Welcome to today's webinar, the first in the series Medical Forensic Examinations for Asylum Seekers. Part one is Legal Framework for Immigrant Victims, an Introduction to the Istanbul Protocol, brought to you by the International Association of Forensic Nurses. In just a moment, I'll introduce today's presenters. First, however, I want to mention that continuing education is offered for attending today. To receive your certificate, you must first complete an evaluation. I also need to let you know that the planners, presenters, and content reviewers of this webinar have disclosed no conflict of interest. Case studies presented in this webinar are based on real-life examples, and identifying details have been purposefully withheld to ensure confidentiality is protected. In addition, today's webinar will be recorded and available for later reviewing. To eliminate the background noise and phone feedback, please know that we have muted all participants, but we still want to hear from you. On the side of your screen is a chat area. Please feel free to use the chat area to privately post a question to the presenter or moderator. Depending upon your question, we will address it at a natural break or we'll hold it until the end of the presentation. Let me introduce today's presenters, Amanda Payne and Layla Halas. Amanda Payne is a board-certified forensic nurse examiner currently working on the Forensic Assessment and Consultation Team at Inova in Fairfax, Virginia. She was trained in the medical forensic examination of asylum seekers through Physicians for Human Rights at the Yale Center for Asylum Medicine. She is a member of IFN's Social Justice Committee and has served as a representative on the Georgia State Human Trafficking Task Force. She recently authored the paper, Sane Forensic Examinations for Immigrant Victims, a case study published earlier this year in the Journal of Forensic Nursing. Professor Halas' teaching and scholarship focus on law, policy, and practices that affect access to justice within the immigration law regime for particularly vulnerable communities, including children, detainees, asylum seekers, and survivors of violence, as well as emerging pedagogy and practices in experiential learning. She regularly speaks and appears in the news regarding migration, refugees, and immigrant children and has written op-eds for Slate, The Boston Globe, and Times-Picayune. Before joining Tulane Law School in 2017, Professor Halas taught at Boston University School of Law as a clinical associate professor, at Georgetown University Law Center as a clinical teaching fellow, and at Loyola University New Orleans College of Law as a staff attorney and Equal Justice Works fellow in the immigration clinic. While at Loyola, she also directed the Office of Law Skills and Experiential Learning on an interim basis. Prior to that, she was awarded the Chadbourne and Park Fellowship to provide legal services to immigrant children at the door legal services. Professor Halas' services on the Board of American Civil Liberties Union of Louisiana and the Clinical Legal Education Association. While in law school, she co-founded the Student Hurricane Network, which recruited and placed more than 5,500 students in pro bono assignments in regions affected by Hurricanes Katrina and Rita. At this point, I am pleased to turn this over to these highly qualified presenters, Amanda Payne and Layla Halas. Hello. Welcome. My name is Amanda Payne. I'll be your guide through all the webinars in this series on the Medical Forensic Examination of Asylum Seekers. In this first webinar, we will be discussing the foundational knowledge you will need to understand the legal framework immigrant victims must operate within. We will also provide a brief introduction to the Istanbul Protocol, which is the United Nations manual regarding the investigation and documentation of torture and its consequences. We will refer to this document throughout all five sessions, and you'll be provided with a copy after you complete this course evaluation. We hope by the end of this session, you'll have an appreciation for the importance of this type of medical forensic documentation, an understanding of the potential impact forensic nurses can have in this arena, a general understanding of the legal process immigrants may face when applying for protected status, and a basic knowledge of the elements of the Istanbul Protocol. This is a relevant course for current forensic nurses at all levels who would like to improve their understanding, cultural competency, and a framework for working with immigrant populations. It is also intended for those who would like to expand their current clinical practice to include working within U.S. and international immigration systems. In later parts of this series, we will have a more in-depth discussion of the Istanbul Protocol and its application. We will go through the clinical and psychosocial interview, physical exam, interpretations, and applied diagnostic rubric, which is the standardized language the Istanbul Protocol recommends to interpret medical forensic findings. I believe this diagnostic rubric will be of interest to many of you. I personally find it very helpful in my day-to-day clinical practice. The last webinar will review the components of writing a medical forensic affidavit for use in immigration courts. Professor Halas will also review best practices of expert witness testimony in these courts and the nuanced differences between immigration courts and the criminal and civil courts most of you are certainly familiar with. So let's start out here with a basic definition and just a little bit of background for those of you who are completely unfamiliar with the immigration system. There are many ways refugees get to the United States. A refugee is a person who is of special humanitarian concern to the United States who is not firmly resettled in another country and must demonstrate that they were persecuted or fear persecution due to race, religion, nationality, political opinion, or membership in a particular social group. These people must file an application and wait for the United States State Department, the United Nations High Commissioner for Refugees, and the Department of Homeland Security to vet these claims overseas. After waiting for an extended period that's often years, they're eventually told where they can resettle. If chosen to come to the United States, they're resettled in the U.S. by the Office of Refugee Resettlement, which is assisted by an approved volunteer agency such as Catholic Charities or Luzon Services. Those agencies are often given a stipend per person to assist the refugees becoming self-sustainable within a few months. Filing an asylum claim is the act of asking for help from the United States and stating that you meet the definition of a refugee after physically presenting in the United States or at a port of entry. For example, someone may have been persecuted because of their sexual orientation in their home country, presents in person at an airport, and requests an asylum on a valid visa. This is just one way to apply for asylum. The diagram you see here is from Jesuit Refugee Services, and after just a cursory review of this slide, you can see that there are multiple very complicated scenarios in which people can request asylum. Professor Halas is going to parse this out for you in detail a little bit later. There we go. The foundation of an asylum application is the claim that one meets the basic definition of a refugee. A refugee is an individual who is outside his or her home country because of a well-founded fear of persecution on account of race, religion, nationality, membership, or membership in a particular social group or political opinion. As you go through this series, you will come to understand that this one definition is enormously important as you conduct interviews, perform physical exams, and write affidavits. It's also important to know that asylum applications are just one form of relief. There are several other alternative forms of protection for which immigrants who've been victims of persecution can apply. Many forensic nurse examiners and sexual assault nurse examiners working with human trafficking victims and immigrant victims of crimes may be generally familiar with some of these forms of protection, such as the T visa or the U visa. Some are specific to children, such as the SIJS, so you're undoubtedly familiar with some of these. For everyone listening to this webinar, it's paramount to remember that the evaluation and documentation you may provide in your current criminal or civil practice for immigrant victims may not just help solve a crime, but could also impact your patient's immigration status and potentially provide some protection from deportation in an increasingly aggressive immigration climate within the United States. Who has a well-founded fear of persecution? To