OAKLAND, Calif. — Dr. Nick Nelson walks via busy Highland Hospital to a sixth-floor examination room, the place he sees sufferers from around the globe who say they’ve fled torture and violence.
Nelson, who practices inside drugs, is the medical director of the Highland Human Rights Clinic, a part of the Alameda Health System. A couple of instances every week, he and his crew conduct medical evaluations of people who find themselves searching for asylum within the United States. The medical doctors hearken to the sufferers’ tales. They seek for indicators of trauma. They scrutinize accidents, together with electrocution scars, bullet wounds and unset damaged bones.
As the Trump administration appears to be like to cut back the variety of asylum candidates, citing loopholes and fraudulent claims, this clinic — and others prefer it in San Diego, Los Angeles, New York and Chicago — seeks proof that may assist decide whether or not somebody ought to achieve asylum within the U.S.
The Highland clinic opened in 2001 as a spot for asylum seekers and refugees to get care. Five years later, the employees began providing forensic exams that goal to discern whether or not there may be proof of torture or abuse. Nelson, who took over as director in 2012, says his crew does between 80 and 120 evaluations annually.
Nelson and his colleagues diagnose bodily and psychological illnesses and, in lots of instances, substantiate these sufferers’ claims about how they have been damage. Sometimes the asylum seekers have well being protection that pays for the exams, however the county covers the price for many who don’t.
“Our job is to make sure that the asylum office understands all the medical and psychological facts about a person’s case so that they can make a decision,” Nelson mentioned.
Nelson bases his findings on an internationally acknowledged protocol for torture documentation.
For instance, he could also be known as on to evaluate whether or not a scar or damage might have occurred because the affected person describes. Sometimes, Nelson mentioned, attorneys ask him to reply particular questions, equivalent to, “Is this burn scar consistent with a cigarette burn?” or “Are these marks on his back consistent with being beaten with PVC pipe?”
Nelson has had some medical coaching on what to anticipate to see in instances of torture. He additionally applies his basic experience as a physician in realizing the way to interview and look at sufferers, and has realized one thing in regards to the nations these asylum seekers are fleeing and the accidents they could have endured.
For instance, when somebody is hit with a protracted, stiff object, it produces a pair of parallel bruises like railroad tracks, he mentioned.
“That’s a specific thing that I didn’t learn in medical school or residency,” he mentioned, “but that I have learned through taking care of a lot of people who have been tortured.”
In most instances, Nelson mentioned, he finds proof to help the tales his sufferers inform him. But there are additionally exams that don’t yield definitive proof.
Nelson additionally addresses the asylum seekers’ well being wants, typically diagnosing instances of tuberculosis or HIV that have been beforehand undiagnosed. Nearly all the sufferers he sees want psychological well being referrals, he mentioned, due to years of torture or abuse of their native nations.
Juan Lopez Aguilar, who fled Guatemala three years in the past, meets with Nelson on the Highland Hospital in Oakland, Calif., in June 2018. (Heidi de Marco/KHN)
One of the sufferers Nelson lately handled is 60-year-old Juan Lopez Aguilar, an indigenous Maya who fled Guatemala three years in the past. He mentioned he was crushed and threatened on and off for practically 4 a long time due to his ethnicity and feared for his life again dwelling. Lopez Aguilar’s son additionally was murdered in 2005 and his daughter fled due to threats, his lawyer mentioned.
“I’m worried,” Lopez Aguilar instructed the physician via a translator, as he sat within the examination room. “There are a lot of gangs. They want to kill people in my community.”
Nelson first examined and interviewed Lopez Aguilar earlier this spring and wrote a report corroborating the person’s account for his asylum case, formally filed final 12 months.
Lopez Aguilar, who grew up in a household of peasant farmers, instructed Nelson that his neighborhood was attacked by troopers when he was in his 20s and that his father was killed throughout that assault. Lopez Aguilar moved to a different a part of Guatemala, the place he continued to be the sufferer of “race-based harassment, extortion and threats,” Nelson mentioned.
The man’s story echoes these of different clinic sufferers, Nelson mentioned, and violence and discrimination towards indigenous Mayan-speaking Guatemalans is common.
