Letters to the Editor
To the Editor:
Annually, almost one million asylum-seekers worldwide experience torture.1 Moreover, 7% to 12% of non-U.S.-born patients treated in the United States report a history of torture.2 Torture causes significant sequelae,3 and survivors face multiple barriers to health care access.4
Physicians have ethical and professional obligations to evaluate and treat torture survivors5; however, only a limited number of medical schools provide any human-rights- or torture-related training.6 Legal representations, coupled by medical affidavits prepared by trained clinicians, increase asylum-approval rates by up to three times.3,7 I propose training for medical students that includes lectures describing the demographics of torture, the asylum process, and sociocultural and health care barriers, complemented by ongoing participation in survivors’ medical evaluations and affidavit preparations. Under faculty mentorship, students could learn approaches to history taking and the physical exam and how to assess the consistency between clinical findings and a survivor’s story. Standard samples of medical affidavits8 could serve as a template to translate the clinical evaluation into a structured legal document for the asylum process.
The training I propose above would bring the concepts of human rights and clinical medicine together to teach medical students clinical human rights and would present the issue of torture and caring for survivors not only as a form of advocacy in medicine but also as a clinical medicine issue.
Metropolitan areas with high numbers of immigrants and refugees could serve as settings to implement such training. Such exposure would likely improve cultural competency and also prepare students to better identify and provide care for other vulnerable populations.
Ramin Asgary, MD
Assistant professor, New York University School of Medicine, Department of Medicine, New York, New York; firstname.lastname@example.org.
2. Crosby SS, Norredam M, Paasche-Orlow MK, Piwowarczyk L, Heeren T, Grodin MA. Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice. J Gen Intern Med. 2006;21:764–768
3. Asgary RG, Metalios EE, Smith CL, Paccione GA. Evaluating asylum seekers/torture survivors in urban primary care: A collaborative approach at the Bronx Human Rights Clinic. Health Hum Rights. 2006;9:164–179
4. Asgary R, Segar N. Barriers to health care access among refugee asylum seekers. J Health Care Poor Underserved. 2011;22:506–522
5. . American College of Physicians. The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. Ann Intern Med. 1995;122:607–613
6. Sonis J, Gorenflo DW, Jha P, Williams C. Teaching of human rights in US medical schools. JAMA. 1996;276:1676–1678
7. Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008;10:7–15