Several years ago a young man came to see me in my clinic. He told me he was running for his life. He said that he fled his home, because there, homosexuality wasn't just illegal, in some cases it was punishable by death. So when his sexual orientation was exposed, his family rejected him, his boss fired him and angry mobs repeatedly attacked him in the streets. And each time the police arrived only to arrest him, detain and torture him further. And he knew that if he couldn't escape the cycle of violence, he would surely be killed.
几年前,一个年轻人 来到了我的诊所。 他告诉我说他正在逃亡。 他逃离了自己的家乡。 因为在那里,同性恋是非法的, 某些情况下甚至会被判处死刑。 所以当他的性取向暴露之后, 他的家人把他赶出了家门, 老板炒了他鱿鱼, 愤怒的暴徒不断在街上袭击他。 然而警察的到来 却并非为了保护,而是逮捕他, 好将他拘留,进一步折磨他。 他知道如果他不能 逃脱这个暴力的循环, 那么死亡将是他唯一的结局。
So he had to do what he needed to do to survive. He left everything behind. All of his friends, his family, his career. He fled his home, he escaped to the United States and here he applied for asylum.
为了生存,他只能丢下所有, 孑然一身的离开。 他将朋友、家人 和事业全都抛之脑后。 他逃离了自己的家乡, 逃到了美国, 在这里他申请了庇护。
But like many people fleeing this kind of persecution, he couldn't carry much. He had some basic ID, barely any money and a few other belongings. He certainly didn't bring official documents from the police who tortured him. No videos from the mob that tried to kill him. He didn't have this kind of evidence to help support his claims, yet here he was, sitting in my clinic, showing me some of the most powerful evidence of his persecution. That was the physical and psychological scars that he brought with him. You see, he suffered from chronic, debilitating pain. He had severe scars scattered over his body, poorly healing wounds that got infected over and over again. He suffered from severe depression and continued to have regular, paralyzing flashbacks and nightmares from PTSD.
但就像很多想逃离这些迫害的人一样, 他几乎带不走什么—— 只携带了基本的身份证明, 除了一点随身物品之外, 他身无分文。 有关他身份的官方证件, 当然都留在了那些 折磨他的警察那里。 因为记录暴徒恶行的影像资料的缺失, 他没有办法提出有效的指控。 但现在,他坐在我的诊所里, 给我展示了一些能证明 他所受到的折磨的最有力的证据—— 他生理和心理上厚厚的疮疤。 很明显,他正在遭受着长期的折磨, 使他身心俱疲。 他身上到处都是严重的伤疤, 反复感染且久不愈合的伤口。 他患有严重的抑郁症, 并继续定期出现创伤后应激障碍 带来的惊愕回忆与噩梦。
So we continued our work. We met regularly for months, documenting each of these pieces of medical evidence. We went over the details of every attack, photographed his scars, documented his injuries and wounds, and we were even able to start chronicling his slow but steady recovery while under our care. Working closely with his lawyers, I submitted a detailed affidavit, including the findings of this forensic medical evaluation, and we included it as part of his asylum application. And then we waited for several long years while he navigated the courts.
我们继续着他的治疗。 几个月来,我们经常见面, 详细记录每一项医学证据。 我们仔细回忆了每次袭击的细节, 对他的伤疤进行拍摄, 记录了他的伤口, 在这样的照顾下, 我们甚至可以开始记录 他缓慢但稳定的康复过程。 通过与他的律师密切合作, 我提交了详细的证明书, 包括法医鉴定的结果, 我们把它作为 他庇护申请的一部分证明材料。 然后我们开始等待, 他在法庭上挣扎了好几年。
And then one day I got an email from him. It said that he was granted asylum. And everyone in the clinic was overjoyed. He said in his email that this was the first time in years that he didn't fear deportation and death. It was the first time in years that he truly felt safe, that he had the security to rebuild his life all over again. And it was only through this medical and legal advocacy that we were able to help restore his legal status and his rights, that he could do that, all through asylum.
