Journal of Immigrant and Minority Health

, Volume 15, Issue 5, pp 961–968 | Cite as

Socio-Medical Challenges of Asylum Seekers Prior and After Coming to the US

  • Ramin Asgary
  • Beth Charpentier
  • Delia C. Burnett
Original Paper


Refugee asylum seekers face complex social and medical challenges. We evaluated 30 consecutive asylees in New York for socio-demographic and health backgrounds, characteristics of torture, presentations and medico legal path. Results: Majority was male, young, educated from sub-Saharan Africa. In home countries, all had employment; 58 % had fair or good access to healthcare; 36 % used traditional medicine; and 14 % had insurance. In the US, social support and accommodations were provided by countrymen; overwhelmingly they were unemployed; none had insurance; and 57 % never had any contact with healthcare system. Sixty nine percent had PTSD and 69 % depression. Almost all had scars with significant sequelae. Eighty eight percent were granted asylum. Ironically, asylees had better access to social and health services in home countries than the US. We recommend better recognition of, and addressing asylees’ social and health needs through a multidisciplinary approach drawing on other countries’ experience, and expanding existent programs for refugees to cover asylees.


Refugees Asylum seekers Socio-demographics Torture Health challenges 



We wish to thank Drs. Liz Kah and Anna Goldman, and Lucy Schulson for their invaluable contribution to the human rights clinic since its inception. We would like to thank Elisabeth Brodbeck for her contribution to the manuscript and its revision, Alexandra Ingber for her contribution to data entry and analysis, and Dr. Sanjat Kanjilal for his contribution to primary data analysis and draft of this manuscript.

Conflict of interest

Authors declare no financial and conflict of interest for this study.


