title: "An absolutely necessary piece": A qualitative study of legal perspectives on medical affidavits in the asylum process.
abstract: A key challenge for asylum seekers in the United States is being able to provide evidence of prior persecution in their home countries. Medical/psychological affidavits corroborating applicants' accounts often make the difference between successful and unsuccessful applications. The purpose of this study was to identify the unmet demand for and features of effective medical/psychological affidavits in the asylum process, as well as the personal and systemic barriers for asylum seekers. This is a qualitative study of semi-structured interviews with legal professionals who work in asylum law. Sixteen asylum lawyers and one Board of Immigration Appeals accredited representative practicing in the state of Michigan, United States, participated in this study. All participants noted that a vast majority of their asylum cases would benefit from a medical affidavit but that they have difficulty finding qualified physicians with experience writing such affidavits and testifying as expert witnesses. The major barriers to obtaining medical/psychological evaluations included inability to pay for services, lack of practitioner availability, and lack of practitioner training. The participants reported that features of a strong medical affidavit included clear, concise, and corroborative accounts that supported the applicant's story from a diagnostic perspective and forensic descriptions that reinforced the credibility of the applicant. Several also noted that medical/psychological evaluations frequently would reveal additional details and incidents of trauma beyond those stated in the applicant's preliminary statement. The study results suggest substantial unmet need for trained physicians to perform medical and psychological evaluations on a pro bono basis. Lawyers' recommendations regarding effective medical affidavits and necessary ongoing support for asylum applicants should inform current efforts to improve physician and lawyer collaborations on asylum cases.
authors.affiliation: University of Michigan Medical School, M4101 Medical Science Building I - C Wing, 1301 Catherine, Ann Arbor, MI 48109-5624, United States. Electronic address: escruggs@umich.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Scruggs
authors.affiliation: Department of Family Medicine, University of Michigan, United States. Electronic address: tguetter@umich.edu.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Guetterman
authors.affiliation: Department of Ob/Gyn Residency Program, University of Wisconsin, United States. Electronic address: ameyer4@uwhealth.org.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Meyer
authors.affiliation: Department of Ob/Gyn Residency Program, University of Michigan, United States. Electronic address: jvanarts@umich.edu.
authors.forename: Jamie
authors.initials: J
authors.lastname: VanArtsdalen
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States. Electronic address: mheisler@umich.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D004282:Documentation; D006304:Health Status; D006801:Humans; D008487:Medical History Taking; D008603:Mental Health; D010808:Physical Examination; D036301:Qualitative Research; D012036:Refugees / Q000331:legislation & jurisprudence*; D014481:United States
keywords: Asylum evaluation; Asylum seekers; Forensic medicine; Human rights; Underserved care