The Scars Match the Stories: Asylum Seekers’ Medical Evaluations Corroborate Violence and Persecution

New Physicians for Human Rights (PHR) investigation finds highly consistent accounts and medical evidence of targeted violence in Mexico and Central America; U.S. policies compound asylum seekers’ trauma.

October 9, 2019 Asylum, Mexico

“I had bruises on my shoulders where they held me down.”

“I’m so anguished that I cannot concentrate on anything…. I faint, my head hurts.”

“If I step on Honduran soil, they will kill us. And they will not care that I have a child.”

TIJUANA, MEXICO – Tens of thousands of asylum seekers from Mexico and Central America wait at the U.S.-Mexico border, many with harrowing testimonies of escaping pervasive violence such as beatings, killings, forcible gang recruitment, threats and extortion, and widespread sexual and domestic violence.

In a new report that adds medical evidence to the asylum debate, doctors with Physicians for Human Rights (PHR) conducted clinical evaluations of adults and children waiting in Tijuana, Mexico to seek protection in the United States. These medical experts documented the physical and psychological evidence of this violence, which consistently corroborated the asylum seekers’ narratives of persecution. The report also details how recent punitive U.S. asylum policies – such as “metering,” the Migrant Protection Protocols, and the Third-Country Asylum Rule – egregiously obstruct the right to seek asylum and expose asylum seekers to further trauma.

While not meant to be a representative sample, these findings provide a unique snapshot of asylum seekers’ lives, why they undertook treacherous journeys to seek protection, and the physical and mental health impacts of the trauma they experienced. The report provides detailed examinations of the cases of 18 asylum seekers (15 adults and three children) from El Salvador, Honduras, Mexico, and Nicaragua who fled severe violence in their home countries, including:

• Threats, coercion, beatings, kidnappings, and killings, reported by every young male interviewed as recruitment tactics to join gangs;
• Domestic and sexual violence against women by gang members and police forces alike;
• Targeted violence based on sexual identity, political beliefs, and occupation;
• Post-traumatic stress disorder (PTSD), identified among 12 of the 15 adults and two out of the three children interviewed;
• Rampant impunity and a lack of support services, leaving many with no option but to flee.

“We’ve documented severe physical and psychological scars from the targeted violence experienced by these asylum seekers,” said Tamaryn Nelson, senior researcher at PHR and co-author of the report. “This new medical evidence underscores the profound need for a safe, fair, and humane U.S. asylum application process.”

“These cases offer insights into the many types of violence that force families to flee their home countries and seek refuge in the United States,” said Nelson. “Our findings indicate that these asylum seekers have strong grounds to seek asylum in the United States, and that they could likely face further persecution if forced to return to their countries of origin. This medical evidence directly refutes President Trump’s many baseless and harmful claims about asylum seekers.”

For more than 30 years, Physicians for Human Rights experts have provided forensic evaluations for asylum seekers fleeing persecution and seeking protection in the United States, relying on the international standard to document torture and ill-treatment known as the Istanbul Protocol. For this research, PHR utilized a three-part clinical evaluation tool: a semi-structured interview documenting the events that drove the person to seek asylum; a physical exam of reported injuries and medical records; and independently-validated psychological screening tools for PTSD and depression. Clinical evaluations were conducted by six PHR-trained medical experts (_for more on PHR’s methodology, see page three of the report.

“As a doctor, I’m alarmed by the public health and human rights crisis at the U.S.-Mexico border,” said Adam Richards, MD, PhD, MPH, DTM&H, assistant professor, University of California Los Angeles (UCLA) Division of General Internal Medicine & Health Services Research, one of the doctors who conducted clinical evaluations for the report. “The adverse physical and mental health impacts of extreme violence in Mexico and Central America are clear. Fourteen of the 18 asylum seekers we interviewed screened positive for post-traumatic stress disorder, and a majority suffered from symptoms of depression and anxiety.”