  1. 1.
    United States Department of Homeland Security. US Citizenship and Immigration Services. Definitions available at Accessed 20 June 2012.
  2. 2.
    Bischoff A, Bovier P, Rrustem I, et al. Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral. Soc Sci Med. 2003;57(3):503–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18(1):44–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Wissink L, Jones-Webb R, DuBois D, et al. Improving health care provision to Somali refugee women. Minn Med. 2005;88(2):36–40.PubMedGoogle Scholar
  5. 5.
    Wong EC, Marshall GN, Schell TL, et al. Barriers to mental health care utilization for US Cambodian refugees. J Consult Clin Psychol. 2006;74(6):1116–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Piwowarczyk L, Keane TM, Lincoln A. Hunger: the silent epidemic among asylum seekers and resettled refugees. Int Migr. 2008;46(1):59–77.CrossRefGoogle Scholar
  7. 7.
    Asgary R, Segar N. Barriers to health care access among refugee asylum seekers. J Health Care Poor Underserved. 2011;22(2):506–22.PubMedCrossRefGoogle Scholar
  8. 8.
    UNHCR Statistical Yearbook 2010: Chapter 2. Population Levels and Trends. Accessed 11 Feb 2012.
  9. 9.
    Goldfeld AE, Mollica RF, Pesavento BH, Faraone SV. The physical and psychological sequelae of torture. Symptomatology and diagnosis. JAMA. 1988;259(18):27259.CrossRefGoogle Scholar
  10. 10.
    Crosby SS, Mohan S, Di Loreto C, Spiegel JH. Head and neck sequelae of torture. Laryngoscope. 2010;120(2):414–9.PubMedGoogle Scholar
  11. 11.
    Norredam M, Crosby S, Munarriz R, Piwowarczyk L, Grodin M. Urologic complications of sexual trauma among male survivors of torture. Urology. 2005;65(1):28–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Wenzel T, Griengl H, Stompe T, Mirzaei S, Kieffer W. Psychological disorders in survivors of torture: exhaustion, impairment and depression. Psychopathology. 2000; 33(6):292–6.Google Scholar
  13. 13.
    Wenzel T. Torture. Curr Opin Psychiatry. 2007;20(5):491–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Vorbrüggen M, Baer HU. Humiliation: the lasting effect of torture. Mil Med. 2007;172(12 Suppl):29–33.PubMedGoogle Scholar
  15. 15.
    Carinci AJ, Mehta P, Christo PJ. Chronic pain in torture victims. Curr Pain Headache Rep. 2010;14(2):73–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Crosby SS, Norredam M, Paasche-Orlow MK, Piwowarczyk L, Heeren T, Grodin MA. Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice. J Gen Intern Med. 2006;21(7):764–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Mollica RF, Caridad KR, Massagli MP. Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees. J Nerv Ment Dis. 2007;195(7):572–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K, Spring M, Westermeyer J. Somali and Oromo refugees: correlates of torture and trauma history. Am J Public Health. 2004;94(4):591–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Burnett A, Peel M. What brings asylum seekers to the United Kingdom? BMJ. 2001;322(7284):485–8.Google Scholar
  21. 21.
    Weine S, Kulauzovic Y, Klebic A, et al. Evaluating a multiple-family group access intervention for refugees with PTSD. J Marital Fam Ther. 2008;34(2):149–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Asgary RG, Metalios EE, Smith CL, Paccione GA. Evaluating asylum seekers/torture survivors in urban primary care: a collaborative approach at the Bronx human rights clinic. Health Hum Rights. 2006;9(2):164–79.PubMedCrossRefGoogle Scholar
  23. 23.
    Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008;10(1):7–15.PubMedCrossRefGoogle Scholar
  24. 24.
    Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? West J Med. 2000;172(5):301–4.Google Scholar
  25. 25.
    Keller AS, Saul JM, Eisenman DP. Caring for survivors of torture in an urban, municipal hospital. J Ambul Care Manag. 1998;21/2: 20–9.Google Scholar
  26. 26.
    The Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (the “Torture Convention”) UN General Assembly of 1984. Accessed 11 Feb 2012.
  27. 27.
    Heisler M, Moreno A, DeMonner S, Keller A, Iacopino V. Assessment of torture and ill treatment of detainees in Mexico: attitudes and experiences of forensic physicians. JAMA. 2003;289(16):2135–43.PubMedCrossRefGoogle Scholar
  28. 28.
    Padder FA. Human rights and the medical profession. Ann Intern Med. 1995;123(8):636.Google Scholar
  29. 29.
    UN Office of High Commissioner for Human Rights, Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, also known as the Istanbul Protocol (IP) (1999). Accessed 11 Feb 2012.
  30. 30.
    Asgary RG, Metalios EE, Smith CL, Paccione GA. Evaluating asylum seekers/torture survivors in urban primary care: a collaborative approach at the Bronx Human Rights Clinic. Health Hum Rights. 2006;9(2):164–79.PubMedCrossRefGoogle Scholar
