For Asylum Seekers and Their Health Advocates, Adjusting to a New Normal in the Time of COVID-19

After surviving sexual abuse and female genital cutting as a young woman in her home country of Guinea, Assiatou[1] fled for her life. When she arrived in the United States, she was placed with a foster family, went to school, learned English, and gave birth to her son.

Now, as a 24-year-old in New York City, she is among the ranks of health workers caring for the most vulnerable and providing essential, frontline care in the U.S. epicenter of COVID-19.

She’s also waiting to find out whether she will be allowed to stay.

Assiatou is just one of thousands of people from around the world pursuing their legal right to seek asylum in the United States. In the midst of the COVID-19 pandemic, legal and medical teams that help represent these claims have had to navigate new hurdles in an already complex legal environment. But through a strong network of practitioners, teams are innovating to help their clients across the finish line.

Going Remote

Before the coronavirus outbreak turned into a full-blown global pandemic, a growing movement of volunteer health professionals were already providing critical support to attorneys and their clients in the U.S. asylum application process. For years, members of PHR’s Asylum Network have regularly provided pro bono forensic evaluations that allowed a medical expert to assess the consistency of an asylum seeker’s physical and psychological signs or symptoms with their claims of persecution and abuse. These evaluations, which are typically conducted in person, are the basis for medical affidavits that reinforce survivors’ accounts of torture and ill-treatment, a critical piece of supporting evidence for a successful asylum claim in the United States.

To help make the transition to this new way of evaluating clients, PHR has convened a series of online discussions for medical experts across the Unites States on best practices for conducting remote interviews.

When the pandemic began, however, clinicians had to find new ways to interview asylum seekers. Members of the PHR Asylum Network started conducting forensic evaluations through phone and video platforms, to ensure that Assiatou and others like her continue to have access to these services.

But how much detail can an expert evaluator elicit through a remote evaluation of past trauma? Quite a lot, as it turns out: extensive studies have shown that diagnosis and treatment outcomes are comparable in telemedicine, and both patient and provider satisfaction levels are high. Although there is less evidence regarding forensic evaluations for asylum cases, a December 2019 study assessed the quality of remote and in-person forensic evaluations, comparing 10 remote and 20 in-person evaluation reports. The study concluded that the ability to diagnose and advocate for asylum seekers through remote assessments is equivalent to in-person evaluations and noted the added benefit of being accessible to those in difficult-to-reach locations, like clients in detention.

So far, a number of clinicians in the PHR network have taken on this challenge to ensure services to asylum seekers can continue. To help make the transition to this new way of evaluating clients, PHR has convened a series of online discussions for medical experts across the Unites States on best practices for conducting remote interviews. In one such PHR webinar on remote psychological evaluations, Dr. Joanne Ahola, a New York-based psychiatrist and PHR Asylum Network member since 1999, remarked that she “found it surprisingly the same to do the evaluation remotely as in person.”

Eric Stone, a California-based licensed clinical social worker, agreed. “Online eval[uation]s are equally as effective as in-person. In fact, I think the clients are slightly less anxious online because they are in their own homes and not traveling to an ‘examination’ which tends to create a buildup of anxiety,” he said.

Though medical experts have so far seen remote evaluations positively, the determination of an affidavit’s reliability – and admissibility to the case – is ultimately made by an immigration judge or asylum officer. There, too, initial signs point in a positive direction. Former immigration judge Susan Roy addressed the reliability of remote evaluations: “Online evaluations, if they’re conducted with the same sort of protection of privacy and objective measures, would be given the same weight as in-person evaluations by immigration judges.”

New Hurdles for Asylum Seekers

While remote evaluations themselves might be an innovative response to the COVID-19 pandemic, new challenges concern U.S. asylum seekers and their advocates. There is a lack of clarity from the Department of Justice’s Executive Office of Immigration Review on the postponement of hearing dates, key appearances in court that are the milestones in an asylum case. Describing her experience with one immigration court in Dallas, attorney Fatma Marouf remarked that “we have three [different] orders by three judges within the court.” Additionally, many attorneys have noted that even if their clients’ hearing dates are postponed, the date by which they must submit all evidence has not necessarily changed. Despite the uncertain progression of the pandemic and its impact on immigration proceedings, attorneys continue to prepare their clients’ cases, knowing that hearting could start up again at any time. 

As attorneys and their clients must prepare everything for cases remotely, new communication needs arise. For example, since in-person visitation in immigration detention centers has been paused due to the pandemic, thousands of people in detention must share limited phones to connect with the outside world. Many attorneys report that the necessary technology has not been made available to detainees by Immigration and Customs Enforcement (ICE), posing serious due process issues of confidentiality and privacy.

Clinicians working with individuals in detention facilities have discovered that policies about remote communication vary greatly. For one client detained at Bergen County Jail in New Jersey, where ICE confirmed the first COVID-19 case in immigration detention on March 24, the PHR evaluation could not happen because the jail does not accommodate video visitation. For the case of this asylum seeker – who was scarred from having been beaten and raped by gang members in Guatemala – video technology was essential.

A Second Chance for Assiatou

Despite the new challenges, PHR experts have conducted more than 67 remote physical and psychological evaluations since mid-March, highlighting the agreement among asylum seekers, attorneys, and expert health professionals that remote evaluations are the safest and most reliable option during the COVID-19 pandemic.

This is welcome news to clients like Assiatou, for whom a psychological evaluation is critical to her claim for asylum: due to her ongoing trauma from the violence she faced in Guinea, she was unable to face the process of applying for asylum in the first year she arrived in the United States. Under restrictive U.S. immigration procedures, missing the one-year deadline is a bar which could have disqualified her from being eligible even to apply for asylum; but having a medical explanation for the delay could give her the chance to have her full story heard.

In the affidavit for Assiatou’s case, the psychiatrist notes that Assiatou “arrived for the Zoom-based interview [and] looked unsettled, possibly just sitting down after other responsibilities.” After an in-depth clinical evaluation, the psychiatrist diagnosed her with post-traumatic stress disorder and depression. Now, the psychiatrist’s affidavit will be presented to an asylum adjudicator, who will decide whether Assiatou can have an extension in her asylum application process. With luck, she will be allowed to stay in New York, continuing her work as a health provider and caring for others in need.

[1] All identifying details have been changed to protect this client’s identity.

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