The medico-legal evaluation effect: Asylum grant rate in the metropolitan city of Milan

The Istanbul Protocol (IP) defines standards and procedures in relation to torture. The main body of the protocol relates to medical and psychological examination of the torture victim and to the writing of a medico-legal opinion in those cases. In a refugee situation, the proof that a person suffered persecution and torture in his country of origin or during his journey represents an important piece of evidence in the application process for asylum. Based on our experience, we analyze the asylum grant rate among asylum seekers receiving medical evaluations, in order to identify predictors of grant status. In Milan, local authority and the academic Section of Legal Medicine, have assembled a team, composed by experts in clinical forensic medicine, ethno-psychiatry, psychology and social workers, with the task of examining asylum seekers. After the evaluation, the Territorial Committee, comprised of civil servants, will determine the positive or negative outcome of the asylum application. We compared medico-legal reports, given according to the IP, and judgements from the Committee. Raising the level of consistency between refugee's narrative and analyzed scars, the percentage of subjects with a positive response increases. Furthermore, the positive outcome depends on the type of reported trauma, especially gunshot victims. In addition, both the number and the co-existence of different types of lesions play a role: the larger they are, the more favorable judgment is obtained. These data show forensic assessment may have a relevant weight on the final judgment given by the Committee, but there are still open problems: – the need for more detailed analysis on these subjects during the examination, maybe using imaging, – an implementation of the IP could allow physicians to increase the grade of consistency, – introducing health professionals, “expert in migrations and torture”, as members of the Committee, could help to empathize the physical and psychological effects of trauma on applicants, – organizing a follow-up program for refugees after the Committee judgmen