UNITED STATES DEPARTMENT OF JUSTICE

EXECUTIVE OFFICE FOR IMMIGRATION REVIEW

Arlington, Virginia

In the Matter of the Application for Asylum of G DOB: April 16, 1981
Race/Ethnicity: Eritrean, Tigrinyan ethnic group
Email/cell:
Date and Time of Exam: 8/15/2012, 5-8PM
Location of Exam: Bread for the City Clinic, Washington DC
Exam circumstances: clinic exam room
Referring entity: Alan Parra, attorney
Name of interpreter: Language Line
Informed consent for full exam given, including use of photos
and communication with attorney: yes
Gender concerns with physician: no

Examiner Name: Dr. Coleen Kivlahan

Qualifications:

1. I am an American physician licensed to practice medicine in the States of Arizona and

Virginia, working at Association of American Medical Colleges as Senior Director of Health
Policy. I volunteer in family medicine/immigration health at the J. Schmidt Free Clinic in
Herndon, Virginia with diabetes/hypertension in uninsured adults, as well as perform asylum
evaluations in that clinical site.

2. I am a graduate of the Medical College of Ohio at Toledo and completed residency in

Family Medicine at the University of Missouri School of Medicine, Columbia, Missouri. This
internship and residency provided extensive experience in history taking and physical
examinations in adults and children including psychosocial evaluations, evaluating and treating
medical and psychiatric conditions as a routine course of care. I am board certified in Family
Medicine, a specialty with recertification boards mandated every six years. In 2004, I recently
was recertified until 2014, and have been continuously, since residency in 1980.

3. I was trained in forensic evaluation and performed asylum evaluations at the Marjorie
Kovler Center for the Treatment of Survivors of Torture, in Chicago. I was not employed there,
nor have I ever received any reimbursement for asylum evaluation services. I also completed
specialized training in the evaluation and documentation of injuries in survivors of torture from
the Doctors of the World/Healthright International (HRI) and from Physicians for Human Rights
(PHR). I have trained new physicians in forensic evaluations for HRI and PHR in the years 2007-
2012. I am now performing examinations in association with HRI and PHR.

4. I have additional years of special training in the forensic evaluation of sexual and
physical assault of children and subsequently formed a statewide physician network of experts

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in sexual abuse/assault in Missouri. I trained 300 physicians for more than 5 years. I also led a
program in Missouri to investigate and improve the forensic evaluation of child homicide and
undetermined child deaths. I have performed hundreds of exams of children and adults who
were alleged victims of abuse and rape over the last 20 years. I have testified for both the
defense and the prosecution and have never accepted reimbursement for any testimony. I
have been trained in forensic evaluations by expert physicians, law enforcement officials,
prosecutors and medical examiners.

5. I have worked in volunteer capacities in Guatemala, Mexico, Ecuador, Haiti, Colombia,

Democratic Republic of Congo, Kenya, Sierra Leone, and Pakistan, providing health care to
indigent populations. In those settings I treated adult and child victims of physical and
emotional torture, rape and many women who had female genital mutilation.

6. In my routine practice as a family physician, I provide primary care, preventive and

chronic care for my patients. I consider a full history, past medical and social histories, physical
exam and behavioral evaluation to be part of a routine, comprehensive examination.

I am a volunteer physician, and in this capacity I conducted a medical evaluation of G. Prior to

the interview I read his affidavit. The following delineates my understanding of the events
leading to G’s asylum application as described by him, together with my clinical interview and
examination findings. My evaluations are done according to the standard protocol of the
UNHCR Manual on the Effective Investigation and Documentation of Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment (Istanbul Protocol).

Medical History Prior to the Alleged Torture events

Disability-none
Surgeries-none
Hospitalizations-none
Medications-none
Fertility-has not fathered any children
Mental health concerns-none
Prior abuse-none
Injuries-no significant ones
Illnesses-none
What was life like before his first arrest/detention: “My parents were good to me, I had a good
life, many siblings and I went to school. My father was a farmer and businessman and we were
always financially stable.”

