Beyond borders

Introduction: Forensic Medical Evaluations (FMEs), which provide objective documentation of physical and psychological consequences of past abuse, can be pivotal in immigration proceedings, offering critical evidence of persecution endured by asylum seekers, which may corroborate their claims. Yet their applicability in humanitarian parole and Title 42 exemption cases remains underexplored. Aim: To characterise the role of Istanbul Protocol–informed FMEs in support of humanitarian parole and Title 42 exemption requests in the United States, and to describe associated clinical, psychosocial, and procedural features. Methods: This qualitative study examined 21 cross-border FMEs and medical vulnerability letters submitted from 2021 to 2024 by an academic medical centre-based asylum clinic in Baltimore, Maryland, in support of applications for humanitarian parole or Title 42 exemption. Results: Remote evaluations were utilised in 85.7% of cases. The largest demographic seeking protection (42.9%) was women from Honduras, Mexico, and Guatemala residing in Ciudad Juárez, Mexico, at the U.S.-Mexico border. Our analysis revealed a significant prevalence of a history of physical or sexual assault spanning from the country of origin to transit. Threats of death or harm, robbery, and racial discrimination were also noted across various stages of the migration journey. Post-traumatic stress disorder (PTSD) was the most common psychiatric diagnosis at 88.9%, followed by major depressive disorder (MDD) and generalised anxiety disorder (GAD) at 66.7% and 22.2%, respectively. Many cases (63.6%) cited inadequate mental health services in their country of origin or transit, with 57.1% of these also highlighting the unavailability of necessary medical treatment. A diverse array of medical reasons for humanitarian protection was identified, including developmental, cardiovascular, pulmonary, renal, infectious, and psychiatric diseases. All cases with known outcomes received humanitarian protection. Conclusion: Our findings demonstrate proof of concept for the utility of remote medico-legal evaluations for cases seeking humanitarian parole into the U.S. in addition to providing a window into the diversity of such claims.

Anxiety · Deportation · Humanitarian aid · Immigration · Mental health · Persecution · Qualitative research · Refugee · Migration, Health and Trauma · Posttraumatic Stress Disorder Research · Torture, Ethics, and Law