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Stop Compounding Shame and Anxiety Felt by Abuse Victims

How archaic and false perceptions are clouding the search for truth in the Kavanaugh Hearings

“And this is precisely why so many sexual abuse survivors remain silent,” we thought, as we watched the Senate Judiciary Committee tear into Dr. Christine Blasey Ford as she tried to explain why some details of the sexual assault she suffered were fuzzy while others were vividly etched into her brain.

As the hearings following the nomination of Judge Brett Kavanaugh to the U.S. Supreme Court descended into frantic chaos last week, with senators leaving the chamber and returning, and some making condescending pronouncements like “she’s an attractive, good witness,” causing a collective gasp from the mouths of most women – and many men – across the nation, we couldn’t help but notice that the focus throughout the hearings was not on understanding the horror of sexual assault, but rather on ensuring that a “good man’s reputation” isn’t tarnished. The needle was very clearly pointed at defending Kavanaugh versus believing, let alone respecting, his accuser.

This hostility toward Dr. Blasey Ford, and the unrelenting questioning of the veracity of her testimony, peppered with insinuations that she remembers wrong, or doesn’t remember enough, or perhaps has confused the identity of her attacker, goes against everything that medical professionals and lawyers, like us, who are experts on sexual violence, know about survivors and about how a brain in a state of high anxiety remembers things.

We know that a traumatic experience ignites the body’s fight or flight response, mediated by a release of certain hormones, including norepinephrine, in the brain. The increase in this neurotransmitter, which specifically relates to high emotional valence memory storage, safeguards the most salient details of an experience – like an attacker’s smell or voice – and locks them into our memories via the Hippocampus, the area responsible for storing emotion-based memory in the brain. Conversely, the more extraneous details – like escaping the scene, or who else was present – may not be recorded at all. Hence memories of trauma can be remembered both vividly, and over time very reliably, while other details of the same trauma are completely forgotten. This is not uncommon. In fact, this is normal.

We also know that most survivors do not report sexual assaults. The reasons range from shame, fear of exposure, fear of re-traumatization or retaliation or being disbelieved, fear of being blamed, a feeling of guilt on their own part – “Did I do anything to cause this?” – a feeling of hopelessness that nothing will come of reporting the abuse, as well as a desire to suppress the event and just “make it go away”.

Those of us who practice medicine know that Dr. Blasey Ford’s testimony, from beginning to end, was wholly in keeping with the experience of a person who has been sexually assaulted.

It may take repeated outcries from survivors who endured assault, and from health care providers or activists who work with them, to change perceptions around sexual abuse and the realities of reporting these crimes. Or perhaps it will take senators being cornered in an elevator, confronted with raw and indisputable truth of emotion and anguish.

Whatever it takes, perceptions must change. The Kavanaugh hearings have sent a dangerous message to sexual abuse survivors that their stories will not be believed, and it further emboldens perpetrators, and perpetuates the notion that abusers – especially those in powerful positions – will be defended at all costs.

Ranit Mishori, MD, MHS, is a professor of family medicine at the Georgetown University School of Medicine and a medical expert consultant for PHR’s Program on Sexual Violence in Conflict Zones. Karen Naimer, JD, LLM, MA, is the director of PHR’s Program on Sexual Violence in Conflict Zones. Gail Saltz, MD is a PHR board member and clinical associate professor of psychiatry at Weill-Cornell Medical College and a psychoanalyst with the New York Psychoanalytic Institute.

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Mukwege and Murad Nobel Win Amplifies Voices of Sexual Violence Survivors in Era of Kavanaugh and Blasey Ford

At a time when leaders and others in powerful positions question the truth of allegations made by sexual violence survivors, and when issues of abuse can divide a nation and send protesters onto the streets, the Nobel Peace Prize win today by two of the world’s leading advocates for sexual violence survivors could not have come soon enough. It’s not only a deserved win for Dr. Denis Mukwege and for Ms. Nadia Murad, but it’s also something that the world sorely needs: a spotlight on the plight of survivors and the need for them to be treated with dignity and respect. What is equally powerful is that the Nobel Committee decided to honor a doctor alongside a survivor – showing the world both sides of the struggle, and highlighting their different, but equally inspiring, reasons for devoting their lives to advocacy.

Our partnership with Dr. Mukwege to help train key stakeholders in the Democratic Republic of the Congo (DRC) began in 2011. Since then, we have strengthened the capacity of local doctors, nurses, police, lawyers, and judges to collect, preserve, and present evidence of sexual violence in order to support prosecutions for these crimes.

