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.
數年前,有位年輕男子 到我的診所來找我。 他告訴我,他在逃難。 他說他逃離了他的家園, 因為在那裡,同性戀是不合法的, 在某些情況下還會被判死刑。 所以當他的性向被揭露出來時, 他的家人都排拒他, 他的老闆把他開除, 在街上,憤怒的暴民不斷攻擊他。 每次警方到場時都只是去逮捕他, 拘留他,並進一步折磨他。 他知道若他不脫離這個暴力循環, 他一定會送命。
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.
所以他做了求生必須要做的事。 他拋下了一切。 他所有的朋友、 他的家人、他的職涯。 他逃離了他的家園, 他逃到美國, 他在這裡申請庇護。
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.
但和許多逃離這種壓迫的人 一樣,他帶不了什麼。 他有基本的身分證件,幾乎 沒有錢,只有少量私人物品。 他肯定沒有帶著證明 警方折磨他的官方文件。 沒有影片證明暴民想要殺害他。 他沒有這類證據來支持他的說詞, 但,他到這裡來了, 坐在我的診所裡, 給我看一些能證明 他被迫害的最強力證據。 就是他一直帶著的 身體傷疤和心理傷疤。 要知道,他長期處在 讓他衰弱的痛苦中。 他全身都是嚴重的傷疤, 癒合得很糟糕的傷口, 不斷重覆感染。 他也受到嚴重的憂鬱症所苦, 持續發生創傷後壓力症候群 造成的經常性幻覺 和惡夢讓他非常無奈。
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.
所以,我們持續治療。 數個月來我們經常會面, 記錄下所有的醫學證據。 我們回顧每一次攻擊的細節, 將他的傷疤拍照, 記錄他的傷口和創傷, 我們甚至開始記錄了 他在我們的照顧下 緩慢但穩定的恢復狀況。 我和他的律師密切合作, 提供詳盡的口供書, 包括法醫評估的發現, 我們把這些資料加到 他的庇護申請書當中。 接著,我們等待了數年之久, 期間他不斷進出法庭。
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 他寄來的電子郵件。 信上說他的庇護申請被通過了。 診所中的每個人都欣喜若狂。 在信上,他說這是多年來頭一次 他可以不再懼怕被驅逐和死亡。 這是多年來頭一次他真正感到安全, 他有安全感,讓他可以 從頭開始重建他的人生。 唯有透過這種醫學和法律的辯護, 我們才能夠協助他 恢復他的法律地位和權利, 讓他透過庇護得到這一切。
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.
許多逃離迫害的人會來 找這類方案計畫和診所, 說出我們難以想像的暴力故事, 及他們被迫害的各種理由。 但有一點總是不變。 對他們施予的暴力 都完全沒有受到懲罰, 有時還是國家直接透過 警方或軍人來施暴。 在其他的情況中, 國家則是視而不見, 並寬恕準軍事團體的行為, 或甚至家暴伴侶的行為。 在其他情況下, 國家則完全無能為力, 無法保護弱勢的人 對抗強大幫派欺壓。
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.
我們知道,這些 健康的社會決定因素 對病人的健康和幸福 有很大的影響: 住房、收入、教育、 種族、社會包容。 但法律的平等保護也同等重要—— 正當法律程序。 特別是在社會中最弱勢、 被邊緣化的人, 甚至那些被主動當成目標的人, 他們是否容易取得這些人權保護, 可能就會決定 他們是生病還是健康, 通常,還會決定他們是生還是死。 對於數百萬名忍受 壓迫和折磨的人來說, 療癒的唯一方式 就是承認確實發生了 人權受侵害的狀況, 並協助他們恢復這些 受到嚴重侵害的權利和保護。
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.
在二次大戰的殘暴行為之後, 便設立了庇護體制, 做為救濟的一種途徑。 但,最近,這條途徑似乎 已經轉變成了一條障礙路, 走上此路的人注定會失敗。 尋求庇護者通常 不知道要從何著手, 更不用說要拖數年的時間 才能完成整個流程。 他們沒有資格找律師, 所以他們不知道他們的權利。 漸漸地,他們甚至被阻擋, 無法進入有可能容身的地方。 他們會被逮捕或起訴, 甚至在還沒見到 庇護官員之前就被驅逐。 就算他們真的走完了流程, 庇護被核准的比率也不到 20%, 對某些人,這個比率還要低更多。 感覺幾乎就像是這個體制是設計來 避免人民行使他們的權利。
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,有一件事是這些人 可能可以去做的。 這件事可能可以將他們的成功機會 提升到 90% 以上。 所以,是什麼事? 找律師並進行醫療評估。 就這麼簡單。 來我診所的那名男子 打贏了他的庇護官司。 醫生和律師同心協力 呈報所有的證據, 包括醫學證據,都交給法庭, 讓法官能有足夠資訊 做出公正的決定。
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.
