Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations

Aaron Gallagher; Gabriela Steiner; Martha Michel; Cesar Nava Gonzales; Sabrina Mendez-Contreras; Alice Lu; Marcos Armendariz; Triveni DeFries; Suzanne Barakat; Coleen Kivlahan

doi:10.7146/torture.v32i3.130227

Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations

Torture. 2022;32(3):49-64. doi: 10.7146/torture.v32i3.130227.

Affiliations

¹ Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
² Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA.
³ Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Human Rights Collaborative, University of California, San Francisco, San Francisco, CA, USA Department of Community and Family Medicine, University of California, San Francisco, San Francisco, CA, USA.

PMID: 36519196
DOI: 10.7146/torture.v32i3.130227

Abstract

Introduction This research, through the analysis of the case-law of the Inter-American Court of Human Rights (IACtHR), seeks to shed light on the nexus between families of the missing' claims, their agency and State compliance with reparations. The IACtHR has a unique follow-up system in the area of reparations, where victims can directly address the judges during hearings. This paper suggests that victims' participation - before and after the judgment- pervades the legal rigidity of international jurisdictions and contributes to a better understanding of reparations.

Introduction: The number of forcibly displaced immigrants seeking asylum in the United States continues to rapidly increase. Movement from Latin America to the United States was the third-largest migration worldwide in 2017 (Leyva-Flores et al., 2019). As migration patterns change, understanding the background and trauma profile of newly displaced populations is essential to meet their health needs and aid successful resettlement. University-affiliated student-run asylum clinics conduct a growing number of forensic medical evaluations of asylum seekers and provide a vital lens to study changes in this population's profile over time.

Methods: A retrospective review was conducted of the first 102 asylum seekers receiving forensic medical evaluations between 2019 and 2021 at a university-affiliated student- run clinic, reporting demographics; trauma, medical, and mental health histories; referral patterns; and legal outcomes. Bivariate statistics were used to investigate the relationship between past trauma and mental health outcomes.

Results: Clients reported an average of 4.4 different types of physical, psychological, and sexual ill-treatment per person. The current mental health burden was extensive with 86.9 percent of clients reporting symptoms of PTSD and/or depression. Clinician-student teams evaluated clients within a clinic structure deploying a continuous improvement model to reduce common barriers to forensic evaluations and promote longitudinal follow- up and referrals.

Discussion: This study demonstrates the complexity of trauma exposure reported by asylum seekers, contributes to the evidence on how trauma results in mental health outcomes, and describes trauma-centred clinic adaptations that reduce barriers to forensic evaluations known to improve the rates of legal protection.

Keywords: Asylum seekers - Forensic medical evaluation - Health and human rights - Student- run asylum clinics - Complex trauma..

MeSH terms

Human Rights
Humans
Mental Health
Refugees* / psychology
Student Run Clinic*
Students
United States