international organization Physicians for Human Rights (PHR), UB’s HRI is one of the largest asylum clinics in the U.S. in terms of the number of clients it evaluates.

HRI students have also assisted students at Brown University, Rosalind Franklin University of Medicine and Science, Stony Brook University and SUNY Upstate, who want to establish asylum clinics at their medical schools.

“We work with Physicians for Human Rights, which serves globally in countries where human rights are being trampled upon,” explained Kim Griswold, MD, professor emerita of family medicine and psychiatry in the Jacobs School and faculty mentor for HRI.  “Nationally, we work for the human right of asylum, which is a legal right in the U.S. We objectively evaluate evidence of any torture or mistreatment that has happened to a client, providing written testimony about the medical and psychiatric examinations that we perform.”

Under the supervision of physician volunteers, medical students train and act as medical scribes for HRI, helping to write affidavits that are presented in court. These affidavits, which document the chronology of the client’s story and clinical presentation, make a powerful difference: According to PHR, when there is no forensic affidavit, 37% of asylum applications are granted, but that number jumps to 89% when an affidavit is submitted to the court.

Sanjida Riea, a Jacobs School student in the class of 2028, spoke about how the group collaborates with lawyers, social workers, psychiatrists and physicians to document clinical evidence of physical or psychological trauma.

“Our role is not to prove anything,” she said. Instead, the terms they use in an affidavit are either that a physical or psychiatric symptom is consistent with or inconsistent with a particular claim of injury or torture.

Griswold added: “We are not advocates for each client. We bear witness to what has happened.”

For an act to be considered torture, Griswold explained, it must have caused severe pain and suffering physically or mentally, and it had to be inflicted on behalf of, or with the consent of, a public official.

HRI members and faculty showed the group images of the different types of injuries that clients have received and whether or not the injuries were considered consistent with the client’s story.

The differences in how injuries heal must also be considered, especially since they likely occurred months or years in the past. A laceration that has been sutured is going to look different compared to one that was left open and developed scar tissue.

Students saw images of different injuries and learned which torture method caused them: burns, gun shots, beatings, blunt force trauma and others, as well as the use of implements, such as whips or electrical cords used to hit people or tie them up. Clients have been dragged across shards of glass or made to stand for hours or days at a time. They have been victims of sexual assaults; sometimes the perpetrator has literally engraved their initials onto the victim’s skin.

Sometimes, Griswold said, the client has trouble telling the story because it is so horrific to recount it. “We see that with a lot of our clients,” she said. “They’re almost bewildered. They think, ‘how could someone plan this out and do this?’ It seems incomprehensible.”

HRI also documents psychological torture in the affidavit; for example, when someone is told that they will be fine, but their entire family is going to be killed. Clients have also been forced to watch family members being raped or killed.

The stories HRI members hear undeniably affect them, too. Dori R. Marshall, MD, associate professor of psychiatry and chief medical officer at Oishei Children’s Hospital, has been working with HRI since its inception. “It can be really challenging to do these interviews because the emotions can be so raw,” she said. Taking care of the client and their needs after an interview is the primary concern. But HRI members also need to check on each other and process what they’ve heard.

Jacob Herron, a student in the Class of 2027, spoke of a client who was granted asylum soon after being evaluated by HRI. The client had said that if she was granted asylum in the U.S., she wanted to go to school to become a nurse in order to take care of people.

“It’s a perfect example of someone leveraging the experience of having this trauma and wanting to do something positive for our community and the world,” Herron said. “Cases like this are a good argument for the fact that their resilience makes our community more resilient as well.”

Griswold added that Buffalo has a lot to offer clients, as it’s home to VIVE La Casa, the nation’s largest resident setting for asylum seekers, known worldwide as a welcoming place for refugees. HRI collaborates closely with local groups like Jericho Road Community Health Center, which provides free health care to asylum seekers and primary care to resettled refugees.

Attorneys from Journey’s End Refugee Services and the Erie County Bar Association Volunteer Lawyers Project represent asylum clients pro bono.

While this critical work is obviously life-changing for clients who are granted asylum, Griswold noted it also benefits medical students in multiple ways.

“We believe in training students in the humanistic aspects of medicine,” she said. “We train them how to listen to a client’s story and how to examine them in a trauma-informed way. That is relevant in any aspect of medicine.”