From Persecution to Prison - Bellevue/NYU Program for Survivors of ...

efugees and displaced persons is high. The 1996 Act set up a legal paradox.Asylum is a legal status designed to protect those fleeing persecutionusually performed by governments or other official actors. 21 The governmentsthat persecute asylum seekers are the same ones that either grant ordeny passports and other official travel documents to these asylum seekers.For this reason, international law provides that asylum seekers should notbe penalized for lack of documentation. (See Legal Standards chapter formore details.) Nonetheless, many people coming to the US who are deservingof asylum are imprisoned because of inadequate travel documents.In the wake of the 1996 Act, health professionals, including severalassociated with Physicians for Human Rights and the Bellevue/NYU Programfor Survivors of Torture, reported seeing detained asylum seekers inINS custody in a fragile state of health. These reports included clinicalobservations that detention appeared to worsen the physical and mentalhealth of asylum seekers, especially those who had been subjected to tortureand trauma.Systematic research on the health of detained asylum seekers has beenextremely limited by difficulties gaining access to detention centers. InAustralia, for example, where a policy of mandatory detention of asylumseekers has been in operation for over ten years, repeated requests by independentresearchers to access asylum seekers have been denied. 22 Despitethese restrictions, a few reports in Britain and Australia have identifiedhigh levels of psychological distress among selected groups of detainedasylum seekers. 23 These reports, however, were based on small samplesand did not use standardized instruments. There are no prior studies concerningdetained asylum seekers in the US.This study provides the first systematic, quantitative examination of thehealth of detained asylum seekers: their access to health care, their treatmentupon arrival in the United States and while in detention, and theimpact of post-migration detention on their physical and mental health.21Those seeking asylum in the US are reviewed under the criteria for establishing refugee status;see, 8 U.S.C. 1158. Those granted asylum, “asylees” are a subset of refugees. In the US,refugees are those people who have fled persecution and are determined by the US or othercompetent authority to be refugees, while still overseas. Asylum seekers are those arriving atthe US border who say they have fled persecution, but who have not yet received officialrecognition of refugee status.22Personal communication with Derrick Silove, July 2002.23Pourgouides C, Sashidharan S, Bracken P, 1996;. Medical Foundation for the Care of Victimsof Torture, October, 1994. 20. Sultan A, O’Sullivan K. Psychological disturbances inasylum seekers held in long term detention: a participant-observer account. MJA.2001;175:593-596. Steel Z, Silove DM. The mental health implications of detaining asylumseekers. MJA 2001; 175: 596-599.24Charu Newhouse al-Sahli, “A Brief History of the Use of Immigration Detention” [Historyof Immigration Detention], Detention Watch Network News, Summer 2001, p.12BACKGROUND 25