BY KENNETH BUSCH, M.D.

Our changing world requires that we, as psychiatrists, become more aware of the mental health problems of our multicultural population. Each year, tens of thousands of displaced people from all over the world seek asylum in the United States. Many of these asylum seekers have been physically and psychologically tortured in their native countries. These individuals may face further persecution, even death, if forced to return to their home countries.

To assist these victims of torture and other human rights violations, Physicians for Human Rights (PHR) created the Asylum Network. PHR is a membership organization of physicians, health professionals, scientists, and concerned citizens. It received the APA Human Rights Award in 1995 and shared the 1997 Nobel Peace Prize. Currently, the PHR Asylum Network is composed of more than 300 health professionals in the United States who volunteer to conduct examinations of asylum applicants and prepare written and sometimes oral testimony.

At this time, the need for psychiatrists to conduct these evaluations is particularly acute. The Asylum Network provides a unique opportunity for us to assist victims of torture around the world—right here in this country. These individuals have suffered a process of brutal human degradation, such as repression or state-sponsored terrorism. What are the mental health effects of the emotional trauma experienced by these men, women, and children? Widespread signs and symptoms from psychological torture can develop into posttraumatic stress disorder, anxiety disorders, major depression, psychosis, and dementia due to head trauma or asphyxiation. In addition, there may be severe physical consequences of torture such as scarring, fractures, hearing loss, neurological problems, and genital trauma. Children are especially vulnerable to exposure to violence and suffer from terrifying traumas such as losing their parents, siblings, homes, possessions, and friends.

Through psychiatric examination of these individuals in the PHR Asylum Network, we can determine whether the injuries or trauma sustained by the applicant are consistent with the person’s account of his or her own experiences. Our role in the asylum-seeking process is crucial as the documentation of torture and other cruel, inhuman, and degrading punishment can provide essential support for an asylum seeker’s legal case. We can help judges and attorneys understand the effects of torture and trauma on the applicant, which is particularly critical when so many of these survivors suffer from PTSD and other disorders. Perhaps most important, these evaluations not only provide crucial evidence of the allegations, but can enable survivors to begin to heal and rebuild their lives.

By participating in the Asylum Network, we can support PHR in fulfilling an important need in the protection and promotion of human rights for these displaced persons. In addition, this experience will provide us with an opportunity to learn more about these victims and the consequences of psychological torture.

A psychiatrist who joins the network will be provided with a training manual, Medical and Psychological Evaluation of Victims of Torture: A Health Professional’s Guide to Political Asylum. PHR will also assign new members to experienced mentors who will provide orientation to the network and the role of the psychiatrist in the asylum process. When a case is referred to the asylum network by an attorney, PHR contacts a member in the area. Upon acceptance, background information and sample evaluations relevant to the case and the region will be sent to the member. PHR also provides periodic training seminars to educate its network members about evaluating asylum applicants. PHR just hosted a training seminar in Boston in November 1999 and is planning to host another one in Miami this spring.

Protection of displaced persons who seek asylum due to psychological torture should be a priority for us. People should not be forced to return to their native countries if their safety cannot be guaranteed. As Secretary of State, Madeleine Albright indicated to the Kosovar Albanians at the U.S. Institute for Peace Conference in Washington, D.C., last September, " Neither democracy nor peace is sustainable without respect for human rights."

We can help protect and promote human rights for asylum seekers through our involvement and participation in the network.

If you are interested in joining the Asylum Network, contact Natalie Audage, the PHR Asylum Network Coordinator, at (617) 695-0041, ext. 216, or naudage@ phrusa.org. For more information on PHR, visit <www.phrusa.org>.