Context, evidence and attitude: the case for photography in medical examinations of asylum seekers in the Netherlands

By Park R, Oomen J. Published in Social Science & Medicine, 2010 Jul;71(2):228-35. Link below is to abstract; full article is available for purchase.

Summary written for www.HealTorture.org by CVT Intern Joseph Walker:

Asylum policy in Western Europe primarily aims to restrict entry to refugees, despite the fact that all European Union members are signatories to international asylum conventions. Though refugees are perceived to be a burden on developed states from violent and unstable countries, they are better described as the individual victims of global pressures and relationships in which these same host countries figure as part of the interconnected global community. Finding refuge in the Netherlands, for example, has become increasingly difficult for asylum seekers as policymakers respond to anti-immigrant sentiment. In response to this xenophobic fervor, the physicians of Amnesty International’s Medical Examination Group in the Netherlands (AI-MEG) have developed a highly effective method of intervention for responding to the denial of refugee status to asylum seekers. The Dutch Immigration and Naturalization Department (IND) bases its decisions primarily on asylum seekers’ verbal testimony because it is often difficult to substantiate their claims with documents; AI-MEG intervenes by producing medical evidence that will be legally admissible. In the case of obvious physical torture, AI-MEG’s medical photographs serve to illustrate and explain torture scars to clients and to the IND, with the long-term goal of creating a larger inventory of torture scars to enable other physicians to compare and recognize common scar patterns. AI-MEG has had a high rate of success in getting decisions reversed, prolonging procedures, or at the very least procuring a general pardon and thereby obtaining for an asylum seeker a residence permit. In the Netherlands, since 1990, 70 percent of the clients examined by AI-MEG have had their negative decisions on asylum requests overturned.

AI-MEG begins by taking an inventory of events told by the victims and translating these into medically defined injuries. Clients describe how they suffered during torture and name all of the consequences they have experienced since then, discuss the effects of any treatments received, and explain how their injuries have healed. Second, physicians carefully inspect the entire body systematically and measure affected areas to record their positions. Third, physicians solicit written informed consent from patients before recruiting professional photographers to take a series of color photos. Since Amnesty International doctors are helping people who have been denied asylum, the photographs are primarily intended to support the narratives contained in their initial application for asylum. Fourth, physicians show the photos to their clients—this is especially important when scarring is out of the client’s own sight, such as on the back. The client again speaks about his or her experience and the physician listens and probes for information. Finally, physicians draft a report in plain language that will be easily comprehensible to the victims, the solicitors, and the appeal judges.

The benefits of medical examinations for asylum-seekers with torture-related physical scarring are numerous. First, medical examinations can enable victims to feel that their experiences and claims are recognized. Second, taking photographs relieves the burden on victims who must testify repeatedly and recount painful traumatic experiences. Third, the medical examinations could reduce the number of appeals through medical-legal reports that can help persuade IND to grant refuge. Finally, having visual evidence may standardize testimonies of torture that appeal to IND. However, using medical photography does little for torture survivors without visible scars. For example, rape victims are physically tortured but do not necessarily present scars. Thus, because photography does not document psychological or invisible scars of torture, physicians and advocates for asylum seekers must be careful to maintain the value of verbal testimonies and to include the reporting of PTSD symptoms that can bolster claims. Nonetheless, photographs of scars are persuasive sources of visual evidence, and their addition to the narratives of asylum seekers counteracts IND’s frequent dismissals of claims of torture. In the legal sphere, one piece of admissible evidence can mean the difference between being admitted to a country of refuge and being sent back to an uncertain fate. As demonstrated by AI-MEG, photographs of torture scars are a powerful marker of truth, and can tip the scales in favor of the asylum seeker. 

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