  31. 31.
    Lavik NJ, Hauff E, Skrondal A, Solberg O. Mental disorder among refugees and the impact of persecution and exile: some findings from an outpatient population. Br J Psychiatry. 1996;169(6):726–32.PubMedCrossRefGoogle Scholar
  32. 32.
    Bodenmann P, Madrid C, Vannotti M, Rossi I, Ruiz J. Migration without borders, but … barriers of meaning]. Rev Med Suisse. 2007;3(135):2710–2, 2714–7.Google Scholar
  33. 33.
    Pitman A. Medicolegal reports in asylum applications: a framework for addressing the practical and ethical challenges. J R Soc Med. 2010;103(3):93–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Agger I, Ansari F, Suresh S, et al. Justice as a healing factor: psycho-legal counseling for torture survivors in an Indian context. Peace Confl J Peace Psychol. 2008;14:315–33.CrossRefGoogle Scholar
  35. 35.
    Germain R, Vélez LE. Legal services: best, promising, and emerging practices. Torture. 2011;21(1):56–60.PubMedGoogle Scholar
  36. 36.
    Gangsei D, Deutsch AC. Psychological evaluation of asylum seekers as a therapeutic process. Torture. 2007;17:79–87.PubMedGoogle Scholar
  37. 37.
    Tol WA, Komprow IH, Jordans MJD, et al. Brief multi-disciplinary treatment for torture survivors in Nepal: a naturalistic comparative study. Int J Soc Psychiatry. 2009;55(1):39–56.PubMedCrossRefGoogle Scholar
  38. 38.
    Menjívar C. Liminal legality: Salvadoran and Guatemalan immigrants’ lives in the United States. AJS. 2006;111:999–1037.Google Scholar
  39. 39.
    Ashcroft RE. Standing up for the medical rights of asylum seekers. J Med Ethics. 2005;31(3):125–6.PubMedCrossRefGoogle Scholar
  40. 40.
    François G, Hambach R, van Sprundel M, Devillé W, Van Hal G. Inspecting asylum seekers upon entry—a medico-ethical complex. Eur J Public Health. 2008;18(6):552–3.PubMedCrossRefGoogle Scholar
  41. 41.
    McNeill PM. Public health ethics: asylum seekers and the case for political action. Bioethics. 2003;17:487–502.PubMedCrossRefGoogle Scholar
  42. 42.
    Physicians for Human Rights and the School of Public Health and Primary Health Care of the University of Cape Town. Dual loyalty and human rights in health professional practice: proposed guidelines and institutional mechanisms. Boston, MA: Physicians for Human Rights; 2002. ISBN 1-879707-39-X.Google Scholar
  43. 43.
    McNeill PM. Public health ethics: asylum seekers and the case for political action. Bioethics. 2003;17(5–6):487–502.PubMedCrossRefGoogle Scholar
  44. 44.
    Department of Health, Caring for dispersed asylum seekers: a resource pack. Available at Department of Health, London (2003). Accessed 12 Feb 2012.
  45. 45.
    Department of Health Introduction to the National Health Service. Accessed 12 Feb 2012.
  46. 46.
    Redman EA, Reay HJ, Jones L, Roberts RJ. Self-reported health problems of asylum seekers and their understanding of the national health service: a pilot study. Public Health. 2011;125(3):142–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Maier T, Schmidt M, Mueller J. Mental health and healthcare utilization in adult asylum seekers. Swiss Med Wkly. 2010;19(140):w13110. doi: 10.4414/smw.2010.13110.Google Scholar
  48. 48.
    Taylor K. Asylum seekers, refugees, and the politics of access to health care: a UK perspective. Br J Gen Pract. 2009;59(567):765–72.PubMedCrossRefGoogle Scholar
  49. 49.
    Sanders J, Schuman MW, Marbella AM. The epidemiology of torture: a case series of 58 survivors of torture. Forensic Sci Int. 2009;189(1–3):e1–7. Epub 2009 May 9.Google Scholar
  50. 50.
    Masmas TN, Møller E, Buhmannr C, Bunch V, Jensen JH, Hansen TN, Jørgensen LM, Kjaer C, Mannstaedt M, Oxholm A, Skau J, Theilade L, Worm L, Ekstrøm M. Asylum seekers in Denmark—a study of health status and grade of traumatization of newly arrived asylum seekers. Torture. 2008;18(2):77–86.PubMedGoogle Scholar
  51. 51.
    McColl H, Higson-Smith C, Gjerding S, Omar MH, Rahman BA, Hamed M, El Dawla AS, Fredericks M, Paulsen N, Shabalala G, Low-Shang C, Perez FV, Colin LS, Hernandez AD, Lavaire E, Zuñiga AP, Calidonio L, Martinez CL, Jamei YA, Awad Z. Rehabilitation of torture survivors in five countries: common themes and challenges. Int J Ment Health Syst. 2010;18(4):16.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ramin Asgary
    • 1
  • Beth Charpentier
    • 2
  • Delia C. Burnett
    • 3
  1. 1.Program in Health and Human RightsMount Sinai School of MedicineNew YorkUSA
  2. 2.Program on Forced Migration and Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Department of Medical EducationMount Sinai School of MedicineNew YorkUSA

Personalised recommendations