This vital work by Dr. Mukwege, as well as Ms. Murad’s advocacy for Yazidi women and girls who are subjected to sexual violence in Iraq, has been critical in raising awareness about how pervasive and widespread sexual abuse is, at all levels of society, and in all industries and cultural landscapes. It shows that sexual abuse exists not only in Washington DC, where Dr. Christine Blasey Ford testified last week about alleged abuse at the hands of Supreme Court nominee Judge Brett Kavanaugh, or on the film sets of Hollywood. It exists in the villages of the DRC and Kenya, in Myanmar and Bangladesh, where Rohingya refugees seek refuge from violence, including sexual abuse – and in Iraq, where Yazidi women and girls try to rebuild their lives after fleeing rape and sexual assault by ISIS.

Dr. Mukwege and Ms. Murad have long advocated for the treatment and protection of sexual violence survivors – at their own personal risk and peril. Their work has played an important part, at this #MeToo moment, in encouraging survivors to come forward and to tell their stories, in a world full of stigma and retribution, where many who have suffered sexual abuse fear re-traumatization and social repercussions – especially when the perpetrators are in positions of power.

The importance of this win cannot be overstated. It’s time for the world to sit up and listen, because the work is far from over. I whole-heartedly congratulate Dr. Mukwege and Ms. Murad and thank them for turning the world’s attention to the epidemic of sexual violence in armed conflict and for strengthening the call for a global reckoning over sexual abuse. It’s as a result of people like them that survivors can find the meaningful justice they deserve and perpetrators can be held accountable for their unacceptable and brutal actions.

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Family Separation Update: PHR’s response to Secretary Nielsen

As you may remember, within days of the first family separations at the U.S. border, more than 20,000 medical professionals and PHR supporters condemned the barbaric practice in a letter to Department of Homeland Security (DHS) Secretary Kirstjen Nielsen. She then responded with a letter full of obvious factual errors and misleading doublespeak.

Secretary Nielsen’s response proves that the U.S. government is clearly ready to sweep this – and hundreds of still-separated children – under the rug. But we will NEVER allow polite words and bureaucratic smoke screens to deter us from fighting back. So we have sent a full and full-throated response to Secretary Nielsen that you can read below. We will continue to fight to prove that facts still matter. The health and human rights of these children still matter. And it’s your actions and contributions that are allowing us to scale up our resistance in the weeks to come. Thank you.

***

The Honorable Kirstjen Nielsen
Secretary
U.S. Department of Homeland Security
3801 Nebraska Avenue, N.W.
Washington, D.C. 20528

Dear Secretary Nielsen,

Thank you for responding to Physicians for Human Rights’ (PHR) letter, which conveyed the grave concerns of over 20,000 health professionals around the country about the severe medical and mental health harms of family separation and related enforcement actions of the Department of Homeland Security (DHS). Your July 19, 2018 letter raised a number of serious issues which we would like address.

Although you deny a “blanket policy” of family separation, your agency implemented “zero tolerance” by systematically separating families at the border and now faces a court order to reunite the families torn apart under this policy. As an initial matter, all immigration policies should respect basic human rights of all migrants, regardless of their immigration status or manner of entry.[1] Criminal prosecution for the administrative infraction of irregular entry fails to comply with U.S. obligations under international law.[2] Criminalizing irregular migration is disproportionately punitive and harsh, and contributes to intolerance and xenophobia.[3]

As referenced in PHR’s letter of June 14, 2018, forced separation violates U.S. and international law protecting the rights of children, as well as refugees and migrants, including the right to family unity. Although your letter describes separation as a collateral consequence of illegal border crossing, parents who presented at ports of entry were also separated from their children, for example, Ms. L, the lead plaintiff in Ms. L v ICE. Seeking asylum at the border is a legal right under US law.[4]

DHS has instead imposed family separation by refusing to exercise lawful discretion in granting parole requests to asylum-seeking families, which would allow them to remain together in community settings.[5] The arbitrariness of such refusals formed the basis of a preliminary injunction issued on July 2, 2018 in the U.S. District Court for the District of Columbia. The judge in Damus v. Nielsen ordered five ICE field offices that were refusing 100% of parole requests, without any justification, to release asylum seekers after their initial interview, unless there was an individualized determination that the individual was a flight risk or posed a danger to the public.

Even absent a written DHS policy of separating families, a manifest pattern of conduct is sufficient for establishing operational policy and intent. Intent to separate may be inferred from a widespread operational policy and practice of family separation by means of detention. You certainly knew that risks of harm to children and families were a foreseeable result of DHS implementation of the “zero tolerance” policy, it was within your power to prevent separation, and you did nothing to prevent the harmful consequences which resulted.

