- •Forensic medical and psychological evaluations aid the complex asylum process.
- •Torture occurs widely, and survivors are common among foreign-born US patients.
- •Both patient and physician factors hinder obtaining a history of torture.
- •Certain practices help healthcare professionals care for torture survivors.
- •Survivors’ long-term somatic and psychological disorders require coordinated care.
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United Nations. United Nations convention against torture and other cruel, inhuman or degrading treatment or punishment. Article 1. Available at: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-against-torture-and-other-cruel-inhuman-or-degrading. Accessed September 2, 2022.
Amnesty International. Torture. Available at: www.amnesty.org/en/what-we-do/torture/. Accessed September 2, 2022.
The Center for Victims of Torture. What is torture? Available at: https://www.cvt.org/who-we-are/frequently-asked-questions. Accessed September 2, 2022.
- Female genital mutilation/cutting in the United States: Updated estimates of women and girls at risk, 2012.Public Health Rep. 2016; 131: 340-347
American Immigration Council. Asylum in the United States. Available at: https://www.americanimmigrationcouncil.org/research/asylum-united-states. Accessed September 2, 2022.
8 U.S.C. § 1101(a)(42)(A).
8 U.S.C. § 1158, 8 CFR § 208.13.
8 CFR § 208.18(a)(1).
8 CFR § 208.17.
8 CFR § 208.16.
- Continued rise in asylum denial rates: Impact of representation and nationality.September 21, 2022 (Available at:)Accessed)
- Impact of forensic medical evaluations on immigration relief grant rates and correlates of outcomes in the United States.J Forensic Leg Med. 2021; 84 (Nov)102272https://doi.org/10.1016/j.jflm.2021.102272
- There stories have changed my life”: Clinicians reflections on their experience with and their motivation to conduct asylum evaluations.J Immigr Minor Health. 2016; 18: 210-218
- Istanbul protocol: Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment.Professional Training series No. 8/Rev. 2. 2022 (Available at)https://www.ohchr.org/en/publications/policy-and-methodological-publications/istanbul-protocol-manual-effective-0(Accessed September 2, 2022)
- Uncovering re-traumatization experiencing of torture survivors in somatic healthcare: A qualitative systematic review.PLoS One. 2021 Feb 4; 16e0246074https://doi.org/10.1371/journal.pone.0246074
- The role of doctors in investigation, prevention and treatment of torture.J R Soc Med. 2012; 105: 464-471
- Recognition and treatment of law enforcement violence against detainees and prisoners: A survey among Israeli physicians and medical students.Torture. 2017; 27: 42-50
- Appropriate use of medical interpreters.Am Fam Physician. 2014; 90: 476-480
- Defining and documenting threats in the context of ill-treatment and torture. Medical and psychological perspectives.Torture. 2021; 31: 3-18
- Asylum medicine: Standard and best practices.Health Hum Rights. 2019; 21: 215-225
- Clinical examination and reporting of a victim of torture.Acad Forensic Pathol. 2017; 7: 330-339
- The nature and significance of memory disturbance in posttraumatic stress disorder.Annu Rev Clin Psychol. 2011; 7: 203-227
- Associations between memory loss and trauma in US asylum seekers: A retrospective review of medical affidavits.PLoS One. 2021 Mar 23; 16e0247033https://doi.org/10.1371/journal.pone.0247033
- Psychological torture: Characteristics and impact on mental health.Int J Soc Psychiatry. 2021; 67: 500-506
- Twenty-seven years of treating survivors of torture and organized violence—associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD.Eur J Psychotramatol. 2021; 12 (Apr 19;12)1904712https://doi.org/10.1080/20008198.2021.1904712
- (edited by)Torture Methods and Their Health Impact.in: Evans MD Modvig J Research Handbook on Torture: Legal and Medical Perspectives on Prohibition and Prevention. Edward Elgar Publishing Limited, Cheltenham, UK2020: 395-416 (edited by)
- Foot torture (falanga): Ten victims with chronic plantar hyperpigmentation.Am J Med. 2021; 134 (-31): 278
- Asylum seekers in a time of record forced global displacement: the role of physicians.J Gen Intern Med. 2018; 34: 137-143
- Assessing signs of torture: A review of clinical forensic dermatology.J Am Acad Dermatol. 2020 Sep 16; (S0190-9622(20)32619-0)https://doi.org/10.1016/j.jaad.2020.09.031
- Postinflammatory hyperpigmentation following torture.J Clin Forensic Med. 2003; 10: 193-196
