The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers

Abstract

Whether through traditional law or modern torture, the body has always been a privileged site on which to demonstrate the evidence of power. But for immigrants, the poor, and, more generally, the dominated—all of whom have to prove their eligibility to certain social rights—it has also become the place that displays the evidence of truth. In France, as immigration control increases, asylum seekers are more and more submitted to the evaluation of their physical sequels and psychic traumas, as if their autobiographical accounts were not sufficient. In this article, we show how nongovernmental organizations (NGOs) deal with the dilemmas posed by this situation, how they develop protocols standardizing their expertise, and how their medical authority progressively substitutes itself for the asylum seekers' word. In this process of objectification, it is the experience of the victims as political subjects that is progressively erased.

Full text

DIDIER FASSIN
ESTELLE D’HALLUIN
The Truth from the Body: Medical Certificates as
Ultimate Evidence for Asylum Seekers
ABSTRACT Whether through traditional law or modern torture, the body has always been a privileged site on which to demonstrate
the evidence of power. But for immigrants, the poor, and, more generally, the dominated—all of whom have to prove their eligibility
to certain social rights—it has also become the place that displays the evidence of truth. In France, as immigration control increases,
asylum seekers are more and more submitted to the evaluation of their physical sequels and psychic traumas, as if their autobiographical
accounts were not sufficient. In this article, we show how nongovernmental organizations (NGOs) deal with the dilemmas posed by this
situation, how they develop protocols standardizing their expertise, and how their medical authority progressively substitutes itself for
the asylum seekers’ word. In this process of objectification, it is the experience of the victims as political subjects that is progressively
erased. [Keywords: body, violence, truth, refugees, biopolitics]
He proceeded to tell me how he was tortured, how bad it
was when they changed the handcuffs for rope, how he
felt like drowning with the wet towel stuffed down his
mouth, and what it was like being in the bag and shot
but not killed. He leant his head forward almost on to
my lap and guided my fingers through the hair to the soft
bulging wounds of irregularly dimpled flesh. “Like wor-
shipers with Christ’s wounds,” murmured a friend days
later to whom I was telling this.
—Michael Taussig
The Nervous System
THE BODY IS THE PLACE, par excellence, on which
the mark of power is imprinted. It is an instrument
used both to display and to demonstrate power, which is
evident when we consider the order of social reproduc-
tion: initiation rites in which “the scars drawn on the
body” are “the written words of the primitive law” (Clastres
1974:159), and the accompanying “harangues” express “the
commandments of the domination of men over women
and the submission of the youngest to the eldest” (Godelier
1982:78). It is also evident when we consider contempo-
rary wars in which “political rape” serves the goal of “elim-
inating a community” (Nahoum-Grappe 1996:283) and in
which “hyperbolic evil” has invented “biopolitical practices
on human material” (Assayag 2004:282). At the extreme—
which is incarnated in the radicality of dictatorial or total-
itarian regimes throughout the 20th century—its very dis-
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appearance is the surest indication of the absolute and arbi-
trary nature of brute force, when all physical traces of indi-
viduals (Scheper-Hughes 2004) or entire nations are elimi-
nated (Hinton 2002). Hence, the body seems to be political
insofar as it always demonstrates, as a last resort, the evi-
dence of power.
Yetinpacified Western societies, this embodiment of
political order was gradually erased or at least reduced
(Fassin 1996), as physical violence lost its legitimacy in im-
posing social relations of power. Even in the punishment of
the guilty, the “torturing core” of criminal justice has been
“enveloped more and more extensively by a penalty of the
incorporeal” (Foucault 1975). The proscription of torture
and the abolition of the death penalty have participated
in this disembodiment of the political that is simultane-
ously engaged in a process of disincarnation, because the
most salient feature of “modern democracy” is clearly the
fact that “the representation of power attests to it being an
empty space” (Lefort 1986). Yet despite having become in-
corporeal and disembodied, the field of politics has not lost
touch with the body. Through a single turnaround in his-
tory, in contemporary societies—at least in those in which
the state more or less fulfils its monopolistic function as
regards legitimate violence—the body is no longer the po-
litical locus in which power is manifested but the place in
which individuals’ truth about who they really are is expe-
rienced. For the poor who have to exhibit the stigmas of

598 American Anthropologist •Vol. 107, No. 4 •December 2005
indigence to benefit from public welfare or private charity
(Fassin 2000), or foreigners who have to report their illness
or suffering to obtain a residence permit (Fassin 2001b), the
body has become the place that displays the evidence of
truth.
It is in light of this new moral order that we need to con-
sider the role of medical certificates regarding applications
for asylum in contemporary France. Certificates, which are
drawn up by a doctor or sometimes by a psychologist and
that attest to torture, have become a key piece of evidence in
administrative case files submitted to evaluation. State in-
stitutions responsible for deciding on the validity of asylum
applications, as well as lawyers and nongovernmental orga-
nizations (NGOs) that wish to better defend their clients’ in-
dividual cases, expect such certificates to be provided. Those
seeking asylum also desire certificates because of the real
or imagined authority conveyed by them. The emergence
of this new regime of truth occurs in the context of a pro-
found delegitimization of asylum in the last two decades all
over Europe. Although in France, during the 1970s, up to 95
percent of all seekers were granted refugee legal status, this
rate rapidly declined in the 1980s and 1990s—dropping to
as low as 12 percent for the administrative evaluation and
18 percent when taking into account the appeals. This dra-
matic evolution has lead to (1) an unprecedented increase in
undocumented foreigners, corresponding to dismissed asy-
lum seekers (Fassin 2001a); (2) a worrying development of
spaces of exception at the national borders, to contain the
unwanted immigrants before they can even present their
case (Fassin 2005); and (3) a growing suspicion toward all
asylum seekers. Far from the generous ideals of the 1951
Geneva Convention, the management of refugees now falls
under the mere logics of immigration control: Narratives
are less often believed and more proof is often requested. In
this new context, the signs left on the body by the torturer
become evidence for the state.
