For the majority of refugees coming to the United States, the process of entering the country is long and difficult, especially for those who have experienced trauma and then have to prove it happened to gain asylum. However, according to a new University study, this burden of proving persecution or trauma is made considerably lighter with the provision of a professional medical examination.

Bridgette Carr, law professor and director of the Human Trafficking Clinic at the University of Michigan, said refugees have to provide substantial evidence of their persecution or trauma to be granted asylum. Trauma can range from domestic abuse, religious persecution or persecution because of sexuality or nationality.

“In America, asylum seekers can put themselves in one of two categories: They can have experienced persecution in the past, and that past persecution can be enough that they get asylum, or they can have had no persecution but they can prove that they have a well-founded fear of future persecution,” she said. “If they prove that they truly are at risk, that their fear is well-founded both subjectively and objectively that they will be persecuted if returned, they can receive asylum.”

In the United States, refugees can apply for asylum for both themselves and their family by filing a Form I-589, which prevents them from being forced to leave. Once an individual is granted asylum, they are permitted to work and live in the United States in the same way as a natural-born citizen.

Elizabeth Scruggs, a third-year medical student who was the first author of the new study and is a member of the UM Asylum Collaborative, said based on their findings, medical examinations appear to be a key part of applying to another country. The UM Asylum Collaborative is a student-led initiative that “mobilizes health professionals to advocate for victims and survivors of human rights violations.”

“Our study, given that it’s qualitative, can’t make any definitive or statistical statement, but really every lawyer we’ve spoken to agreed that it’s a key or crucial piece of the application,” Scruggs said. “It’s something that should always be present, but often is not present simply because of lack of access, lack of resources or simply lack of a physician to perform the evaluation.”

Carr, though not a researcher in the study, said she agreed about the importance of a medical exam.

“If you’re doing a female genital mutilation case and you don’t have a medical affidavit from a doctor in the U.S. examining your client that says it’s happened to her, if that’s your claim of past persecution, you won’t win,” she said.

Even in cases where no physical proof of past abuse remains, a medical exam can greatly boost a refugee’s chances of being granted asylum, according to the study. Scruggs said psychological exams play an important role in corroborating a refugee’s story and assessing for the clinical findings of post-traumatic stress disorder.

Most refugees aren’t afforded this chance, however, as obtaining a medical exam as a refugee can be very difficult.

“You’re not entitled to a lawyer,” Carr said. “If you are not represented by a lawyer, what you can bring forward might be pretty minimal, and if you’re represented by a lawyer or an NGO that has a ton of resources, then what they can cobble together will be fundamentally different. I would say that for the majority of clients who seek asylum, the majority of their evidence is their testimony.”

Another factor hindering the availability of medical exams, Scruggs said, is a lack of training in the medical community to perform such exams. 

“Even though physicians receive extensive training throughout their schooling, there are specific skills that are helpful, and some would argue necessary to be able to perform these types of evaluations, and that training is somewhat hard to come by,” she said. “Unless you really seek it out and attend the training through Physicians for Human Rights, or through an asylum clinic like our own here at Michigan or at Cornell or elsewhere, it’s not very easy to come by.”

Even when doctors do have the proper training, however, Scruggs said there is a lack of awareness of the issue. Though many doctors do volunteer work and are interested in humanitarian issues, the refugee crisis isn’t always the first thing that comes to their mind.

“I think many physicians are unaware that they can use their skills and their training in this regard,” she said.

As well, after a medical exam is obtained, applicants still have to wait — sometimes years at a time — for their case to be heard, simply because the court system is so backlogged. Scruggs said out of fifty cases UMAC has teamed up with University faculty on to facilitate asylum-related exams, only two have been heard thus far.

“So, of those 50 cases that UMAC has taken on in the last two and a half years or so, most of those cases are still pending,” she said. “We have these two cases that are successful; these are literally the only cases that have been heard.”

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