Short Abstract:

For asylum seekers, the prevalence of trauma is pervasive and distinct from the experiences of other traumatised populations due to not only experiencing war, torture and persecution prior to migrating but also due to the myriad of harsh conditions faced post-migration including separation from family, immigration detention, financial hardship and the challenge of adapting to a new environment.

Long Abstract:

Context:

Since its introduction into the public sphere in 1980 various descriptions have been ascribed to the term PTSD. Over time, these descriptions have ranged from an ‘anxiety disorder’ to a ‘mental and behavioural disorder’, a ‘psychiatric disorder’ and a ‘mental health condition’.

This paper defines PTSD according to its diagnostic definitions, its symptoms, and effects on those who are seeking asylum, and how this translates to refugee status determination. This paper highlights the importance of the Istanbul Protocol for the effective identification, documentation, and assessment of medical evidence within the asylum decision-making process. Given the high prevalence rates of PTSD amongst those seeking asylum, this article advocates for medical examinations and evidence documenting the physical and psychological symptoms of acts of torture and ill-treatment, as per the standards set out by the Istanbul Protocol, to be considered as an integral part of refugee status determination.

Methodology:

This paper uses an interdisciplinary mixed methods approach including secondary data analysis, qualitative fieldwork and doctrinal research methods to determine the impact of PTSD on asylum seekers and the way in which medical evidence is assessed in refugee status determination. The paper involves interviews with asylum decision-makers employed by the UK's Home Office to determine the qualifications, training and experience of asylum authorities and better understand how medical evidence is assessed by the Home Office. Analysis of caselaw from the UK's appeal courts is undertaken to consider the permissible scope of the evidence put forward by a medical expert and the role of international guidelines such as the Istanbul Protocol for the medical documentation of torture and its consequences.

Analysis:

The physical and psychological effects of PTSD are wide-ranging and include difficulties sleeping, headaches, fatigue, worsening of existing medical problems, feelings of shame, anxiety, depression, self-harm, suicidal thoughts, difficulties in maintaining a job, and feelings of helplessness and distrust. PTSD is often described as a “disorder of memory” but is best summarised as a complex syndrome of somatic, cognitive, affective and behavioural symptoms caused by the psychological trauma of direct or indirect violence or threats to life.

PTSD’s debilitating nature and its main symptom of avoidance manifestation results in intrinsically reduced help-seeking behaviour which is observed in low rates of referral for treatment, with minority groups less likely to seek treatment, delayed referral as many people seek treatment only after experiencing symptoms for extended periods of time, and high rates of early drop out from treatment. PTSD is described as a “life sentence” not only due to its serious interpersonal and occupational challenges, estimated to result in 3.6 days of lost productivity per month on average for each person suffering from this illness, but also due to its high comorbidity and long term effects on health given that it is associated with an increased risk of chronic disease, and premature mortality.

For asylum applicants, PTSD can have debilitating consequences impacting their day-to-day life, and long-term health, as well as hindering their ability to fully participate in the asylum determination process due to the lack of access to treatment and support. Although the 1951 Refugee Convention does not require asylum applicants to be ‘credible’ in order to avail protection, the assessment of refugee status requires an evaluation of the applicant’s statements concerning personal facts and circumstances including past experiences of ill-treatment coupled with general objective information surrounding the applicant’s country of origin. When determining refugee status, State authorities therefore place emphasis on whether an asylum applicant is able to narrate a “consistent, credible and plausible account” of their past experiences.

Despite scientific research demonstrating that the degree of consistency has a limited value in determining the accuracy of past events, where asylum applicants fail to provide consistent details, State authorities often consider this a sign of incoherence, labelling such applicants as “not credible”, accusing them of fabricating their traumatic experiences and thereby denying them refugee status. The very basis of a successful asylum claim is therefore dependent on the asylum applicant’s ability to consistently and accurately recall autobiographical memories despite scientific research establishing that these memories are a reconstruction of events based on several elements and subject to distortion.

Individuals who suffer from PTSD recall their memories of traumatic experiences in the form of images and sensations rather than voluntary verbal accounts. Repeat questioning regarding traumatic events can trigger a vivid re-experiencing of the event which prevents the ability to describe experiences in a coherent manner. Moreover, due to the strong stigmatisation attached to mental health and its treatment in various cultures, feelings of fear and shame may lead to a failure to disclose mental health illnesses resulting in the hidden comorbidity of PTSD.

PTSD can therefore impact an applicant’s claim for refugee status as it may hinder the ability to recount a coherent account of past experiences to validate traumatic experiences and demonstrate previous acts of torture or ill-treatment. This is further exacerbated by the asylum procedure itself as long delays between interviews, the interview technique and format utilised, repeat questioning regarding peripheral details of events, the attitude of the interviewing officer, difficulties arising from intercultural and non-verbal communication along with compassion fatigue, social stereotyping and time constraints can all play a part in the assessment of an asylum applicant’s credibility.

Conclusion:

It is well-established that asylum seekers are at a higher risk of developing PTSD and comorbid mental health issues with torture and cumulative traumatic events known to be the main predictors for development of PTSD. Inconsistent statements involving peripheral details of past events must not be regarded as decisive factors for determining refugee status. Medical examinations and evidence documenting the physical and psychological symptoms of acts of torture and ill-treatment, as per the standards set out by the Istanbul Protocol must therefore be considered as an integral part of the refugee status determination procedure.