- Skin lesions, differential diagnosis and practical approach to potential survivors of torture.J Eur Acad Dermatol Venereol. 2019; 33: 1232-1240
- Cultural practices affecting the skin of children.Curr Opin Pediatr. 2010; 22: 423-431
- Clinical correlates of deliberate self-harm among migrant trauma-affected subgroups.Front Psychiatry. 2021; 12 (Sep 22)529361https://doi.org/10.3389/fpsyt.2021.529361
- Intentional burn injury: Assessment of allegation of self-infliction.J Forensic Leg Med. 2017; 51: 9-21
- Skin lesions and traditional folk practices: a medico-legal perspective.Forensic Sci Med Pathol. 2019; 15: 580-590
- Recognizing culturally related findings on refugee physical examinations.J Am Board Fam Med. 2018; 31: 653-657
- Invisible and involuntary: Female genital mutilation as a basis for asylum.Cornell Law Rev. 2010; 95: 599-626
- Histories of pervasive gender-based violence in asylum-seeking women who have undergone female genital mutilation or cutting.J Trauma Stress. 2022; 35: 839-851
- Female genital mutilation/cutting as grounds for asylum requests in the US: An analysis of more than 100 cases.J Immigr Minor Health. 2020; 22: 675-681
- Female genital cutting: an evidence-based approach to clinical management for the primary care physician.Mayo Clin Proc. 2013; 88: 618-629
- Female genital mutilation: Fact sheet No 241.2013 (Available at:)Accessed September 232022)
- Somali and Oromo refugees: correlates of torture and trauma history.Am J Public Health. 2004; 94: 591-598
- The prevalence of torture and associated symptoms in United States Iraqi refugees.J Immigr Minor Health. 2014; 16: 1069-1076
- War trauma and torture experiences reported during public health screening of newly resettled Karen refugees: a qualitative study.BMC Int Health Hum Rights. 2015; 15: 8https://doi.org/10.1186/s12914-015-0046-y
- Mental health of Cambodian refugees 2 decades after resettlement in the United States.JAMA. 2005; : 571-579
- Mental health of refugees and torture survivors: A critical review of prevalence, predictors, and integrated care.Int J Environ Res Public Health. 2019 Jun 28; 16: 2309https://doi.org/10.3390/ijerph16132309
- Asylum seekers and refugees in Britain. The health of survivors of torture and organized violence.BMJ. 2001; 322: 606-609
- Demographic characteristics, torture experiences, and posttraumatic stress disorder symptoms among asylum seekers and refugees persecuted for same-sex behaviors.J Trauma Stress. 2022; 35: 1167-1176
- Transgender women's experiences with stigma, trauma, and attempted suicide in the Dominican Republic.Suicide Life Threat Behav. 2018 Dec; 48: 788-796
- 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: 301-304
- Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice.J Gen Intern Med. 2006; 21: 764-768
- Survivors of torture: prevalence in an urban emergency department.Acad Emerg Med. 2012; 19: 1158-1165
- Refugees’ perspectives on barriers to communication about trauma histories in primary care.Ment Health Fam Med. 2012; 9: 47-55
- Special considerations for the treatment of pain from torture and war.Curr Anesthesiol Rep. 2016; 6: 319-326
- Implicit bias in healthcare professionals: a systematic review.BMC Med Ethics. 2017; 18 (Mar 1): 19https://doi.org/10.1186/s12910-017-0179-8
- Tackling implicit bias in health care.New Eng J Med. 2022; 387: 105-107
- Medical approach to refugees: Importance of the caring physician.Ann Glob Health. 2020 Apr 16; 86: 41https://doi.org/10.5334/aogh.2779
- Supporting asylum seekers: Clinician experiences of documenting human rights violations through forensic psychological evaluation.J Trauma Stress. 2018; 31: 391-400
- Cultural considerations in the assessment of survivors of torture.J Immigr Minor Health. 2019; 21: 586-595
- Assessing trauma in a transcultural context: challenges in mental health care with immigrants and refugees.Public Health Rev. 2018 Aug 22; 39: 22https://doi.org/10.1186/s40985-018-0102-y
- Female genital mutilation/cutting and birthing: Enhanced education and training is critical for health care providers.J Glob Health. 2022; 12 (Sep 3): 03059https://doi.org/10.7189/jogh.12.03059
- Refugees’ advice to physicians: how to ask about mental health.Fam Pract. 2014; 31: 462-466
- Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum-seekers in high-income countries: a systematic review and thematic synthesis of qualitative research.BMJ Open. 2017; 7e015981https://doi.org/10.1136/bmjopen-2017-015981