qualify for asylum in the United States, applicants must show that they have suffered or have a reasonable fear that they will suffer persecution in their home country. Female genital mutilation, torture, physical and emotional abuse are all considered types of persecution under U.S. and international law. Forensic nurse examiners can play a key role in the asylum review process because of our ability to corroborate claims of torture, physical abuse, and other forms of persecution through a medical forensic exam and documentation. This is not a stretch by any means from the common day-to-day practice in our field. However, there are a number of considerations we must make as we consider caring for this population. This photograph is from Kaiser Health News and is of an asylum seeker from Eritrea who is meeting with Dr. Nick Nelson. Dr. Nelson directs the Highland Human Rights Clinic located at the Highland Hospital in Oakland, California. A few times each week, Nelson and his team conduct medical evaluations of asylum seekers. The medical staff at this clinic do exactly what we're training you to do in this entire series, which is to perform a comprehensive interview, search for signs of trauma, scrutinize injuries, perform trauma-informed, culturally sensitive, patient-centered care, and document their findings. Most groups who perform these types of evaluations currently in the United States are physicians, and there are a handful of human rights clinics like this one around the country. However, with an increasing awareness of these issues in the immigration system within the United States, improving accessibility and availability for these types of exams is badly needed. Forensic nurses around the country have the experience, skills, and credibility to fill this need. Now for some background and understanding why we have asylum law in the first place. The United Nations Commission on Human Rights was established in 1946 to weave the international legal fabric that protects our fundamental rights and freedoms. I think to many Americans today, the United Nations is perhaps a nebulous amalgamation of nations overseeing the world broadly. However, in the aftermath of World War II, it was, and still is today, the mechanism of accountability for all nations worldwide and creates a necessary fabric to maintain global peace. The United Nations Commission on Human Rights, now known as the Human Rights Council, was created by international human rights treaties and examines, monitors, and publicly reports on state parties' compliance with their treaty obligations. So in a nutshell, this body attempts to mandate that nations not abuse their citizens. One of these monitoring bodies was created in 1948, called the UN Convention on Torture Against Torture. In 1999, this group published the Istanbul Protocol, which is also known as the Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhumane, or Degrading Treatment or Published Punishment, so we'll continue referring to this as the Istanbul Protocol. The Istanbul Protocol is the first and primary set of international guidelines for forensic evaluators to use when investigating crimes that fall under the international law umbrella. When persecution is institutionalized within a society or where police and rulers can act with impunity, the threshold at which persecution is seen as an appropriate tool can decrease. The targets of torture and persecution can be those who are obvious political or prominent opponents to those in power or those who are under-recognized as targets, so the poor, marginalized, ethnic, cultural, religious, or sexual minorities, women and children, accidental victims, which would be civilians caught in the crosshairs of wars or conflicts across borders. These marginalized groups constitute many of the asylum applications in the United States. We're now going to watch a short eight-minute video from the United Nations High Council on Refugees on some of the minors arriving to our southern border fleeing violence in El Salvador, Guatemala, and Honduras. In 2014, under the Obama administration, the Central American Minors Program was created, which meant parole was offered to these children even if they had been denied refugee status. In 2017, the Department of Homeland Security terminated this program. Let's see if that works. ♪ When I was two or three years old, I was living with my mom and dad, my grandmother Graciela, and my grandmother went out to wash the dishes for lunch, and when she went out to wash them, she was killed, and I was there with my cousin. My dad was killed. I was not sure how, let's say, the people who killed him, maybe they were going to come to my family to kill the others. All the people who knew about the crime, they killed a lot of people, and they also killed an uncle of mine with a machete, they killed him. They killed people, they threw them on the street, I don't know. They killed him because he was gay, because he was a faggot, I don't know. Terribly, if it was known as it is today, tomorrow you could be found on a dead street. It's a crime, there are a lot of gangs trying to oppress young people because they are easily influenced. A gang wanted me to be part of them, because if I didn't, they were going to kill me. Well, the first time they told me they were going to kill me, so I said no, because I didn't want to. I have my sister, and they try to harass my sister, because when they saw the opportunity, that there was no one around, they tried to touch her. Things like that, she can't defend herself. My grandfather is a little older, he can't do much, so they say, we are going to kill your grandfather, we are going to do something to your sister. There are a lot of threats. Psychologically, they are killing you. We couldn't be there until 8 or 9 at night on the street, because they were killing people who were outside at that time. A lot of times, gang members kill people in front of the police. So the people, the police, they... We are going to do something to your sister, we are going to do something to your grandfather, we are going to do something to your sister, we are going to do something to your grandfather, we are going to do something to your grandfather, we are going to do something to your grandfather, You had to make the decision to leave or stay. It was two choices. You either want to live or you want to end your life. You suffer from a lot of things because you find a very different climate. It's cold at night, sometimes you don't have to eat. Mara is also another place where immigrants are looking to kidnap you or ask for money. It was a very hard situation. A lot of things happen. You know, when you come to a country that's not yours, it's very, very difficult. Sometimes the train was going up, when you got on it, it was full of blood. It was terrible. Without thinking about it, many of them lose their lives. Many lose an arm, a leg, all those things. And it's very sad to see that. You are forced to see it. We saw rapes of women, so many things. Children, people who kidnap. And so many things that happen to people. We crossed the Bravo River. Then we kept walking up for about two hours. And then the coyotes told us to wait there. That they were going to see how the immigration process was going. They didn't arrive. They left. They left us there. We were there, and a policeman came. And the policeman said, nobody runs. And he took out his gun and said, whoever runs, I'll shoot them. So I stopped there because I'm afraid of firearms. I saw that there were good people, and I never saw what I saw in my country, so I feel safer here. In my country, unfortunately, it is a very ignorant country, and people like that have no right to any kind of government protection. Just because they know it, they kill you. When you just leave the house, you have to be prepared for anything that will happen. When you get on the bus, you don't feel safe. When you're walking down the street, you don't feel safe. When you leave school, or anywhere, you don't feel safe. I came to this country to leave a bad life, to stop being afraid and have dreams like everyone else. If I was afraid, I would break my dreams, or I would throw them away. When you're here, you realize the opportunities, that if you work hard, that if you study hard, that if you take a path because you want to go, if you don't give up, you can achieve many things. Your dream is too important for everyone, not just for yourself, but for everyone. on where you live, and oftentimes we just don't know how to help, and this is a really tangible way to help. So just to highlight the potential impact of expanding forensic nursing practice to include this type of work, one study conducted by Physicians for Human Rights in 2007 demonstrated that asylum applicants who underwent a medical forensic exam received asylum 89% of the time compared with 37.5% of all asylum seekers nationally. I think that's just