The French procedure of recognition of refugees in-
volves two institutions, both created in terms of the 1952
Asylum Act: Ofpra (Office fran¸cais pour la protection des
r´efugi´es et des apatrides), the French agency for the protection
of refugees and stateless persons, rules in the first instance,
whereas CRR (Commission des recours pour les r´efugi´es), the
commission for refugee appeals, examines the dismissed
cases. Asylum seekers file an initial application with Ofpra,
which decides whether to hear them and whether to grant
them asylum. In case of refusal, applicants may appeal to
the CRR, the decision of which is considered final. Medi-
cal expertise may be requested at either of these stages by
Ofpra or CRR, the asylum seekers themselves, or the lawyers
or organizations acting as legal or social mediators between
the two factions. Even though the medical certificate has
not replaced the need for an autobiographical account in
which candidates for political refugee status try to prove
that they meet the criteria of the 1951 Geneva Convention,
it is requested more and more often to verify the validity
of that account. Scars, both physical and psychological, are
the tangible sign that torture did indeed take place and that
violent acts were perpetrated. Like Thomas, the skeptical
apostle in the Gospel, the French State needs to touch the
wounds to believe.
The refugee’s body, thus, becomes the place of an in-
scription, the meaning of which relates to a double tempo-
rality: an inscription of power, through the persecution they
suffered in their home country, and an inscription of truth,
insofar as it bears witness to it for the institutions of their
host country. However, this new configuration presents two
tragically paradoxical situations. The first comes from the
parallel and contradictory evolutions of practices of torture
that are more and more hidden and demands of physical ev-
idence that are, therefore, more and more difficult to bring.
In opposition to its classical counterpart, “modern torture is
typically secret,” as Talal Asad (1997:289) affirms, because
it is both illegitimate and illegal: When war is over or when
the oppressor is defeated, the torturer may be brought in
front of an international or a national court of justice. The
war criminal’s elementary rule is, thus, to leave no physical
mark. It is in this context of concealment favorable to all
types of subsequent denial that the medical certificate as-
sumes increasing importance in societies in which the vic-
tims of political violence are supposed to be accepted and
protected. Although their word is systematically doubted,
it is their bodies that are questioned; however, quite often
these bodies speak little, for it is in the torturer’s interests
to silence them. The second paradox relates to the increas-
ing expectation of physical evidence simultaneous to the
state’s decreasing confidence in the victim’s demonstration
of it. The role of “medical expertise” on “emergent forms of
lives,” which Michael Fischer (2003:41) considers in both its
clinical and scientific dimensions, must also be considered
from a political perspective. The medical certificate leads to
a reification of the asylum seeker’s body. Detached from the
lived experience of the victims of persecution, it attempts
their objectification through experts’ words and ends up in
desubjectifying them.
For the past two years, we have investigated this com-
plex and ambiguous situation of the request for asylum,
which turns the body into a political resource through an
expert’s mediation. Our study has consisted of surveys of
NGOs that assist immigrants and especially asylum seek-
ers. We collected and analyzed the abundant literature pro-
duced by these organizations, and we conducted 20 inter-
views with their members and leaders. We, furthermore,
attended their meetings and events as participant-observers.
In the case of one organization, we were present at medi-
cal examinations and studied 200 certificates, both quali-
tatively and quantitatively. In this framework, cooperation
was developed that could formally be described as “obser-
vant participation” but that could also be regarded as re-
lated to a politics of involvement in research, because both
of us have personal commitments within two of the NGOs
working in the domain of asylum. Our fieldwork results
have been presented and discussed with the doctors, psy-
chologists, and social workers from the organization, to
contribute to their own reflection on the implications of

Fassin and d’Halluin •The Truth from the Body 599
the certificates and to the redefinition of their positions in
this respect. The trust that made this cooperation possible
is noteworthy, considering the sensitivity of the domain—
one in which researchers are not always welcome—
and because other institutions proved far less willing to
share their data and many finally closed their doors to
us.
“THE BEST OF ALL PROOFS”
Paris, [July 12, 2001] AFF: refugee status.
Sir, Further to the hearing .. . at the CRR, in order to ob-
tain refugee status, you must absolutely send me a medical
certificate on the traces that remained on your body after
the torture and bad treatment inflicted on you, especially
as regards your eye. Please feel free to contact me if you
encounter any problems. Yours faithfully. [lawyer’s letter
to client, July 12, 2001]
Paris, [July 12, 2001] Urgent.
Dear Sir, The CRR has informed me telephonically that it
will make its decision only when it has been proved by
a medical certificate that the marks on your body do in
fact correspond to your account. For that purpose, you
must urgently make an appointment with the doctor at
the Avre as well as a doctor of the Comede. When you
have the medical certificates of these two doctors, please
fax them to me immediately. Yours sincerely. [lawyer’s
letter to client, July 12, 2001]
These two letters are part of the corpus of lawyers’ let-
ters that the Comede (Medical Committee for Exiles [Comit´e
m´edical pour les exil´es]) coordinator collected over the past
few years. They show to what extent the body has be-
come the place of production of truth on the asylum seeker.
Comede is a medical organization founded in 1979 to de-
liver health care to immigrants; it currently provides 10,000
consultations annually in a hospital in the south of Paris.
The institution recorded twice the number of medical cer-
tificates issued as part of applications for political refugee
status in 2000 as in 1990. More than 1,000 are now issued
annually and some commentators have even referred to an
“epidemic of requests for medical certificates” (Veisse 2003).
This increase is indeed remarkable, if we refer to the an-
nual reports of the organization. In 1984, when medical
expertise started to develop, 151 certificates were issued by
this organization; in 1994, this figure had risen to 584; and
by 2001, it had reached 1,171. When related to the num-
ber of health consultations, the trend is even more striking:
During the same period, the proportion of certificates rose
from 2.2 percent to 10.9 percent. In other words, today doc-
tors devote five times more of their activity to this type of
examination than 15 years ago. This increase was brought
under control recently by specific steps taken to limit the
number of certificates issued. Theoretically, there should
be no more than five per day, and because the demand
is continuing to increase, the waiting periods for obtain-
ing the precious appointments have stretched to over three
months.
