The 1951 Refugee Convention prohibits states from returning refugees to countries where they would be at risk of persecution. 1 To be granted asylum in the United States, applicants must prove that they have a well-founded fear of persecution if they return home. Most asylum seekers arrive without documents or witnesses to substantiate their claims of abuse or torture, however, and the majority of applications for political asylum in the United States are denied. 2 Medical and psychological evaluations can therefore be critical in corroborating reported abuse and torture. The predominant current problems of the applicant, physical or psychological, usually determine whether a medical or psychological assessment is indicated.
Many applicants require both.
Interview Techniques and Procedures Obtaining medical and psychological histories usually requires use of a translator, and awareness of culture-specific syndromes and native language idioms of distress through which symptoms are communicated is thus of paramount importance. To ensure purity of translation, the clinician must ask for literal translation of all that is said and explanations of any nonverbal communications. The clinician needs to realize that the evaluation may evoke feelings of powerlessness, of being interrogated, and of being intruded upon, potentially replicating circumstances of the torture situation and increasing the woman's anxiety and her resistance to disclosure. Therefore, specific precautions and interventions to minimize distress and maximize a climate of trust and safety should be employed. The applicant must be allowed to request breaks, to interrupt the interview at any time, and to leave if the stress level becomes intolerable.