Nationwide, there is a backlog of 1.6 million asylum cases, with an average wait time of 1,621 days (1). Surprisingly, despite being a long-established destination for immigrants, Massachusetts has the second lowest asylum grant rate in the nation (15%) and the second largest increase in asylum case backlogs from 2021-2022 (2). As a resident of Massachusetts, I would not expect this from a “progressive” state known for its medical care, social services, and educational institutions. However, in August 2023, Governor Maura Healey declared a state of emergency in MA when housing in the Greater Boston area was unable to accommodate migrants (3).
The Cambridge Health Alliance Asylum Program (CHAAP) has helped bridge this gap for over 20 years, providing critical support to those seeking asylum in Massachusetts. CHAAP provides Forensic Medical Evaluations (FMEs), which substantiate claims of physical and physiological harm, and have been shown to increase the likelihood of being granted asylum by two times (4). In 2023, in partnership with the CHA Center for Health Equity Education and Advocacy (CHEEA), CHAAP established the nation’s first asylum residency training elective with a paired mentorship model.
The Leah Zallman Center for Immigrant Health Research (LZC) at ICH partnered with CHAAP and CHEEA to understand the impacts of the training elective and the overall program. Led by Dr. Sara Snyder and Dr. Jessica Santos, our team gathered data from residents (N=8) and key informants such as leaders in the field at CHA and at partner organizations (N=17). We found key impacts of the program at multiple levels, for residents, faculty, healthcare systems, and the regional/state level, while also identifying opportunities for sustainability.
For residents and faculty, CHAAP provided learning and teaching opportunities not usually available as part of standard medical training, as well as meaningful peer and professional connections. Elements of the CHAAP elective, such as training in trauma-informed care, human rights, and immigrant health, also represent broad benefits to healthcare systems. Lastly, the provision of FMEs through programs such as CHAAP provides needed support for a legal system experiencing a severe backlog in asylum cases.
Despite the many benefits of CHAAP, key informants noted that the program lacks structural sustainability. Funding mechanisms to support asylum medicine are lacking, and the continuation of the program is a “labor of love” that depends on “the devotion of one or two extremely devoted individuals.” Opportunities to increase sustainability include greater infrastructure and funding investment in asylum medicine, and more support for clinicians providing FMEs. In addition, asylum medicine should be included as part of the continuum of care, and considered key to CHA’s mission of achieving health equity. As one key informant shared:
“It’s all connected, and excellent, equitable care for everyone every time would mean no matter who you are or how you get here or what your status is.”
Recommendations for future actions include greater regional collaboration between asylum programs, grassroots organizations, and the legal system, as well as expansion of the training elective model to other medical systems. Lastly, advocacy to prioritize asylum medicine and identify cost reimbursement structures is key to ensuring increased sustainability of programs like CHAAP.
The continuation and expansion of support for asylum seekers is critical, as part of the healthcare system’s health equity mandate to care for all. Particularly at this moment in history, hospitals and health systems such as CHA have an obligation to provide care such as FMEs and other medical support to asylees. To meet this mandate, it is critical to support programs such as CHAAP, and identify ways to integrate and prioritize asylum medicine.
To learn more about health equity and care for asylum seekers, see the December 2023 Leah Zallman Center ‘Spotlight on Asylum’ Brief here.
Meissner, Doris, Faye Hipsman, and T. Alexander Aleinikoff. 2018. The U.S. Asylum System in Crisis: Charting a Way Forward. Washington, DC: Migration Policy Institute.
Gorrivan, Emily, et al. 2022, pp. 1–31, Lives in Limbo: How the Boston Asylum Office Fails Asylum Seekers. Retrieved from https://mainelaw.maine.edu/wp-content/uploads/sites/1/Lives-in-Limbo-How-the-Boston-Asylum-Office-Fails-Asylum-Seekers-FINAL-1.pdf
Healey, M., & Driscoll, K. (2023, August 8). Governor Healey Declares State of Emergency, Calls for Support for Newly Arriving Migrant Families. Retrieved from https://www.mass.gov/news/governor-healey-declares-state-of-emergency-calls-for-support-for-newly-arriving-migrant-families
Atkinson, Holly G, Wyka, Katarzyna, Hampton, Kathryn, Seno, Christian L., Yim, Elizabeth T., Ottenheimer, Deborah, Arastu, Nermeen S. Impact of forensic medical evaluations on immigration relief grant rates and correlates of outcomes in the United States. Journal of Forensic and Legal Medicine. Vol 84. 2021. https://doi.org/10.1016/j.jflm.2021.102272.