Brief initial reaction from iMMO to the RvS ruling April 2, 2025
The full ruling can be read here. (in Dutch)
The full ruling can be read here. (in Dutch)
On February 25, 2025, the Roermond District Court ruled on Ekele’s* repeated asylum application. He applied for asylum in the Netherlands because of his claimed problems regarding his homosexual orientation and conversion to Christianity. In his first asylum application, the above asylum motives were not deemed credible. His second asylum application was dismissed. With his third asylum application, Ekele submitted an iMMO report as medical support evidence of his asylum motives. This report named, among other things, his PTSD-related symptoms, feelings of guilt and shame, and stress-related physical symptoms in addition to scars from abuse.
Ekele obtained a residence permit in 2021. The IND did not want to reimburse for the iMMO examination. However, the court ruled that it had to.
The court ruled that the difference between initial and subsequent applications is not justified because some aliens do not submit medical reports until later because of psychological problems or other obvious reasons. Aliens cannot judge whether their statements are sufficiently convincing to the IND. Perhaps a medical report is not necessary at all. It is also possible to wait for a court ruling before collecting additional evidence. Also, an iMMO examination may be too burdensome for some people.
The court stated that there are good reasons why an iMMO examination should not be conducted in the first proceeding and that it is not natural for a traumatized alien to recognize for himself his psychological symptoms and their effect on his statements.
This court ruling highlights why aliens may not always be able to submit a forensic medical report in the initial proceedings. Since 42% of all applications for iMMO examinations are filed within a subsequent asylum application, this ruling on reimbursement is highly relevant.
* Names are fictitious.
After Kevin* submits his first asylum application in 2021, the IND rejects it on the grounds that his statements are implausible and inconsistent. Kevin appeals the decision, submitting an iMMO report as medical support evidence.
On October 24, 2024, the District Court of The Hague rules on Kevin’s appeal, which included the iMMO report. The court rules that the appeal is well-founded and that the IND must make a new decision on Kevin’s asylum application.
In addition to the substantive assessment of Kevin’s asylum application, the focus of this ruling is whether the iMMO report was carefully prepared. If the iMMO assessment would not have been carefully prepared, the IND does not have to engage a medical expert to refute the content of the iMMO report. The IND may then decide not to consider the content of the iMMO report in their assessment of the asylum application.
The court finds that the iMMO report was indeed carefully produced. If the IND questions iMMO’s expertise, it must request a contra-expertise from another medical expert. The court thus states that the IND cannot refute the contents of the iMMO report on its own. Finally, the court appoints the influence of shame and distrust on the ability to explain. This is in line with the Council of State ruling of December 13, 2023. (ECLI:NL:RVS:2023:4620).
In its conclusion, the court ruled that the IND did not sufficiently involve the iMMO report in its decision on the asylum application and that the IND must reimburse the costs for the iMMO report. The IND has to make a new decision on the application.
The case study can be found here.
* Names are fictitious.
Kevin* becomes a victim of abuse and violence because of his bisexuality. To protect himself, he joins a gang, but a gang war causes him to flee. During his escape, he becomes a victim of human trafficking and is forced to work in prostitution for years before he is able to escape and seek asylum.
Kevin is a 36-year-old man from an African country. His mother runs a restaurant and his father is a businessman. As an only child, he finds out at an early age that he is different from others. Namely, he falls in love with boys as well as girls. Both at school and by his parents, he is punished for his dealings with boys. In the process, he is beaten with a cane and ruler. His mother sees his bisexuality as a spiritual problem and takes him to different churches to get him cured.
Kevin is smart and goes to college. At college, fellow students catch him with a boyfriend, after which he is assaulted. This involves Kevin being beaten many times and stabbed with a knife in his genitals. There is a group in and around school attacking him. The incidents increase and so do the intimidations.
To protect him, a friend introduces him to a gang. He is sent blindfolded to a forest for a ritual in which he is beaten and stabbed with stones, hoes, knives, machetes, axes and guns by a group of about 40 boys. This eventually renders him unconscious.
Afterwards, he wakes up in his own bed while being cared for by his friend. He now understands that all this time in college he was being harassed by a rival gang. The incidents and harassment cease because he is now protected by the gang he joined.
