A Doctor’s Mission – and How You Can Help

by Jason Dzubow

Kate Sugarman is a family physician in Washington, DC. Here, she writes about her experience assisting detained asylum seekers who have health problems, and she invites you to join her and Doctors for Camp Closure for a lobby day and march on October 18 and 19, 2019.

In about 2005, I learned that if I can properly document scars of torture for someone who is seeking asylum, it greatly increases the odds of their being granted protection. So began my passion for human rights medicine and working to bring justice to immigrants seeking asylum in the United States. I have interviewed, examined, and written up forensic evaluations for well over 600 immigrants seeking asylum. All of these people have either been granted asylum or their cases are still pending.

Over the past several years, I have also been asked to go into ICE detention centers to document scars of torture for immigrants seeking asylum. Most of these people were detained upon entering the U.S. They have not committed any crimes, and are being held only because they have requested asylum in the United States.

Dr. Sugarman’s prescription for good health: Eat right, exercise, and stay away from ICE.

During the summer of 2018, like many other Americans, I became upset over family separations happening to those arriving at the ports of entry along the Southern border. I reached out to human rights doctors and lawyers and I became aware that many immigrants being detained in ICE facilities were being denied necessary medical care. I started building a medical-legal partnership, in which lawyers who were working with individuals being denied medical care while being held in detention could contact our group of doctors for an assessment of their client’s medical risk as a result of having appropriate care withheld. We then wrote medical letters to ICE to describe our findings, as a means of advocating for detainees to receive the care they needed and deserved. Some of our letters included medical assessments, such as “Denying HIV infected people their HIV pills would result in their getting sick and dying from a treatable illness,” “Denying surgery for a growing and painful inguinal hernia puts a patient in terrible pain and in grave danger,” and “Not treating a patient with a deep osteomyelitis that is now oozing large amounts of pus and giving her a fever will cause her to die from a treatable condition.”

Until a few months ago, more than half of these letters resulted in the person getting released. That is no longer the case, as ICE is now refusing to release asylum seekers, even if they are severely ill. As a result, I am shifting my energies, though I continue to work on behalf of detained immigrants who are being denied health care.

One case I worked on recently was for a man named Yoel, who is seeking asylum from Cuba and whose case was profiled on NPR. His lawyers contacted me because they were hoping I could get him released based on his untreated medical condition. He had been detained in Louisiana. He has a lung mass, which is quite suspicious for lung cancer. Instead of giving him a lung biopsy, which is the standard approach in this situation, ICE kept moving him back and forth from Louisiana to Mississippi. Despite a nationwide outcry from many doctors and members of Congress, he was deported, even though his wife is a U.S. resident living in Florida. Two days later, the U.S. Supreme Court ruled that people arriving at the Southern border to request asylum have to wait in extremely dangerous conditions in Mexico without being allowed to enter the United States.

A few days later, I testified on behalf of a woman seeking asylum. Since she is not being provided appropriate medical care, her neurological degenerative disease is getting worse. The judge spent most of his time grilling me over details that had no relevance at all to what I was trying to tell him. In that case, we are still waiting for a decision and the asylum seeker is still behind bars.

Which leads me to why I joined D4CC – Doctors for Camp Closure. There is no healthy amount of time for any man, woman or child to be behind bars, denied the basics of human health and dignity. Seeking safety and asylum in the United States should not result in inhumane, dangerous incarceration. We have already seen the results with multiple adults and children dying in ICE custody.

Please join us Friday October 18, 2019 as we lobby Congress for the health and safety of immigrants. Our March for Migrants in Washington, DC on Saturday October 19 is open to everyone who shares our concerns. Spread the word and let’s work together to put an end to mass incarceration of people who deserve care, not condemnation.

You can find more information about D4CC and the upcoming events here:
Facebook: https://www.facebook.com/groups/915776502154354/
Twitter https://twitter.com/Doc4CampClosure
Instagram: @Doctorsforcampclosure
Website: https://d4cc.squarespace.com

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Asylum for People With Serious Medical Conditions

by Jason Dzubow

In the latest outrageous move against non-citizens, the Trump Administration seems to be eliminating a long-standing program that allows people with serious medical conditions and their caregivers to remain in the United States beyond the normal period of stay. The change means that children and adults with cancer, leukemia, AIDS, and other serious health problems could be deported to their deaths.

The program on the chopping block is known as deferred action. It is basically a form of prosecutorial discretion. The government simply chooses not to initiate deportation proceedings against a person who is in the U.S. without status. In some cases, the person may receive permission to work. A person could receive deferred action for different reasons, but for the cases at issue here, the non-citizens were permitted to remain in the U.S. due to serious–and often life-threatening–health problems. Here is a statement from USCIS, as conveyed to the American Immigration Lawyers Association–

USCIS field offices will no longer consider non-military requests for deferred action, to instead focus agency resources on faithfully administering our nation’s lawful immigration system. This redirection of agency resources does not affect DACA or other deferred action requests processed at USCIS service centers under other policies, regulations, or court orders (such as VAWA deferred action and deferred action related to the U nonimmigrant status waiting list). As deferred action is a type of prosecutorial discretion used to delay removal from the United States, USCIS will generally defer to the DHS component agency responsible for removing individuals from the United States – U.S. Immigration and Customs Enforcement (ICE) – to make most non-DACA, non-military deferred action determinations.