astounding. Training more physicians and nurses to conduct these types of exams and increasing their accessibility and availability around the nation will undoubtedly have a profound impact on individuals and families currently applying for protection within the United States. So with that little bit of background and a snapshot of what we're going to cover in future webinars, Professor Halas is now going to go over in-depth covering U.S. asylum law and the immigration process. Great. Thank you for having me. I'm really glad to be speaking to this group of folks. So what I'm planning to do is first kind of just talk broadly about who are the actors in the immigration system. It's at times a bit complicated and so I think it's helpful to kind of just go through all the different agencies that may be impacting one of your patients' lives. And then I'm going to discuss some of the specific immigration protections that were flagged early on. So certainly asylum but kind of a number of other protections and how a forensic evaluation might relate to those different types of cases, specifically to the legal claims behind those cases. So you know who's in charge of our modern immigration system? The kind of agency that is most important, that has the most responsibilities is the Department of Homeland Security. Some people may have heard of the INS, the Immigration and Naturalization Service. That's a legacy agency, although occasionally I'll still see a movie that makes a reference to it. It no longer exists after kind of 9-11, the government reorganized and put kind of the majority of immigration responsibilities under the Department of Homeland Security. Specifically with these three branches listed on the PowerPoint, you'll see Citizen and Immigration Services or sometimes we call them USCIS, Immigration and Customs Enforcement, ICE, so the kind of law enforcement branch, and Customs and Border Protection. And again that's kind of law enforcement at the border. And the other very major department is the Department of Justice, which houses the immigration court system. So I'm going to talk specifically about these kind of two agencies. Within the Department of Homeland Security, as I mentioned, there are three main kind of subdivisions. USCIS, which we often refer to kind of the services side or the benefits side. In fact, in the notices that they issue to immigrants who are applying for benefits to them, they have a customer service number. So that they, you know, they tend to grant or deny applications. They have a special asylum division within their office, so people may be applying directly to USCIS, the asylum office, and be interviewed by those offices to receive asylum. They also have a number of regional offices and service offices. And so sometimes someone, a patient, may need to go into one of these offices for an interview or sometimes the type of application doesn't require an interview, but they may have to mail off documents to one of these offices. So it depends on what the type of case is, what the visa type is, or the protection is that the immigrant is applying for. But depending on that, they may need to go before a regional office. And so many of you may have those in the city, if you live in a city, or there may be one a few hours away. And then there are a few centralized service offices. The Vermont Service Office, in particular, is one that deals with some of these humanitarian statuses that we'll be talking about, U visas, T visas, and VAWA. Then under ICE, there are a number of different divisions, but generally we think about the kind of police officers who are part of Enforcement and Removal Office, and they're responsible for enforcing immigration laws. So they have the authority to arrest immigrants, they have the authority to detain them in immigrant detention centers, and then if someone is ordered deported by a court, they can effectuate that deportation order. So they are responsible for physically deporting people to other countries. Within ICE, there's also a branch called the Office of Chief Counsel. These are the the trial attorneys who represent the government in immigration court. There's no right to an appointed counsel in immigration court. So sometimes an immigrant, oftentimes an immigrant, may be representing themselves in court, and they'll be facing an opponent who's an ICE attorney on the other side. So there's an experienced kind of government prosecutor at all times in these immigration court proceedings. Lastly, there's also the Customs and Border Protection. So this is another law enforcement agency. They have jurisdiction over the border, and they can arrest and temporarily detain immigrants, and then they're supposed to hand those people over to ICE, who has the authority to detain people kind of in a more long-term setting. You know, Customs and Border Protection, people may, you may sometimes see them. You may live in a landlocked state, and you may see a Customs and Border Protection vehicle. That's because CBP has a very broad jurisdiction. They can be within a hundred miles of any international port of entry. What that means is, if there's an international airport in, you know, where you live, that they can be within 100 miles of that conducting enforcement, so arresting people. So the, the one kind of, you know, one caveat when Customs and Border Protection arrests unaccompanied minors, so some of the young people we just saw in that video, they are supposed to hand them over to, not ICE, but to a department called, a department within Health and Human Services called the Office of Refugee and Resettlement. So you'll see there's very limited jurisdiction of duties of Health and Human Services within, within the immigration realm, but the Office of Refugee Resettlement, which is part of HHS, provides certain services for vulnerable populations. So it's not only unaccompanied minors, but also refugees and asylees. A number of people may receive certain benefits from this agency. Children may end up living in youth centers that are overseen by ORR. ORR has the duty to then try to reunite children with family members or other responsible adults, and so you may see in your practice a child that was detained and held in a youth center by ORR, but then was eventually released to a family member, to a guardian, and so they may have gone through that system. And they still, you know, may be fighting their immigration case before the immigration judge, even though that, you know, they've been released or, you know, whether they're being held by the Office of Refugee Resettlement or if they're released, their court case is ongoing. So that's that the Office of Refugee Resettlement only has to do with kind of their custody and who's holding them. So within the Department of Justice, as I mentioned, the immigration court system is there. Immigration judges are lawyers appointed by the Attorney General, so this is not a regular federal court as we imagine them. This is, it's an administrative court, so it's part of the executive branch of government, and they fall under the direction of the Attorney General. Sometimes these immigration judges, oftentimes they've had service in the federal government before. The most common kind of background that many of these judges have had is actually being a trial attorney, so being those government prosecutors in the immigration cases. If an immigrant loses their case at that immigration court stage, they do have the ability to appeal their case and have it heard by the Board of Immigration Appeals, that's the kind of appellate body, and, you know, this, I realize this may be a little bit too much law, but, you know, just so people are aware, the Attorney General actually has oversight over the Board of Immigration Appeals, and so the Attorney General can actually write case law in the immigration world. They have authority to do that, and, in fact, the Attorney General Sessions, before he retired, was quite active in kind of certifying cases as important precedential cases and then writing case law in order to restrict their protections that asylum seekers are able to obtain. If you lose your case at this Board of Immigration Appeals stage, people can also appeal sometimes to an appellate court in the federal system, so the Court of Appeals, and then very important cases could then be appealed even to the Supreme Court, so that's kind of the life of someone's immigration case. I want to go over a little kind of general terminology because this may come up. Sometimes applications are affirmative. That means that someone is not in what we call removal proceedings or deportation proceedings, so those are those court proceedings that happen in immigration court. If that's the case, they can apply for benefits before the immigration agency. Again, it depends on what the type of benefit is, but we call that an affirmative application, and so if there's a forensic evaluation for