In his third year of study, violence between rival gangs suddenly flares up. Shots are fired and everyone runs in panic in all directions. Kevin is injured by hail blasts. A traditional healer has been able to remove almost all the pellets of hail.
Soon after, his own gang wants him to take an active part in the fight against the other gang. He does not like this and, in addition, is still wounded by the incident. At this he decides to flee the country. This is difficult because two men are watching him closely. When he can go to the bathroom alone, he escapes and goes on the run. His own gang takes revenge and they kill not only his father but also his friend.
Kevin’s flight goes through Libya where he ends up imprisoned and is severely mistreated. To be released, he must pay a large sum of money. And so Kevin becomes a victim of human trafficking. To pay the debt to the human trafficker, he has to work in a European country in prostitution and as a drug courier. At some point he manages to flee to the Netherlands.
The examination by iMMO identifies many scars. In accordance with the Istanbul Protocol, a number of scars are assessed as typical and highly consistent with the events described. The psychological examination reveals that he has post-traumatic stress disorder-related symptoms and somberness complaints.
The legal follow-up can be found here.
* All names are fictitious.
In the latest Torture Journal (vol 34 – no. 2 – 2024), the editorial extensively discusses the cross-cultural aspects of forensic medical assessment of torture victims. The article outlines key considerations for conducting a cross-cultural assessment of a victim.
The first part introduces basic ideas in anthropology, medicine and cross-cultural psychology and psychiatry. Then the most relevant elements related to a forensic medical report are discussed, with particular attention to cultural considerations related to the ethical aspects of the Istanbul Protocol.
How to conduct a forensic medical assessment is also discussed. This includes the interview, medical issues such as the physical examination with special attention to pain and suffering, and psychological and psychometric assessment. In addition, attention is paid to consistency and credibility analysis.
In the final section, the text reviews cultural considerations as contained in the Istanbul Protocol.
EU legislation (EU Directive 2013/32, Article 24) requires member states to have procedures in place to identify vulnerable people as part of the asylum procedure. In the Netherlands, this is arranged through the Medical Advice ahead of the asylum interview and the possibility of a forensic medical assessment.
In September 2024, the European Migration Network together with the Red Cross (EU), presented the paper Practices and challenges in identifying victims of torture and ill-treatment in the context of international and temporary protection. The paper reiterated the great impact that medical issues have on the declarations of survivors of severe violence. iMMO is not without criticism of the current medical advice practice in the Netherlands, but believes that with some modifications it is a very workable tool that can greatly benefit the IND during interviewing and in decisionmaking.
iMMO also attended a meeting on the implementation of the new EU pact organised by Vluchtelingenwerk and the Meijers Commission. The new asylum pact being rolled out at EU level and the Dutch government’s intention to make the asylum procedure more austere – which includes removing medical advice from the procedure, means the coming years will be crucial in ensuring a careful procedure for this group of highly vulnerable people.
Being underage can affect how an asylum narrative develops as evidenced by scientific research. It has been found that the ability to construct a “life story” is not achieved until late adolescence or during young adulthood (early 20s). At the same time, experiences such as significant psychotrauma or depression can negatively affect an adolescent’s autobiographical memory (1). This can lead to less specific memories of events.
To illustrate, the following case study. 16-year-old Oscar* grows up with his mother in a country in West Africa. He does not attend school, but is home schooled by his mother. His mother was disowned by her family when she had Oscar as an illegitimate child. Oscar and his mother are happy together. As a bastard, Oscar does get teased and bullied, scolded and humiliated by children in the neighborhood. This makes him feel different and less worthy than others.
When Oscar is 14 years old, he is assaulted by several men as he walks outside on the street. He is beaten, stabbed in the legs with a knife and dragged across the street. He is threatened with death; the men indicate that, as a bastard child, he has no right to live. Oscar is very afraid they will kill him. When people come to see what the commotion is about, the men run away. Afterwards, the men turn out to be the brothers of Oscar’s mother.
Oscar and his mother go to hide with a friend out of fear. There they hide for several months before fleeing the country with this friend’s help. With the help of people smugglers, Oscar and his mother eventually reach Morocco. Along the way, Oscar experiences many unpleasant things. He witnesses how human traffickers abuse and shoot refugees.