USCIS confirmed that this change became effective on August 7, 2019, and that no public notice about the change was issued. The public is being informed about the change on an individual, case by case basis.

The Trump Administration has also announced a plan to turn excess children into a nutritious snack.

This basically means that medial patients and their caregivers who applied for deferred action may now be denied. The denial letters that I have seen in the press indicate that applicants have 33 days to leave the United States or face removal proceedings. The letters do not indicate how these medical patients can apply to ICE for deferred action, and at this stage, it is unclear whether ICE is even accepting such applications.

You can imagine how these denials would affect sick people (many of whom are children) who suddenly learn that they have to leave the U.S. and quite possibly lose their medical treatment. Here is a statement from Jonathan Sanchez, who has cystic fibrosis and whose sister earlier died from the same disease:

“If they deny the program, then I need to go back to my country [Honduras], and I’ll probably die because in my country, there’s no treatment for CF [cystic fibrosis],” Sanchez said, crying and trying to catch his breath. “Doctors don’t even know what’s the disease. The only ones who can help me are here in the United States.”

Even if he is ultimately allowed to remain here for treatment, the idea that this boy has been threatened with deportation at a time when he is fighting for his life is a true horror. From my point of view, the fact that we are even having this conversation is extraordinarily repulsive. That our country would mistreat people–especially children–in this manner is a black stain on our nation (one of many, unfortunately). All that said, the question I want to address here is, Can these medical patients (and their family members/caregivers) make a viable claim for asylum, so that they can try to remain in the country?

First, to receive asylum, you need to demonstrate that you filed for asylum within one year of arriving in the United States. There are exceptions to this rule, and if you have (or had) deferred action, you may meet such an exception (the “extraordinary circumstances” exception). However, once deferred action ends, you must file within a “reasonable” period of time; otherwise the asylum application will be considered untimely filed, and it will be denied. What is a reasonable period of time? There is no set definition, and I have seen cases indicating that two or three months is reasonable, but six months is not reasonable. So the bottom line is, if your deferred action ends and you want to request asylum, you should file your application as soon as possible.

Second, in some deferred action cases, more than one family member is in the United States (for example, a sick child and a caregiver parent). Certain family members can file for asylum together, and so it is worth considering which family member, if any, has a viable asylum case. An adult asylum applicant can include a spouse and any minor, unmarried children in her asylum case. A child who is over 21, or who is married, cannot be included in a parent’s asylum application. An unmarried couple would each have to file their own application for asylum. A child with his own asylum case cannot include a parent in that case (though sometimes when a child faces persecution, the parent can articulate her own, independent claim – an example might be where the child faces FGM or female genital mutilation, and the parent faces harm for trying to protect the child). So you have to think about who in the family might have a claim for asylum, and whether all family members could be included in that application.

Third, if a person was persecuted in the past–even the distant past–based on race, religion, nationality, political opinion or particular social group, he may be eligible for “humanitarian” asylum or “other serious harm” asylum. Humanitarian asylum is available to people who have faced severe persecution in the past. Even if the country is now safe, we allow the person to remain in the United States rather than force him to go back to a place where he faced terrible harm. I once did such a case for a Rwandan woman whose family was massacred during the genocide, when she was only 11 years old. The Immigration Judge found that the harm she suffered qualified her for humanitarian asylum, even if it would be safe for her in Rwanda today. Other serious harm asylum is for people who suffered persecution in the past based on their race, religion, nationality, political opinion or particular social group. If such a person would face any other serious harm today, even if that harm is not on account of a protected ground, she can qualify for asylum. So for example, if a woman was subject to FGM as a child (FGM is persecution on account of a particular social group) and today, she faces harm due to a lack of medical treatment for cancer, she might qualify for “other serious harm” asylum.

Finally, what if there is no basis for asylum other than the medical condition itself? Such cases are often difficult, since there needs to be a “persecutor” – someone who wants to harm the asylum applicant. Poor hospital conditions or lack of medical care–without more–would not normally qualify for asylum protection. But sometimes, people with medical conditions face discrimination that rises to the level of persecution. For instance, we once obtained protection for a Mexican man who was HIV positive. We argued that discrimination in Mexico was so severe that his life would be at risk there. For people from countries where law and order has broken down, one argument might be that people with medical conditions will be targeted by criminals or member of society due to their particular vulnerabilities. Central American countries with rampant gang issues may be places where vulnerable people are specifically targeted by gang members, and maybe that could form the basis for an asylum claim. Other medical conditions, such as albinism, are so stigmatized in certain societies that people with those conditions face harm or death. The key to cases like these often involves obtaining country condition information that demonstrates the danger faced by people with medical conditions. Specific examples of people who were harmed can also help. For example, we did a case where a Turkish man faced imprisonment for political reasons. The man had leukemia, and so we argued that even a short imprisonment would be life threatening. We supported our claim with newspaper articles about people who died in prison due to health problems. These articles demonstrated that the harm faced, at least for this specific person, was severe enough to qualify him for asylum.

