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Medical Evidence Highlights Urgency to Restore and Expand Legal Protections for Survivors of Domestic and Gang Violence who Seek Asylum in the United States

A new report from Physicians for Human Rights and researchers from UCLA provides data to endorse restoration and expansion of U.S. asylum protections, details resilience of asylum seekers with access to support in the United States

In recent years, survivors of domestic and gang violence seeking asylum in the United States have been inhumanely stripped of asylum protections, despite evidence detailing the real and severe harm they experienced and their inability to obtain protection in their home countries. A new report from Physicians for Human Rights (PHR), in collaboration with faculty from the University of California, Los Angeles (UCLA), graduate students from the UCLA Fielding School of Public Health, and medical students at the David Geffen School of Medicine at UCLA, illuminates the persecution and resilience of asylum seekers, details the widespread impunity of perpetrators of domestic and gang violence in asylum seekers’ countries of origin, and provides medical evidence that underscores the need to expand legal protections for refugees and asylum seekers under U.S. asylum law.

Under the Trump administration, U.S. government protections for asylum seekers and refugees fleeing domestic and gang violence were drastically rolled back, upending decades of progress in the establishment of violence against women as a human rights violation, and undermining efforts to hold perpetrators accountable. Despite increasing rates of people from Central America seeking asylum in the United States on the basis of domestic and gang violence in their home countries, the Trump administration and like-minded policymakers have dismissed these bona fide claims as meritless, and significantly undermined asylum protections for this category of asylum applicants..

The report, “Profiles in Resilience: Why Survivors of Domestic Violence and Gang Violence Qualify for International Protection,” spotlights the widespread brutality experienced by asylum seekers fleeing domestic and gang violence, further exacerbated by both a debilitating lack of government protection and the traumatizing normalization of abuse in their home countries. The evidence substantiates and defends their qualifications for asylum and brings new insights to inform efforts to advocate for changes in United States asylum policies.

Together with researchers at UCLA and members of the LA Human Rights Initiative, PHR staff and physicians analyzed 132 medical-legal affidavits from evaluations conducted by volunteer clinicians in PHR’s Asylum Network for peoples who were successful in obtaining asylum in the United States from 1999 to 2019 to capture relevant criteria for international protection. Out of the 132 affidavits analyzed, 107 people were seeking asylum due to domestic violence and 38 were seeking asylum due to persecution by organized gangs; 13 of these people had experienced both forms of violence. This study specifically focuses on people who were granted asylum based on the protected ground of membership in a particular social group (such as women unable to leave an abusive relationship, or a person resisting gang recruitment), as this group has been targeted by recent policy changes that consider their cases unworthy of international protection.

“Our research finds a debilitating pattern of survivors’ inability to seek out or receive critical support in their home countries due to the normalization of violence in their communities, chronic impunity toward perpetrators by government and authorities due to corruption or collusion, and the stigmatization of victims,” said Adam Richards, MD, PhD, MPH, co-author of the report, associate professor of global health at the George Washington University Milken Institute School of Public Health, and a PHR medical expert. “These compounding factors provide a more than substantive basis for a person’s right to seek asylum and demand the expansion of protections for victims of domestic and gang violence. Asylum seekers often face further trauma, injury, abuse, or death by staying in their home countries. Applying for asylum in the United States is often the only chance they have at living a life free from violence and persecution.”

The research team documented how many asylum seekers continued to experience trauma even after arrival in the United States, and that this ongoing trauma was associated with clinical mental health diagnoses. Trauma in the United States often took the form of ongoing threats to themselves or their loved ones by former persecutors through phone or social media. For example, a 19-year-old girl from El Salvador reported that a week after she arrived in the United States, the MS-13 gang reached out to her through Facebook and threatened to kill her because she had left the country.

Despite further exposure to trauma in the United States, the report also reveals asylum seekers’ resilience. The findings show the potential for improvement of survivors’ mental health symptoms through access to safety and support systems in the United States, including family and social support, religion and collective identity, work and school, and access to mental and other clinical health services. The study demonstrates that the ability to attend work, school, and social gatherings without fear of harm helped individuals recover from their prior trauma and adjust to a new life in the United States.

“Asylum seekers are often driven to leave their home countries as an absolute last resort, leaving behind family and community out of fear of endemic violence and unspeakable harm. Though these individuals have experienced severe trauma, access to support systems they can only find while safely living in the United States gives them an opportunity to heal,” said Eleanor Hope Emery, MD, co-author of the report, program officer at Cambridge Health Alliance’s Center for Health Equity Education and Advocacy, and member of PHR’s Asylum Network. “The Biden administration must recognize that the opportunity to recover from trauma is denied to people in U.S. immigration detention or who are awaiting immigration proceedings in northern Mexico due to the Migrant Protection Protocols, expulsions under Title 42, and other policies which impinge upon their legal right to seek asylum in the United States.”