有一天我收到了他的邮件, 上面说他已经获得了庇护。 诊所里的每个人都欣喜若狂。 他在电子邮件中说, 这是多年来, 他头一次成功逃离了 被驱逐和死亡的阴影。 这是多年来, 他第一次真正感到安全, 并且重新有了安全生活的保障。 只有通过这种医疗手段和法律辩护, 我们才能够帮助恢复 他的合法地位和权利。 他能做到这些, 都要依赖庇护系统。
Now for many people fleeing persecution, they come to programs and clinics like this telling unimaginable tales of violence and different reasons they were persecuted. But one thing is always the same. The violence meted against them was done with complete impunity, sometimes by the hands of the state directly through police or military officials. In other cases, the state just turns a blind eye and condones the acts of paramilitary groups or even violent domestic partners. In other cases, state is completely powerless to protect the vulnerable from powerful gangs.
现在有许多人为了逃避迫害, 来到类似的项目和诊所, 讲述发生在他们身上的 令人难以想象的暴力故事。 他们被迫害的原因有很多。 但有一件事总是一样的。 他们被暴力袭击, 但施暴者却没有受到惩罚。 施暴者有时是 由国家直接指派的警察, 有时是军官。 在其他情况下, 政府只是睁一只眼闭一只眼, 纵容这些非法军事组织的行为, 或是有暴力倾向的家庭伴侣。 在其他情况下,国家在保护弱势群体 不受强大帮派的侵害时, 往往显得无计可施。
Now we know that social determinants of health play a huge role in determining the health and well-being of our patients: housing, income, education, race, social inclusion. But the same can be true for equal protection in the law -- due process. Especially in societies for the most vulnerable, the marginalized and even those who are actively targeted, their access to these human rights protections that can mean the difference between sickness and health, and often it's the difference between life and death. And for millions of people who endure persecution and torture, the only way to heal is to acknowledge the human rights abuses that have occurred and to help restore the rights and protections that were so violated.
现在我们知道,社会因素 在决定病人的健康 和福祉方面起着巨大的作用, 比如住房、收入、教育、种族, 还有社会包容程度。 同样重要的还有 法律中的同等保护权—— “正当法律程序”。 特别是对那些 被社会边缘化的人、 弱势群体, 和那些经常被针对的人来说, 他们获得这些人权保护的机会, 可能决定了他们是否能健康的生活, 通常这就是生与死的区别。 对于成千上万 遭受迫害和折磨的人来说, 治愈伤痛的唯一办法, 就是承认已经发生的 侵犯人权的行为。 然后帮助恢复他们 被严重侵犯的权利和庇护。
After the atrocities of World War II, the asylum system was set up as one pathway to that kind of relief. But these days it seems like that pathway has turned into an obstacle course, setting people up to fail. Asylum seekers oftentimes don't know how to start, let alone complete the process that can drag on for years. They're not entitled to lawyers, so they don't know their rights. Increasingly, they're even being barred from setting foot in places of potential refuge. They're arrested or prosecuted, even deported before they ever get to see an asylum officer. And even if they do make it through the process, asylum grant rates can be as low as 20 percent and far worse for some. It's almost like the system was designed to keep people from exercising their right.
在第二次世界大战的暴行之后 所设立的收容制度 就是实现这种援助的一个有效途径。 但如今,这条道路 似乎已经铺满了障碍, 让人难以获得帮助。 寻求庇护者往往不知道如何开始, 更不用说完成这个 可能要拖上好几年了。 他们没有权利请律师, 所以他们不知道自己的权利。 他们甚至被禁止 踏入可能的避难所。 他们被逮捕或起诉, 甚至在见到庇护官之前 就被驱逐出境。 即使他们真的 通过了这个过程, 成功获得庇护的概率 可能也只有区区 20%, 对一些人来说这个数字还要更低。 这个系统就像是设计好的一样, 故意阻止人们行使他们的权利。
But there is something that many of these people can do. Something that can potentially increase their chances of success to 90 percent or more. So what makes the difference? Getting a lawyer and having a medical evaluation. It's as simple as that. The man who came to my clinic and won his asylum case. Doctors and lawyers working together to present all of the evidence, including the medical evidence, to the courts allows judges to make informed and just decisions.