Even if institutional policies and organizational prac-
tices vary from one organization to the next, they all regu-
larly denounce the same thing: “Does one need a paper to
prove torture?” asks the indignant anonymous author of a
an article on medical certificates in the June 2002 newslet-
ter of the organization Primo Levi, which specializes in aid
to victims of violence. The same author refers to a “progres-
sive inflation of requests to doctors and psychotherapists”
(Association Primo Levi 2002). This trend in asylum poli-
cies has structural causes that need to be examined in the
context of the history of “Western hospitality.”
Like other countries, France is more generous when the
cost is minimal. When applications for asylum are few in
number, in an economic context in which labor is in de-
mand, it shows its solidarity with victims of persecution in
the world, faithful to the spirit of the June 24, 1793 Con-
stitution that “grants asylum to foreigners banished from
their home countries for the cause of freedom”—even if,
in reality, suspicion has often contradicted hospitality since
that period (Wahnich 1997). In this sense, we could say that
throughout the 19th century, there was no real problem of
asylum, even though demographic pressure was felt during
certain conflicts beyond France’s borders. It was only in the
20th century that the “refugee question” became an issue,
especially in the aftermath of World War I and even more
so in the aftermath of World War II, when foreigners flee-
ing persecution or violence became Europe’s “unwanted”
(Marrus 1985). The first international response was the cre-
ation of the High Commission for Refugees in 1921, under
the aegis of the League of Nations—although it was more di-
rectly related to the Bolshevik revolution and the hundreds
of thousands of exiles it produced than to the world conflict
itself. The rise of totalitarianism and nationalism in Europe
during the interwar period soon put more pressure on this
institution’s modest financial and regulatory resources than
it was designed to bear.
In 1951, the signing of the Geneva Convention marked
the official entry of refugees into contemporary politics. Yet,
from the early years, tension has been at a peak between
a humanist ideology advocating the right to asylum, with
its ennobled representation of the refugee’s status, and a
pragmatic policy that mistrusted these stateless people and
reduced them to the economic condition of immigrants
(Noiriel 1991)—a fact that is often overlooked. The utopia
of the former, still marked by the spirit of “never again”
after the discovery of Nazi crimes, encountered the realism
of the latter, already tinged with the “liberal rationale” of
advancing globalization as European reconstruction led to
international economic expansion and its demand for a la-
bor force. Once the immediate postwar wave of refugees
had been absorbed, European states paid relatively little at-
tention to them, and they were more tolerated for their
contribution to national wealth than recognized in a spirit
of justice.
In the early 1970s, the situation changed abruptly un-
der the effect of the “oil crisis,” the rise of unemployment,
and the discovery of the “living conditions of foreigners” by

600 American Anthropologist •Vol. 107, No. 4 •December 2005
NGOs who began putting pressure on the French govern-
ment. The “administrative liberalism of immigration struc-
tures” was replaced by a real state policy designed to control
migratory flows and promote the integration of foreigners
(Viet 1998). Demographic control initially concerned mi-
gration for employment, which was strongly limited from
1974 on (July 3, 1974, Cabinet decision under Jacques
Chirac’s right-wing government), and then concentrated
on family reunification, especially after 1984 (December
4, 1984, Decree, under Laurent Fabius’s left-wing govern-
ment). Social integration was addressed primarily through
housing projects to reduce the large concentrations of tem-
porary residences and insalubrious private buildings (Weil
1991).
In this new context, the number of asylum seekers
rose steeply. In 1974, there were 2,000; in 1975, 15,000.
These figures climbed steadily in subsequent years, reaching
61,422 in 1989—30 times more than 15 years earlier. The re-
lationship between the interruption of job-related immigra-
tion and the increase in applications for asylum, glaringly
obvious in Ofpra statistics, was nonetheless complex. It is
generally believed that many candidates for immigration,
seeing the French borders as closed to those seeking employ-
ment or reunification with their families, turned instead to
asylum as a means of getting in the country. Asylum was
still being widely granted at the time: In 1974, 90 percent
of all asylum applications were accepted by authorities; in
1976 the rate was at its peak with 95 percent; it then slid
down rapidly to 28 percent in 1989. This interpretation is
partially valid, yet it overlooks the fact that until the 1970s
there were no public policies for managing migratory flows.
Therefore, the law of supply and demand was the only reg-
ulator of migration, and the job contract served de facto as
a residence permit (Schor 1996). In these conditions, many
potential candidates for asylum had no need to go through
the Ofpra’s administrative evaluation, because finding a job
provided both material and legal security.
However, in the new immigration configuration, asy-
lum policy was redefined in depth. In the mid-1970s, 19 out
of 20 asylum seekers obtained refugee status; two decades
later, this ratio had plummeted to three out of 20. Since
the mid-1990s, it has remained more or less stable, at that
same level. In 2001, 18 percent of all Ofpra and CRR deci-
sions combined were favorable. A quarter of a century ago,
asylum was a matter of trust, in which the applicant was
presumed to be telling the truth. Today, asylum is set in
a climate of suspicion, in which the asylum seeker is seen
as someone trying to take advantage of the country’s hos-
pitality. It is, therefore, in the light of this “crisis in po-
litical asylum” (Legoux 1995)—marked by the increase in
applications and the decrease in authorizations, but also,
more fundamentally, by the loss of credit of the concept of
“asylum” itself—that the development of medical expertise
is meaningful.
In an NGO meeting we attended, one physician ex-
plained, “As the number of applications for certificates in-
creased, the number of asylum seekers who obtained refugee
status dropped” (personal communication, November 9,
2002)—referring to the futility of the medical certificates
that he was asked to produce. To him, their ineffectiveness
was obvious. He observed a decreasing return on applica-
tions for asylum, with the proportion of successful cases
dwindling steadily over the past 25 years, despite the fact
that medical expertise was more and more often requested.
