NYMC’s Center for Human Rights Helps Migrants Navigate the Asylum Process

Having survived kidnapping, assault, and torture by a gang—who partially severed three of Jane’s fingers—Jane* made it to the United States and applied for asylum. Like all asylum seekers, Jane had to apply for asylum within one year of arriving in the U.S. The process involved interviews and court hearings at which Jane had to demonstrate a credible fear of persecution based on race, religion, nationality, political opinion, or belonging to a particular social group. Detailed testimony about any physical, psychological, or sexual abuse, or threats experienced in Jane’s home country or while journeying to the U.S. is required. The procedure takes a careful medical and psychological evaluation to elicit such traumatic testimony. That is where New York Medical College’s (NYMC) Center for Human Rights (CHR) comes in.

Medical Evaluations Strengthen Asylum Claims

Founded in 2017, CHR is a student-run clinic that provides pro-bono forensic medical and psychological evaluations to asylum seekers, including sex- and labor-trafficked victims, in Westchester County, New York. These evaluations are critical to their applications for asylum or legal protective status in the U.S. Ninety-four percent of asylum seekers’ applications that include a medical evaluation receive approval, compared to 37.5 percent that do not. Yet, human rights organizations, overwhelmed by unprecedented numbers of migrants seeking asylum cannot meet the demand for needed medical evaluations, making CHR’s work more crucial than ever. In January 2019, the U.S. had a backlog of 325,277 asylum cases.

To produce these evaluations and the affidavits that asylum seekers need to present in court, CHR works closely with local human rights organizations, such as My Sister’s Place, Neighbor’s Link, and Physicians for Human Rights. It also relies on a cadre of generous volunteer clinicians—physicians, social workers, nurses, and physician assistants—who conduct the evaluation interviews. But it is NYMC’s student volunteers who drive the organization by overseeing all its efforts, including advocacy and research, to meet the medical and social needs of individuals who have suffered human rights abuses.

“NYMC values and prides itself on cultivating students who can assimilate and process a vast amount of clinical information, and who are also committed to serving individual patients and the good of society,” says Rebecca A. McAteer Martin, M.D., ’08, associate professor of family and community medicine and CHR’s faculty advisor. “A number of students at CHR are immigrants themselves or have come over as asylees, which makes this work particularly meaningful to them.”

Student Volunteers Find Meaning Supporting CHR

One such student is Rahim Hirani, an M.D./Ph.D. candidate and one of CHR’s executive directors. Born and raised in Pakistan, Hirani witnessed family and friends endure the trials of pursuing safety in the U.S. “I have seen how mentally and financially draining seeking asylum can be, so this work feels very personal to me,” Hirani says. “For this reason, I want to make sure that I can contribute whatever I can,” he says.

Hirani partners with co-executive director Kavya Tangella, School of Medicine (SOM) Class of 2026, to make sure that the clinic runs smoothly. This entails shepherding attorneys’ requests for client information to CHR’s co-directors of clinical operations, Jacob Fiedler, SOM Class of 2026, and Helen Ng, SOM Class of 2026. Fiedler and Ng pass along these requests to one of CHR’s four case managers, Yael Weitzner, Emily Zhang, Francesca Ricciardi, or Talia Saal, all from the SOM Class of 2026, who then try to find clinician volunteers to conduct the necessary evaluations. Psychiatric evaluations take place remotely, while physical evaluations take place on campus.

Once a case manager identifies an evaluator, they schedule the evaluation, according to when they, the client, clinician, client’s attorney, an interpreter, and two student volunteers can attend. Although only clinicians speak directly with clients, other attendees may quietly observe, while the student volunteers take notes of the interview, transcribe them, write up the evaluation, and draft the affidavit. “Case managers make sure that evaluations contain all the information that an affidavit and immigration judge would need about the trauma that a client has endured, why they should receive asylum, and why returning them to their country would endanger their life,” Hirani explains.

After drafting both the interview notes and affidavit, students send them to the clinician evaluator for comments and corrections. The clinician then has the documents notarized and the case manager delivers them to the client’s attorney. “Without student volunteers, it would be difficult for clinicians to do evaluations because of the time it takes to transcribe them and write the affidavits,” Tangella says.