但有些事情是这些人可以做的。 可以潜在的将他们获得庇护的概率 提升至 90% 或以上。 那么是什么造成了这种差异呢? 正是请一个律师 和进行医疗评估。 就这么简单。 对于那个来我诊所, 并获得了庇护申请的人来说。 他的医生和律师合作, 一起拿出所有的证据, 包括医学上的证据 呈至法庭, 帮助法官了解情况, 以做出公正的裁决。
And it's this kind of medical-legal partnership that's now more important than ever, because we live in a time of epic, forced migration due to violence and conflict. In 2018 there were 70 million people worldwide forcibly displaced due to war, conflict and persecution. It includes 40 million internally displaced, 25 million refugees and three million asylum seekers. Here in the United States, we see the impact of escalating violence in places like El Salvador, Guatemala and Honduras, where murder rates can be as high as those in Syria and Afghanistan. Where police corruption and gang violence are on the rise, where poverty and child abuse are widespread and tolerated, where basic systems of governance -- public safety, child protection -- are ineffective.
正是这种医疗法律合作关系, 在现在比以往任何时候都重要。 由于暴力和冲突, 我们生活在一个 漫长艰难的, 被迫迁徙的时代。 2018 年,由于战争、冲突和迫害, 全球有 7000 万人 被迫流离失所。 其中包括 4000 万境内无家可归者, 2500 万难民和 300 万寻求庇护者。 在美国,我们可以看到 由于萨尔瓦多、危地马拉和洪都拉斯 不断恶化的暴力所带来的影响, 那里的谋杀率可能和 叙利亚、阿富汗一样高。 那里的警察腐败 和帮派暴力呈上升趋势, 贫困和虐待儿童现象 普遍存在,并被纵容, 而且那里的基本治理制度—— 公共安全、 儿童保护, 都是无效的。
It's no surprise then that many of the most vulnerable in some of these societies -- children, women and other targeted groups -- they're growing increasingly desperate and fleeing in unprecedented numbers. Like over the past 10 years, the numbers of unaccompanied children trying to seek safety at our southwest border has increased 18-fold, from 3,300 in 2009 to over 62,000 this past year. That's in addition to nearly half a million people traveling as families. Men, women and children trying to seek refuge at our borders, but who are stranded in a humanitarian crisis.
因此,在这些社会中, 许多最脆弱的群体—— 儿童、妇女, 和其他被针对的群体, 越来越绝望, 逃离人数越来越多, 也就不足为奇了。 在过去的 10 年里, 试图在我们的西南边境寻求庇护的, 与父母失散的儿童的数量 增加了 18 倍—— 从 2009 年的 3300 人 增加到去年的 62000 多人。 除此之外,还有近 50 万人 和家人一起逃离。 陷入了人道主义危机的男女老少, 试图在我们的边境寻求庇护。
And what makes matters worse is that they're caught in this fog of claims and counterclaims about who they are, what they've experienced, where the proof is and what they deserve. Do they deserve our help? Sometimes people make claims that they're not fleeing human rights abuses but are simply economic migrants. Others say these children are actually being exploited and trafficked by their parents. Others say they're not even children at all; they're hardened criminals, they're gang members trying to infiltrate our country.
更糟糕的是, 他们陷入了诉讼 和反诉讼的迷雾中, 被反复询问他们是谁, 他们经历了什么, 证据在哪里, 以及他们的诉求。 他们值得我们的帮助吗? 有时人们会说 他们不是在饱受 侵犯人权之苦的难民, 而只是经济移民。 其他人说,这些孩子 实际上是在被他们父母剥削, 以获取身份的工具。 其他人说他们根本就不是孩子; 而是心狠手辣的罪犯。 他们是企图渗透到 我们国家的黑帮成员。
To cut through some of this fog, my colleagues and I conducted a study. We looked at data from children seeking asylum who had medical evaluations. And this is what the evidence told us. 80 percent of these children had evidence of exposure to repeated physical violence: assault and torture. 60 percent of the girls and at least 10 percent of the boys had evidence of repeated exposure to sexual violence. One young girl, telling a story and having corroborating evidence of being detained, beaten and raped over the course of three years, trafficked to other men and even having the threats of the murder of her entire family if she should ever escape or try to seek help. 90 percent of these children had evidence of psychological harm from indirect violence, including such severe threats, but also witnessing untold atrocities with their very eyes.
