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Scientific Assessment Crucial to Protecting Torture Victims, Experts Say at AAAS
Torture—the word conjures medieval images of mangled limbs and jagged scars. But the torturer’s repertoire today includes practices that leave less dramatic evidence of their use, such as rape and waterboarding. For victims fleeing torture or persecution, gaining the sanctuary of asylum in the U.S. often requires rigorous science-based assessment, experts said at a two-day workshop at AAAS.
Victims often have escaped their country without time to gather evidence of their abuse. “But they do have the scars on their bodies and scars on their minds,” said Christy Fujio, director of the Physicians for Human Rights Asylum Program.
“The physical and psychological evaluations that clinicians can provide and turn into the judge or the asylum officer may be the only thing that supports the credibility of this person.”
Historically, only about 30% of asylum petitions are granted in the United States, according to Fujio. “But for patients who are represented by an attorney and have a clinician doing a forensic examination, the approval rate is 90%. It’s a huge jump. It is critically important for people to have this kind of professional assistance.”
Processes and techniques for documenting the physical and psychological evidence of trauma associated with abuse were the focus of training provided on 22-23 September at AAAS in collaboration with Physicians for Human Rights (PHR). The first day drew about 50 volunteers for basic training, while the second honed the skills of those with experience in the field.
This was a natural fit for the AAAS Scientific Responsibility, Human Rights and Law Program, said Senior Program Associate Theresa Harris. She works on the program that “connects scientific methods and tools with human rights.” Much of the program is carried out through the On-Call Scientists network of about 750 volunteers, which has ongoing requests for help.
“We take requests from human rights organizations for experts where they need some type of pro bono assistance” and try to match them up with volunteers with the appropriate skills, Harris said. Past efforts have ranged from evaluating a data management system for human rights projects to a survey of mining toxic waste and its psychological impact in central Africa.
“The goal of torture is to terrorize you, to depersonalize you, and to not have any markings. To see scars is extreme and indicates profound injury,” said Coleen Kivlahan, a doctor and PHR volunteer trainer and a senior medical director at the Association of American Medical Colleges.
The medical evaluator in an asylum petition reads the history of claims by the victim and then does a thorough head to toe physical examination documenting every imperfection, assessing whether or not it is relevant to the claim made, and if relevant the degree of certainty that it was caused by the claimed actions.
Conducting a physical evaluation takes at least two hours and a psychological evaluation even longer. Processing through the bureaucracy of a detention facility can add more hours. Often the interview must be done with an interpreter if the petitioner has poor or no command of English.
Kivlahan presented a series of slides from past examinations and asked trainees to evaluate them with regard to supporting or not supporting claims made by the petitioner.
One was a large raised bruise on the head with four perfectly parallel red welts at its center. The bruise could have been caused in a number of ways, including the victim’s claim of having been beaten with a police baton.
But the spacing of the welts matched perfectly with indentations seen on police issue batons. A photo of a baton beside the bruise demonstrated the congruence and provided a high level of certainty that the petitioner had been a victim of a police beating.
Kivlahan reiterated the need for examiners to be objective and dispassionate, not advocates for the petitioner; “Don’t feel that you have to go beyond your boundaries.” She prefers to use straightforward language of fact and observation and avoids drawing conclusions unless she has the training and expertise in the medical specialty that would justify making those conclusions.
“If there is one word to remember from this part of today, it’s consistency,” said Joanne Ahola, medical director and supervising psychiatrist of the Weill Cornell Center for Human Rights in New York. “We are looking to see if there is consistency, or not, among the story the person tells, the symptoms they report suffering, and the signs you see in your evaluation.”
The most common psychiatric diagnoses of torture victims are simple and complex post-traumatic stress disorder (PTSD) and major depression, she said. Complex PTSD and other factors such as fear, shame, mental illness, substance abuse, or an emerging lesbian, gay, bisexual, or transgender identity may explain why the petitioner did not file an asylum petition within the strict one-year timeframe allowed by law and may help gain an extension of that deadline.
It is important to get a sense of the victim’s early life, including medical and psychiatric problems, as a context for how torture has changed them.
The Diagnostic and Statistical Manual of Mental Disorders “is what is used in United States courts,” Ahola said, so everybody has to have a label, even though the tests are geared for the United States and are likely to be less relevant for other cultures and societies.
Ahola urged evaluators to take excellent notes and use direct quotes from the interview to “bring the person alive on the page” of the affidavit. “You can say in a quote from an applicant what you cannot say yourself as a professional.”
An increasing proportion of asylum claims is now based upon sexual orientation or being HIV-positive, according to Ahola. She has made this the focus of much of her work.
“When you see someone coming from one of those countries where it could be so dangerous to be anything other than straight, it helps make the case for you as a clinician,” Ahola said. Where Sharia religious law is enforced or homosexual acts are illegal, “who would be gay if you didn’t have to [be gay] in those places?”
Physicians, psychiatrists, and social workers who conduct these examinations are not advocates for individuals seeking asylum, Fujio reminded the trainees. Rather, they are “independent evaluators...producing medical-legal affidavits in all of the cases.”
AAAS’s Harris was struck by the fact that asylum is granted to only 30% of applicants when there is no medical evaluation in the dossier, but it soars to 90% for applicants who have undergone a medical/psychological evaluation.
“Evidence that scientific professionals can bring to these cases can be the difference between somebody being safe here in the United States and being sent back to where they could be tortured,” she said. “It is a vivid illustration of how scientific methods and expertise can support human rights.”
11 October 2012