Your agency’s failure to record separated family members has helped ensure that the severing of parents from children is long term and in some cases, permanent. In all cases, there was, and in some cases continues to be, a period where parents are unaware of their children’s whereabouts and are not able to contact them. Thus, your agency’s policy of forced separation may effectively result in temporary forced disappearances— an extremely grave human rights violation which should be avoided at all costs.[6] The Administration has deported at least 366 parents who are still not reunited their children.[7] There is credible evidence that these deportations took place under conditions of duress and deceit. In addition, the over 900 parents who have been deemed “ineligible” of reunification have had their parental rights terminated in a manner which has deprived them of meaningful access to due process.

Executive Order 13841 of June 20, 2018 directed the Attorney General to request a modification of the Flores settlement. PHR strongly condemned the Attorney General’s request as inconsistent with human rights standards. The Attorney General has requested that the time limits in the Flores settlement be removed so that children can be detained indefinitely and to remove the requirement that children and families be held in state-licensed facilities. Detaining children indefinitely is cruel and inhumane treatment, and detaining anyone in unlicensed facilities is inhumane. Flores is not a loop hole, but rather a minimum protection for vulnerable children. Using Congress to reverse the Flores decision because the courts have declared the Attorney General’s request to be unconstitutional is not a permanent fix, it is a cynical attempt to subvert Constitutional protections through backroom political deals.

Families seeking safe haven at our borders are not smugglers or nefarious actors. The government did not substantiate in any way that these parents were unfit parents or had committed any crimes apart from the administrative infraction of irregular border crossing. PHR evaluations of families over the past 25 years have demonstrated the vulnerability and the real trauma and persecution experience by those seeking refuge in the US.

Parents and children must be reunited. Your Department has broken the law and is under court injunction to provide remedies to the families that you have harmed, which you are so far failing to do. We are registering our concerns for the record, as medical professionals, and as concerned citizens who hold you accountable. As medical experts, we stand ready to provide expert guidance towards development of immigration and border enforcement policies and practice which respect health and human rights.

Respectfully,

Donna McKay

Executive Director

Physicians for Human Rights

256 West 38th Street

New York, NY 10018



[1] A/HRC/7/12, Report of the Special Rapporteur on the human rights of migrants, Jorge Bustamante, 25 February 2008

[2] Article 31(1) of the UN Refugee Convention, whose 1967 Protocol is ratified by the United States, “The Contracting States shall not impose penalties, on account of their illegal entry or presence, on refugees who, coming directly from a territory where their life or freedom was threatened in the sense of article 1, enter or are present in their territory without authorization, provided they present themselves without delay to the authorities and show good cause for their illegal entry or presence.”

[3] A/HRC/17/33, Report of the Special Rapporteur on the human rights of migrants, Jorge Bustamante, 21 March 2011.

[4] Refugee Act of 1980, Pub. L. No. 96-212, § 208, 94 Stat. 102 (1980), codified at 8 USC § 1101.

[5] 2009 Immigration and Customs Enforcement (ICE) Directive on Parole of Arriving Aliens Found to Have a Credible Fear of Torture or Persecution.

[6] A/HRC/36/39/Add.2, Report of the Working Group on Enforced or Involuntary Disappearances on enforced disappearances in the context of migration, 28 July 2017

[7] https://www.pbs.org/newshour/nation/24-migrant-children-under-age-5-remain-separated-from-their-parents-new-court-filing-says

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PHR honors Iraqi Dr. Nagham Hasan

PHR salutes Dr. Hasan for her extraordinary work treating and supporting survivors of sexual slavery and genocide perpetrated by ISIS against Iraq’s Yazidi minority.

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Syrian Heroes, Dr. Lena and Dr. Nour

Partners of Physicians for Human Rights (PHR), Dr. Lena and Dr. Nour, have risked their lives to provide medical care in Syria and to document human rights abuses, including torture and sexual violence, committed against their patients. PHR honored Dr. Lena and Dr. Nour at our 2016 Gala to recognize their important contributions to the Syrian people and for their efforts at attaining justice.

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Take Action to End Family Separation

The U.S. administration’s appalling crackdown on desperate immigrants reached new lows in early May, when the Department of Justice began forcibly separating children from their parents as they cross into the United States from Mexico. Forced family separation is profoundly harmful to children and to families and violates fundamental human rights.