为了驱散这层迷雾, 我和同事进行了一项研究。 我们查看了寻求庇护, 并进行了医学评估的儿童的数据。 这是我们通过分析证据 而得出的结论。 80% 的孩子有 经常遭受身体暴力的证据: 包括人身攻击和折磨。 有证据表明,60% 的女孩 和至少 10% 的男孩 曾经多次遭受性暴力。 一个有着确凿证据的年轻女孩 向我们讲述了 她曾被拘留、 殴打和强奸了三年, 并被卖给其他人的经历。 如果她逃跑或试图寻求帮助, 她的家人就会被灭口。 这些儿童中有 90% 有从间接暴力, 像是这种严重的威胁, 和亲眼目睹了无数暴行 所带来的心理创伤的证据。
One young boy described the terror and the grief and the utter fear of seeing the mutilated bodies and faces of his younger brother, his aunt, his uncle, his cousin, all killed in a single gang attack meant to send the community a message.
一个小男孩描述了看到他弟弟 残缺不全的尸体和脸时 所受到的惊吓、心中的悲伤 和彻骨的恐惧—— 他的阿姨、 他的叔叔、他的表弟, 也都在一次帮派袭击中被杀, 只为了向他的社区发出警告。
And of course the psychological toll is immense. 19 percent of these children had signs of anxiety disorder; 41 percent, depression and 64 percent, PTSD. 21 percent also had signs of suicidality as children. To put this into some perspective, returning combat veterans, they have PTSD on the order of 10 to 20 percent. These children at three to six times more likely to have PTSD than a soldier returning from war.
因此,这些儿童往往都伴有 严重的心理问题。 其中 19% 的儿童 有焦虑障碍的迹象; 41% 的人出现抑郁症状, 64% 的人出现了创伤后应激障碍 (PTSD)的症状。 21% 的儿童有自杀倾向。 对比来看, 就算是退伍军人, 他们得上 PTSD 的概率 也不过 10% 到 20%。 而这些儿童患 PTSD 的可能性, 是退伍军人的三到六倍。
Now despite this burden and despite this trauma, there are many others, still. Children who come to seek safety and enter into our immigration system only to find further abuse and even torture reminiscent of the places that they fled. You might remember some of those headlines, some of those images this past year. Children being ripped from the arms of their parents. Toddlers, infants in cold and unsanitary cages. The absence of food, water clothing and even soap. There's also increasing reports of medical negligence, preventable complications, child abuse, sexual abuse and even child deaths in US custody. Sadly, many of these abuses and crimes aren't new. Some date back many years and even across administrations. But something's changed. The scope and scale of these abuses and crimes, the systematic and seemingly purposeful endangerment of asylum seekers and also the impunity with which it's being done has raised the harm to an entirely new level.
尽管承受着这样的负担和创伤, 他们中的许多人, 那些为寻求安全 而进入我们移民系统的儿童, 却受到了更多的虐待, 并勾起了更多痛苦回忆。 你们可能还记得 去年的一些新闻标题, 和一些图片。 孩子们从父母的怀抱中被抢走。 幼童和婴儿 住在又冷又不卫生的笼子里, 没有食物、水、衣服,甚至肥皂。 关于医疗事故, 原本可预防的并发症、 儿童虐待 和性虐待的报告 也越来越多, 甚至在美国,监护期间的 儿童死亡率也在上升。 可悲的是,这些虐待和犯罪 早已不是新鲜事了。 有些现象可以追溯到许多年前, 甚至横跨多届政府变更。 但是有些事情发生了变化。 这些虐待和罪行的范围和规模, 对寻求庇护者的系统性 和看似有预谋的危害, 以及罪犯的逍遥法外, 已经把危害提升到了 一个全新的高度。
It reminds me of one of the girls in the study who told us how she pleaded with one of her attackers, asking him to stop, asking why she was targeted. And do you what his response was? He says, "We can do this, because there's no one here to protect you."