In Morocco one night they are picked up and taken to the sea. Oscar does not know what is going to happen or where they are going. There are lots of people by the water and Oscar and his mother have to get into a boat. In the middle of the sea, the boat breaks down; everyone is screaming and Oscar hears his mother calling his name. All the people end up in the water. Oscar is rescued by another boat and taken to Spain. His mother drowns. Oscar is in shock and feels very guilty for not being able to save his mother. Eventually, with help, Oscar travels on to the Netherlands where he applies for asylum.
During the iMMO assessment, it is noticeable that Oscar has difficulty talking about the many upsetting events. He falls silent and prefers not to talk about them at all. He indicates that talking about the unpleasant events evokes memories that he wants to avoid. He is troubled by recurring images and thoughts of his mother. In his dreams she is there and when he wakes up, she is suddenly gone. He also suffers greatly from recurring images of the beatings and threats by the men. Seeing the scars on his legs reminds him of this.
In different places on Oscar’s body, dozens of scars are identified. In accordance with the Istanbul Protocol, most of these scars are assessed as typical of the alleged violence that prompted Oscar’s flight. There are also psychological symptoms that can be related to Oscar’s asylum story. The avoidance, specific re-experiences and triggers for these re-experiences are also typical of Oscar’s alleged asylum story. iMMO’s medical assessment reveals clear supporting evidence for his asylum narrative.
The IND objects to Oscar’s testimony as being insufficiently detailed. iMMO’s file review reveals that Oscar was already struggling with trauma and grief symptoms during the interviews at the IND and that he received psychological help. Oscar also seemed to have difficulty understanding some of the questions during the hearings. The iMMO concludes that both Oscar’s psychological complaints and his young age must be taken into account during the interviews and decision making process, as both affect his ability to explain consistently and coherently.
(1) Autobiographical memory: the part of human memory that allows us to recount what we have experienced (specific and general memories about your own life).
(*) Names are fictitious.
On August 2, 2024, the District Court of The Hague issued a ruling in an asylum case involving an iMMO report from 2020. This ruling is relevant to iMMO because it provides insight into how an iMMO report is used in the examination and judgement of the application. It is particularly important to read how being a child at the time of the interview should be taken into account in the final decision on asylum.
Many years ago, Rudo* applied for asylum as a minor. After he had been granted temporary (categorical) protection for several years, an application for asylum for an indefinite period of time was rejected, and this rejection is well established in law. Using a 2020 iMMO report, Rudo then made a subsequent asylum application in 2021 where the asylum narrative remained the same as what he had previously told.
iMMO investigated whether Rudo’s medical problems stemmed from the alleged history of violence underlying the asylum application. iMMO also looked at whether there were any medical problems at the time of the earlier asylum hearings that cpuld have interfered with the ability to explain. This refers to the interviews when Rudo was still a child. Earlier, the IND rejected the subsequent asylum application because he had declared implausible, inconsistent and incongruous. This he appealed.
In this ruling, the court ruled that the appeal was well-founded and that the IND must make a new decision on Rudo’s asylum application. The ruling is relevant to iMMO because the court elaborates on how the conclusions of an iMMO report can be applied in assessing an asylum application. The court notes that credibility is central to asylum cases, rather than the complete certainty of the account. The underlying iMMO report finds that two of Rudo’s scars are consistent with the violence narrative, one group of scars is highly consistent, and two other scars and the psychological symptoms are typical according to the gradations of the Istanbul Protocol.
The IND previously objected that these gradations leave too much room for other causes for the scarring and psychological symptoms. However, the court concluded that if a gradation other than characteristic of the alleged violence is given, it does not necessarily mean that the account is therefore implausible.
That the court appoints this nuance is important to iMMO and the weight of iMMO reports. Additionally, it is significant that the court states that the IND applied an incorrect credibility assessment because the IND previously acknowledged that the iMMO report was competent and carefully prepared.
Finally, this ruling highlights the influence of being a child or adolescent at the time of interviews and how this should be taken into account, especially in light of the person’s medical and psychological problems. According to the court, the IND did not take this sufficiently into account in their decision and it can indeed have an influence. iMMO often conducts research on individuals who are minors at the time of the iMMO research, or at the time of their initial asylum application. This ruling therefore provides valuable insight into the assessment framework used by the IND and what role minority plays in it.
(*) Names are fictitious.