a patient in this scenario, they're just going to have kind of a paper filing. They're going to ask for this paper report and maybe the CV or resume of the person who conducted the evaluation, and they're going to submit that to the immigration agency via paper, and that's going to be the end of it. There's not a court proceeding attached to that where people give testimony, but if it's a defensive application, if it's a defensive, in particular, if it's a defensive asylum application, people are seeking the protection and the person who makes the decision is the immigration judge, so it's not one of these asylum officers. It's an immigration judge, and in those types of hearings, it's possible for the person who wrote the forensic evaluation to potentially be called as a witness and to answer questions. That doesn't always happen, but that's something certainly that could happen. Immigration courts are different than federal courts. The rules of evidence, which you're probably not very familiar with, but those very formal rules don't apply in immigration court. It tends to be a much more informal setting. They have a very kind of general rule that the proceedings are supposed to be fundamentally fair, but any kind of credible evidence can be presented. So forensic evaluations, it's usually very important that we have the CV or resume accompanying the evaluation so it's clear with the educational credentials and background of the person who conducted it were and that it's appropriate. If someone's going to testify, they may have to answer a few questions to make sure that they can be certified as an expert, so that's a little bit similar to what might happen in a state or federal court if you're familiar with that. Although often, because it's an informal proceeding, you'll have both sides just kind of agree that there's enough kind of educational background and information that it's clear that this person is an expert and can speak to whatever findings that they made. So in the immigration court context, in addition to having some kind of written evaluation occasionally, if it be particularly helpful for an asylum case, someone might be called to testify. So that's one of the differences. Sometimes people are in removal proceedings and they're applying still before USCIS and that's because, as I mentioned, there are certain types of applications that the immigration court doesn't have the right under law to decide. So U visas and T visas, those always have to be decided by the immigration agency. At the same time, the person might be in deportation proceedings, so that's something that's important to know. So I'm going to now move on, you know, I know that's a lot of information, but you have now a kind of broad sense of who the players are in the immigration system and how there might be a case before an immigration agency or it might be before the immigration court. Now we're going to talk about what are those applications? What are these types of humanitarian immigration applications that people may be applying for? And it's great that many of you are already familiar with some of these. So there are many, many types of immigration applications that have different types of outcomes with some immigration statuses. So if you get awarded the protection, you might have the permission to stay in the United States. It might give you permission to work here lawfully. Some statuses don't give you those things, but they're just a stepping stone. If you get this type of visa, then it's a pathway to applying for lawful permanent residence or what we call a green card. So today we're going to focus on immigration applications that some of these have different types of outcomes and I'll talk about what those outcomes are. And we often refer to these immigration applications together as a group as the humanitarian immigration applications. There are other statuses based on having a family member with lawful permanent residence status or based on having lived in the U.S. for a long time. There's a full kind of alphabet of visas from letter A through V that we're not going to talk about, but occasionally some of these other types there might be something important in having a forensic medical exam. But these are the most common types of applications where it's really needed or quite useful and they're all based on kind of harm that someone suffered and so we refer to these as the humanitarian immigration applications. So I imagine everyone's heard of asylum and you know we hear about in the news all the time. There is a related protection called withholding of removal. I'll talk about those two together, but generally these are people who are fleeing persecution and as you heard in the definition earlier it's because of a very specific reason race, their religion, their nationality, their political opinion, or their membership in a particular social group. Often someone may also be applying for a protection under the Convention Against Torture which is when someone fears torture at the hands of their country's home government or at the acquiescence of the government that they're going to be tortured by a non-state actor but the government has acquiesced to that. You know often it's important in a case like this for example someone may have been tortured in the past and that's going to show that if they're likely to be tortured in the future they may have specific scars because of how they were tortured. They may have scars you know on the bottom of their feet if they were whipped there, they may have burn marks. My clinic represented a gay Egyptian man and the security forces had kind of had forced his hands into boiling water and so he had these very particular scars on his hands and he had suffered kind of all sorts of you know very specific physical assaults as well and so we were able to get a forensic evaluation in that case where the physician documented the scars that he had and as well as his narrative about what he remembered and described how these marks were consistent with what was presented and with a narrative and it was you know very powerful. U visas as many of you may know those are for survivors of serious crimes. It may be sex abuse, a serious assault, domestic violence, rape, false imprisonment, trafficking, stalking, blackmail, extortion, witness tampering. There's a more than two dozen enumerated crimes that come under the U visa and it has to do with people who are not only victims to this crime but then are helpful to law enforcement in investigating the crime. T visas are specifically for severe victims of severe human trafficking. SIDJ stands for special immigrant juvenile status and this is for children who can't be reunited with at least one of their parents due to abandonment, abuse, or neglect and also a state court has found it's not in their best interest to return to their home country. So this might be this might have been that there was harm in the US or it might be harm in the home country. So it doesn't matter for this type of status like where the harm happened it's just the fact that the child cannot reunify with one of the parents because of the abuse, abandonment, or neglect. And then lastly I'm going to talk about VAWA protection for survivors of domestic violence if the domestic violence is being committed by a US citizen or lawful permanent resident and and that person is a spouse, the child, or the parent. I'm just going to pause briefly because there's a very short question that's related to the immigration court system which I was just talking about asking if there are immigration courts in every federal courthouse across the United States. That's not how immigration courts are structured. They're not inside the the Court of Appeals or the district courts of federal courts. You know they might happen to be in that same building but there are a couple hundred immigration courts in the country. Some states have no immigration courts. So for example I teach at Tulane Law School. We're in New Orleans. There is an immigration court here in New Orleans but because there's no immigration courts in the state of Mississippi anyone who's arrested in the state of Mississippi has to travel to New Orleans to go to immigration court. So there are there are some states that may have no immigration court. There are some states that may have you know three immigration courts. So it's not it's not related to the the federal judicial system at all. The the Department of Justice has kind of decided where they think these courts need to be and then it's decided who has to go to which courts. And then there are specifically the detention courts. There are courts near to detention centers so that people who are being detained during their whole immigration proceedings have to go to those courts. So now I'm going to spend a minute talking more specifically about these types of humanitarian applications. I'm first going to focus on