这让我想起了调查里的一个女孩, 她告诉我们她是如何 恳求其中一个袭击者 停下来, 问她为什么成为受害者。 你们知道他的回答是什么吗? 他说,“我们之所以这样, 是因为这里没有人保护你。”
We can't let this be true of children and other asylum seekers trying to find help at our borders. But what do we do? As a physician, I'm often dealing with difficult decisions with some of my sickest and most complex patients. Of course we want to keep our focus on their health, their well-being, their quality of life, but sometimes it requires a deeper exploration of their values to really understand how to move forward. In a similar way, our nation is facing a crisis with the increasing number of asylum seekers at our borders and in our communities, and it compels us to re-examine some of our own fundamental values.
我们不能让儿童 和其他试图在我们边境 寻求帮助的人往火坑里推。 但我们该怎么办呢? 作为一名医生, 我经常需要做出艰难的决定, 与一些病情最严重、 最复杂的病人打交道。 当然我们要关注他们的健康, 他们的处境, 保证他们的生活质量, 但有时需要对他们的价值观 进行更深入的探索, 才能真正搞清楚下一步该怎么做。 同样的, 我们的国家正面临着危机。 随着边境和我们的社区里 寻求庇护者人数的增加, 它迫使我们重新审视 我们的一些基本价值观。
What does it mean when we value health and safety? What does it mean when we value security, life, liberty, the life of children? What about this one -- what does it mean when we say we value law and order? Does that also include respecting due process rights for an asylum seeker?
当我们说我们重视健康和安全时, 它意味着什么? 我们说我们重视国家安全、 生命、自由、 孩子的生活,又意味着什么? 那这个呢—— 当我们说我们重视法律和秩序时, 这意味着什么? 这是否也包括尊重 寻求庇护者获得正当程序的权利?
Now for some, when they hear these terms they immediately gravitate towards wanting to build more walls, deploying more border patrol, deporting more people even if it means separating children from their families, subjecting them to psychological torture or deporting them to places where they might die. All in the name of security. All in our name.
对于一些人来说, 当他们听到这些术语时, 他们马上就想要建造更多的墙, 部署更多的边境巡逻力量, 驱逐更多的人, 即使这意味着把孩子 和他们的家人分开, 使他们遭受心理折磨, 或者将他们驱逐到 会面临死亡危险的地方。 而这些全都是以安全的名义。 以我们的名义。
But for me and for many others, when I think of these values, that pushes me in an entirely new direction and renews my commitment to try to meet the needs of these asylum seekers with every tool I have at my disposal. So that when we say that we value life and liberty, we'll see these people who have taken unimaginable risks to flee imminent danger and harm to try to find safety. We'll meet them where they are and provide food, water, shelter, clothing. And we'll certainly meet them with medical care and mental health care that they so desperately need. When we say that we value the rule of law, and not just the privileges it provides a few but the responsibilities it requires of all of us, we'll make sure that we have a functioning immigration system. We'll make sure that we have trained judges. We'll make sure that we're not settling for the illusion of law and order that maybe a tall wall or a militarized border might provide us. We want the real thing. We want judges to be able to evaluate the evidence, including the medical evidence, and we want them to administer justice ... fairly.