The scars left by sexual violence are often more psychological than physical. This is also the case with 40-year-old Carolina*. She is an only child and grows up with an aunt because her mother was too young to take care of her. Her father dies when she is still young. Conform local custom her family chooses a partner for her, but she decides to marry the man of her choice. Shortly thereafter, her mother dies. Her family blames Carolina for her mother’s death, proclaiming it is the result of her refusal to consent to the arranged marriage.
Carolina and her husband are happy together. In addition to their work, they help street children. These children are regularly assaulted and sexually abused by soldiers. They give them shelter, food and see to their safety. The soldiers try to counter this. They have to be careful because “the soldiers wanted the children for themselves.”
At one point, riots break out in the country. There is unrest in many places. Soldiers invade the premises of their organization in search of her and her husband. During this time Carolina has to flee several times, is arrested, raped and abused. She is beaten with weapons, kicked, burned with cigarettes and other objects. Furthermore, she is imprisoned several times. She has to stay in crowded cells without toilets and sanitation.
The rapes and beatings continue, until a prison chief hears her crying and mumbling in her native language. He recognizes the language because he is from the same area and helps her flee.
Carolina manages to escape but during the flight she is forced into prostitution several times. She is also raped several times by those who say they want to help her. In Europe, she is supposed to pay back the cost of her journey by working in prostitution. At Schiphol Airport, however, she is stopped by the Dutch military police.
Carolina is ashamed about what she has been through. She ends up in jail in the Netherlands, afraid and no longer trusting anyone. Before the assessment at iMMO, she never told anyone about the sexual violence.
During the iMMO assessment, it is noticeable that she falls silent at times. This happens especially while recounting the sexual violence. When the researchers ask about this, she indicates that she is distracted. The images of these rapes intrude on her. She prefers not to talk about it. In daily life, she has difficulty with loud noises and the smell of excrement. These smells and sounds bring up images she wants to forget. Her most unpleasant re-experiences are the memories of the rapes in the presence of her husband.
Scattered over Carolina’s body, several dozen scars are identified from multiple acts of violence, including a scar in the genital area. In accordance with the Istanbul Protocol, most of these scars are assessed as highly consistent. There are psychological problems that can be related to the asylum story. Specific re-experiences, triggers for the re-experiences, avoidance and distrust are typical in content and nature of the claimed asylum narrative as indicated by her.
In Carolina’s case, there is one genital scar to mark the sexual violence suffered. Often rape leaves no visible injuries or scars. This is the paradox of sexual violence, which often actually produces a lot of psychological damage and relatively few visible physical scars. In this case, the scars from the other violence contributed substantially to the conclusion of the assessment. This illustrates the importance of conducting a full investigation.
The iMMO report was introduced in the repeated asylum application. (See case law for follow-up.)
* All names are fictitious.
The iMMO report on Carolina’s asylum account* plays an important role in the judgment of the Council of State. After the court had stated that the rejection of the asylum application was insufficiently motivated, the IND also does not include the iMMO report in the appeal.
On April 17, 2024, the Council of State** declares the State Secretary’s appeal unfounded based on abbreviated grounds. This is a case in which an iMMO report is given an important role precisely because it is ignored by the IND. In Carolina’s appeal against the rejection decision, the court had previously found that the IND had insufficiently motivated their decision. According to the Council of State, the IND could have easily rectified this in new decision-making.
After the first asylum application is rejected, Carolina files a second asylum application with the help of iMMO’s expert report. The second asylum application is also rejected, after which Carolina appeals. The court already ruled that the outcome of the iMMO report had not been adequately considered in the IND’s final decision, and ordered the IND to pay the full costs of the medical assessment and the iMMO report. According to the court, the report clearly showed that there were multiple scars that could be attributed to the alleged violence, and psychological problems that affected the ability to provide consistent, coherent and complete testimony at the time of the interviews.
The court also mentions the influence of feelings of guilt and shame that can cause limitations during the interview. In a previous newsletter, the influence of feelings of guilt and shame on the ability to explain about the alleged violence is further explained within the framework of the Council of State ruling of December 13, 2023 (202108163/1, ECLI:NL:RVS:2023:4620).
With the ruling, the Council recognizes that the outcome of the iMMO assessment must be taken into account in the final decision. The IND has to take a new decision.
* All names are fictitious.
** Number 202204804/1, ECLI:NL:RVS:2024:1571