Social History
Alcohol-none
Tobacco-none
Drugs-none
Current living situation-lives alone but near his sponsor in Washington, DC

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 Employment-he has worked in the past in both farming and car/engine mechanic; now
he has a work permit in the U.S. and is going to technical school at Booker T Washington
Education- he attended grade school in Kudobuur, Eritrea, Adi Ugri Secondary School in
Mendefera and graduated in 2000. He then passed the university entry exam and was
scheduled to attend college in 2001
Language- Tigryna, minimal English
Religion-Christian evangelical, he was raised as an Orthodox, but converted to
evangelical faith

Family History
Place of birth- Adi Abraham, Eritrea
Family members- Both parents are alive and members of the Tigrinyan ethnic group and
live in Adi Abraham, Eritrea. He has five siblings, all of whom live in Eritrea. His brother
and brothers-in-law serve in the National Service of Eritrea (brother was injured and
disabled while fighting in the National Service)
Marital status-in 2004, he married A. She lives in Addis Ababa, Ethiopia after fleeing
government officials in Eritrea. No pregnancies or children.

Detention History: At the end of his high school education, G was forced to enter the military
and prevented from attending college. He describes the following: “I wanted to go back to my
family and help them on the farm. I wanted to further my education. I know what life is like as
a fighter, my brother was one. I am not able to do that. I did not want to hurt or kill anyone.”
He spoke with the military officials and told them of the objections of his conscience. Instead of
hearing him, they actually put him in a detention camp for several weeks, he was not given any
rank, nor was he told how long he needed to stay in the military beyond the stated year of
mandatory service. (Eritrea: Amnesty International (AI) has written extensively on military service in Eritrea (AI 21 Dec. 2006; ibid.
Dec. 2005, 15-17; ibid. 28 July 2005; ibid. May 2004 22-27). With respect to the nature of military service, age of recruitment and length of
service, a December 2005 AI report notes that under the national service regulations of 23 October 1995, national service of six months'
military training and 12 months' development service (such as labor on construction projects) is compulsory for all Eritrean citizens aged
between 18 and 40 years, male and female. In late 2004 the upper age limit for female conscription was reportedly reduced to 27 years. There
are also military reserve duties between the ages of 40 and 50 for former EPLF [Eritrean People's Liberation Front] veterans and former
conscripts. National service has been made more military in nature and extended indefinitely as a result of the failure of the border
demarcation process and corresponding fears of renewed armed conflict with Ethiopia. (AI Dec. 2005, 15; see also HRW Jan. 2007; ibid. 18 Jan
2006; US 8 Mar. 2006, Sec. 6.c) With respect to exemptions from military service, the same AI report notes that [t]here is no exemption for
conscientious objectors, whether on account of a principle of religious faith or other conscientious belief or opinion. Jehovah's Witnesses who
have been conscripted ... are detained indefinitely without any judicial process. (AI Dec. 2005, 15; US 8 Mar. 2006, Sec. 2.c) AI reports that
many young people avoid conscription by escaping the country and also that there is a "high rate of defection from national service, despite the
risks of being caught and severely punished" among those within the military (ibid., 15). To prevent young people from avoiding the draft, the
government requires youth who are 17 years old to register for national service for the following year and refuses them exit-permits to leave
the country (ibid., 15). The government's method of conscription includes "round-ups" (AI 21 Dec. 2006; ibid 28 July 2005; ibid. May 2004, 25),
which are known as giffa and involve house and workplace searches as well as road blocks (ibid.). In July 2005 and again in December 2006, the
Eritrean government arrested and held hundreds of the parents and family members of young draft evaders and deserters without charge as a
form of "collective punishment" (AI 21 Dec. 2006; ibid. 28 July 2005; Asmarino Independent 16 Dec. 2006; Awate.com 7 Dec. 2006; HRW Jan.
2007). These arrests reportedly took place in the southern Debub region (AI 28 July 2005; ibid. Dec. 2005, 16; EHDR-UK 22 July 2005), in Tsaida
Kristiyan to the west of Asmara (Awate.com 7 Dec. 2006), in the region of Asmara (AI 21 Dec. 2006) and in the capital city itself (Asmarino
Independent 16 Dec. 2006). The authorities pressured the relatives to either produce the missing conscript or pay a fine of between USD 660
and USD3,500 (AI 21 Dec. 2006; ibid. Dec. 2005, 16; HRW Jan. 2007). Those unable to do so were to be forced to serve in the army for six
months in place of the missing relative (AI 21 Dec. 2006). penalties for "refusal to perform military service," "failure to enlist," "intentional
provocation of unfitness" and "fraudulent evasion of service" range from "simple imprisonment" for six months to "rigorous imprisonment" for
up to fifteen years (ibid., Art. 296-299). Penalties for desertion range from five years of "rigorous imprisonment" to the death penalty (ibid., Art.
300). The US Department of State notes that the government authorizes the use of lethal force against anyone "resisting or attempting to flee
during military searches for deserters and draft evaders," and that deaths were reported throughout 2005 (US 8 Mar. 2006, Sec. 1.a). Human
Rights Watch reports that persons detained for evading national service are often "held incommunicado indefinitely without formal charge"