但对我和其他很多人来说, 当我想到这些事情时, 这把我推向了一个全新的方向, 令我重申我的决心, 尽我所能去努力满足 这些寻求庇护者的需求。 所以当我们说 我们珍视生命和自由时, 我们会看到这些人 冒着难以想象的风险 逃避近在眼前的危险和伤害 去寻找安全的环境。 我们将在他们所在的地方 与他们见面, 并提供食物、水、住所和衣服。 我们也定会给他们提供医疗服务 以及他们迫切需要的心理健康护理。 当我们说我们重视法治, 而不仅仅是它提供给 少数人的特权, 而是它要求我们所有人 所需承担的责任, 我们将确保我们有一个 健全的的移民体系。 我们会确保我们有 训练有素的法官。 我们将确保我们不会 满足于一堵高墙, 或军事化边界带来的 有关法律和秩序的幻想。 我们希望能有实际的行动。 我们希望法官能够评估证据, 包括医学证据, 并且能公正的 主持司法。
When we say that we value health and well-being, that we don't want to perpetuate harm, then we'll deploy trauma-informed strategies at all levels of the immigration system. It might start with retraining border patrol agents or immigration officials, but it needs more medical, mental health and child welfare experts across the whole system.
当我们说我们重视健康和幸福, 我们不想让伤害持续下去时, 我们应在移民系统的各个层面 实施真正了解 并能有效愈合创伤的措施。 也许从重新培训 边境巡逻人员 或移民官员开始, 但我们还需要在整个系统里 分配更多的医疗、心理健康 和儿童福利专家。
And when we say that we value justice, we won't let ourselves be turned into the torturers that many of these children and other people fled. We'll open up our detention centers and our courts to experts and advocates to hold ourselves accountable. And we may find that we need to shut down most of them and close these camps.
当我们说我们重视公正时, 我们不能让自己变成施虐者, 变成那些儿童和其他人 避之不及的人。 我们将向专家和律师们开放 居留中心和法庭, 让我们自己负起责任。 我们也许需要关闭大多数, 或停止设立一些难民营。
I believe that by working in effective partnerships with lawyers, doctors, human rights advocates and many others, that we can work together to meet these asylum seekers' needs, that we can meet our historical, humanitarian and legal obligations to them. And when we do, I think something powerful will unfold. Not only will these asylum seekers -- like the man who came to my clinic and won his asylum case, like the children in the study or the many thousands of others seeking a new life, they'll be able to find that safety and security. We'll recognize the abuses that have occurred, and we'll restore the rights and protections that were lost. And I think that we'll be in wonder when we see them in the fullness of their humanity. Not just their strengths and weaknesses, their hopes and joys, not just the trauma that we acknowledge, but we'll also stand with them and we'll be inspired by their resilience. They'll blossom, and they'll add to the richness of this nation.
我相信通过与律师、 医生、人权倡导者 和其他有志者 建立有效的伙伴关系, 我们可以共同努力, 满足这些寻求庇护者的需求, 并能够履行我们曾对他们许诺的 人道主义待遇 和法律义务。 当我们这样做的时候, 我认为这样就会带来 一些意义深远的影响。 不仅是这些寻求庇护者—— 就像那个来我诊所获得了庇护的人, 像是我的研究中的孩子一样, 还是成千上万寻求新生活的人, 他们都能获得安全的保障。 我们会认识到 曾发生过的权力滥用现象, 且将恢复他们曾失去的 权利和保护措施。 我想,当我们看到他们 重获人性与活力的时候, 我们会感到非常惊讶—— 惊讶于他们的长处和弱点, 还有他们的喜悦和希望, 而不仅仅是我们发现的创伤, 但我们也将与他们站在一起, 被他们的坚韧精神所鼓舞。 他们的人生会如花般绽放, 并为这个国家增添财富。
I think by staying true to our fundamental values in the way that I've described, that's how we build a sane and humane immigration system. That's how we remain the golden door. And that's how it happens that we remain the shining light of the world.
我认为,通过我所描述的方式 来忠实于我们的 基本价值观, 将是我们建立一个理智、 人道的移民体系的方式。 这就是我们让那扇金色大门 保持敞开的方式。 同时, 我们也仍是世界上那束耀眼的光芒。
Thank you.
谢谢。
(Applause)
(掌声)