The report also finds that restrictive U.S. asylum policies have stranded asylum seekers in Mexico, possibly exposing them to further trauma. For example, the practice of “metering” – severely restricting the number of migrants who can be processed at a U.S. port of entry on a given day – is creating bottlenecks and blocking timely access to asylum applications. The Migrant Protection Protocols, also known as “Remain in Mexico,” force asylum seekers to await the processing of their claims in Mexico, leaving them vulnerable to violence and without access to legal support. Finally, the Third-Country Asylum Rule requires asylum seekers to apply unsuccessfully for protection in the countries they transit through before applying in the United States, which effectively bans asylum almost entirely for nationals of El Salvador, Honduras, Nicaragua, and other countries who arrive at the U.S.-Mexico border.

These punitive policies defy both international and U.S. law by obstructing the right to seek asylum. They place asylum seekers who are in extremely vulnerable situations – like everyone profiled in this report – at great risk of further violence and traumatization.

“The Trump administration’s asylum policies are compounding trauma for an already traumatized people,” said Mary Cheffers, MD, clinical faculty at the University of Southern California’s (USC) Keck School of Medicine. “Returning or forcing asylum seekers to wait in Mexico endangers their lives and is a catastrophic stressor to their physical and mental health.”

Alongside the report, PHR has published a trio of multimedia galleries that showcase the harrowing stories of asylums seekers fleeing violence in Central America and Mexico. The three digital galleries, grouped thematically, focus on individuals and families who are survivors of gang violence and forced recruitment, rape and sexual violence, and witness killings and intimidation.

PHR’s report makes a number of detailed policy recommendations to the U.S. government, U.S. Congress, United Nations member states, the Inter-American Commission on Human Rights, and the governments of El Salvador, Honduras, Mexico, and Nicaragua. Specifically, Physicians for Human Rights calls on the United States to:

1. Ensure that the right to seek asylum is safeguarded and that the asylum process in the United States is safe, predictable, and transparent;
2. End all practices that bar asylum seekers from protection inside the United States, such as the practice of “metering,” the Migrant Protection Protocols, and the Third-Country Asylum Rule;
3. End any programs that allow border patrol agents to conduct “credible fear interviews” of asylum seekers and ensure that only well-resourced and well-trained asylum officers screen asylum seekers’ claims;
4. Stop the use of tariffs, trade sanctions, foreign aid, or other measures to pressure countries to enter into “third country” agreements, especially if these countries are unable to provide safety or effective legal protection to asylum seekers; and
5. Cooperate with regional and international human rights monitoring mechanisms through the United Nations and the Inter-American Commission on Human Rights.

Additional quotes from asylum seekers profiled in the “_If I went back, I would not survive”_ report:

• “He would always tell me that he would kill me if I did not go with him. He would not let me be with anyone else… He told me that he would kill me and bury me.” – Adriana,* a 16-year-old girl from El Salvador (case 1), who escaped an abusive relationship with a gang member who physically assaulted her while pregnant, causing her to lose the pregnancy.
• “I am afraid. I think something would happen to me. I think they would kill me and my parents.” – Antonio,* an eight-year-old boy from Honduras (case 17), who was attacked by two men with a machete and reported symptoms of PTSD and anxiety as well as somatization, whereby psychological distress manifests as physical ailments and attention problems.
• “Most young men are returned [to their families] dead in black bags. And even those are lucky because they often kill the family, too. If I went back to El Salvador, I would not survive.” ­– Benjamín,* an 18-year-old man from El Salvador (case 3), who was kidnapped and beaten by police, leaving him with injuries assessed by PHR as being consistent with his testimony.
• “They burn people alive. They put a lot of clothes on them, tie them up, and then drench them in gasoline…. I did not let them catch me. They would have burned me alive.” – Jorge,* a 60-year-old-man from Honduras (case 9), whose family members were conscripted into a gang and who received death threats after reporting gang violence to government officials.
• “_I had bruises on my shoulders where they held me down. I had pain in my abdomen for three days and in my stomach throughout the pregnancy… If I had told anyone, the gang members would have found out and killed me.” – _ Jimena,* a 21-year-old woman from Honduras (case 8), who was raped by gang members after her husband refused to join a gang.

Full descriptions and clinical evaluations for all cases are available in the report (page 30).

*Names changed to protect asylum seekers from reprisals.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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