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(HRW Jan. 2007). Prison conditions are reportedly harsh and include overcrowding, extreme temperatures, solitary confinement, the absence
of sanitation, "starvation rations," hard labor and mental abuse (ibid.; see also US 8 Mar. 2006, Sec. 1.c).
http://www.unhcr.org/refworld/docid/469cd6b83.html)

G transitioned from anxious smiles and good eye contact at the beginning of our evaluation, to
deeply sad and staring off into space, to quiet crying during this part of the history. When
asked about his emotions, he stated that: “When I am talking about these things, I can
remember everything like it is happening right now. I think of my family and what I, and they,
went through.” In the military, he was ordered to work as a mechanic since he had experience
on his father’s farm working on generators. He noted that other conscripts who were
connected to government officials in the ruling party of Eritrea were released from duty and
permitted to attend college. G asked to be released to go to school and complained about the
violation of his basic human rights. He was also prohibited from practicing his faith, Bibles were
confiscated and G saw other conscripts were tortured and killed when caught reading the Bible.
He was quickly labeled by commanding officers as anti-government and a trouble-maker. He
was punished by being granted no leave for years, he was detained, beaten and forced to
assume stress positions for hours. He was put in stress positions multiple times during the
years he was in the military. These included the ‘otto’ position in which he was forced to lie on
the ground with his knees flexed and feet tied behind his back, while his arms were forced
behind his back with elbows flexed. All four extremities were tied together with rope or wire
and then he was suspended in the air for 1-4 hours at a time. (see photo) At that point G laid
down on the floor face down. He flexed his arms behind his back, bent his knees and lifted his
feet up at 90 degrees to his knees. He showed how the rope tied his hands and feet and then
how he was suspended in the air. The other position, they called the ‘almaz’ position, in which
his hands were tied up straight above his head, his feet were lifted behind him and he was tied
to the opposite wall so that his whole body was suspended above ground. He was then beaten
in that position. He watched people lose their fingers and others die in that position. “I have
seen with my own eyes people who died in that position, and many people have become
disabled because of this torture.” He was also placed in the ‘helicopter’ position in which his
arms were stretched out to his sides, and legs pulled to the sides (see drawing).

“From the time I was forced to join the military, I prayed for limited time there and to be able
to go home soon. I never gave that up. I voiced my opinion and told them I needed to know the
total time I would be in. They took that as disobedient. I became even more vocal that life
should be more respected. They told me that they had had enough, then things became even
more difficult for me. They tied me up and they beat my face, head and body.” G’s voice was
shaking and he was crying heavily. He described being beaten with a baton-like instrument that
was part hard rubber and part plastic over iron/steel. “They can hit you with either side. I know
a lot of people who have lost their eyes and others who I watched die.”