However, the relation of inference should be seen as inverse:
It is because asylum has become illegitimate—and therefore
more seldom granted on the sole basis of an applicant’s ac-
count of torture—that these certificates are playing a greater
role. In a context of limited recognition of the validity of
applications for asylum (S´
egur 1998), any evidence is wel-
come, but that which is produced by an agent assumed to be
both neutral and expert has even more authority. An asses-
sor of the CRR commented during an interview in August
2002:
All proof, evidence, or other is acceptable. Afterwards, the
judge forms a conviction on the basis firstly of the ac-
count, that remains the basic element, and on its consis-
tency, credibility, or contradictions, and then, somewhat
like in a criminal case where the confession is perceived
as the ultimate evidence, the medical certificate is seen
by lawyers and asylum seekers as something like the best
of all proofs. [interview, August 2002]
He nevertheless added: “In fact, it’s true and it’s not true. A
certificate can’t ever serve on its own. If the account isn’t
credible or coherent, if the information as a whole is prob-
ably going to be rejected, it is highly unlikely that the med-
ical certificate will change anything. But if there’s a doubt
plus the certificate, then it’ll be to the person’s advantage”
(interview, August 2002). This comment points to two phe-
nomena: (1) the importance that the imaginary power con-
ferred to the medical certificate and (2) its very relative effec-
tiveness. This has already been observed in the case of the
residence permit: Foreigners who have been denied such a
permit endow it with almost magic virtues of social inte-
gration (Fassin and Morice 2001). It is only once they have
obtained the permit that they realize what limited access it
provides for obtaining a job, housing, and simply a place
in French society. Foreigners, thus, discover that although
they were nothing “without papers,” they were hardly more
once they had obtained them.
On either side of this “veil of ignorance” (Rawls 1972),
which separates those who submit to judgment and those
who judge, the symbolic value of the medical certificate is
altered, if not inverted. For asylum seekers and their lawyers,
it is an “open sesame”; for officials and judges, it is a piece of
evidence among others; and for both it is an innovation in
governmentality. Although “refugees embody a visceral hu-
man geography of dislocation” and “the involuntary migra-
tion of bodies across space is neither passive nor apolitical”
(Hyndman 2000:xv), the validation of their accounts by the
corporal inscription of their persecution constitutes a new
form of transnational administration of peoples. If more
medical certificates are requested, it is also because fewer
asylum seekers are summoned to testify. Confronted by

Fassin and d’Halluin •The Truth from the Body 601
the tragic experiences of political violence victims—many
of whom find it difficult to put words to the unspeakable
(Su´
arez-Orozco 1990) and to whom the officials of asylum
pay less attention (Delouvin 2000)—the institutions pro-
viding refugee status only offer the routine of an evalua-
tive procedure of managing migratory flows, in which the
physical trace of torture represents the last form of truth
telling.
TAKING AN ETHICAL STAND
Speaker 1: On what grounds are medical certificates justi-
fied?
Speaker 2: We know that it’s a form of help that we can
give them, isn’t it?
Speaker 1: Yes, but the question is: what value does it
have? What we’ve come to do here is to ask
a political question or rather a question on a
political stand.
Speaker 3: Refusing to do certificates is immediately a po-
litical position. It’s a refusal to be a government
office. And anyway we know that it’s pointless.
Have you ever tried to calculate the number
of patients who obtain the status, compared to
the number to whom you issue certificates?
Speaker 4: It’s not on those figures that you can judge. But,
to answer your question, we haven’t calculated.
Speaker 3: By issuing certificates, we’re busy judging
who’s guilty and who’s innocent. What sit-
uation are we in? We’re neither experts nor
jurists.
Speaker 5: It’s not only a matter of no longer doing certifi-
cates. That decision has to be accompanied by
a political declaration by all the organizations,
to denounce the myth of proof and to promote
the right to asylum.
Speaker 6: But you’ve got to evaluate the risk, if we fail,
that the requests from the institutions go to
paid experts who will take advantage of it. And
we’ll probably be seen as extremists, if we’re
not understood properly.
Speaker 4: I don’t see it as so straightforward. I’m under
the impression that the certificate is useful in
some cases. That’s what the patients tell us, and
the lawyers, and the organizations.
Speaker 3: We’ll never have a complete answer. But it’s
important to take an ethical stand. [Speaker 1,
3, and 5 are from Primo Levi Center; Speaker
2isfrom the Center for Rights and Ethics;
Speakers 4 and 6 are from Comede; Field notes,
November 9, 2002]
This discussion between members of organizations
working to help asylum seekers took place on November 9,
2002, near Paris. The members of three of the main French
organizations working in the area met to discuss the prob-
lem of medical certificates—specifically, to compare and, if
possible, to harmonize their positions regarding the mount-
ing pressure from government authorities and asylum seek-
ers and their lawyers for certificates to confirm the validity
of applications for asylum.
The Comede coordinator opened the meeting by not-
ing that, although his organization had been founded pri-
marily to provide free health care, the question of whether
to issue certificates had been raised from the very beginning.
He also noted the eventuality of a “strike,” or refusal to issue
certificates, which his organization had considered doing a
few years previously, because of the increase in requests for
certificates. The Comede had finally decided against it but
laid down rules concerning the criteria and procedures in is-
suing certificates. Because the waiting period to obtain the
precious document was now three months, they sent the
client a letter simply stating that he or she would be sum-
moned for a consultation during which the medical assess-
ment would be made. Surprisingly, when presented to the
governmental authorities, in particular Ofpra, such a letter
without any clinical details was considered as attesting to
the organization’s support.
The second person to speak at the meeting was both a
representative of the Center for Rights and Ethics in Health
(Centre droit et ´ethique de la sant´e) and a medical doctor. He
explained how things worked in his institution and the
fact that, being specialists in forensic medicine, they had
found themselves doing more and more certificates for asy-
lum seekers. In fact, this was the organization’s only activ-
ity; it did not administer health care. In their practice, the
swelling demand for certificates also led to longer waiting
periods—around two months for an appointment—so they
had decided to see only those applicants who had been re-
fused by Ofpra. Consequently, they had contact exclusively
with CRR, for which they agreed to do emergency certifi-
cates when necessary. The members of the third organiza-
tion, the Primo Levi Center, made up mainly of psycholo-
gists, then responded by harshly criticizing the practices of
the experts in forensic medicine who had preceded them.