- Perspectives of Somali Bantu refugee women living with circumcision in the United States. A focus group approach.Int J Nurs Stud. 2009; 46: 360-368
- Conversations about FGM in primary care: a realist view on how, why and under what circumstances FGM is discussed in general practice consultations.BMJ Open. 2021; 11e039809https://doi.org/10.1136/bmjopen-2020-039809
- Female genital mutilation/cutting among Somali women in the U.S. state of Arizona: Evidence of treatment access, health service use and care experiences.Int J Environ Res Public Health. 2021; 18: 3733https://doi.org/10.3390/ijerph18073733
- Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol.Int J Legal Med. 2021; 135: 583-590
- Head and neck sequelae of torture.Laryngoscope. 2010; 120: 414-419
- Torture and its neurological sequelae.Spinal Cord. 2002; 40: 213-223
- Urologic complications of sexual trauma among male survivors of torture.Urology. 2005; 65: 28-32
- Review of infectious diseases in refugees and asylum seekers—current status and going forward.Pub Health Rev. 2017; 38 (Sep 8): 22https://doi.org/10.1186/s40985-017-0065-4
- Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need.Global Health. 2014 Apr 3; 10: 24https://doi.org/10.1186/1744-8603-10-24
- From survival to survivorship—framing traumatic injury as a chronic condition.N Eng J Med. 2022; 387: 581-583
- Pain from torture: assessment and management.Pain Rep. 2018 Oct 28; 4: e794https://doi.org/10.1097/PR9.0000000000000794
- Chronic pain in refugees with posttraumatic stress disorder (PTSD): A systematic review on patients’ characteristics and specific interventions.J Psychosom Res. 2019 Mar; 118: 83-97
- Chronic pain in torture victims.Curr Pain Headache. 2010; 14: 73-79
- Psychosocial factors and central sensitivity syndromes.Curr Rheumatol Rev. 2015; 11: 96-108
- Torture-survivors’ experiences of healthcare services for pain: a qualitative study.Brit J Pain. 2021; 15: 291-301
- How hospital stays resemble enhanced interrogation.Ann Int Med. 2020; 173: 572-573
- Central sensitization and symptom severity and patient-provider relationships in a community setting.J Prim Care Community Health. 2021; 12 (Jan-Dec)21501327211031767https://doi.org/10.1177/21501327211031767
- IASP terminology.September 2, 2022 (Available at)Accessed)
- Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs.Eur J Pain. 2019; 23: 1497-1506
- Chronic pain diagnosis in refugee torture survivors: A prospective, blinded diagnostic accuracy study.PLoS Med. 2020 Jun 5; 17e1003108https://doi.org/10.1371/journal.pmed.1003108
- Validation of the Brief Pain Inventory for chronic nonmalignant pain.J Pain. 2004; 5: 133-137
- How is depression experienced around the world? A systematic review of qualitative literature.Soc Sci Med. 2017; 183: 151-162
- Socio-medical challenges of asylum seekers prior and after coming to the US.J Immigr Minor Health. 2013; 15: 961-968
- Settling Ulysses: An adapted research agenda for refugee mental health.Int J Health Policy Manag. 2018; 7: 294-296
- I just need to be with my family”: resettlement experiences of asylum seeker and refugee survivors of torture.Global Health. 2021 Mar 9; 17: 27https://doi.org/10.1186/s12992-021-00681-9
- Latinx trans immigrants’ survival of torture in U.S. detention: A qualitative investigation of the psychological impact of abuse and mistreatment.Int J Transgend Health. 2022; 23: 36-59
- Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. A systematic review and meta-analysis.JAMA. 2009; 302: 537-549
- Predicting the mental health and functioning of torture survivors.J Nerv Ment Dis. 2018; 206: 33-39
- Psychological, social, and welfare interventions for torture survivors: A systematic review and meta-analysis of randomized controlled trials.PLoS Med. 2019; 16 (doi.org/)e1002919https://doi.org/10.1371/journal.pmed.1002919
- The 10-year course of mental health, quality of life, and exile life functioning in traumatized refugees from treatment start.PLoS ONE. 2020 Dec 31; 15e0244730https://doi.org/10.1371/journal.pone.0244730
- Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: a pilot investigation.Eur J Psychotraumatol. 2019 Nov 11; 101686807https://doi.org/10.1080/20008198.2019.1686807
- Group treatment for survivors of torture and severe violence: A literature review.Torture. 2016; 26: 45-67
- Complementary and alternative medicine in the treatment of refugees and survivors of torture: a review and proposal for action.Torture. 2012; 22: 38-57
- National Consortium of Torture Treatment Programs.September 22, 2022 (Available at:)Accessed)