In late 2007, after years of this torture, forced labor and religious persecution, he was granted
leave after his father posted bond for him. He went home to see his mother who was sick with
anemia requiring blood transfusions and problems with her vision. I was detained on December
31, 2007 after I had been granted leave to visit my family. He had been hearing about his
mother’s illness but he could not get permission to visit her. G states that he knew that if he

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obtained leave, he was going to defect. He had planned to escape to Ethiopia after his family
visit, but when he was ready to defect, he heard from others that there were too many soldiers
on his escape route at the border and it was too dangerous to attempt. G’s answers to
questions are spontaneous, highly internally consistent, no sign of social desirability or
embellishment and show an appropriate progression of emotion throughout the exam. He
states that his father was encouraging him to escape, “My father said ‘They are going to kill me
one day.” G stated that he knows other conscripts who were killed on their way to Ethiopia.
Because of the danger in escaping, he reluctantly returned to his base but was 10 days later
than his leave allowed. He was made to stand trial in a makeshift court and was accused of
desertion. In order to avoid severe punishment (prison for 10 years), he denied that he was
trying to desert. They tied him in the otto position, beat him repeatedly and kept him in that
position on and off for several days. During the beatings, he admitted to desertion because the
torture was so terrible. While he was beaten, he frequently was wearing only underwear.
There were no episodes of sexual torture or threat. He was held in detention for several
months and interrogated several times. . He was tied in the “helicopter” position and beaten
with a steel rod; and on another occasion he was placed in a small isolation container and lost
consciousness because of the excessive heat. They took him to a hospital for care briefly. He
knew that at any time, the next beating could result in his death. After this, because of
manpower shortages due to conscript escapes, they took him, under armed guard, to work as a
mechanic where needed. G stated that is was like ‘house-arrest.’

He was transferred to a military base near the border of Sudan, and in his mind, he plotted his
escape. One day, he saw an opportunity to run from his workplace across the border. When he
started to run, he heard gunshots all around. He decided “I would rather die here trying to escape
than live in this way any longer.” He states that he kept running despite people being shot at
around him. He looked down at one point and saw blood running from his left ankle. He states
that he kept running until he was safely across the border in Sudan and made it to a nearby
hospital where they provided treatment. He stayed in this area for several days and then moved
on to Khartoum (this was during August 2008). He states (while crying and appearing wide-eyed
and afraid) that after his escape was discovered, his father was detained for five months to pay
for G’s escape. He expressed great concern about his father going through what he had
experienced during detention. He also stated that his wife had been living with his family, but
the police came looking for her after he left the country and she could not return to her
home. She and her brother went to a refugee camp in Ethiopia, she is living there but he
died in transit. I did not review the details of G’s harrowing trip from Sudan through many
countries (purchased entry and transport from a smuggler) to gain entry to the U.S. but he
mentioned that his boat capsized off Colombia in the ocean, all his documents and medical
records were lost and he was floating in the ocean for 24 hours before they were brought
ashore. He also mentioned his time in a prison in Panama because of his illegal status. He
entered the U.S. in March 2010.
He showed me his U.S. driver’s license, SS card, school ID, bank and Metro cards, etc and he
appeared very excited to be in school.

Physical Exam

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General appearance and vital signs: Western clothes, shirt and trousers. He appeared healthy
but anxious. Vital signs normal
Affect: Anxious at first, good eye contact, smiling appropriately but frequently due to anxiety,
was cooperative, spontaneous. His affect changed after about 10 minutes of introductory
history. As soon as we began talking about his period of military service, he became agitated,
his face became vacant and distant, his eyes were filled with spontaneous tears during most of
the exam and he broke down crying on multiple occasions. He appeared to be embarrassed
about this and dried his eyes with his shirt and looked away. (see photos)
Thought content and process: despite language challenges, he was quick and consistent in his
response to questions, did not appear rehearsed or forced in his answers. He tended to be
general in his responses and consistently underestimated the extent of his injuries, while
describing how lucky he was to be alive and not disabled or dead like others he knew.

Skin: one acute, thin superficial 6 cm abrasion on his right lower arm from recent trauma on a
sharp object (unrelated to detentions). He has acne on his upper chest and upper back. There
are many scars to be detailed below.