The Primo Levi Center group felt that those in the med-
ical profession were not there to collaborate with official
bodies by providing medical expertise, their mission was to
treat people—which is why they had decided to stop doing
medical certificates. Likewise, they wanted all the organi-
zations to put up a common front against the government
authorities’ approach. The argument became heated, and
two psychologists stormed out of the meeting to show their
disagreement.
The haunting question among all these organizations is
whether or not to carry on doing medical certificates. What
purpose do they serve and how are the people that issue
them used? On the basis of our assessment of the minutes of
their meetings, their annual reports over the past 15 years,
and our conversations with long-standing members, these
organizations have constantly been faced with questions
on the effectiveness and signification of these certificates.
In a Comede document from 1991 found in their archives,
the rapporteur of the “certificates commission” writes: “It
is difficult to transcribe the richness of the arguments of
each person which in the final analysis provide no clear
and simple solution. We note a general uneasiness in the
current situation, where no one is satisfied, between a wish
to stop everything, a feeling of saturation, dissatisfaction
concerning the lack of time now available for writing the
report.”1An article written during the same period by the

602 American Anthropologist •Vol. 107, No. 4 •December 2005
coordinator of this organization explains this uneasiness:
Almost instinctively the government agents and magis-
trates attach greater importance to the physical effects
of torture, when in fact it is part of a programme de-
signed to destructure and depersonalize the individual.
The certificate lies in a legal gap. The Ofpra, the admin-
istrative body that is supposed to apply the law by ask-
ing the applicant to produce a certificate, brings the doc-
tor and the Comede into the picture in a procedure that
is neither provided for nor evaluated. While ambiguities
are unavoidable, they are also worsened by some of the
administration’s attitudes. They reflect an infringement
of civil rights and contravene the Geneva Convention.
[Didier 1992]
Thus, the organizations’ recriminations concerning medi-
cal certificates are nothing new and neither are the institu-
tional demands. In fact, Ofpra’s and CRR’s attitudes can be
seen as responses to a double bind: the increase in the flow
of asylum seekers from the mid-1970s on and, partly as a
result, restrictive instructions by the government from the
late 1980s on. Because the government had to substantially
limit the number of people who obtained refugee status,
they also had to find criteria to decide who would be al-
lowed access to this rare resource. In the practices of “local
justice” (Elster 1992) that, thus, became a necessity—which
had previously not been so when demographic and political
pressures were weaker and allowed a generous distribution
of refugee status—medical expertise was progressively given
precedence over the victim’s word.
Even though the organizations are divided as to the best
strategy to follow, their analysis of the situation is similar.
If we consider their discussions in the documents we found
and the interviews they gave us, they identify four main
problems.
The first is a political problem. In terms of Article 1,
Chapter 1, of the Geneva Convention, a refugee is any per-
son who “owing to a well-founded fear of being persecuted
for reasons of race, religion, nationality, membership of a
particular social group or political opinion, is outside the
country of his nationality and is unable or, owing to such
fear, is unwilling to avail himself of the protection of that
country” (1951). Agreeing on the necessity to provide ev-
idence of marks on the body—which assumes that such
marks were made (even though certain forms of violence are
not physical) and that they remain visible (despite the fact
that torturers find ingenious ways of ensuring that no evi-
dence is left)—considerably reduces the scope of the Geneva
Convention. This is underlined by a report of the Comede in
2001: “By replacing the word of the victims, the certificate
tends to replace their right” (Comede 2001:3). Admittedly,
medical certificates are not required to obtain refugee sta-
tus, but the value granted to physical marks diminishes the
principle of “fear of being persecuted,” which, by definition,
has no physical translation.
The second problem is an ethical one. A psychologist
from the Primo Levi Center recalls: “Once an officer from
Ofpra called me: ‘If you tell me that this woman was raped,
I’ll see her.’ But why did I have to confirm that she’d been
raped for her to be received?” (Field notes, NGO meeting,
November 9, 2002). More generally, by requesting that the
doctor certify that the person has been subjected to the
treatment they claim to have undergone, more credit is
granted to the expert’s word than to that of the victim. The
certificate of the former, describing symptoms and signs,
validates the account of the latter, reporting his or her per-
sonal experience. This depreciation of the asylum seeker’s
word is obviously particularly problematic when the medi-
cal doctor has little to say about the facts, as in the case of
sexual violence where the physical marks can rapidly fade.
Psychological scars then sometimes replace the missing cor-
poreal inscription of the trauma. But in all cases, the experts
replace the victims. By trying to help refugees, physicians
and psychologists deprive them of their truth.
The third problem is therapeutic. As a Comede doctor
explains: “For me, there is a huge problem, and that is certi-
fication. Because it alters the therapeutic relationship. I feel
like I’m reduced to an instrument. I very often see a person
who has medical problems and who asks me for a certifi-
cate. Once the certificate is done the relationship is over. It’s
frustrating” (Field notes, NGO meeting, November 9, 2002).
The conflict between expertise and care revolves around the
very principle of the “therapeutic relationship”: By subordi-
nating clinical activity to medical expertise, the confusion
of genres runs counter to its effectiveness and induces a
form of instrumentalization of the medical professional.
The fourth problem is of a practical nature. The very
effectiveness of the certificate is doubtful, at both an indi-
vidual and a collective level. On the one hand, contrary to
the beliefs of asylum seekers and their lawyers, medical ex-
pertise probably has a limited effect on the final decision.
“What’s the point?” wondered one member of the Primo
Levi Center at an NGOs meeting in November 2002. In
Ofpra and CRR refusals, they sometimes specify that the
certificate was not convincing. On the other hand, clini-
cal expertise, by testifying in certain cases only, implicitly
recognizes that others show no evidence, thus admitting
that there are degrees of truth, or at least of proof. As one
Comede doctor commented, “By doing certificates we’re
disserving the right to asylum. . .. This creates the illusion
that the number of false refugees, without certificates, is in-
creasing” (Field notes, NGO meeting, November 9, 2002).