Need for Clinical Evaluations

The work is time- and labor-intensive, which explains CHR’s shortage of evaluators. In 2021, the organization had only two clinician evaluators. Now it has seven or eight, which is still too few, Hirani says. “We do not have enough evaluators for the number of requests we receive, so unfortunately, we have to turn people away,” he says.

Of the 40 interview requests that CHR received from April through September 2023, 20 were accepted and successfully evaluated. “We are receiving more and more requests but have been able to handle only 50 percent of them because we do not have enough clinicians,” Hirani says. “In the last month alone, we received 11 or 12 requests, which reflects the unprecedented number of refugees in New York City,” he adds.

Dr. Martin, who is a full-time palliative medicine consultant at Westchester Medical Center and faculty advisor for several other on-campus programs, finds time every few months to conduct one asylum interview for CHR. “Each interview takes upwards of three or four hours with a translator,” she says. “The stories themselves are often difficult to hear, and there are times when clients re-experience trauma, so you have to be so careful when you do these interviews,” she says.

Following the interview, she often conducts additional research to support her findings. “Sometimes a judge will say there are discrepancies or gaps in a report, and so I will include evidence in the literature that demonstrates the impact of post-traumatic stress syndrome on memory,” she says. Then, she will edit the final eight to twelve-page report, which includes her diagnostic assessment and treatment recommendations.

All CHR’s volunteers, including clinicians, must complete an online training, which includes an overview of the immigration and asylum systems in the U.S. and a template for interviewing asylum seekers. Even though most evaluations are psychological, any clinician with a health care certification, primary care training or skills in interview-based care can perform them since a template supplies all the questions. “The training consists of a few online modules and takes no more than a couple of hours,” Tangella says. “Clinicians do not need to make a major commitment or have any prior related experience. They can do interviews whenever they have availability, whether that is once every month or once every year. It just takes being interested,” she adds.

Advocacy and Research

Providing medical and psychological evaluations is only part of what CHR does. The organization also has an advocacy team that educates clients about local resources to help them find employment, learn English, or cope with difficult issues like domestic violence. In collaboration with local organizations, community health centers, and clinical care networks, the advocacy team plans community events addressing human rights issues. “We also have a journal club for students as a forum to talk about issues relating to asylum seekers, like gang violence and other topics,” Tangella says. “Having the space to discuss these topics is important for us as future physicians,” she notes.

CHR also has a newly formed research team that is hoping to explore the impact of student-run asylum clinics on clients and students, and effective approaches to treating victims of human rights abuses. The Center also has a recruitment team that tries to engage clinicians by educating them about its mission, work, and the impact they can make.

Dr. Martin, who has dedicated her career to treating suffering patients like Jane, who she interviewed, says that volunteering for CHR is her duty as a physician. “The people who CHR serves are so vulnerable, and medical schools are obligated to consider vulnerable populations, including asylees and human trafficking victims,” she says. “If we as clinicians do not do it, then who does? If we do not advocate for and model this work for students, then who will? It will increasingly become an underserved need. It already is.”

She urges clinicians to give CHR whatever time they can spare. “If you have administrative time, then take one afternoon every three months to do an evaluation. If you are in private practice, then try to block out one afternoon every quarter to provide pro-bono care and get buy-in from your practice that this is valuable work. If every clinician in the U.S. gave half a day a week, a tithe of their time, we would not have a problem with medically underserved populations.”

At the time of this writing, neither Dr. Martin nor CHR know how Jane’s asylum case turned out. “Even though having a medical evaluation increases clients’ chances of being granted asylum by 70 to 80 percent, these cases can take up to 10 years to settle, and we may never know what happens to the individuals,” Tangella says. It is a scary unknown but one that strengthens the resolve of CHR’s volunteers to continue their work. “Whatever field I go into I want to do this work,” Hirani says. “We can actually make a difference in people’s lives while we are in medical school, which is the most meaningful thing we can do,” adds Tangella.

Visit NYMC CHR for additional information or to learn how to volunteer.

* Name has been changed to Jane to protect the individual’s identity.