asylum, withholding of removal, and convention against torture or CAP protection, because often someone may apply for all three of these at the same time. It's the same form, the immigration form, that they fill out, and so there is a lot of overlap, although there are some very significant differences that I'll talk about as well. I mentioned to you earlier the difference between affirmative and defensive applications. So asylum in particular can be applied for affirmatively or defensively. So someone could be before the asylum office affirmatively applying for asylum, and they're going to have their case heard, and it's actually an office, you know, that they're interviewed in. It's a much more informal setting. There's someone just sitting across the table asking them questions. There's no prosecutor that's trying to poke holes, necessarily, in their case, although the asylum officer, you know, is supposed to kind of fully investigate all the parts of the claim. But folks who are in immigration court, defendants in immigration court, they're applying defensively, and immigration court's the only place that can consider the withholding of removal and CAT claims. So asylum officers aren't allowed to make decisions about that. Asylum officers in those affirmative applications can only grant or deny asylum. If they deny asylum, then the case generally goes to the immigration court, and then an immigration judge will review the case de novo. That means, you know, just from the start. They don't have to rely on anything the asylum officer decided, so they have their own hearing and can receive more evidence, but that judge also has the ability to make decisions about these two other types of immigration relief. Asylum, as I'll describe in a moment, is the most protective form of relief. It's the most beneficial of these fear-based forms of relief. You get the best benefits out of it, but usually someone will apply for all three because if they get denied asylum, they still don't want to be deported, so they want to be able to stay either because they're granted withholding of removal or CAT. You know, for example, the man that I mentioned before, he was only eligible for CAT protection because he had a criminal conviction that made him ineligible for asylum or for withholding of removal. So he only applied for CAT, but there are many clients who are able to apply for all three. I also represented a Tibetan woman who was living in India. She was an actress. She had made a movie about Tibetan rights. She had participated in kind of Tibetan cultural practices, and because of this kind of political art activism, the Indian police came after her. They threatened to deport her and remove her to China where she might be imprisoned. She was assaulted, and she ended up successfully winning asylum. She would have been eligible for withholding of removal and CAT as well, but the judge didn't need to decide those alternative forms of relief because she was granted asylum. In that case, we also had a forensic examination that documented the scars and physical harm that she suffered, and that was critical to her case. So let me talk a little bit about some of the differences between asylum, withholding, and the Commission Against Torture Protection. It's important to know that asylum is discretionary, so that means even if you meet all of the requirements, the immigration judge or the asylum officer doesn't have to grant it. If there's something that they don't like about the applicant, they can use their discretion and deny the case based on that. So particularly if there are some bad factors, but they aren't factors that bar the application. So for example, it's common that asylum seekers have suffered a lot of past trauma. They may end up kind of self-medicating. They may end up drinking or using drugs. They may have arrests, not even convictions. That might be used against them as a negative discretionary factor, and the judge could decide that I'm not going to give asylum to this person because I don't like what I see here. That's not true for withholding of removal and for Commission Against Torture Protections. If you prove all of your elements, the judge has to grant them. So there are differences, though. It's actually harder to prove the withholding in CAT cases. So I think the burden of proof is more likely than not. So for withholding of removal, you have to show it's more likely than not that this person is going to be persecuted, and it has to be on the basis of a very specific reason. With torture, you have to show it's more likely than not that they will be tortured in the future by the government, whereas for asylum, it's that there is a well-founded fear of future persecution. And one court held that that might be less than 10%, so it's definitely much less than more likely than not. The best way of proving harm is usually because something has happened in the past to the immigrant that they have been harmed in the past, and therefore it's likely to happen again. And that's why forensic exams and evaluations can be so helpful in these cases. It's so important to show that. You'll see for both asylum and withholding of removal, it doesn't matter only that you're going to suffer this harm. You have to show that, but you also have to show why you're suffering the harm. If it's just general civil strife, if it's a random form of violence, no matter that you almost died or that family members have been killed, if it's random, then you will not be granted asylum. It has to be because of race, religion, nationality, political opinion, or a particular social group. Convention against torture protection, that's not needed. There doesn't have to be one of these specific reasons. If the government is likely to torture you, that's sufficient to ensure that you're going to be protected. So there are, as I mentioned, asylum might be decided by an asylum officer or it might be decided by the immigration court. It says EOIR because that's the government agency that the immigration court, their official title stands for Executive Office of Immigration Review. But withholding and cap protections are only before the immigration court system. Only a judge can decide that. There are different bars, and I'm going to talk a little bit about what those bars are. Asylum has the most bars. So even though the burden of proof is lower, you might be knocked out from even being eligible to apply for asylum for a number of different reasons. But it has the best benefits, as I mentioned. And so with asylum, you can not only get status for yourself, but you can get status for an immediate family member and a derivative. So if you have a child, your child can be granted asylum. If you have a spouse, the spouse can be granted asylum based on the fact that you were granted asylum. You also have then the ability to petition for family members. So say you have a family member who is overseas. They weren't here in the United States. You can petition for them to be able to enter the country. And then as they enter, they'll also have that asylum status. After one year of being an asylee, you are eligible to apply for lawful permanent residence. So you can be a green card holder, and that's a pathway to citizenship as well. As an asylee, you can actually travel outside the United States. You can get a refugee travel document. You have permission to work. That's what EAD means. It's an immigration kind of acronym, but it has to do with being able to legally work. So it's not as good to be granted withholding a removal or a CAT, although sometimes people are often very grateful to have that, because at least it's protection from not being sent back to where they fear being persecuted or tortured. So the major differences are that you're basically not allowed to travel. If you leave the country and have withholding or a CAT, the U.S. is not going to allow you to come back in. You have permission to work, but you're going to have to renew that permission every year. And you don't have any other kind of status. So you're not on a pathway to lawful permanent residence. You're not on a pathway to citizenship. And you don't have the ability to get status for your family members. So if you are a mother of a small child and you traveled here to the United States together and you're denied asylum, that's a pretty big deal, because now even if you're granted withholding of removal, your child is not granted that status. They don't have any status. So that's a major difference and one of the ways that these other forms of relief are really inferior to asylum. So I'm going to talk a lot about the harm aspect, because that's really where forensic evaluations come into play. Persecution is the type of harm that we have to prove as lawyers for asylum and withholding of removal, and it has a very specific legal definition. Not all harm is enough. So just being physically attacked, that might not be enough. Just