Despite these pleas against the uses and abuses of clin-
ical expertise, it remains that medical certificates still give
an asylum seeker an extra chance at asylum and that, there-
fore, it is unacceptable to turn down someone who is re-
questing a certificate. It is usually this combination of an
uncertain hope and a moral demand that carries the most
weight in the decision of whether or not to provide a med-
ical certificate.
Thus, an ethical line divides the involved organiza-
tions. For some, irrespective of their disagreement with the
way the procedure is developing and the manner in which
requests are directed to them, it is not possible to shirk the
expert’s role. People have the right to ask for a certificate,
doctors must respond to those requests, and, in the end, the

Fassin and d’Halluin •The Truth from the Body 603
certificate may be the additional humane touch that enables
a candidate to obtain refugee status. Moreover, if the orga-
nizations were to stop issuing certificates, there would be a
risk of them being replaced by a body of government experts
who might charge more for their services and who might
be less personally inclined to help clients. Comede has de-
cided to carry on issuing certificates. So has the Minkowska
Center, a mental health service founded in 1951, whose
main activity is to provide psychological and psychiatric
care. The same applies to the Center for Rights and Ethics in
Health, a forensic medicine service in Lyon that has no clini-
cal activity and for which issuing certificates is consequently
not a problem. For the other organizations, the refusal to
enter into the ambiguities and contradictions of the system
of certificates prevails over the assumed benefits. Therefore,
to avoid any collaboration in the current procedure, which
they would see as a form of complicity, they have made
a clear break from the administration and magistrates who
use the organizations for issuing certificates. The Primo Levi
Center, which was created in 1995 to provide medical and
psychological support for victims of torture and gives 3,000
consultations annually, once announced that it would no
longer issue certificates.
To use the distinction posed by Max Weber (1959:172),
the first position corresponds to an ethics of responsibility
and the second to an ethics of conviction. The former judges
by predictable facts; the latter relies on a superior doctrine.
Of course, the advocates of refusal do not disregard the ef-
fects of their decision (or, by contrast, the maintenance of
the status quo), but they give precedence to principles over
immediate consequences. Likewise, those who agree to is-
sue certificates are not operating without a doctrine (they
do participate with the others in the political fight for asy-
lum rights), but they highlight the expected, albeit limited,
advantages of doing so. The fact remains, however, that
there are two types of relationship between a means and
an ends. In one of the positions analyzed here—that of be-
ing grounded in an ethics of responsibility, particularly in
the case of the Comede—the refusal to certify is consid-
ered primarily from the applicants’ point of view. In the
short term, refugees’ probability of obtaining asylum status
may be lessened because of the lack of a medical certificate.
However, in the long term, their chances may be hurt by
the replacement of the activist organizations by new ex-
perts reputed to be less militant and, therefore, less favor-
able toward refugees. In the opposite position, grounded
in an ethics of conviction—that of the Primo Levi Center,
in particular—this loss of an individual’s chances is seen
as the price to pay to avoid compromises (collaboration
with the authorities in a restrictive asylum policy) and to
force the government to take responsibility for its choices
(and not leave the experts to carry the burden). One can
interpret these positions as a pragmatics of dialogue, on the
one hand, and a strategy of rupture, on the other hand.
Although all the organizations share the same attitude
of “voice”—in the sense that Albert Hirschmann (1970)
gives to this form of solution to a frustrating situation—
their political choices are based on different ethical
premises.
The options described above correspond to the more
or less stable official positions of the different organiza-
tions. They describe a state of the public sphere or, more
precisely, of the domain that Nikolas Rose (1999:188) quali-
fies as “ethico-politics,” but they do not account exactly for
practices. Within each of the organizations, the positions
of the doctors and psychologists vary: It was obvious in our
interviews with them, in our observation of their consul-
tations, and in our examination of the certificates issued.
Furthermore, practices of the organization as such may de-
part from its official line: Although it took a strong position
against the certificates, the Primo Levi Center never com-
pletely stopped doing them. Yet, even when members dis-
tance themselves from the local norm of their NGO, what
is remarkable is the depth of the ethical reflection and dis-
cussion in the daily politics of the organizations. There are
the emotions and rifts that such contemplations cause in
debates (we witnessed some heated discussions, not only in
meetings within an organization but also in relations with
patients, for example when patients requested medical ex-
pertise in a too-insistent manner). Then, too, there are the
doubts and difficulties these contemplations produced in
the daily practice of each clinician (several of them told us
about their hesitation to carry on working in their organi-
zation, especially because of the expert role that they were
asked to play when all they wanted to do was treat people).
To do or not to do medical certificates: Around this
dilemma, everyone, both in conversation and in action,
manifests real ethical passion corresponding to the emo-
tional logic peculiar to the management of asylum (Graham
2003). Apart from their dissensions, physicians and psy-
chologists both perceive the gap between the meaning that
violent acts can have for the people who were subjected to
them and the semantic reduction that the clinical examina-
tion affects by describing physical scars. In addition, they
recognize the gap between the profound reasons for their
own commitment to the refugees’ cause that first prompted
them to do such work, and the administrative acts of veri-
fication that they are expected to perform. As advocates of
the right to asylum, they find themselves used for policing
bodies.
As Marilyn Strathern notes, “Ethical practices refer to
the interests of third parties, which are at once the rea-
son for and lie outside the loop through which profession-
als demonstrate (to other professionals) their adherence to
standards” (2000:292). In the dialogue between the actors
from the organizations and the public authorities—a dia-
logue that is often virtual because the production of reflec-
tion and discussion remains limited essentially to the field
of the promoters of asylum—it is the refugees that consti-
tute the reference, both as individuals who are being helped
to obtain a status and as a collective whose cause is being
defended. We can posit that the ethical tensions between
the organizations and within each of them are particularly
strong because they have so little room to maneuver. In a

604 American Anthropologist •Vol. 107, No. 4 •December 2005
sense, the questions of knowing whether to do certificates
and whether they are effective are settled outside the space
in which they are debated.
