Thank you for your interest in Module 3: Conducting Medical Evaluations for Asylum and Protection!

This training is designed to equip medical providers with the foundations to begin conducting evaluations for survivors of torture, persecution, and human rights abuses. We have divided this module into four essential video trainings excerpted from prior recordings of our live medical evaluations workshop:

• Commonly-observed types of torture (Module 3.2)

• Preparing for and conducting an evaluation interview (Module 3.3)

• Drafting the medical evaluation affidavit (Module 3.4)

• Volunteer resources and next steps (Module 3.5)

These videos are accompanied by a Medical Evaluator Workshop packet that contains supplementary tip sheets, checklists, a sample affidavit, and affidavit template. In addition to these materials, each video description contains citations and links to additional resources on each subtopic. (Evaluators who join EAHR's network will also receive access to an extensive volunteer resource library of other articles, tools, and affidavit samples.)

Once you have watched all four videos and completed the Module 3 Post Training Assessment and EAHR Training Series Feedback Survey, we invite you to apply to volunteer with EAHR!

The clinical portions of this video series are presented by two highly experienced evaluators, who have both made an immense impact on community capacity for evaluation services in Seattle and for whose time and support we are exceptionally grateful:

• Dr. Carey Jackson is a professor in the Department of Medicine at the University of Washington and a general internist with graduate training in both medical anthropology and public health. He is the medical director of the International Medicine Clinic in Seattle, Washington and has been a service provider to Seattle's refugee communities for more than 25 years. He additionally serves as the Director of EthnoMed, an ethnic medicine website that publishes medical and cultural information about immigrant and refugee groups, as well as the Medical Director of the Northwest Health and Human Rights, coordinating the evaluation and treatment of torture survivors in Washington State. 

• Dr. Alexandra Molnar is a primary care provider at Harborview's International Medicine Clinic and Pioneer Square clinics, as well as a clinical assistant professor at University of Washington School of Medicine. She has more than a decade of experience conducting medical evaluations for asylum-seekers and torture survivors. Her clinical interests include women's health, female genital cutting, medical education, wound care, care of immigrants, refugees, and torture survivors, as well as homeless individuals and harm reduction. She earned her bachelor's degree from Harvard University and her MD from the University of Washington. 

The material presented in our medical training modules and workshops was developed by Dr. Jackson and Dr. Molnar, in collaboration with other expert evaluators, and reflects their extensive experience conducting evaluations for survivors of torture in Washington State. Dr. Jackson and Dr. Molnar are a part of a wider constellation of evaluators and care providers around the world who have worked tirelessly for decades to establish international guidelines for documenting the evidence of torture and best practices for treating and supporting survivors. This global community of health professionals has laid the groundwork for programs like the Evaluation Alliance for Human Rights. 

Please note that the forms of persecution and torture presented in Module 3 are limited to those most often seen among the asylum populations we serve here at the Evaluation Alliance, but torture and human rights abuses occur everywhere, including in the United States. We must also acknowledge the complex factors that contribute to global inequities, wars, and persecution – including the role of the US government in destabilizing and exploiting many of the countries that survivors come from. It is especially important to engage in this work with cultural humility and to recognize that survivors come from countries with dynamic cultures, rich traditions, and nuanced histories that it is our ongoing work to better understand and confront our unconscious bias.

Above all, we honor the survivors who volunteered to share their scars and stories in order to help train new evaluators, so that other survivors may also have access to critical evaluation services. While the survivors’ identities are redacted in all of our training materials, please note that the following videos contain detailed descriptions of persecution and torture methods, as well as photos of the resulting scars and wounds. We strongly recommend that you take a moment to consider your environment and your pace before starting this video series. We encourage you to take pauses for breath, grounding, movement and reflection. 

All of the evaluations produced by our program are a testament first and foremost to the resiliency of the applicants that we work with, as well as the strength of the volunteers and interpreters who helped tell their story. We are grateful to you for your interest in joining this ever-growing community of evaluators committed to human rights and health justice, and we welcome connecting with you about any ideas for further improving this module.