being detained in a government prison, that might not be enough. It's going to depend on how long it was and what the conditions were. So the judge or the asylum officer is going to decide if the immigrant has met their burden under the law to show that the harm that they fear or perhaps the harm that they already experienced meets that definition of persecution or torture. So this is a really critical place where collaboration with nurses, psychologists, social workers, as well as doctors, this is really where the rubber hits the road in these cases. If they can conduct forensic and mental health evaluations, that can help prove that the harm happened in the past. It can help prove the severity of the harm, and that in turn can prove that there will be future harm, which is one of the central elements to these types of cases having to prove that harm. Evaluations are often the best type of proof where it's explained exactly how the evaluation was conducted, what all of the symptoms are that are present, if there's a documentation of what physical scars or what other conditions are present. That kind of thorough evaluation is often the best type of proof. But even, frankly, medical letters explaining what records exist or briefly what kind of conditions exist, even those can be quite helpful if it's not possible to obtain an evaluation. So there are different types of evidence, varying levels of evidence that can be quite helpful. I'll give you an example involving asylum. I represented a Somali woman who was forced into a marriage. She suffered a very severe form of female genital mutilation. She was sexually assaulted and harmed by her husband. She also came from a political family, and she was raped by the political opponents as kind of a political act. And she was terrified, unsurprisingly, about going back to Somalia, and she had a number of reasons for being terrified. When she came to the U.S., she started getting regular medical treatment for both the physical harm she suffered as well as psychological harm. She was diagnosed with major depressive order, severe PTSD. She had a procedure done to kind of undo the FGM that was done to her that she had suffered. We had an evaluation done which documented the FGM. That is a type of persecution, so that proves that there was a type of harm. It's also a basis for claiming asylum based on a particular social group. So it also went to another type of claim, and so we had really important documentation about these two different legal elements. It also included information about the past sexual assault, which is a type of persecution under the law, so it was really, really critical evidence. It also included mental health symptoms and a diagnosis, which went to proving harm as well, because psychological harm on its own sometimes can amount to persecution. That's very hard, but also cumulatively, along with the physical harm, it can count as persecution. You can see how the evaluation can really be critical to prove that there was persecution, the severity of the persecution, or torture, as well as going to other elements in the case. A few other factors that are really important in asylum cases and withholding of removal cases, and that are really relevant to these types of examinations. One of the biggest pieces of evidence is often the immigrant's own testimony about what happened to them. Credibility and corroboration are really important. Courts have found that corroborating evidence, like a forensics exam, can bolster the credibility of an applicant, so it can actually prove someone's case. If someone seems like they might not be credible to the judge, and often, unfortunately, the judge may make decisions based on not understanding the effects of trauma. Someone may have some difficulties remembering certain parts of the harm that they suffered, and that may have to do with trying to block out those harms. They may have an affect that the judge thinks is not appropriate in talking about that harm, but in fact, it may be quite appropriate with someone with the appropriate kind of training and understanding trauma. So having an exam can really address those issues of credibility. It can actually identify the affect and kind of how that interrelates, but also just kind of documenting the physical harm can literally ensure that someone is found to be credible and all of that evidence of their testimony is able to come into the case. Additionally, for asylum cases, applicants are required under law to reasonably corroborate their cases, so they're supposed to show other evidence that proves the other elements in their case. If it seems reasonable that other witnesses, if family members witness what happened to them, then the government may require that they have statements from those witnesses, that they have corroboration. If you can't get that corroborating evidence, then under the law, you're supposed to show why it wasn't reasonable for you to get that evidence, so you can testify to that. So the evidence might be statements from other people. It might be arrest warrants if you were a political dissident who was arrested. It might be hospital records if you were hospitalized as a result of some of the harm. But again, forensic evaluations are a type of corroboration. They may corroborate multiple points of the testimony, and so it can help satisfy that legal element. It's really, really critical. And then, as I've kind of mentioned earlier, asylum is discretionary, so it's important to show positive discretionary factors, particularly if there are some negative factors at play. So having a forensic exam documenting the severity of some type of harm, that's actually considered a positive discretionary factor. It's a humanitarian factor if you have suffered a great deal of past harm. And so that evaluation can go to this legal point as well, to the discretion. So lastly, one issue I mentioned, you know, sometimes people aren't eligible to even apply for asylum. One of the ways that people often are denied asylum is because they've missed what's called the one-year filing deadline. You're supposed to apply for asylum within one year of entering the United States. And you're supposed to prove that by clear and convincing evidence that you did apply within one year of your entry. There are two exceptions that you still may be able to get asylum, even if you didn't apply within one year. One exception is called change circumstance, so that's that there are some changes in the home country or changes in personal circumstances that materially affect your eligibility for asylum. So for example, if someone's claiming asylum based on their sexual orientation, but they didn't come out until quite recently, and that's what made them really more at risk for persecution, that can be considered a change circumstance. You know, what if you're claiming asylum based on having HIV and the way that HIV positive people in your home country are targeted, and you've just been diagnosed with it? That's a change circumstance. So you can be excused for the one-year filing deadline. You still have to file within a reasonable period of time after that change circumstance occurs. So it's very common for a forensic evaluation to document or somehow bolster a legal argument around an extraordinary circumstance. So as you can see here, factors that might be considered an extraordinary circumstance is a reason why you weren't able to file on time. So it could be a serious illness. It could be mental or physical disability. It might be because of the trauma that you've suffered, and that's made it impossible for you to file on time. It might be that you're a child. There's a legal disability. It's also considered an extraordinary circumstance if you are in a different type of lawful immigrant status. So there might be someone here who has been in a student status for many, many, many years. So they didn't feel the need to apply for asylum because they were in a student status. But as their term is coming to an end, they realize they're otherwise going to have to return to the place that they fear persecution. So they can still apply for asylum while they're maintaining that lawful immigrant status, even though they may have entered many, many years in the past. So, you know, often someone may miss the filing deadline by a few months or by a year, maybe two years. It's very common to miss it by that amount of time and still try to fall into one of these exceptions. I once represented a Somali man who had missed the deadline by 20 years, so it's a very kind of unusual case. Most people would say that he has no possibility of being eligible for asylum. In fact, lawyers he had met with before told him he was not going to be eligible for asylum. But we were able to win the case and we had a legal theory that really explained how there was a combination of extraordinary circumstances. He had been on a student visa, but he was a