At the international level, it was in the EU Dublin
Agreements of 1990 that relations of solidarity between
states regarding asylum were decided. It was in the
Amsterdam Treaty of 1997 that the Europeanization of asy-
lum policies and immigration was instituted. Finally, it was
at the Tampere Summit in 1999 that asylum policies and im-
migration were linked, even though the specificity of each
of the two was affirmed (Berger 2000). In parallel, at a na-
tional level, the question of defining and implementing re-
strictive criteria is settled in the instructions given by the
government and the administration to its agents to limit
the number of people who obtain refugee status, and prob-
ably also in those agents’ interiorization of a set of common
ideas about the exponential growth in the number of asy-
lum seekers, on the absence of validity of many requests,
and on the need to put an end to granting the status too
generously, none of which is specific of the French situa-
tion (Heyman 1998). In these conditions, it is noteworthy
that, since 1995, independently of the international situ-
ation and the number of applications, the combined rate
of successful applications to Ofpra and CRR has remained
stable—specifically between 15.6 percent and 19.5 percent,
as if an implicit “norm” on the right proportion of “gen-
uine” asylum seekers were now being applied. Hence, the
influence of certificates can but be marginal: They “save” a
few cases without denting the general economy of asylum.
The administrative concept of a “secure country,” or the
bureaucratic zeal of certain Ofpra officials or CRR assessors,
carries far more weight than the medical certificates with
which the organizations torment themselves. However, it is
their burden and their duty to testify, through their exper-
tise, to the persecuted persons’ truth—through the words
they can put on the evidence of their bodies.
BELIEVING IN THE VERACITY OF ALLEGED FACTS
Mr B.’s account of the circumstances of his arrest and tor-
ture and his subsequent internment in the N. jail is par-
ticularly detailed, coherent and sometimes even tinged
with emotion. Yet the clinical examination remains poor.
Thoracic pains appear to be related to a post-traumatic
chondro-sternal arthritis that cannot be identified by
X-ray. The fact that Mr B. has a missing tooth, whereas
the rest of his teeth are in a good condition, is very likely
to be due to the stated cause. The abdominal scar can-
not be related to a precise injury by Mr B., who says that
he more or less lost consciousness. On the whole the al-
leged facts are nevertheless plausible. Certificate handed
directly to the interested party.2
How can one write about violence? How can one ex-
press the suffering of its victims? To these questions the
anthropologist can only answer, as Veena Das (1997) did
in the case of Indian women, by talking of the necessity
and simultaneously the powerlessness that the anthropolo-
gist feels. But for the expert responsible for testifying to the
traces of torture on a body, the problem is not ontological;
it is technical. It is a matter of mobilizing competence at the
service of a cause. The expert has to describe consequences
to validate an account. The preceding excerpt concludes a
long medical certificate drawn up by a Comede doctor con-
cerning a man “of Zairian nationality.” They attest to the
medical professional’s expertise and to the veracity of the
applicant’s discourse.
The form of this type of document is standardized. It
starts with “I, the undersigned,” continues with the per-
son’s “statement,” his or her “grievances,” the “examina-
tion,” and finally the “conclusions.” In the present case,
the statement, in a direct style and in the indicative mood,
is rather long: 36 lines. The political circumstances are men-
tioned: “Mr B. tells us: ‘I was working for the company S. as a
storeman when one of the officials asked me to let through
propaganda material transported by the air company in the
name of Mr V., a Belgian socialist who was supporting the
clandestine opposition party, the UDPS. I agreed and I let
several through.’ ” The account of the arrest is detailed: “On
30 July 1985, five BCRS agents came to arrest me at my
home. I was hit from the moment they arrested me and in
the jeep that transported me. When I was kicked in the left
cheek I felt that one of my teeth had been touched, it was
very painful, I started to bleed, then I realized that the tooth
had fallen out.” The physical torture during his internment
in the detention camp is then reported:
In the afternoon they came to fetch me and took me to
the office to be questioned by one of the commission-
ers. I told the truth about what had happened and then
one of the soldiers slapped me and since I didn’t want to
answer anymore, they hit me with a rubber truncheon
on the head and shoulders. I couldn’t stand it anymore,
I was stunned. They threatened to kill me. Then they
handcuffed me behind my back and took me outside.
They threw cold water on me and told me to stay lying
there. That’s when I saw that I was injured in the stomach.
They made me stand up again after an hour, they carried
on punching me and telling me to talk. They wanted to
force me to carry someone on my back and because I
wasn’t able to, I was kicked three times in the chest. The
third kick knocked me out.3
The grievances listed in the certificate are “the thoracic
pains,” “the absence of a tooth,” and “a scar on the ab-
domen”: They represent the victim’s discourse on the se-
quels of the violence to which he or she was made to sub-
mit. Compared to this account, the examination adds very
little: “The pain is revived by anterior-posterior pressure on
the thorax” but the X-ray “shows no lesion on the bone.”
Of course “the absence of the second upper left premolar”
is noted, but there are many reasons for losing a tooth. To
be sure, there is “a rough horizontal and rectilinear scar”
on the abdomen, but it is difficult to ascertain its origin.
Hence, the above conclusion attests to a profound convic-
tion attached to the narrative, far more than to a clini-
cal truth read on the body. Unable to ascribe the physical
signs with certainty to a violent cause, the author of the
certificate mentions the detail, coherence, and even emo-
tion of the account, ending with the statement that “on the
whole the alleged facts are nevertheless plausible.” This last

Fassin and d’Halluin •The Truth from the Body 605
statement, in absence of clinical evidence, amounts more
to a profession of faith than anything else.
