The skin on her back was discolored and rough, the extensive burn scar clearly the result of a brutal assault. As I analyzed the wounds of the 30-year-old Central American before me, I sought to ease her vulnerability and avoid re-traumatization. I reassured her she was in safe hands.
This was not the first medical evaluation I had done of an asylum seeker, and I knew that scars could speak. But the stories *Maria’s burns told me that day reinforced the power of forensic medical evidence.
A thorough forensic medical evaluation is critical in providing evidence of past persecution and establishing a basis for asylum. Accurate reporting of the medical condition and torture evidence is a responsibility that my colleagues and I take very seriously. When physical scars corroborate a story of persecution and torture, applicants are more likely to receive asylum – which, for some, means avoiding being killed if sent back to their country of origin.
Physicians for Human Rights, whose volunteer doctors provide forensic medical and psychological evaluations of asylum seekers, has a 90 percent success rate for reported asylum outcomes, versus the average national asylum success rate of just 30 percent. But with President Trump’s public defamation of asylum seekers’ motives, the chances of even getting an opportunity to apply for asylum have been severely hampered under increasingly restrictive immigration policies.
Maria’s scars confirm her story of being beaten when she was kidnapped by gang members for being “different.” Not only had she been targeted for being indigenous, they took aim at her because of her gender identity: Maria was assigned male at birth, but identifies as a woman – something which one group of gang members thought warranted electrocution. They placed her in a water trough and inserted electric cables which shocked her three times, after which they threw battery acid on her. It would not be difficult for me to translate the marks on Maria’s body into evidence to bolster her asylum claim.
In the United States, to be eligible for asylum, applicants must prove that they have a credible fear of persecution as a result of their race, religion, political opinion, nationality, or membership in a particular social group. The legal affidavit that followed my evaluation of Maria’s scars would go a long way toward strengthening her lawyer’s argument that she indeed suffered extreme trauma in her country of origin and that returning there would put her life in danger.
But some cases don’t bear evidence on the outside. Some scars fade. Some physical abuse doesn’t leave a permanent mark. And then there’s the psychological trauma. International and U.S. law consider infliction of severe pain or suffering – whether physical or mental – to be part of the definition of persecution, but proving that someone is emotionally traumatized can be much more difficult. Putting the case forward for invisible scars is far more challenging in an immigration court, where appealing to a judge’s emotions goes hand-in-hand with laying out the forensic evidence.
*Vanessa was in her late 40s when I evaluated her. Though there were no discernable marks on her body, it was immediately apparent that her psychological scars ran deep. She had been living in the United States for several decades but was undocumented. She raised a family, and one of her children had even joined the U.S. armed forces. En route to a military training graduation ceremony, she was arrested and taken into Immigration and Customs Enforcement detention. Over the next few weeks, she was moved from detention in Arizona to Louisiana to Texas, and eventually deported to Mexico. U.S. immigration officers dropped her at the border after sundown and told her to “walk into town” on her own – a town she had never been in before, and where she knew no one. Within 10 minutes of crossing the border, she was kidnapped, beaten and raped by gang members. She never did attend her child’s graduation ceremony. In fact, it would be months before she was reunited with her family, after running across the border between legal ports of entry into Arizona. Her decision to run had been an easy one. She had been held at gunpoint by cartel members who had been following her since the initial attack, and who now threatened to kill her, telling her, “The only way for you to escape us is to run across the border where we cannot follow.”
Someone like Vanessa would need to be evaluated by my colleagues who specialize in psychiatry and psychology and who work alongside me as part of Physicians for Human Rights’ Asylum Network. Their evaluations are similar to the physical exams that I do, but they seek to extract trauma embedded deep within. They translate symptoms of trauma into forensic evidence, which is often life-saving. When someone claims they’ve been tortured but there are no witnesses, or if they were tortured in a secret location, or when there’s a lack of medical documentation from the time of the attack, the only evidence that exists is what is buried in their minds. It could be panic attacks, flashbacks, and nightmares, or a state of numbness, lack of emotion, and forgetfulness – all psychological aftereffects which are highly consistent with post-traumatic stress.
Immigration courts across the United States are suffering severe and growing backlogs, and the government shutdown resulted in more than 80,000 hearings being canceled. But even on a so-called “good” day, the legal process that awaits all applicants seeking asylum is grueling, and almost always includes a period of detention.
Crossing the border in search of a better life is not a manipulative ploy by gangs to infiltrate the United States. The scars that I see each day tell me that these are frightened individuals who embark on this journey out of desperation and hopelessness – often as a last resort. Simply put: they have nowhere else to be safe. Being granted asylum will never take away the trauma they suffered in their countries of origin, but it guarantees that they never have to return to the horrors from which they fled.
*Names have been changed to conceal identities.
Dr. Norma Price is based in Tucson. She has been practicing medicine for over 45 years and has more than a decade of experience working with migrants along the U.S.-Mexico border. Dr. Price serves as a medical expert for Physicians for Human Rights as part of its Asylum Program.