Lopez Aguilar, who has labored as a dishwasher, has now returned to the clinic for an everyday medical go to. He tells the physician in his native language that he has been having extreme complications and dizziness since quickly after he arrived within the U.S.
His spouse and a few of his youngsters are again in Guatemala, he defined, and he can’t petition to deliver his spouse to the States until and till he’s granted asylum. That received’t be earlier than 2020, when his courtroom date is scheduled.
Men like Lopez Aguilar have confronted more and more robust odds since early June, when U.S. Attorney General Jeff Sessions announced that gang violence and home abuse would now not be thought of grounds for granting asylum.
Lopez Aguilar had spent a long time being persecuted as an indigenous Maya. “I’m worried,” he says via a translator whereas sitting within the examination room. “There are a lot of gangs. They want to kill people in my community.” (Heidi de Marco/KHN)
To be eligible for asylum, candidates should show they face bodily violence, or concern it, based mostly on elements equivalent to race, ethnicity or faith.
Even earlier than the Trump administration’s current crackdown, getting asylum was a troublesome and time-consuming proposition. In 2017, solely about 38 p.c of asylum seekers within the U.S. have been granted that standing by the immigration courtroom, in response to knowledge from the nonpartisan Transactional Records Access Clearinghouse at Syracuse University.
The harsher federal insurance policies, together with detentions on the border, have generated anxiousness and uncertainty amongst these searching for asylum and their advocates and immigration legal professionals.
“Every day is a roller coaster,” mentioned Oakland lawyer Haregu Gaime, who steadily refers her shoppers to the Highland clinic.
Niloufar Khonsari, government director of Pangea Legal Services, a Bay Area authorized advocacy group, mentioned the obstacles received’t deter folks from searching for a secure place to dwell or from searching for judicial assist to remain within the U.S.
When candidates are examined on the Highland clinic, Khonsari mentioned, it “definitely makes a difference for judges.”
Gaime mentioned the clinic’s stories steadily assist corroborate her shoppers’ experiences in a means that their testimony alone can’t.
“Sometimes a traumatized person is not able to relay what happened to them in a way that tells the full story,” she mentioned.
Ira Mehlman, spokesman for the Federation for American Immigration Reform, which favors stricter controls on immigration, famous that there are limits to a physician’s means to interpret these instances. Doctors might be able to decide if any individual suffered an damage, he mentioned, however not essentially the circumstances that led to it. “And they can’t determine if it was because of political persecution,” he mentioned.
Mehlman mentioned there isn’t any query that there’s violence in Central America and that gangs are rampant, however the U.S. can’t settle for everybody who’s hazard.
Nelson searches Tefamicael for indicators of trauma and examines accidents and wounds. (Heidi de Marco/KHN)
On the identical morning that Nelson noticed Lopez Aguilar at Highland clinic, he additionally examined Gebremeskl Tefamicael, an asylum seeker from Eritrea. Nelson took notes as he listened to Tefamicael’s story of being conscripted into the army, then imprisoned and tortured.
Nelson requested Tefamicael precisely what his tormentors used to tie him up.
It was a rope produced from tree bark, the affected person responded, as Nelson wrote in his pocket book an outline of the scars on Tefamicael’s wrists.
Afterward, Nelson’s report for the courtroom acknowledged that Tefamicael’s bodily scars and psychological state are in keeping with the person’s description of what occurred to him.
Nelson mentioned he received concerned with the clinic as a result of he needed to deal with individuals who have been underserved. People fleeing their nations and searching for asylum listed below are “definitely one of the more … underserved and generally marginalized” communities, he mentioned.
Often, Nelson doesn’t hear till months or years later whether or not his sufferers have been granted asylum. But when the request is authorized, he mentioned, he sees an amazing change in them.
Getting asylum doesn’t take away the trauma, nevertheless it relieves these folks of the concern of returning to a rustic the place they aren’t secure, Nelson mentioned.
“When someone who has got a real basis for an asylum claim gets granted, and you were part of demonstrating why that should be the case,” he mentioned, “that feels really good.”