Clinic examines immigrants seeking asylum
OAKLAND — Dr. Nick Nelson walks through busy Highland Hospital to a sixth-floor exam room, where he sees patients from around the world who say they have fled torture and violence.
Nelson, who practices internal medicine, is the medical director of the Highland Human Rights Clinic, part of the Alameda Health System. A few times each week, he and his team conduct medical evaluations of people who are seeking asylum in the United States. The doctors listen to the patients’ stories. They search for signs of trauma. They scrutinize injuries, including electrocution scars, bullet wounds and unset broken bones.
As the Trump administration looks to reduce the number of asylum applicants, citing loopholes and fraudulent claims, this clinic — and others like it in San Diego, Los Angeles, New York and Chicago — seeks evidence that can help determine whether someone should gain asylum in the U.S.
The Highland clinic opened in 2001 as a place for asylum seekers and refugees to get care. Five years later, the staff started offering forensic exams that aim to discern whether there is evidence of torture or abuse. Nelson, who took over as director in 2012, says his team does between 80 and 120 evaluations each year.
Nelson and his colleagues diagnose physical and psychological ailments and, in many cases, substantiate these patients’ claims about how they were hurt. Sometimes the asylum seekers have health coverage that pays for the exams, but the county covers the cost for those who don’t.
“Our job is to make sure that the asylum office understands all the medical and psychological facts about a person’s case so that they can make a decision,” Nelson said.
Nelson bases his findings on an internationally recognized protocol for torture documentation.
For example, he may be called on to judge whether a scar or injury could have occurred as the patient describes. Sometimes, Nelson said, attorneys ask him to answer specific questions, such as, “Is this burn scar consistent with a cigarette burn?” or “Are these marks on his back consistent with being beaten with PVC pipe?”
Nelson has had some medical training on what to expect to see in cases of torture. He also applies his general expertise as a doctor in knowing how to interview and examine patients, and has learned something about the countries these asylum seekers are fleeing and the injuries they may have endured.
For example, when someone is hit with a long, stiff object, it produces a pair of parallel bruises like railroad tracks, he said.
“That’s a specific thing that I didn’t learn in medical school or residency,” he said, “but that I have learned through taking care of a lot of people who have been tortured.”
In most cases, Nelson said, he finds evidence to support the stories his patients tell him. But there are also exams that don’t yield definitive evidence.
Nelson also addresses the asylum seekers’ health needs, sometimes diagnosing cases of tuberculosis or HIV that were previously undiagnosed. Nearly all of the patients he sees need mental health referrals, he said, because of years of torture or abuse in their native countries.
One of the patients Nelson recently treated is 60-year-old Juan Lopez Aguilar, an indigenous Maya who fled Guatemala three years ago. He said he was beaten and threatened off and on for nearly four decades because of his ethnicity and feared for his life back home. Lopez Aguilar’s son also was murdered in 2005 and his daughter fled because of threats, his attorney said.
“I’m worried,” Lopez Aguilar told the doctor through a translator, as he sat in the exam room. “There are a lot of gangs. They want to kill people in my community.”
Nelson first examined and interviewed Lopez Aguilar earlier this spring and wrote a report corroborating the man’s account for his asylum case, formally filed last year.
Lopez Aguilar, who grew up in a family of peasant farmers, told Nelson that his community was attacked by soldiers when he was in his 20s and that his father was killed during that attack. Lopez Aguilar moved to another part of Guatemala, where he continued to be the victim of “race-based harassment, extortion and threats,” Nelson said.