Access to care

Asylum seekers in many states are not eligible for public insurance, thus making it difficult or impossible to access the medical care that they need.  As the regulations under the Affordable Care Act go into effect, it is possible that immigrants’ access to care may become even more difficult.


Full Disclosure: Out of pocket costs as side effects

This article, in the New England Journal of Medicine, offers a useful perspective related to the costs of medical treatments, especially for patients that have limited income, as many torture survivors do after arriving in the U.S.  Many torture survivors arrive in the U.S. with injuries they incurred during torture and were unable to obtain medical care for in their home countries.  Most torture survivors who are seeking asylum in the U.S. are not eligible for health insurance as they go through the asylum process in an attempt to obtain legal immigration status and safety.

Holes in the Safety Net - Legal Immigrants' Access to Health Insurance

Wendy E. Parmet, J.D. Published in the New England Journal of Medicine 2013; 369:596-598August 15, 2013DOI: 10.1056/NEJMp1306637

Over 12 million immigrants are lawfully present in the United States, yet face similar barriers as undocumented immigrants face. Legal immigrants can be legal permanent residents (green card holders), refugees, asylum seekers, and others. This article examines the reasons why legal immigrants have such low rates of health insurance, including the sectors they work in as well as linguistic and cultural barriers.

In the Shadows

Hugo Scornik, M.D. Published in the New England Journal of Medicine 2013; 369:598August 15, 2013DOI: 10.1056/NEJMp1305614

This article show the struggles that undocumented immigrants face while living without insurance. Because their children born in the United States are eligible for Medicaid, adults often seek medical advice from their children’s physician.  This article is available for free from the link below.

Stuck between Health and Immigration Reform - Care for Undocumented Immigrants

Benjamin D. Sommers, M.D., Ph.D. Published in the New England Journal of Medicine 2013; 369:593-595August 15, 2013DOI: 10.1056/NEJMp1306636

Approximately 25 million noncitizens live in the United States, 11 million to 12 million of them undocumented. Though more than 75% of undocumented residents are Latin American, U.S. immigrants are more diverse than generally recognized, with substantial numbers from South and East Asia, Europe, Canada, and Africa. Regardless of its origins, this population's health care options remain limited.

Link is to full text of article.

Survivors of Torture: Prevalence in an Urban Emergency Department

Academic Emergency Medicine
Volume 19, Issue 10, Article first published online: 25 SEP 2012
Survivors of Torture: Prevalence in an Urban Emergency Department
Braden Hexom, MD, Dinali Fernando, MD, MPH, Alex F. Manini, MD, MS, and Lars K. Beattie, MD, MS
This article examines attempts to estimate the prevalence of survivors of torture presenting to an urban ED. Through data collected at Elmhurst Hospital (home of Libertas Center) in New York, the authors concluded that self-reported survivors of torture did present to that urban ED.


Effective Strategies for Recruiting and Retaining Pro Bono Providers

This webinar, from September 23, 2015, features a panel of Marianne Joyce from the Marjorie Kovler Center, Lauren Pesso from HealthRight International, and Liz Sweet from Lutheran Immigration & Refugee Service. This webinar is part of the National Capacity Building (NCB) webinar series. NCB is a project of the Center for Victims of Torture.


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Tuesday, 29 September 2015


In a recent survey conducted by CVT’s National Capacity Building Project to Survivors of Torture programs, many of you responded that when working with community providers, you experience significant challenges in developing effective, ongoing services for survivors.  In this webinar three torture treatment programs that have developed a network of successful pro bono relationships will discuss their strategies for recruiting and retaining this valuable resource and share special considerations to make when working with these providers.


After attending this webinar participants will be able to:

  1. Describe 3 successful recruitment strategies
  2. Put into effect strategies to identify appropriate community pro bono providers
  3. Recognize what special considerations should be taken into account when recruiting pro bono providers


Liz Sweet, Director for Access to Justice, Lutheran Immigration and Refugee Service

Liz Sweet is the Director for Access to Justice at Lutheran Immigration and Refugee Service (LIRS).   LIRS’ Access to Justice program supports a network of partners across the United States to respond to migrants impacted by detention by offering legal services, visitation and community based services for individuals released from detention.  Prior to her work with LIRS, Liz was the Associate Director for the ABA Commission on Immigration and directed a pro bono legal services project in San Diego to recruit and train pro bono attorneys to represent individuals at all levels of the immigration court system.  Following law school at Northeastern University School of Law, Liz represented detained children in Arizona as a Staff Attorney for the Florence Immigrant and Refugees Rights Project.

Marianne Joyce, LCSW, Heartland Alliance Marjorie Kovler Center

Marianne is a licensed clinical social worker and serves as the social services manager, primarily responsible for conducting clinical evaluations, supervising and training graduate student interns, providing psychotherapy for clients, providing consultation for volunteer therapists, writing psychological affidavits and testifying in court to support asylum claims of survivors. Additionally, she provides education about torture treatment in various university and community settings in Chicago. She has been closely involved with survivors bringing lawsuits against perpetrators residing in the U.S. International experience includes Peace Corps/Guatemala as a volunteer and trainer, providing consultation and training in Haiti, Guatemala, Turkey, and Sri Lanka for physicians and psychologists working with war trauma, and extensive travel in South and Southeast Asia. She taught a course on social work and human rights at the University of Chicago for three years. She holds an M.A. from the School of Social Services Administration at the University of Chicago. Ms. Joyce is fluent in Spanish and licensed to provide mental health services in the state of Illinois.

Lauren Pesso, LMSW, MPA, Program Director, Human Rights Clinic, HealthRight International

Lauren Pesso is the Program Director of the Human Rights Clinic (HRC) at HealthRight International, where she is responsible for overseeing the HRC’s work providing forensic and case management services to immigrants fleeing torture and other severe human rights abuses. Lauren has worked for over a decade to address the health and wellbeing of vulnerable populations in the United States and abroad. Directly prior to this post, she developed and oversaw the expansion of an anti-human trafficking program in New York, and has coordinated gender-based violence research studies and a variety of maternal and reproductive healthcare programs. She holds a Masters of Social Work (MSW) and a Masters of Public Administration (MPA) from Columbia University, and a Bachelor's Degree in Sociology and Religion from Wesleyan University.


Volunteer Manager's Toolkit from CLINIC

Access to Justice information sheet from LIRS

Services for Survivors of Torture from HealthRight