My patient asked me to evaluate him for evidence of his beatings and torture. This is a common scenario for doctors who examine asylum seekers. By documenting physical marks and psychological effects of refugees’ trauma, we can add credibility to their applications seeking asylum in the United States. But during the Trump administration, the asylum process ground to a halt, among many controversial actions taken against immigration. I received so few requests for my evaluations, I worried I had accidentally been dropped from the email list — I had not. Helping these people secure legal status is more likely to save lives than any regular clinic visit.
The Biden administration has already approved an executive order on Deferred Action for Childhood Arrivals (DACA) and has signaled new plans to support asylum seekers waiting in Mexico. To its credit, the administration in March proposed systemic changes focused on administrative restructuring, e.g., moving cases away from the Department of Justice’s immigration courts to the Department of Homeland Security to reduce case backlog and shorten processing times from years to months. Beyond long-term restructuring, however, we urgently need immediate action to help those waiting and in need now. We must also work beyond simply restoring the system, to expand it.
Seeking asylum is a common dilemma, with growing crowds of asylum seekers backed up at our borders. These people deserve compassion and attention.
My first asylum-seeking patient startled me with his request for filling out legal paperwork. I was on a medical school rotation in rural Uganda. Though I knew abstractly that life was difficult for the refugees, I had never before personally encountered torture. This man was trying to avoid returning home, where he feared for his life.
He explained how soldiers beat him in his home country, the Democratic Republic of the Congo, just five kilometers away. I lifted up his shirt and found healing linear scrapes in the pattern of ropes. He confirmed that he had been whipped repeatedly and bound after being imprisoned.
Since finishing my medical training, I have made supporting asylum seekers a part of my practice, and have trained other volunteers to do the same, in partnership with groups like Physicians for Human Rights. It is not my job to scrutinize their stories, as the government does. I only assess if their exams are plausibly consistent with the histories they describe in affidavits. That confirmation can be powerful and persuasive to those who review their applications.
In 2016, our team’s study in JAMA Internal Medicine showed that asylum seekers with medical evaluations had success rates of 79% to 89% compared with the national average of 37.5%. Though this reflects correlation, and not necessarily any causative relationship, it did suggest that medical examinations have enormous impact. A doctor’s exam and medical affidavit could mean the difference between securing legal status in the United States or being deported to a country where they will face persecution and torture.
Some might argue that with COVID-19 and many policy fronts to tackle, the asylum program might take lesser priority. But to save lives, President Joe Biden must not only wind back Trump’s punitive moves — he must also restore and expand the blocked refugee resettlement program.
Humbled by the stories I hear, I am grateful that some of my patients have gotten asylum. I do not always find out what happens to them. For example, one woman from an extremist religious community was obligated to marry an older man of her father’s choice, commemorated with ritual genital mutilation (often known as female circumcision). She absconded to the United States, and given her abandonment, her father and brothers intended to kill her. She is only one case.
I have seen patients from Asia, Africa, and South America who were beaten by gangs, or had lives threatened because of political protests. The Trump administration decided these lives were not worth saving, actively working toward ending asylum for anyone. Even with so many crises at once, the Biden administration must prioritize saving and expanding the asylum system. We must renew the United States as a bold world leader in standing for the dignity of human rights.
Jules Lipoff, MD, is an assistant professor of clinical dermatology at the Perelman School of Medicine and a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. The opinions expressed in this article do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.