The migrants in the caravan are not coming to invade, they are seeking relief of their suffering

by Craig Blinderman

On a recent windy morning, walking past the Soldiers’ and Sailors’ Monument on West 89th Street in New York City, seeing the flag at half mast, just days before the midterm elections, and a week after the deadly shootings at the Tree of Life Synagogue in Pittsburgh, on my way to take my daughter to her dance class at Ballet Hispánico, I couldn’t help but reflect on the offensive and false rhetoric about the caravan of men, women, and children fleeing Honduras and other Central American countries, and the horrific outcomes when one takes such ideas seriously.

As a palliative care physician who also teaches in medicine, I have been trained—and train others—to understand pain and suffering, to understand its taxonomy, its causes, and how to reduce it when it occurs in individuals with chronic pain, a serious illness, or at the end of life.

I have also spent the past five years volunteering with Columbia Physicians and Surgeons’ Asylum Clinic, a student-run human rights initiative, working with Columbia medical faculty, to offer free medical and psychiatric evaluations to individuals seeking asylum in the United States.

My palliative care skills of listening to and understanding how individuals suffer with a serious or life-threatening illness has helped me to identify and document the ways in which individuals seeking asylum have suffered in their home countries; the impact their physical, emotional, psychological, and sexual traumas continue to have on their lives; and the risk to their physical and mental well-being should they be forced to return.

Aside from the physical and emotional pain, the suffering that asylum seekers, as well as seriously ill patients, are most tormented by is existential in nature. It is the fear of their own deaths. As Søren Kierkegaard famously wrote, “The most painful state of being is remembering the future, particularly the one you’ll never have.” Unlike the patient with a terminal illness, the existential threat can be attenuated (at least temporarily) for the individual seeking asylum by simply not being sent back to their home country.

While immigration law is complicated and continues to change, the underlying legal standard for seeking asylum is well defined: the applicant must demonstrate that he or she is unwilling or unable to return to his or her home country because of past persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular group, or political opinion.

Until recently, victims of domestic and gang-related violence were allowed to seek asylum under U.S. law. This change followed Attorney General Jeff Sessions’ reversal of an immigration appeals court ruling that granted asylum to a Salvadoran woman who said she had been sexually, emotionally and physically abused by her husband.

Her story sounded like my client, “Alejandra,” also from El Salvador, whom I evaluated through the Columbia Asylum Clinic. Alejandra was hospitalized multiple times after being beaten and raped by the father of her eldest daughter. The local government did nothing to ensure her safety. Alejandra’s only crime was being a pregnant woman, who are at increased risk for domestic violence. And so it was with Alejandra—the violent and near life-threatening attacks escalated when she was pregnant. She suffered from chronic pain, post-traumatic stress disorder, and depression. Her only hope was a modest one—to not have to return to her country, where she would face unthinkable harm and possible death.

I also remember “Jorge,” whose only “crime” for persecution in his native El Salvador was being gay. Jorge suffered psychological, emotional, physical, and sexual abuse by gang members. He was stabbed, beaten, gang raped, and repeatedly threatened. His hopelessness stemmed from his fear that if he were to be forced to return to El Salvador he expected to be killed by members of this gang. Jorge suffered from chronic neuropathic pain, depression, anxiety, and post-traumatic stress disorder.

I have yet to meet an individual seeking asylum whose stories of abuse I did not determine to be accurate based on my medical assessment.

No one that I have interviewed posed a threat to the United States or its citizens.

Given my experience evaluating asylum seekers, I am deeply troubled to hear the false claims about the intentions of the migrants in the caravan whom Trump and Fox News commentators don’t know (nor seem to care to know). In fact, the migrants are fleeing poverty, gang-violence, and political instability. I imagine that many of their stories are similar to Alejandra’s and Jorge’s, or similar to the stories of other asylum seekers I have interviewed over the years, and that they have suffered greatly, and hope to find some relief for themselves and their loved ones.

With the current rhetoricactions, and policy changes that have occurred under this administration, I fear that the stories of the most vulnerable seeking refuge and asylum will not be heard, that cases like Alejandra and Jorge will never make it to immigration court, and that in the end we will be morally culpable for the unnecessary suffering and potential deaths that will occur as a result.

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Craig D. Blinderman, MD, MA, FAAHPM is an Associate Professor of Medicine and the Director of the Adult Palliative Care Service at Columbia University Medical Center.

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