The MGH Asylum Clinic at the Center for Global Health—founded in October 2017—provides forensic medical and psychological evaluations to survivors of persecution seeking asylum in the United States and to seeks to educate the medical community on caring for asylum-seekers and refugees. Since its inception, the clinic, a part of the MGH Center for Global Health’s Disaster Response and Humanitarian Action programs, has completed evaluations for 325 asylum-seekers.

Asylum Clinic Director Matthew Gartland, MD, shares updates on the clinic and the current efforts being made to increase clinic’s capacity and advocate for asylum-seekers and detainees.

What services does the Asylum Clinic currently offer?

We offer forensic medical evaluations. These physical and psychological evaluations are provided for individuals seeking asylum. We are documenting evidence of prior persecution or trauma to be used in the individuals’ legal cases as they apply for asylum in the U.S.  We have 140 active multidisciplinary volunteer providers at MGH and network of about 65 volunteers from the wider Boston region such as Brigham and Women’s, Cambridge Health Alliance, Beth Israel, and others.

Before the COVID-19 pandemic, what was the process for conducting a forensic medical examination?

Before COVID-19, we had a partnership with the MGH Infectious Diseases Clinic who provided us with clinic space. On Monday nights, twice a month, we had as many as six clients come in.

We complete all our evaluations in teams. So, on any given night we might have 18 people affiliated with the Asylum Clinic. There was an element of camaraderie and teamwork in those evenings.

How many asylum-seekers has the Asylum Clinic served and can you tell us some of the outcomes of those cases?

We’ve seen about 325 asylum-seekers in the last three and a half years. We started operations in October 2017 and our volumes have ramped up to more than 100 individuals a year.

One challenge for asylum-seekers right now is that there is a year’s long backlog—COVID-19 has certainly delayed that further. We have clients we saw that very first month of 2017 still waiting for a decision in their application, but we’ve had 77 clients receive asylum or another form of relief. Close to 90% of our cases are successful in that regards. However, the vast majority of cases are still pending.

How did COVID-19 change Asylum Clinic operations?

It changed everything. We stopped evaluations for a 4-week period during March last year. Then we looked at our volunteer pool, participated in some training around virtual evaluations, and launched a fully virtual Asylum Clinic in April.

How did this pivot to virtual evaluations change forensic medical examinations?

Our volume of clients never decreased and pivoting to virtual created some benefits for our clients. Completing an evaluation in someone’s home creates a level of comfort. It is less traumatizing, and it allows clients from places like Springfield, MA or New Bedford, MA to access services in Boston that would be very difficult otherwise.

We have even done virtual—both telephonic and video—examinations with people in ICE detention centers.

Outside of examinations what are other things the Asylum Clinic does?

When we see people for evaluations, we are objective expert evaluators. When we are called to testify in court, our credibility is staked on our ability to provide expertise and not advocacy. We complete our work pro bono; we are not paid by the attorneys or clients.

That being said, we also feel there is a role we need to play as advocates. We saw that immigrants who were in ICE detention were at tremendous risk of COVID-19; they didn’t have access to proper hygiene or social distancing and weren’t being provided with testing or adequate medical care.

A number of us have been called to provide expert testimony in lawsuits on behalf of ICE detainees and have written academic papers about the risks they encounter. We have had a lot of success getting people released on medical grounds.

There is also not a lot of medical literature about asylum-seekers. So, we use deidentified data to study our client’s needs, to understand the kinds of trauma they’ve experienced, and to help us inform how we train our volunteers.

Finally, we have a number of advocacy projects including a partnership with a legal organization in Texas who represents families in ICE detention, and we have really great partnerships with groups like the Harvard Immigration and Refugee Clinic.

What does the future of the Asylum Clinic look like?

There are two really exciting initiatives that will evolve the care we have. First, we hired a Program Coordinator to work on connecting our clients to resources in the community. Because we serve a client group that is not just from Boston, it has always been challenging to connect people to care locally.

Our program coordinator is building a library of resources in different localities and will be screening our clients for their needs. She will be looking at social determinants of health needs that people have and then connecting people to resources locally, whether for primary and mental health care or for food or housing resources.

Second, we are building our community connections. We are partnering with The Center for Immigrant Health at MGH to build a community advisory board. In that group will be people with lived experience of seeking asylum, immigrants, and people leading community organizations who are serving the immigrant community. This group will help us determine what the needs of our potential clients are and will strengthen our connection to our community.

What is something you would like the broader community to understand about this work and asylum-seekers?

I think there are a lot of misconceptions about asylum seekers and refugees.  It is important to understand where people are coming from, what they experienced, and the incredible resilience they demonstrated to get themselves and their families here to the U.S. to seek protection. I think if people understood those stories, they would feel a lot more compassion. We would recognize these are people; these are families; these are children.

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