Safe & Sound

Growing up in Azerbaijan, Yusif was frequently attacked for being gay. Over the years, he was beaten up at school, punched and kicked by neighbors, and pelted with rocks and had homophobic slurs written on the door of his family’s home. The violence escalated when he was 18: Three men dragged Yusif to a schoolyard one night in 2012 and put a knife to his throat. Two took turns raping him, while the third filmed it on his phone and threatened to show the video to others. Yusif went to the police, but an officer refused to file a report even though he could identify his assailants. “Everything changed after that,” says Yusif [not his real name, which he asked be withheld to protect his privacy]. “I said to myself, ‘You have to get out of here. Your life is going to end soon.’ I felt it.”

A year later, Yusif’s mother borrowed money so he could buy a plane ticket and enroll at a language school in the New York area, which allowed him to enter the United States on a student visa—although upon arriving, he discovered that the school didn’t exist and they’d been swindled. With nowhere to go, Yusif lived hand-to-mouth for months, working at places that only paid him in fast food, and for a time, sharing a room with seven other people. He eventually connected with family friends in New Jersey, who gave him a temporary home and referred him to an asylum attorney. That brought him to the Weill Cornell Center for Human Rights, a medical student-run clinic that provides pro-bono physical and mental health evaluations for immigrants seeking asylum in the United States, based on abuses due to race, gender, sexual orientation and other grounds. Though Azerbaijan decriminalized homosexuality in 2001, the country has done little to protect its LGBT community from discrimination, violence, hate crimes and police harassment. “I don’t consider my life before as a life,” says Yusif, who was diagnosed with post-traumatic stress disorder (PTSD) and depression. “I considered it survival.”

Yusif—who was granted asylum last year—is one of 318 clients from 63 countries who have been evaluated by the center since 2010, when Weill Cornell Medicine students founded it with Physicians for Human Rights (PHR). It was the first clinic of its kind in the United States, serving as a model for similar programs at more than a dozen schools including Columbia, Brown and the University of Pennsylvania. With a roster of 65 volunteer clinicians—many of whom are Weill Cornell Medicine faculty—and more than 150 trained student evaluators, the center examines asylum seekers and prepares medical legal affidavits that can be used at court hearings. Its high success rate underscores the value of such evidence in helping applicants prove their claims: of the clients whose cases have been adjudicated, about 94 percent have been granted asylum—nearly three times as many as those without this type of documentation, according to figures from a study led by researchers at the University of California, San Francisco  that was published in The Journal of Immigrant and Minority Health in 2008. “Because they’re fleeing persecution, the only evidence they can bring with them is, quite literally, the physical and psychological scars that they carry on their bodies,” says the center’s co-executive director, Andrew Milewski, a sixth-year MD-PhD student. “So our affidavits are crucial pieces of evidence in their immigration court proceedings.”

The center connects with clients through referrals from PHR, private immigration attorneys and local law schools. Exams are done at Weill Cornell Medicine’s Margaret and Ian Smith Clinical Skills Center or at a clinician’s office, led by a physician or mental health professional. Student volunteers take detailed notes of the interview and carefully document signs of abuse, then help write the affidavit; the clinician finalizes it and, if necessary, testifies in court. The center has seen Syrian refugees suffering from extreme PTSD, women who’ve endured genital mutilation—common in certain African and Middle Eastern countries like Egypt, Somalia, Guinea and Burkina Faso—as well as victims of torture and other brutalities from places in Central America where gang violence has skyrocketed in recent years. Other clients seek asylum because of domestic violence, escaping homelands that don’t offer legal protections. One evaluation that Milewski assisted with in 2014 involved three siblings who fled Honduras because of their father’s mistreatment. Milewski says that the father would often whip one of the daughters and had broken the son’s nose; when they moved in with relatives in an effort to escape the abuse, one of the sisters was sexually assaulted by a cousin. “That was a really hard case,” says Milewski, who notes that the siblings were granted asylum a few months after the evaluation. “The trauma was still very fresh with those kids.”

The center doesn’t just provide a valuable service for asylum seekers. It trains the next generation of evaluators—who are desperately needed, given the current backlog of more than 620,000 asylum cases in U.S. courts. It also gives students hands-on clinical experience early in their medical training. “They get to contribute in a meaningful way to securing our clients’ access to a future free of fear and danger,” says Dr. Joanne Ahola, the clinic’s medical director emeritus and a former adjunct assistant clinical professor of psychiatry at Weill Cornell Medicine, who helped found the center and still works as a volunteer evaluator. “Plus, they get to help a woefully underserved population.”

Even if the students don’t continue to help with asylum cases later in their careers, their involvement with the clinic teaches them how to sensitively treat patients who have endured physical and emotional trauma. Dr. Thomas Kalman, a clinical professor of psychiatry and the center’s medical co-director, sees such experience as a vital part of any medical student’s education. “This exposes students to human cruelty—which is an ugly sounding term, but it’s very real and it exists,” says Dr. Kalman, a psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center. “Here in the United States, we have gun violence, natural disasters—terrible things that leave people traumatized. This clinic is an opportunity to introduce students to some of these things and to show them that people can overcome them.” Milewski agrees, noting that he’s thankful for the chance to observe how resilient many of the center’s clients are. “Knowing that some of our clients, despite what they’ve experienced, still have hope for a better future—that’s incredibly heartwarming and inspiring,” he says.

Indeed, for Yusif, the future looks brighter. Now in his 20s, he’s studying to become a nurse. He volunteers at an LGBT center near his New York area home, wanting to give back to a community that has offered him invaluable support since he came to America. “To any LGBT individuals that for any reason are afraid, possibly under pressure or threat by homophobic people, I would like to say that you are not alone,” he says. “There are resources and people who will support you.” Ever since he learned he’d been granted asylum, he adds, his chronic nightmares and anxiety attacks have abated considerably. “All my life I never felt safe,” he says. “That day was the first time I felt like, ‘OK, I can sleep well tonight.’”

— Heather Salerno

This story first appeared in Weill Cornell Medicine, Vol. 16. No. 4

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