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Inside the world of asylum forensic exams

Asylum seekers who undergo medical exams as part of their legal case are more than twice as likely to be granted asylum as those who do not.

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Dr. Nora Rowley - MICHELLE KANAAR
  • Michelle Kanaar
  • Dr. Nora Rowley

On a frosty day in February, Dr. Nora Rowley sat on the floor of the mustard-yellow playroom in the Marjorie Kovler Center in Rogers Park helping five-year-old Oscar* push a dump truck around the room. The boy had recently come to the city with his mother from Guatemala, and Rowley asked him what he thought of his new home. Oscar said he didn't like the wind and winter here.

Was there anything he didn't miss from his old home? she asked.

"The bad guy," Oscar said.

"Who is the bad guy?" Rowley asked.

"My daddy," Oscar replied. "He hit mommy and me."

When Rowley examined Oscar she found scars all over his body from being abused by his father, a gang member.

Oscar and his mother had fled the violence and sought asylum in the U.S., hoping to find safety far from the gangs of their home country. Last year, 97,000 people sought asylum in the U.S., a nearly 20-fold increase from a decade before, driven in large part by destabilization in South and Central America.

The U.S. government is required by international treaties to evaluate all claims of asylum to determine if they have a "well-founded fear of persecution." Immigration judges deny most of these claims, rejecting 65 percent of cases last year, the highest denial rate since the Transactional Records Access Clearinghouse began collecting data in 2001.

But asylum seekers like Oscar and his mother who undergo medical exams as part of their case are more than twice as likely to be granted asylum as those who do not, according to a study that compares the asylum grant rate among U.S. asylum seekers from Physicians for Human Rights. Asylum seekers often have to find forensic evaluation providers on their own or are recommended by lawyers to evaluators who might offer services pro bono. By matching the stories of asylum seekers to the trail of evidence hidden on their bodies, forensic evaluators like Rowley are able to show judges that people have endured harrowing persecution and violence and should be allowed to stay in the U.S.

Trained as an emergency room doctor, the 57-year-old has sewn sutures, reset broken bones, and seen all forms of physical trauma. Rowley says that many of the people she's treated over the years have been tortured by the state and military in regions like sub-Saharan Africa, eastern Europe, and Central America. She has frequently examined patients for criminal evidence collection in cases of rape and abuse. In 2009, during a stint with Doctors Without Borders in Myanmar, Rowley was moved by witnessing torture of Rohingya Muslims and underwent training from Physicians for Human Rights to document the injuries of asylum seekers.

In the last ten years, she has evaluated 185 people, ranging from children like Oscar to senior citizens seeking safety in the U.S, conducting almost all of them as a volunteer. She gets cases through the National Immigrant Justice Center in Chicago and volunteers extensively at Kovler, a torture survivor center located in a restored former convent tucked away on a tree-lined side street in the heart of Rogers Park.

Mario Gonzalez, Kovler's senior director, who himself immigrated to the U.S. from Guatemala, has been treating torture survivors and survivors of post-traumatic stress disorder since 1989. He says many asylum seekers are unsure which documents are necessary to win their cases and are often left to fend for themselves throughout the immigration process. "Not many asylum seekers know how important the forensic medical exam is, and many cases are lost because of the lack of evidence to support their claim. It is sad but true," Gonzalez says.

Most asylum seekers at Kovler make their way to the center by word-of-mouth or through referrals from the National Immigrant Justice Center, however, a handful of survivors have been sent directly from immigration court. "There are a few judges who see that the case is being misrepresented from a lack of evidence, and they've said, 'You should get your papers together at Kovler. It's free,'" says Gonzalez.

The soft-spoken doctor begins each evaluation with a conversation. Interviews can last a few hours. Many asylum seekers feel immense shame and even grow upset while recalling what happened to them in their home country, so Rowley has to ensure they feel comfortable throughout the process.

"[She] takes the time to be warm and gets to know them before diving into explaining what she's going to do," says Marie Shebeck, a senior case manager at Kovler.

Rowley carefully encourages her interviewees to be specific and vivid. She asks for details of their attack so she knows what to look for during the exam. "Some people don't have any visible scars," says Rowley. "Like if only one of their lateral eyebrows is thick. A punch to the eye can definitely do that. But it can be easily missed."

After the conversation, Rowley gives the asylum seeker a full medical exam and records any physical evidence she finds in an affidavit that is shared with the court. She takes photos of injuries as well, which she puts in PowerPoint presentations for the judge, circling any evidence she has found.

The work can be overwhelming. "Within my first two years at Kovler, I had a woman who had been serially raped every day for a year and a half in her captivity as a political prisoner," Rowley says. "That day, after the evaluation, I went home, and it was an hour later I realized that I had been lying in a fetal position on the couch."

Despite the difficulty of the work, Rowley cannot imagine turning away from the asylum seekers she helps, especially when the need for her evaluations is so great. According to Physicians for Human Rights, there are only two other medical professionals trained by them in forensic evaluations for asylum seekers in Chicago, and the waiting period to get an evaluation from PHR can be up to 12 weeks.

At Kovler, the waiting period depends on the asylum seeker's deadline for document submission. The center typically has 180 patients per year waiting to be examined. "There are hundreds of thousands of asylum seekers, so it is difficult for clinicians to keep up with the demand," says Kathryn Hampton, a network program officer with Physicians for Human Rights. "Donors do not fund forensic evaluations at the same levels as legal services provision."

The tremendous need for low-fee and pro bono representation of asylum seekers coupled with a backlog of nearly one million asylum cases nationwide has left direct legal service organizations, like National Immigrant Justice Center, stretched thin. "Our ability to provide consultations for new asylum-seeking clients is extremely limited, to the point that our asylum intake hotline has been paused for much of the past two years," writes Alejandra Oliva, a communications coordinator with the National Immigrant Justice Center, via e-mail.

Yet in a political climate where asylum seekers' stories are being challenged, forensic evaluations can make the difference between being granted asylum and being sent back home. In April, President Donald Trump claimed that Central American asylum seekers arriving at the U.S. border were making up stories of violence. "It's a scam. It's a hoax," Trump said. "Our system is full."

The president's claim doesn't match up to Rowley's experience with asylum seekers. In her ten years of work evaluating nearly 200 cases, Rowley says she has only seen two cases where some aspects of a person's stories did not match their scars. But even in those cases, she says, the trauma endured by the asylum seeker may have been to blame for the discrepancies. Trauma can affect an asylum seeker's memory and make it difficult to recall things consistently in detail, according to research published in The Journal of the American Academy of Psychiatry and the Law.

In March, five-year-old Oscar and his mother were summoned to Chicago's downtown immigration court at 525 W. Van Buren for their asylum hearing. Rowley was called to testify if needed. While she waited outside the courtroom with Oscar, the judge asked his mother and their attorney questions and looked over the evidence Rowley had prepared.

After 90 minutes, the attorney called Rowley and Oscar inside the courtroom. Oscar and his mother had been granted asylum and would be allowed to stay.

"They were so nervous with the possibility of being sent back," Rowley says. "Now they can start to heal."   v

*Name has been changed.

If you are an asylum seeker looking for a forensic evaluation or a medical professional interested in volunteering your services, contact Physicians for Human Rights or HealthRight International.

This story was reported as a part of 90 Days, 90 Voices' Asylum City series on immigration and sanctuary in Chicago and made possible thanks to support from the International Women's Media Foundation and the Social Justice News Nexus at Medill in Northwestern University.

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