The U.S. administration’s appalling crackdown on desperate immigrants reached new lows in early May, when the Department of Justice began forcibly separating children from their parents as they cross into the United States from Mexico. Forced family separation is profoundly harmful to children and to families and violates fundamental human rights. Physicians for Human Rights immediately activated our Asylum Network, mobilizing medical professionals across the country to stand up to this cruel policy. More than 5,000 medical professionals and others signed our letter [PDF] to Attorney General Jeff Sessions and Secretary of Homeland Security Kirstjen Nielsen demanding an end to forced family separation and calling attention to its lasting negative health effects on children. With your support, we are sending a clear message to the U.S. administration that its inhumane immigrant detention practices must end. Please sign our letter today!

Sign Now!

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We Fixed Secretary Nielsen’s Letter on Family Separation

PHR's response to Secretary Nielsen

As you may remember, within days of the first family separations at the U.S. border, more than 20,000 medical professionals and PHR supporters condemned the barbaric practice in a letter to Department of Homeland Security (DHS) Secretary Kirstjen Nielsen. She then responded with a letter that simply shouldn’t be shared without pointing out the obvious factual errors and misleading doublespeak. So, red pen in hand, we attempted to fix Secretary Nielsen’s letter for her.

But there is simply no amount of red ink that could “fix” this disingenuous letter. And because we will NEVER allow polite words and bureaucratic smoke screens to deter us from fighting back, we have drafted a serious response to Secretary Nielsen that you can read here.

Please share this shameful letter (and our attempts to “fix” it!) to expose DHS’s callous twisting of the facts. Click here to share using the social media buttons at the top of the page.. We will be in touch soon with more ways you can stand with children and families at the border.

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Take a Stand for Refugees

#Care4Refugees

We Stand With Refugees

Members of the Physicians for Human Rights board of directors, Dr. Marion Bergman, Dr. Kathleen Foley, Dr. Adam Richards, Dr. Michele Heisler, Dr. Robert Lawrence, Dr. Deborah Ascheim, and Dr. David Dantzker.

Join us in standing with refugees by showing your support on social media. Download a sign here and use our hashtag #Care4Refugees.

President Trump’s executive orders banning refugees are a violation of the law and an affront to the values of humanity and human rights. As health professionals in PHR’s Asylum Network can attest, it’s particularly troubling that these executive orders target those who are already suffering, imperiling thousands of lives and arbitrarily punishing those who have already survived the horrors of war and deprivation.

We’re also outraged that the Trump Administration chose to single out Syrian refugees specifically. Since 2011, we’ve been tracking just how devastating the relentless attacks on civilians, hospitals, doctors, and health care infrastructure have been for the people of Syria. To deny them refuge is to increase their suffering and to put their lives in even greater jeopardy.

As health professionals, and human rights activists, join us in standing side by side with refugees and their families. Snap a photo with one of our downloadable signs, and then share it on social media using our hashtag #Care4Refugees. Tell us why you support immigrant and refugee families, and we’ll share some of your responses.

Here’s how it works:

STEP ONE:

Download and print any one of these pre-made signs that explains why YOU support refugees.

•    I stand with refugees because my job is to relieve suffering
•    I stand with refugees because I’ve seen the scars of their trauma
•    I stand with refugees because freedom from persecution is a human right
•    I stand with refugees because everyone has the right to a safe haven
•    I stand with refugees because I come from an immigrant family
•    I stand with refugees because my ancestors were refugees
•    I stand with refugees because I won’t turn my back on suffering

Or make your own sign!

STEP TWO:

Snap a photo of yourself, your colleagues, your friends, or your family members holding the sign. You can take the picture at home, outside, at your office or clinic, or anywhere else you want to show your support.

STEP THREE:

Share your photo on Facebook, Twitter, or Instagram using the hashtag #Care4Refugees and tell us why you support refugees.

Share on Twitter

Open Letter

PHR Calls on Turkish President to Release Jailed Physician

PHR and leading medical organizations sent a letter to Turkish President Recep Tayyip Erdoğan calling for the immediate dismissal of all charges against Dr. Serdar Küni, the Human Rights Foundation of Türkiye’s representative in Cizre and former president of the Şırnak medical chamber. Dr. Küni was arrested and detained on October 19, 2016 on charges of providing medical treatment to alleged members of Kurdish armed groups. The authorities subsequently charged Dr. Küni with being a member of an armed organization, based on allegations that he provided medical treatment to members of armed organizations during fighting in Cizre in 2015 and 2016. In the letter, we call upon the president to:

1. Immediately release Dr. Serdar Küni, and drop all legal actions immediately and unconditionally;

2. Respect and fulfill Türkiye’s obligation to protect the right to health, medical neutrality, and freedom of association and expression; and

3. Provide an effective remedy and reparation to victims of arbitrary arrest, detention, and judicial and legal harassment.

>>Read the full letter here.

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