torture survivor and because of the trauma, he fell into alcoholism and that became very severe. He became homeless because of that. His health deteriorated a great deal. He had untreated diabetes. He had a number of medical conditions that actually led to his blindness. He almost died from a heart attack. So he had so many health factors going on. And we were able to work with medical professionals who could piece together his medical history and document it. They were able to create an evaluation. Once he was being treated, we were able to obtain those records as well. And that was critical in showing the series of events that were really unending. There wasn't a time that it was going to be reasonable for him to apply during that time in his life. So again, a really critical piece of evidence. The forensic exam may also be important to an alternative theory of asylum called humanitarian asylum. So as you learn from the definition, you have to have a well-founded fear of future persecution. There's one exception. Sometimes you don't have to have a future fear of persecution. If you've proved that you have been persecuted in the past. So sometimes someone has been persecuted in the past. Say they were in a political minority. They were being persecuted by the ruling government. They fled, came to the United States. And then there's a regime change and suddenly the party that they're affiliated is in power. So they perhaps don't have a well-founded fear of future persecution because now the people in power are the people in the same political party as them. They still may be eligible for asylum because U.S. law has said if they have suffered so severely that they should be granted in the interest of the public interest and humanitarian needs, then they can be granted asylum. There's a separate exception. You could show instead that they might suffer what's called other serious harm if they have to go back to their country. So this could come up in a number of ways. So as I mentioned, it might be that they've suffered so greatly, the evaluation shows that level of past persecution. Or if with other serious harm, it might be unrelated to the trauma they suffered. And then it might be unrelated to their medical condition. So I had a case of a Rwandan woman who was politically active against the state and we had argued for humanitarian asylum based on other serious harm because he had a severely disabled daughter who was going to suffer and not be treated if he and his daughter were returned to Rwanda. And so we had medical records and a medical exam of the daughter that was related to his grant of asylum. So now I'm going to kind of, you know, I spent the bulk of the time talking about asylum. We're going to talk really briefly about these other forms of relief. So U visas are for people who have suffered serious crimes and are helpful in the prosecution or investigation of the crimes. A U visa is going to give someone, if they're granted permission to stay in the United States, work in the United States, a pathway to a green card. It's also great because family members can get this benefit as well. They can petition for them as well. And so the way that this usually relates to a forensic medical exam is because we have to prove that the victim of the crime was substantially, suffered substantial physical or mental abuse relating to the criminal activity, which results in impairment of emotional or psychological soundness. And in determining if it's substantial, the immigration officer is going to consider the nature of the injury, how severe the conduct was, how severe the harm was, how long it lasted, and if, you know, there are lingering or permanent effects as well as their health and their kind of general mental soundness. If they have some underlying condition, aggravating that pre-existing condition can be considered in that type of harm. So for example, you know, I represented a woman who was suffering pretty horrific domestic violence. That's a U visa crime. Her partner, you know, beat her. She was sexually assaulted. He even took a knife to her throat and she had a scar along her throat. She reported it to the police. They certified her as a crime victim. And so along with kind of her testimony and police reports, we included a medical report and an exam that showed the physical harm that she suffered, that she had these kind of longer lasting scars and that they were the result of this attack. If someone has also suffered mental harm, PTSD, if that's documented as well, that can also support the claim. I represented a different woman related to a domestic violence claim. And the crime was actually she was just pushed. Her partner pushed her. She was pregnant at the time. And so from a single assault like that, it seemed like it might be hard to show substantial physical or mental abuse. But she had preexisting harms. This wasn't just an isolated event. She had been abused for a decade by him. And so this was kind of one more incident that contributed to both physical harm as well as psychological harm. And the fact that she was pregnant and concerned about the health of her future child also added to it. And so having documentation related to that was really critical. Lastly, in a Eubie's case and in other types of cases too, which I'll mention briefly, sometimes someone might have what looks like it's going to be a bar to their application and they can apply for something called a legal waiver. But they have to show that it's going to be in the public interest. And so again, demonstrating the severity of the harm, having a forensic exam can be helpful to that kind of legal element in the case. So often when we talk about Eubie's, we talk about T visas because they're very similar types of immigration applications. But T visas are only for the crime of human trafficking. So people who have suffered either a severe form of labor trafficking or sexual exploitation. We have to show that they would suffer extreme hardship involving unusual and severe harm if removed from the United States. And so that might have to do with harm that's both because they've suffered physically or psychologically. I worked with a group of Indian gas workers who were working with a company called Signal Corporation. They ended up being able to obtain trafficking visas based on what was happening to them. They were being crammed into these trailers, which reeked. There was like one toilet for two dozen men crammed in this small trailer. They were often forced to eat spoiled food. Their lodging and food was deducted from their wages. If they got sick and couldn't go to work, that was deducted from their wages. Their passports were taken away from them. They were restricted from traveling off site. Their belongings were regularly searched. And so they were falling deeper and deeper into debt. So in some ways it didn't look like a traditional trafficking case, but in fact they were being trafficked. Their wages were an illusion because they were taking away all of the money from the wages to pay for this spoiled food and terrible accommodations that were making them sick. And so medical records can show what their health was like. One of their co-workers attempted suicide and others witnessed that and that had an effect on their well-being and on their mental health. So again, forensic evaluations are kind of critical in being able to document that type of harm, as well as being able to show that they deserve this positive exercise of discretion and if there are any waivers that they should be granted those as well. SIJ or Special Immigrant Juvenile Status is that child protection that we mentioned briefly. It's for children who've been abandoned, abused, or neglected by at least one of their parents and reunification is not viable and that it's not in their best interest to be returned to their home country. This was kind of the case that I did them most often of in my first years of practice. I worked at a youth center, represented children who had all sorts of harm. I represented a girl who was a survivor of incest at the hands of her dad. She was in foster care. So that was the harm that was suffered. Also a child who never knew his mother, so he was abandoned as a toddler and reunited with his father. In these types of cases, there actually is a state court action. So the state court has to make the finding that they've been abandoned, abused, or neglected before an immigration agency will be able to determine if they can get the visa. So that's a requirement. Sometimes the evidence is really important for the state court to be able to make those findings because they sometimes don't want to make the findings based just on the testimony of the child or of other witnesses. This SIJ is a pathway to lawful permanent residence. SIJ itself is not discretionary but lawful permanent residence green cards are discretionary. So having documentation of mental and psychological