Head and Face: has old acne scars on cheeks. Scalp-hair is black and short. More than 20 linear
scars, at all angles, 1-3 cm, some depressed, are seen on his scalp. All are consistent with blunt
trauma resulting from a weapon striking at multiple angles and scars are highly consistent with
trauma from the steel rod/baton he describes above. None of the scars appear to have been
primarily repaired, they all appear to have healed by secondary intent (not sutured). (see
photos)
Two scars on face: Left superior cheek 2 cm horizontal scar, 3-4 mm deep, 2 cm below left eye
consistent with blunt lacerating trauma to the face as he describes from being struck with the
baton/stick (see photo)
Chin: under left chin within facial hair there is a 2 cm horizontal scar consistent with blunt
trauma. Both have healed by secondary intent (no sutures). (see photo)

Neck- clear

Mouth-clear

Chest-clear

Breasts-clear

Heart-normal

Abdomen-normal, soft, no masses, bowel sounds present

Back-acne scars on shoulders. On left mid-back there is a large depressed hyperpigmented oval
scar, 2 x 4 cm with clear edges and central striations highly consistent with blunt trauma. This is

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consistent with a significantly larger wound that contracted with healing. He also has 4-5 small
round scars in the center of his lower back consistent with blunt trauma.

Arms- He is right handed. All sensory and motor evaluations of upper extremities are normal.
Right forearm and hand: 2-3 cm irregular hyperpigmented scar on lower right outer arm about
3 cm above right wrist highly consistent with abrasive trauma from ligature scar as he
describes. There are also 2 similar hyperpigmented scars, 1 cm each oriented vertically on right
dorsal surface wrist. There are several other linear and round, deep scars from recurrent
abrasions consistent with rubbing from wire/rope ligatures. On the inside (volar aspect) of his
right wrist, there are multiple linear scars of 0.5-1 cm that are oriented in several directions
consistent with abrasive trauma due to ligatures. On the right forearm, there is a patterned
pigmented round scar of 3 cm on anterior surface consistent with blunt trauma. G is not sure
what instrument caused this during one of his many beatings. On the posterior aspect of his
forearm and elbow, there are multiple linear scars 2-5 cm at all angles, some in parallel tracks
and all are consistent with blunt trauma. There is an irregular 2 cm hyperpigmented scar on
right upper inner arm consistent with blunt trauma.
Left hand and lower left arm: On the back (dorsal aspect) of left hand and wrist, there are 3-4
small scars at several angles consistent with abrasive trauma from ligatures as he describes. On
the left inner dorsal wrist near the left thumb, there are two jagged 2 cm scars highly consistent
with ligature abrasions. The inside of his wrist (volar aspect) shows 1-3 cm several scars with
hypopigmented centers consistent with deep abrasive trauma highly consistent with ligature
scars.
He spontaneously stated that he had vaccinations while in Mexico on his left arm.

Legs-Both knees have several horizontal 2-5 mm wide scars of 2-3 cm length with sharp edges
consistent with blunt trauma while having his knees against floor at times during beatings.
Left posterior thigh has a long 12-14 cm x 0.5 cm hyperpigmented linear scar beginning at his
left buttock and extending to mid-thigh that is highly consistent with whipping blunt trauma.
Left medial ankle-multiple small hyperpigmented scars with central hypopigmentation
surrounding medial malleolus highly consistent with ligature abrasions
Left lateral lower leg there are two scars: the most superior is 2-3 cm oval sharply defined scar
with peripheral hyperpigmentation and central clearing and 2 cm below that scar is an oval
linear scar of 3-4 cm with peripheral hyperpigmentation and central clearing with a linear
extension superiorly. These two scars are highly consistent with grazing wounds (entry and exit)
from a gunshot as he describes.
Right posterior knee shows multiple scars: two diagonal 5-7 cm linear scars just above right
knee highly consistent with whipping blunt trauma and a set of hyperpigmented, 3-4 cm keloid
scars on posterior knee at multiple angles highly consistent with abrasive blunt trauma and
could have resulted from ligatures around knees in the forced positions he describes.
Right medial ankle with hyperpigmentation over medial malleolus (ankle bone) with central
horizontal scar with hypopigmented center and multiple smaller laceration scars surrounding it
consistent with ligature scars.

