About 20 years ago, one of Katherine McKenzie’s colleagues asked her if she was interested in performing forensic medical evaluations (FME) for asylum seekers.
“I didn’t know much about the field, but she mentored me for the first one or two evaluations,” said McKenzie, who is now an associate professor of medicine (general medicine) at Yale School of Medicine and director of the Yale Center for Asylum Medicine. “After that, I realized that this was an area that was deeply rewarding and that I wanted to incorporate it into my professional life.”
McKenzie started seeing asylum clients regularly. Eventually, she asked her section chief of general internal medicine if there might be an opportunity to create a center specifically for this kind of work. That’s how the Yale Center for Asylum Medicine was born.
Since 2003, the center has offered FMEs and examinations for 25 to 30 asylum seekers annually, documenting cases of physical and psychological trauma due to persecution based on race, religion, political opinion, nationality, or membership in a particular social group. The asylum seekers who are seen by YCAM may have experienced unlawful detention, torture, harassment, domestic violence, female genital mutilation and homophobic hate crimes, and most often come from countries in sub-Saharan Africa, Central America, and South America.
While referrals generally are made from attorneys for asylum seekers — including lawyers from Yale Law School, other laws schools, and advocacy groups — the doctors’ role is not as advocates, but as impartial evaluators of the nature and extent of injury exhibited.
The doctors’ objective findings are then shared with the client’s attorney in the form of affidavits and/or testimony to be used in immigration court.
We’re kind of this expert witness who provides objective evidence of scars related to persecution.
Faculty members volunteer their time when performing evaluations, and the section of general internal medicine provides a small amount of funding for the program administration.
In an interview, McKenzie discusses the role of FMEs in the asylum process, her own experiences working with the center, and the importance of being an objective witness.
The interview has been edited for length and clarity.
What is the role of forensic medical evaluations (FME) in the asylum process?
Katherine McKenzie: Studies performed by Physicians for Human Rights, one of our closest partners, have shown that somebody who is applying for asylum and undergoes an FME is approximately twice as likely to be granted asylum as someone who does not. So, it’s a powerful tool. What attorneys tell us is that we are these objective evaluators, and we can interpret for immigration courts and for immigration judges this level of evidence that trauma, persecution, and injury resulted in physical and/or psychological scars. We’re kind of this expert witness who provides objective evidence of scars related to persecution.
How do you approach performing forensic medical interviews and examinations, especially given the trauma many asylum seekers have experienced?
McKenzie: When we’re trained to do this work, we’re certainly made aware of the possibility of vicarious trauma. As we’re hearing the stories of clients who have been traumatized and injured in ways that are almost unimaginable, we’re trained to understand that the things that we hear might be overwhelming. Mentorship is key to the field. We turn to our colleagues, and the students who work at YCAM turn to us. We always make sure that everybody, especially the trainees, are emotionally supported through this work. But there is a recognition in doing the work that it’s challenging.
A student and McKenzie evaluate a client.
Sometimes, we can perform these evaluations and actually experience vicarious resilience when we see the resilience that the clients have despite what they’ve been through. But sometimes we really need to reach out for support to each other.
In addition to performing medical evaluations yourself, you’ve also appeared as an expert witness in immigration court. What is that experience like? What does it entail?
McKenzie: The attorneys we work with might ask us to testify during the client’s immigration hearing, and this can be done via telephone or in person. When I have testified, my objectivity might be questioned by the opposing attorney. I state clearly that my role in performing the FME is to be an objective evaluator and to emphasize that I am not an advocate for the client. The judge may also ask to clarify some of the findings in the affidavit.
As you can imagine, it can be a little daunting. But the attorneys whom we work with are able to review with us in advance what we might expect in court. We’re speaking very narrowly about our area of expertise, including the medical affidavit that we wrote. It’s not our responsibility nor should we weigh in on who is eligible for asylum. We’re not even expected to opine on the veracity of what the asylum seeker is telling us. We’re giving our expert opinion about scars. For example, “the scar on man’s leg is highly consistent with the scar that would be the result of being cut with a bayonet” or “this client’s scar is consistent with being hit with a police baton and the scar that would result.” We’re able to rely on our expertise and aren’t expected to comment on legal issues specifically.
Lobbying in Washington D.C. with Physicians for Human Rights.
What else would you like people to understand about the experience of seeking asylum here in the U.S.?
McKenzie: It’s always been difficult to be an asylum seeker in the United States. I don’t think there’s ever been a time that it’s been easy. But the asylum system still exists, and we’re still receiving referrals to perform FMEs. Just a month ago, we got a notification that one of the clients we evaluated was granted asylum. So, people are still being granted asylum.
It’s a challenging system, but we try to contribute what we can. We have this unique skillset that we can use, and it’s satisfying to be able to do that. We can’t reform the asylum system, and we can’t manage immigration courts, but we can provide our expertise based on the training and experience we’ve had as clinicians.