Sincerely, 

The EAHR Support Team

Goal: Upon completing this section, participants will be able to identify commonly-observed physical evidence for the most prevalent types of torture that asylum-seeking populations in the U.S. have survived. Participants will also be familiar with key terms for assessing and documenting this physical evidence as defined by the Istanbul Protocol.

Speaker Bio: Dr. Carey Jackson is a professor in the Department of Medicine at the University of Washington and a general internist with graduate training in both medical anthropology and public health. He is the medical director of the International Medicine Clinic in Seattle, Washington and a service provider to Seattle's refugee communities for more than 25 years. He additionally serves as the Director of EthnoMed, an ethnic medicine website that publishes medical and cultural information about immigrant and refugee groups, as well as the Medical Director of the Northwest Health and Human Rights, coordinating the evaluation and treatment of torture survivors in Washington State. 

Citations:

Atkinson, Holly G. et al. “Impact of forensic medical evaluations on immigration relief grant rates and correlates of outcomes in the United States.” Journal of Forensic and Legal Medicine,  Volume 84, 2021. Available at: https://www.sciencedirect.com/science/article/pii/S1752928X21001578

Hearst, Adelaide & Molnar, Alexandra. "Female Genital Cutting: An Evidence-Based Approach to Clinical Management for the Primary Care Physician." Mayo Clinic proceedings, Mayo Clinic 88(6): 618-629, 2013. Available at: https://www.researchgate.net/publication/237002607_Female_Genital_Cutting_An_Evidence-Based_Approach_to_Clinical_Management_for_the_Primary_Care_Physician

Physicians for Human Rights. Examining asylum seekers: A clinician’s guide to physical and psychological evaluations of torture and ill-treatment. Cambridge, MA: Physicians for Human Rights, 2012.

UN Office of the High Commissioner for Human Rights (OHCHR), Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment ("Istanbul Protocol"), 2004, HR/P/PT/8/Rev.1, available at: https://www.refworld.org/docid/4638aca62.html 

Additional Resources:

• To access the updated 2022 Istanbul Protocol, click here to view the full document from the U.N. Office of the High Commissioner for Human Rights 

• To learn more about implementing the Istanbul Protocol, check out this webinar from the International Rehabilitation Council for Torture Victims: Investigating Torture: Understanding and Using the Istanbul Protocol (June 1, 2022)

• To learn more about conducting medical evaluations for children and youth survivors, check out this webinar from ISPCAN: Identifying & Responding to the Torture of Children: A 4-Part Series for Healthcare Professionals (February 1-22, 2022)

• To access handouts and quick guides on documenting specific types of torture and sexual violence, visit the Synergy for Justice Resource Library

• To learn more about refugee & asylum-seeking torture survivors in the United States, read this 2015 report from the Center for Survivors of Torture

Goal: Upon completing this section, participants will have a clear understanding of the expectations for equipment and documentation that should be prepared prior to a medical evaluation appointment, as well as a general understanding of medical evaluation interview components and flow. Participants should also be prepared to implement basic techniques for trauma-informed approach and interviewing to minimize the risk of harm during an evaluation.

Speaker Bio: Dr. Alexandra Molnar is a primary care provider at Harborview's International Medicine Clinic and Pioneer Square clinics, as well as a clinical assistant professor at University of Washington School of Medicine. She has more than a decade of experience conducting medical evaluations for asylum-seekers and torture survivors in Washington State. Her clinical interests include women's health, female genital cutting, medical education, wound care, care of immigrants, refugees, and torture survivors, as well as homeless individuals and harm reduction. She earned her bachelor's degree from Harvard University and her MD from the University of Washington. 

Citations:

Ferdowsian, Hope et al. “Asylum Medicine: Standard and Best Practices.” Health and human rights vol. 21,1 (2019): 215-225. Available at https://pubmed.ncbi.nlm.nih.gov/31239628/ 

Physicians for Human Rights. Examining asylum seekers: A clinician’s guide to physical and psychological evaluations of torture and ill-treatment. Cambridge, MA: Physicians for Human Rights, 2012. 