這種醫療—法律合作關係 在現在顯得特別重要, 因為我們所處的這個時代, 暴力和衝突造成了 大量不得已的移民。 2018 年,全球有七千萬人 因為戰爭、衝突,及迫害, 而被迫離開家園。 當中有四千萬人在國內遷移, 兩千五百萬人是難民, 三百萬人尋求庇護。 在美國這裡可以看見 在薩爾瓦多、瓜地馬拉、 宏都拉斯等地方的暴力逐步加劇, 在那些地方的謀殺率 不輸給敘利亞和阿富汗。 在那些地方,警方腐敗 和幫派暴力都越來越嚴重, 在那些地方,貧窮和虐童 非常普遍且是被容許的, 在那些地方,基本的管理制度—— 公共安全、 兒童保護—— 都沒有效率。
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.
並不意外在這些社會中, 許多最弱勢的人—— 兒童、女人,及其他 成為目標的族群—— 他們越來越絕望, 逃難的人數也增加到前所未見。 在過去十年間, 在我們西南方邊境 試圖尋求安全的隻身兒童人數 增加了十八倍, 從 2009 年的三千三百人, 增加到去年的六萬兩千人。 除此之外還有 近五十萬人與家人同行。 男人、女人、孩童 在我們的邊境尋求庇護, 但他們被困在 一場人道主義危機當中。
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.
讓情況更糟糕的是, 他們被卡在訴求 和反訴求的角力當中, 爭論他們的身份、 他們的經歷、 證據在何處, 及他們應受的待遇。 他們應該得到我們的幫助嗎? 有時,有人會主張 他們不是逃離人權侵害, 只是單純的經濟移民。 其他人則說這些孩子其實 是被他們的父母利用和販運。 還有人說他們根本不是孩子; 是根深蒂固的罪犯, 是要滲透我們國家的幫派成員。
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.
為了解開這些歧見, 我和我的同事進行了一項研究。 我們研究的資料,是尋求庇護 且具有醫療評估的兒童的資料。 而證據告訴我們這些: 這些孩子當中有 80% 有證據 證明他們重覆受到身體 暴力對待:攻擊和虐待。 60% 的女孩和至少 10% 的男孩 有證據證明他們重覆 受到性暴力對待。 有位小女孩說了個故事, 且有確證可以證明她被拘留、 毒打、強暴,長達三年, 販售給其他男人, 甚至被威脅如果她逃走去求助 就要殺害她全家。 這些孩子當中有 90% 都有間接暴力造成心理傷害的 證據,包括這類嚴厲的威脅, 還有親眼目睹無法言喻的殘暴。
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.
有位小男孩 描述了他感受到的可怖、悲慟, 和極度的恐懼,因為他看到 他的弟弟、阿姨、叔叔、 表親的面孔和殘缺不全的屍體, 幫派為了傳遞訊息 給社區而發動攻擊, 他們都在攻擊中被殺害。
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.
當然,心理上的損傷也相當巨大。 這些孩子當中有 19% 都出現焦慮症的徵兆; 41% 憂鬱症, 還有 64% 創傷後壓力症候群。 21% 也有兒童自殺傾向的徵兆。 和戰爭返家的退伍軍人 比較會更清楚, 退伍軍人有創傷後壓力 症候群的比例為 10~20%。 比起從戰爭返家的士兵,這些孩童 得到創傷後壓力症候群的 比例高出三到六倍。
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.
儘管有這種重擔和這種創傷, 還有許多其他的。 來尋求安全並進入 我們移民體制的孩童 卻受到進一步虐待甚至折磨, 讓他們想起他們逃離的地方。 你可能還記得去年的 一些頭條和影像。 孩童被強行帶離他們父母的懷抱。 還在學步的兒童、嬰兒, 被關在冰冷又不衛生的籠子裡。 缺乏食物、水、衣物, 甚至沒有肥皂。 也有越來越多報導指出 他們缺乏醫療照護, 得到本來可預防的併發症, 兒童被虐待,性虐待, 甚至有孩子在被美國監禁時死亡。 感傷的是,許多這種虐待 和犯罪都不是初次發生。 有些在許多年前,甚至在 不同人執政時都發生過。 但也有些改變: 這些虐待和犯罪的 範圍和規模加大、 尋求庇護者受到系統性 且似乎有目的的危害, 以及做這些事 卻免受懲罰的程度更高, 讓造成的傷害達到了新高。
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."