The status of deferred action cases is still unclear. Will ICE announce a procedure for people with serious medical conditions to apply for deferred removal? Will USCIS respond to the backlash and re-institute the program? It now appears that cases filed before August 7, 2019, which were denied, are now being reopened, but the fate of the program going forward seems uncertain (at best). For those affected, it is important to start thinking about alternatives. One such option may be asylum; other options may exist as well, depending on the case. Talk to a lawyer, and if you cannot afford a lawyer, remember that free or low-cost help is available. Unfortunately, this new change affects the most vulnerable, and it is easy to lose hope. But there are many people who want to help, and the sooner you take action, the more likely you are to find an alternative way to remain in the United States.

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A Medical Doctor Reflects on the Treatment and Healing of Torture Survivors

by Jason Dzubow

Kate Sugarman is a medical doctor at Unity Health Care in Washington, DC, a public community health clinic. She works with people who have survived abuse and trauma, including many refugees. As a family physician, she is qualified to make medical diagnoses and prescribe treatments. She has particular experience in diagnosing and treating post-traumatic stress disorder through her family medicine training program and her clinical practice, which focuses on minority and immigrant patients, many of whom suffer from physical and mental disorders. She is also an adjunct faculty member at the Georgetown University Law School Center for Applied Legal Studies (the Law Clinic) in support of their asylum work. Here, she discusses her work, and the new reality of a Trump Administration:

The morning after the election felt like day zero of the apocalypse.

Dr. Sugarman running from one appointment to the next.
Dr. Sugarman running from one appointment to the next.

Like most of us, I learned that night that Trump had won. But I knew I could not stay up too late to mourn. I had to meet a patient at 7:30 AM for a forensic evaluation.

Just to explain: When I say a forensic evaluation, what I mean is a medical examination that is part of an asylum seeker’s evidence in his or her quest for asylum. I do not perform psychological forensic evaluations, which would mean psychological evidence of the effects of being tortured, such as anxiety, depression or PTSD. Those exams are most often conducted by mental health professionals. I conduct medical forensic evaluations. Most of the effects of torture that I document are visible scarring on the skin from beatings, stabbings, burning, etc. I also document any other visible medical signs of the effects of being tortured, like swelling, hearing loss, damage to bones and joints, etc. I never charge the asylum seekers for these examinations.

I conduct the examination in the following way. First, I read the patient’s personal statement–which explains why that person fears persecution in the home country–so I have a basic idea of what happened. Then I gently interview the patient, always trying my best not to retraumatize the person. The focus of my interview is the physical violence that has left visible scarring and other signs of torture on the person’s body. Then I examine the patient, looking for scarring and other signs of abuse. Since I have performed these examinations for so many years on so many people, I have a sense of whether scarring is consistent with the stated explanation of how it happened.

The 7:30 AM  patient had approached me the previous week. He told me that his asylum case had been denied, but he found a lawyer who had agreed to try to reopen the case. He asked me whether I could document his scars. I told him yes, as long as he could bring me his personal statement. The interview and examination were straight forward. As often happens, he only reported one scar to me. I had him get partially undressed at which point, I discovered more scars that he had forgotten to describe to his lawyer or me. Because asylum applicants often fail to remember all their old injuries, I always try to do a “head to toe” examination whenever possible.

After we finished, I rushed off to clinic where I had another asylum seeker waiting for me. This person had no visible scarring, but had been seeing me for some time in clinic to be treated for depression and insomnia due to the torture. His lawyer wanted a summary of my clinic notes describing the emotional distress that this person had been experiencing.

Both patients were extremely grateful for my services.

According to a study from Physicians for Human Rights, forensic reports from physicians can make a big difference in the outcome of an asylum seeker’s application. I choose to do this work because I find it enormously rewarding. I have heard so many times from attorneys that judges and Asylum Officers comment on my reports, saying that the evidence I documented was very helpful in evaluating the applicant’s claim.

I have discovered over the years, in addition, that just the fact of the client presenting their story to me, and my active and compassionate listening, seems to have a therapeutic value to the client. Clients sometimes seem a little less burdened after I have finished listening to them and documenting their scars. Of course, there is no greater gift than when someone comes running into clinic to hug me, and tell me that they were just granted asylum. Twice in the past few weeks, people came up to me, thanking me for my detailed and kind forensic evaluations, which they said were very helpful in their receiving asylum. I had examined each of these people more than five years ago, but they apparently never forgot me.

But now–with the election of Donald Trump–asylum seekers may be feeling more fearful. So what would I tell a Trump supporter? That is a difficult question, but I suppose if Mr. Trump wants to make America great again, we should help wonderful and deserving people be granted asylum. If my grandparents had not been allowed into the United States, then they would have been killed by Hitler, and I would not be here in the U.S. doing this important work.

I cannot undo Trump’s victory, but I am determined to do everything in my power to help as many asylum seekers as possible.

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