The study underscores the need to ensure gender-sensitive international asylum protections for survivors of domestic and gang violence that recognize widespread gender discrimination and uphold the fundamental human rights of people seeking asylum. Narratives of asylum seekers included in the report not only shed light on the severity and frequency of harm experienced, but also reveal the prevalence of gender-based persecution reinforced by community attitudes regarding traditional gender roles. In many instances, individuals cited an unwillingness of their families, community members, or government and authorities figures to protect them on the basis of their position in society as a woman, or as a member of the LGBTQ+ community.

The report features anecdotes from survivors that illustrate this particular suffering, including the detailed abuse experienced by “Ms. X,” a 31-year-old woman from El Salvador who reported being abducted, undergoing social isolation, and being a victim of sexual violence that was both domestic and gang-involved. She explains how she was treated as a possession of her captor, who classified her as “his woman,” for numerous years, and how her family and community refused to help protect her. After the birth of their first child together, Ms. X was beaten and humiliated by her captor, which intensified after his initiation to a gang. She was also forced to have sexual relations with other men in exchange for money that her captor collected.

Since the United States adopted the United Nations High Commissioner for Refugees 1951 Refugee Convention’s refugee definition into federal law in 1980, there has been measurable progress in asylum protections in certain areas, despite politically-motivated backlash. However, federal regulatory, judicial, and legislative changes in U.S. immigration policy have made it even more difficult to prove that a person meets the complicated and narrowly interpreted criteria for asylum protections under the refugee definition. PHR’s research finds a critical need to clarify or expand U.S. protection laws, particularly in the case of gender-based protections, as existing laws were developed in a time when gender-based violence was not widely recognized as a human rights violation.

“An individual’s right to bodily integrity and freedom from violence, including domestic violence, is inherent in international human rights law and must be applied without discrimination based on race, sex, religion, political opinion, or any other status to uphold fundamental human rights. This is not up for debate,” said Kathryn Hampton, MSt, co-author of the report and senior officer of PHR’s Asylum Program. “U.S. immigration policy must recognize the dangerous ambiguities in its existing refugee law, ambiguities that the Trump administration repeatedly leveraged to deny asylum claims. This research documents the severe forms of harm experienced by asylum seekers, which should be protected under domestic, regional, and international law.”

The report includes a series of recommendations for the Biden administration. These include immediately restoring access to asylum by revoking the Title 42 order, which used public health as a pretext for expelling asylum seekers at the U.S. border, and allowing absentia and the renewal of cases for asylum seekers who were denied or deported under the Migrant Protection Protocols. PHR also calls on the administration to recognize the evidence of severe impacts of persecution on the physical and mental health of  asylum seekers by introducing a trauma-informed approach to the adjudication process. Furthermore, PHR calls on the Biden administration to implement humane immigration policies that foster resilience among asylum seekers, including ensuring asylees can work legally, access education, and are released from detention into community settings, and by putting an end to family separation.

PHR also calls on Congress to consider whether the United States should introduce a form of complementary or subsidiary protection for asylum seekers whose cases may not meet the full criteria for asylum, but have demonstrated that the person is likely to face serious harm if returned to their country. The report also recommends that Congress review the characteristics and dynamics of harm laid out in this research to consider codifying them into law to safeguard asylum protections at the legislative level, including considering adding gender as a sixth ground for asylum. Additionally, PHR urges Congress to allocate increased funding for the asylum adjudication process to promote efficiency and fairness, including hiring additional immigration judges and asylum officers, funding legal orientation and representation programs, and ensuring access to essential services, education, and work opportunities for asylum seekers while their cases are pending.

The LA Human Rights Initiative is a student-run, faculty-supervised organization at UCLA. LAHRI runs an Asylum Clinic that provides pro bono forensic evaluations to asylum seekers and other immigrants and creates opportunities for experiential learning and professional development for medical students and residents.

Additional PHR resources on asylum and persecution at the U.S. southern border:

  • Fact Sheet: “Title 42 Border Expulsions: How Biden and the CDC’s Misuse of Public Health Authority Expels Asylum Seekers to Danger,” May 20, 2021
  • Press Release: “Biden Administration Must Provide Redress for Survivors, Accountability for Perpetrators of Family Separation Policy: PHR,” March 1, 2021
  • Press Release: “The Biden Administration Must Act Now to Protect the Health and Human Rights of U.S. Asylum Seekers: PHR,” February 2, 2021
  • Report: “Forced into Danger: Human Rights Violations Resulting from the U.S. Migrant Protection Protocols,” January 19, 2021
  • Webinar: Family Separation and Reunification Efforts, December 4, 2020
  • Report: “‘You Will Never See Your Child Again:’ The Persistent Psychological Effects of Family Separation,” February 25, 2020
  • Report: “‘If I went back, I would not survive:’ Asylum Seekers Fleeing Violence in Mexico and Central America,” October 9, 2019
  • Report: “‘There Is No One Here to Protect You:’ Trauma Among Children Fleeing Violence in Central America,” June 10, 2019
  • Program Page: PHR’s Asylum Network
  • Resource Page: Asylum and Persecution

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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