Buttocks-clear

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Genitalia-normal

Rectal/anus-normal

He drew two drawings: one of a baton/stick with rubber over steel on one end and plastic/steel
on the other of about 1 meter in length. He also drew the helicopter position which was
described above. (see drawings)

Residual/post-torture physical symptoms include:

He has joint and extremity pain when it gets cold

Post-detention behavioral/emotional concerns

Flashbacks-yes: “I do have memories of the time I was there, the bad ones, the torture
especially, because after I left, my father was detained for months and was asked to pay 50,
000 Eritrean dollars in a fine.” His father was placed in detention a second time because of
trying to send something to G in the U.S., and his case is scheduled to go to court in 6 months.
G imagines what happened while he was in detention to be happening to his father and family
and that causes him great distress. When I asked him to describe what he was feeling, he was
unable to describe the intensity of what he feels even though he was looking off into space,
crying. He uses religion/faith to avoid facing the trauma he experienced, as well as minimization
of his experience. . “When I think about these things, I always say, I have seen the light, our
people are in suffering, I just wish that everybody can get the chance that I have had.”
Intrusive thoughts-yes, G’s voice was shaking when I asked this question. “I do remember these
things I have gone through in my life. It does not have a negative impact on me. I am lucky to be
here. When I was in Columbia, we were in the ocean for almost 24 hours when our boat
capsized. I have many friends who have died, I am just happy that I am lucky enough to be here
and go to school and study. I have come out of the darkness and into the light.” He was crying
and frightened when describing the
Nightmares-none
Anxiety-he denies worrying or anxious; “I have to keep calm and strong, to endure.”
Sadness-He denies sadness, yet he was crying throughout this part of the history. He
states that “If I met someone who resembles a person (one of his torturers) who has caused me
all this pain, and done me and others wrong, I would tell him what he did wrong and ask if they
are a victim?” If they have faith and believe in God, they will overcome their problems. I am a
Christian, I read the Bible. People have had a lot of hardship and they still come to victory.
Avoidance- he denies this
Withdrawal-he denies this
Fear-he denies being afraid of anything now that he is safe; except for his family’s safety
Anger-he denies this
Hypervigilance-he denies it
Sleep-he denies any trouble falling or staying asleep
Suicidal or homicidal thoughts/ideation-denies it

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 Inability to recall an important aspect of the trauma-he states that he experienced so
many injuries, he cannot recall every scar and every beating
Difficulty concentrating or memory loss-

When asked if there was anything else he wanted to say: He stated that “I have hope for my
future. What I really want to focus on when my papers are in order is my studies. This is my
passion.

Rcecommended tests:
He has not had any medical evaluation, nor does he have access to ongoing medical or
psychological care. He has never seen a mental health professional.

Interpretations/Opinions:

My assessment, based on my comprehensive examination and my experience as a family

physician treating many victims of abuse and torture over 25 years, is that G demonstrates
historical and physical evidence highly consistent with the forced conscription, beatings,
detention, forced positions, and threats at the hands of government military officials as he
alleges. His evaluation demonstrates multiple scars on his arms and legs, multiple scars on
his head consistent with repeated head injuries, physical evidence consistent with ligature
marks on his wrists and ankles, scars consistent with gunshot wound of his left posterior
ankle. All of these injuries are inconsistent with self-inflicted trauma. His history was highly
internally consistent, and he described, with ease, vaccinations and reports of recent
trauma unrelated to torture. Behavioral observations include frequent crying (of which he
appeared ashamed), frequent episodes of dissociation, denial and avoidance, a high degree
of religiosity, and significant fear about the impact of his escape on his wife and his family.
In addition to his physical detention and torture, the separation from his wife and his family,
the detentions of his father, his exile from his home, his loss of educational and
occupational attainment and his harrowing journey to apply for asylum have led to
significant personal challenges. His strengths include his deep Christian faith, his
commitment to survival and his love for education. In my decades of experience, G’s view
on his experiences and detentions is consistent with many other East African men I have
evaluated: their commitment to survival, their recognition that many people suffer
equivalent or worse torture and punishment, and their intense faith increase the likelihood
that they will underestimate the extent and impact of the torture on themselves, using
denial and avoidance as their primary strategies.

I declare under penalty of perjury, pursuant to the laws of the United States, that the foregoing
is true and correct and that this affidavit was executed on _________ in _________.

State of Virginia )
)
County of Fairfax )

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On this th day of 2012, Coleen Kivlahan, M.D. personally appeared before me and signed
the above/attached document.

Notary Public

Commission Expires:

____________________________________
Dr. Coleen Kivlahan, MD, MSPH

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