Additional Resources:

• To view some sample country conditions reports, explore the Refugee Wellness Country Guides Library from Gulf Coast Jewish Family and Community Services

• To view a mock medical evaluation interview, watch Forensic Physical Evaluation for Asylum Seeking Immigrants: A Case Example, developed by the Center for Health Equity Education & Advocacy with support from Physicians for Human Rights, the Yale Center for Asylum Medicine, and the Cambridge Health Alliance Foundation

• To learn more about best practices for interviewing children, check out Trauma Informed Interviewing Techniques: A Toolkit for Attorneys and Other Professionals Working with Immigrant Children from the Stanford Center for Health Education and the University of Texas at Rio Grande Valley

• To access handouts with additional guidance on interviewing survivors of torture and sexual violence, visit the Synergy for Justice Resource Library

Goal: Upon completing this section, participants should be able to strategically organize their affidavits into clear sections and numbered paragraphs that will communicate their clinical findings most effectively to the asylum officers, immigration judges, and adjudicators reviewing this evidence. Participants will also understand how to present their credentials to this audience, as well as common pitfalls to avoid that may inadvertently harm the asylum-seeker's claim or compromise their perceived objectivity in the eyes of adjudicators.

Speaker Bio: Dr. Carey Jackson is a professor in the Department of Medicine at the University of Washington and a general internist with graduate training in both medical anthropology and public health. He is the medical director of the International Medicine Clinic in Seattle, Washington and a service provider to Seattle's refugee communities for more than 25 years. He additionally serves as the Director of EthnoMed, an ethnic medicine website that publishes medical and cultural information about immigrant and refugee groups, as well as the Medical Director of the Northwest Health and Human Rights, coordinating the evaluation and treatment of torture survivors in Washington State. 

Citations:

Green, Aliza S. et al. "Immigration Judges’ Perceptions of Telephonic and In-Person Forensic Mental Health Evaluations." Journal of the American Academy of Psychiatry and the Law Online April 2022, JAAPL.210075-21; DOI: https://doi.org/10.29158/JAAPL.210075-21. Available at https://pubmed.ncbi.nlm.nih.gov/35444056/ 

Scruggs, Elizabeth et al. “"An absolutely necessary piece": A qualitative study of legal perspectives on medical affidavits in the asylum process.” Journal of forensic and legal medicine vol. 44 (2016): 72-78. doi:10.1016/j.jflm.2016.09.002. Available at https://pubmed.ncbi.nlm.nih.gov/27639654/

UN Office of the High Commissioner for Human Rights (OHCHR), Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment ("Istanbul Protocol"), 2022, available at https://www.ohchr.org/en/publications/policy-and-methodological-publications/istanbul-protocol-manual-effective-0  

Additional Resources:

• To view a selection of redacted sample affidavits, visit Sample Medical-Legal Affidavits/Declarations from the Society for Asylum Medicine's resource library. (Please note that best practices for affidavit writing at other evaluation service programs may differ from EAHR, and refer to the redacted affidavit and affidavit template on pages 8-14 of the Medical Workshop Packet for samples that specifically reflect EAHR's program best practices. Once onboarded, volunteers also gain access to EAHR's volunteer resource library with more redacted affidavit samples.)

Goal: Upon completing this section, participants will have a clear understanding of the resources, mentorship, and support offered to EAHR volunteers, as well as next steps to apply.

Speaker Bio: Pauline Khoury, MPH, PMP is the EAHR Program Coordinator at the IRC office in Seattle. Prior to joining the team at the IRC, Pauline served as a public health project manager with 10+ years of experience responding to humanitarian crises in the Middle East and North Africa, in which capacity she coordinated extensive trainings for the region's health professionals on war surgery and other disaster response topics. She holds a Bachelor's in Nursing from Université Saint Joseph, a Master's in Public Health from the American University of Beirut, a Master's in Business Administration - International Health Management from the Swiss Tropical and Public Health Institute, and a certificate in Health Emergencies in Large Populations from Johns Hopkins University.

Still have questions about whether an EAHR volunteer position is right for you? Contact the EAHR Support Team!