這讓我想起研究中的一個女孩, 她告訴我們,她懇求 其中一位攻擊她的人, 拜託他停手,並問 她為什麼成為目標? 你知道他的回應是什麼嗎? 他說:「我們能這麼做是因為 在這裡沒有人會保護你。」
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.
我們不能讓這種事 真的發生在孩子和在邊境 求助的尋求庇護者身上。 但我們能做什麼? 身為醫生,我常要 和重病最複雜的病人 處理困難的決策。 當然,我們想把焦點放在 他們的健康、幸福、生活品質上, 但有時,會需要更深入 探究他們的價值觀, 才能真正了解下一步要如何走。 同樣的,我們的國家 正在面臨危機, 在我們的邊境及我們的社區中 都有越來越多尋求庇護者, 這讓我們不得不重新檢討 我們自己的基本價值觀。
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?
當我們說我們重視健康 和安全時,是什麼意思? 當我們說我們重視 安全、生命、自由, 及孩童的性命時,是什麼意思? 還有這個呢—— 說我們重視法律和秩序是什麼意思? 那是否也包括要尊重 庇護尋求者的正當法律程序權利?
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.
有些人一聽到這些詞, 馬上就會轉向要建立更多圍牆, 部署更多邊境巡邏, 驅逐更多人, 不在乎必須要將孩子 與他們的家人分開, 讓他們受到精神上的折磨, 或者將他們驅逐到 可能會害死他們的地方。 全都以安全為名。 全都用我們的名義。
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.
但對我及對許多其他人來說, 思考這些價值觀 將我推向全新的方向, 並讓我重新承諾要用 我所能取得的所有工具 來試圖滿足這些 庇護尋求者的需求。 這麼一來,當我們說 我們重視生命和自由時, 我們會看到這些承擔極大風險 逃離迫近危險和傷害, 試圖找到安全的人。 我們會配合他們的需求, 提供食物、水、庇護所、衣物。 我們肯定也會做好他們非常需要的 醫療照護以及心理健康照護。 說我們重視法律規定 不只是它提供給少數人的特權, 還有它要求我們所有人負起的責任, 我們要確保我們有 能夠運作的移民體制。 要確保我們有受過訓練的法官。 要確保我們不能妥協接受 高牆或軍事化邊境 帶給我們一種有法律 和秩序的幻覺。 我們要的是真實的。 我們希望法官能夠評估證據, 包括醫療證據在內, 我們也希望他們能執行正義…… 公平地執行。
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.
當我們說我們重視健康和幸福時, 我們並不想要讓傷害延續下去, 那我們就要在移民體制的各層級 執行創傷知情的策略。 第一步可以是重新訓練 邊境巡邏員或移民官員, 但整個體制都需要有更多醫療、 心理健康,及兒童福利的專家。
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.
當我們說我們重視正義時, 我們不會讓我們自己變成這些孩子 和其他人想要遠離的虐待者。 我們要向專家及辯護者開放 我們的拘留中心和法庭, 讓我們扛起責任。 我們可能會發現我們需要關閉 大部分這類地方及這些營區。
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,若能和律師、 醫生、人權倡導者, 及許多其他人有效地合作, 我們就能同心協力滿足 這些庇護尋求者的需求, 我們可以盡到對他們的歷史、 人道,及法律義務、 我認為當我們做到時 會有很強大的結果。 不僅這些庇護尋求者—— 就像來我的診所並打贏 庇護官司的那名男子, 就像研究的那些孩子, 或其他數以千計 想要尋求新生活的人, 他們將能夠找到安心感和安全感。 我們要承認已經發生的虐待行徑, 我們要找回那些失去的權利和保護。 我想,當我們能把他們當作 完整的人類來看待時, 我們會驚嘆不已。 不僅是他們的長處與短處, 他們的希望和喜悅, 不僅是我們承認的創傷, 我們也會和他們並肩而戰, 我們會被他們的恢復力所鼓舞。 他們會像花一樣盛開, 會讓這個國家更豐富。
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.
我想,照我剛才說的方式, 忠於我們的基本價值觀, 我們就能建造一個健全 且人性化的移民體制。 這就是我們維持金色大門的方式。 這就是我們繼續為世界 扮演亮光的方式。
Thank you.
謝謝。
(Applause)
(掌聲)