Primary care providers who evaluate torture survivors often lack formal training to identify and address their specific needs. We assessed 89 asylum seekers from 30 countries to evaluate the pattern, spectrum, and presentation of abuses and the outcomes of the medico-legal process of seeking asylum. Commonly reported reasons for abuse were political opinion/activity (59%), ethnicity (42%), and religion (32%). The most common means of abuse were punching/kicking (79%), sharp objects (28%), genital electric shock (8%), witnessing murder/decapitation (8%), and rape (7%). Persistent psychological symptoms were common; 40% had post-traumatic stress disorder. The high success rate of asylum approval (79%) in this sample highlights the need for physician witnesses trained in identification and documentation of torture, working in collaboration with human rights organizations.

The immigrant health curriculum was useful for residents. Multiple teaching modules, collaboration with grassroot organizations, and an ongoing clinical component were key features.

A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.

Varying dimensions of social, environmental, and economic vulnerability can lead to drastically different health outcomes. The novel coronavirus (SARS-CoV-19) pandemic exposes how the intersection of these vulnerabilities with individual behavior, healthcare access, and pre-existing conditions can lead to disproportionate risks of morbidity and mortality from the virus-induced illness, COVID-19. The available data shows that those who are black, indigenous, and people of color (BIPOC) bear the brunt of this risk; however, missing data on race/ethnicity from federal, state, and local agencies impedes nuanced understanding of health disparities. In this commentary, we summarize the link between racism and COVID-19 disparities and the extent of missing data on race/ethnicity in critical COVID-19 reporting. In addition, we provide an overview of the current literature on missing demographic data in the US and hypothesize how racism contributes to nonresponse in health reporting broadly. Finally, we argue that health departments and healthcare systems must engage communities of color to co-develop race/ethnicity data collection processes as part of a comprehensive strategy for achieving health equity.