harm can be really helpful to show positive discretionary factors and also if there are any waivers. And it can also sometimes go to this issue of best interest to not return to the home country if you can show documentation of the harm and a narrative from the child regarding kind of consequences. I represented a kid who had lived with his parents in his home country. They had taken him out of school. They were living in poverty but he had a heart condition and severe lung issues but he was forced to work long hours. He was coughing the whole night and in pain and was never taken to see medical professionals in his home country. When he got to the U.S. they kind of realized the significance of his health issues. And so he was reunited with an uncle and able to go through guardianship proceedings. The court found that he was neglected but again the medical evidence was really critical for them to be able to make that finding. So lastly, the last type of protection is the Violence Against Women Act. And similarly you have to show a form of harm. It's called extreme cruelty. There's a few different types of protections for people seeking protection under the Violence Against Women Act. And so usually you're showing extreme cruelty and one type of protection you have to show extreme hardship. But this was created because the general way that an immigrant gets status through the family process, so through a spouse or through a parent or through a child, is that the person with the immigration status, the citizen or the lawful permanent resident, has to petition for their immigrant relative. Well what happens in situations of domestic violence? Well the immigration status is going to be used against the victim. It's going to be one more tool in the perpetrator's hands to exert power over them. And so VAWA was passed so that immigrants could petition for themselves when they're the spouse, child or parent of a lawful permanent resident or of a U.S. citizen who's abusing them. So again you can imagine how the medical evaluation can be quite critical for forensic evaluation to show the harm that's suffered and that in fact the person did suffer extreme cruelty which could involve psychological abuse. It can involve physical abuse, sexual abuse as well as kind of forced detention. So, you know, lastly I just kind of included this case study so that you could see that sometimes there might be an immigrant who has multiple types of immigration relief that they're going to seek. This is a case of Rima. She's Yemeni. She was 16 when she was forced into a marriage with a U.S. citizen. She was sent to the U.S. She thinks that her mom actually received money because of the marriage and was forced to leave. When she gets to the U.S. her husband won't allow her to leave the house, forces her to perform sexual acts against her will, physically assaults her. And so and she's suffering psychologically as well in addition to medically. She sees a hotline number. She calls it. And she's also afraid of being deported because she knows what happens to girls who have been forced into marriages like herself. And so this is someone who could be eligible for asylum, withholding of removal, special immigrant juvenile status, a U visa or a T visa. And so, again, that piece of evidence, that evaluation would be helpful in all of those cases. Thank you. All right. This is Amanda again. I feel so honored that Professor Halas agreed to help us open up this type of training to our nurses. Her expertise is just invaluable. Immigration is such a small legal specialty in the United States. And in my personal experience, I've always had cases with pro bono lawyers where that's just not their expertise. So it's so important to be educated on the legal foundation for this type of work. If you're anything like me, after listening to this, your brain is sort of turning, going over what these exams actually look like and what your report might look like. And luckily this is really well researched and standardized by the United Nations. So this whole webinar series is founded upon the recommended training content from the Istanbul Protocol. So this was originally published in 1999 and it was developed over the course of three years by a team of 75 forensic doctors, different physicians, psychologists, human rights monitors, and lawyers representing 40 organizations from 15 different countries. So just to give you a little snapshot, the manual includes a comprehensive set of guidelines for clinical exams to detect the physical and psychological evidence of torture and ill treatment. It also includes relevant international legal standards, ethical codes, and provides guidance on the legal investigation of torture. This guide is something I think every forensic nurse examiner should have a copy of in their office. I reference it regularly, especially when I sit down to write an affidavit. Again, we'll send out a copy to you after you complete the course evaluation, but I really encourage you to parse through it before we do the next webinar. In part two, which is going to be, I think, on December 11th, we're going to review the clinical interview, the psychosocial interview, and considerations for vulnerable populations, including those in detention specifically. And that's going to be with Dr. Altaf Saeedi, who's a practicing neurologist and fellow with the National Clinician Scholars Program at UCLA. So she recently participated in a Human Rights First tour and participated in that report on immigration detention facilities in the United States on their southern border. In part three, we're going to review the actual physical exam, and we're going to go over different torture methods and their physical consequences, looking at injuries over the course of years. And that's going to be with Dr. Mary Jo Fink, who's the Medical Director of the Human Rights Initiative at Columbia University Medical School. She's also a longtime evaluator with Physicians for Human Rights. In part four, we're going to review the evaluation of female asylum seekers, talk about gender-based violence, and do an in-depth training on general mutilation with Dr. Deborah Oppenheimer. She's a New York-based OB-GYN and evaluator with the Icken School of Medicine Human Rights Clinic at Mount Sinai and the WHEEL, I think I'm pronouncing that, Cornell Center for Human Rights. And she specifically works with women with general mutilation, domestic violence, and sex trafficking applications for asylum or other protected status to the United States. In part five, we're going to be with Professor Velasquez again to review writing a medical legal affidavit and providing expert oral testimony in immigration courts. I know we're running out of time. We're going to go to the next slide here. This is just a little bit of a teaser. The Istanbul Protocol covers general considerations for interviews and exams and covers the physical and psychological evidence of torture. The thing I think many forensic nurses might be really interested in is this diagnostic rubric included in the Istanbul Protocol. In my criminal forensic practice, I rarely, if ever, discuss an acute entry in sort of absolutes or as a diagnostic tool in isolation of any other evidence, even when I sit as an expert. But the IP diagnostic rubric asks the medical forensic examiner to rate the consistency of injury with the story covered in the interview. And usually, these are non-acute injuries. So I'll let you just sort of peek at the rubric now. So you can start really thinking about this in the back of your mind during the future webinars and really encourage you to take a look at the original document before we go into the next few webinars. Thank you so much for taking time today to participate in this webinar. I think we'll maybe open it up for questions. We have a few more minutes left, I think. Yes, it looks like there was a question. There will be a separate registration for each segment. Sarah, that might be a good question for you to answer. I know our next session is on December 11th at 1 p.m. Is that correct? That's correct, Eastern Time. Okay. And they'll open the registration soon. All right. Any other questions? Well, I want to thank you so much for that fabulous presentation. And thanks to all of you for joining us today. Remember to look for the follow-up email from us in the next few days. You can always reach out to us at elearning at IEFN.org if you have any questions. Thank you again for joining us. And thank you, Amanda and Layla. We really appreciate it. Thank you. Thank you.

Medical Forensic Examinations

Asylum Seekers

Forensic Nurses

Legal Framework

Immigrant Victims

Department of Homeland Security

Department of Justice

Asylum

U Visa

T Visa

Forensic Evaluations

Court Testimony

webinar

Istanbul Protocol

documenting torture

agencies

humanitarian immigration applications

persecution

healthcare professionals

evidence collection