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A Medical Assessment of Trump’s Asylum Policy

After World War II, when Jewish refugees arriving in the US were sent back to Europe, where many died in Nazi concentration camps, Americans declared, "Never again." With US President Donald Trump's Migration Protection Protocols, never has arrived.

LOS ANGELES – In a stuffy attic-turned-office in Tijuana, Mexico, Juan (his name has been changed to protect his identity) described the harrowing events that drove him to flee his home in Guatemala, travel thousands of miles by foot, and request asylum in the United States. As emergency physicians at a Los Angeles hospital that serves the city’s most disenfranchised residents, we are no strangers to tales of despair. But Juan’s story would be enough to stun even the most jaded of our profession – and yet it wasn’t enough for US President Donald Trump’s administration to offer him refuge.

As physicians with special training in forensic evaluations, we had traveled to Tijuana to meet with Juan, at the request of his lawyer. Our goal was to determine whether the physical and emotional toll of the violence Juan had suffered in Guatemala could be confirmed objectively, thereby corroborating Juan’s claim of a credible fear of returning home – a basic criterion for granting an asylum request.

It quickly became clear that Juan easily met this threshold. He meticulously recounted occasions in which masked men – members of a gang backed by the local government – shouted racial epithets at him and beat him nearly to death, then showed us physical scars that supported his claims.

When Juan described watching the gang burn alive three of his neighbors, his trembling hands reflected untold emotional scars. Indeed, his demeanor, together with the results of a standardized psychological screening tool, strongly indicated that Juan was suffering from post-traumatic stress disorder.

In Guatemala, Juan had faced unfathomable violence. That is why he traveled to the southern border of the US, surrendered himself to border agents, and attempted to submit an asylum claim. But the only part of the US Juan would see was a government holding cell.

Juan arrived just as the US Department of Homeland Security (DHS) began to enforce the Trump administration’s Migrant Protection Protocols (MPP), also known as the “Remain in Mexico” policy. So, after making his request at the border, he was handcuffed, taken to a small cell, and told to sign papers that he could not read, without consulting a lawyer or representative. Juan was then released to the Mexican side of the border and instructed to return intermittently to ask about his case.

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One month after we submitted a forensic medical evaluation in support of Juan’s US asylum claim, we learned from his lawyer that Juan had left Tijuana to return home. Like many other asylum seekers, he had found life in Tijuana unbearable. It was almost impossible for him to acquire the documents he needed to work there. He was terrified by rumors that drug cartels were abducting migrants and forcing them to work as drug mules and foot soldiers. He was the target of racial slurs, and feared that the verbal assaults would turn physical.

Juan had been faced with a near-impossible choice: stay in Tijuana, in fear of violence and with no support network or livelihood, or return to Guatemala, where he had narrowly escaped death. The US policy that forced him – and forces thousands more like him – into that position is unconscionable. We have not heard from Juan since his departure, and do not know what has happened to him.

For decades, asylum seekers have been allowed to remain in the US while their claims were evaluated. This policy can be traced back to World War II, when Jewish refugees arriving in the US were sent back to Europe, where many died in Nazi concentration camps. “Never again,” Americans decided.

But never has apparently arrived: according to the MPPs, people who request asylum at the US border may be denied refuge until an immigration judge makes a final determination on their case, a process that can take years. This is not only a betrayal of American values; it is a violation of federal and international law, which prohibits expelling anyone to a country where their life or freedom would be threatened on account of their race, religion, nationality, political beliefs, or membership in a particular social group.

DHS claims that the MPPs will help deter “individuals who fraudulently claim asylum.” This assumption is highly flawed. Physicians for Human Rights has documented the extensive trauma that many asylum seekers have endured not only in their home countries, but also while in transit. If anything would serve as an effective deterrent of false claims, it would be the arduous and risky journey to the US.

But even if the MPPs do deter some fraudulent claims, it is not worth the cost – including preventing people like Juan, who have a credible fear of severe violence, from awaiting the outcome of their asylum claims in safe conditions in the US. Instead, over 58,000 asylum seekers have been left to wait for an unspecified period in often-squalid conditions in Mexican border cities, some of which are so dangerous that they are included on the US State Department’s “Do Not Travel” list. This is what the Trump administration calls a “spectacular success.”

As doctors, we know that the trauma asylum seekers like Juan experience is real. As human beings, we empathize with them. As Americans, we are outraged by the Trump administration’s mockery of federal and international law, and of basic human decency. We all should be, too.

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