This medical certificate was drawn up in 1987, the early
days of clinical expertise on torture. It belongs to the corpus
of two hundred certificates we analyzed. The institutional
demand had just emerged and the organizations had not
yet established its doctrine. Each of the doctors solicited
by asylum seekers or by the government administration re-
sponded as best as he or she could, combining the canons
of medical certification (standard expressions, careful de-
scription, and cautious interpretation) with a sense of the
just word (faithful transcription of the account, highlight-
ing of important details, and personal engagement in the
conclusion). Yet none of the expert’s styles were hampered
by general rules. Our analysis of a series of certificates writ-
ten during this period shows widely diverse styles, as can be
expected when people are left to their own devices. How-
ever, this “free style” practice belongs to the past.
From the early 1990s, under the pressure of the so-
cial and political demand, the Comede has established
standards, first synthesized in an internal document in
November 1991. The new rule was to “try to be brief and
accurate,” especially in the account. Whereas certificates
were previously one and a half page long, they now con-
sist of only a few lines in an indirect style and with a dis-
tant mode, as in the following example from 2002: “This
patient of Tamil origin was reportedly arrested in 1996, due
to his involvement in aiding the Tigers, and incarcerated.
He claims to have been tortured, hit with a bayonet, and
burned with cigarettes.”4The contrast is striking with the
detailed report in which Jonathan Spencer (2000) describes
scenes of violence in this civil war through the history of a
young Sri Lankan. In the clinical part of the certificate the
instruction is to “give precise information on the grievances
or observations of the examination.”5Everything concern-
ing medical expertise is detailed: “At the root of the left
thumb, two scars, one longitudinal, 3cm, and the other
oval, related to a cut; on the left upper arm, five round
lesions typical of cigarette burns; on the right leg, several
scars from knife-wounds.”6The following recommendation
connects the account to the examination: “Draw a conclu-
sion,” it suggests, by trying to “link up the stated facts and
the observed sequels” and avoid any mention of “negative
elements in the grievances or the examination.”7Hence,
the author will no longer refer to “a poor clinical exam-
ination,” or note that “the scar could not be related to a
precise injury,” thus manifesting honesty that the author
may have believed could be effective for the asylum seekers’
case—such practices are no longer acceptable. In fact, the
concluding remark is coldly standardized: “On the whole,
the observations correspond to the patient’s statements.”
By following an established rhetorical structure, the med-
ical certificate, thus redefined in its informative content,
takes on a different social meaning.
Reduced to its simplest expression, there are three main
reasons for the reduction of the patient’s case history: (1) as
an effort to avoid redundancy with the patient’s own words,
which could lose their legitimacy; (2) as an effect of exhaus-
tion related to the number of applications, which leads to
a sort of routine established in practice; and (3) as an at-
tempt to adhere to the deontological principle that a doctor
should only discuss that to which he or she can attest. Po-
litical, practical, and procedural reasons, thus, combine to
put the account at a distance from the expertise. This sepa-
ration is set in a broader movement that can be described as
a differentiation of functions and a sharing of roles in the
construction of public causes (Sarat and Scheingold 1998).
In this case, the defense of asylum seekers takes place pri-
marily on three fronts: (1) the law, through which the public
authorities are called to act; (2) the account, which enables
people to construct the case history to present to the of-
ficials and the assessors; and (3) medical expertise, based
on the certification of traces of violence for those same in-
stitutions. In individualized support for asylum seekers, the
narrative and the body are separated. As Liisa Malkki (1996)
notes, with the loss of individual histories, it is the collective
dehistoricization of refugees that is set off.
To be sure, the doctor has to link up what the body
reveals and what the story tells. However, the doctor op-
erates only on his or her home ground—that of clinical
medicine—leaving the biographical reconstruction to spe-
cialized agents: lawyers, naturally, but also to such organi-
zations as Cimade (Committee Interorganizations for Dis-
placed Persons [Comit´e intermouvements aupr`es des ´evacu´es])
and Cada (Centers for Asylum Seekers’ Accommodation
[Centres d’accueil pour les demandeurs d’asile]), who have de-
veloped this sort of activity. The validity of the doctor’s ex-
pertise depends on the limitations of his or her competence
in the medical field. Giving up the moral sentiment that
originally prompted him or her to engage in this activity of
“care and support” is the price to pay for the medical certifi-
cate to be credible and, therefore, effective. Consequently,
doctors no longer talk of “emotion” in the account and no
longer claim to “believe” the applicant’s words. They ex-
amine and describe “observed scars,” trying to affirm the
probability of a link with the “alleged facts.” Finally, they
state the compatibility between the two on the basis of the
same expert’s logic as that of the occupational health spe-
cialist who expresses an opinion on an employee’s ability
to work (Dodier 1993). The militant doctor has been turned
into an expert of forensic medicine.
By a sort of inversion of meaning and return to sender,
the expertise nevertheless has a function other than the
openly announced utilitarian one. Although the medical
certificate was originally intended for the Ofpra official or
the CRR assessor working on the asylum case, this precious
document turns out to be invested with a therapeutic func-
tion as well. Drawing up a certificate is a way of recogniz-
ing that the person has indeed been a victim of the violent
acts to which he or she claims to have been subjected. Not
only are the people listened to, they also know that they
have been heard. Although, as Michael Pollack (1990:29)
notes, all those who have experienced extreme horror are
faced with the painful fact of having to “manage the un-
speakable,” often they are also confronted with the no less
painful fact of having to manage the inaudible.

606 American Anthropologist •Vol. 107, No. 4 •December 2005
Today, the government administration’s ethos regard-
ing asylum is dominated by suspicion. People’s case histo-
ries are questioned, facts are challenged, and evidence is
disqualified. Having convinced the physician or the psy-
chologist is therefore a first step, and possibly a decisive
one, in the production of the person’s truth. Henceforth,
the mark is no longer only on—or in—the body. It is present
in a document that has legal value. Whether it reproduces
the account or attests to the consequences, the scriptural
trace envelopes the fragile words and invisible wounds of
the asylum seeker in its legitimacy. Writing has not only the
practical, and thereby intellectual, values that Jack Goody
(1977) revealed; it also has a symbolic value, and conse-
quently a political one, that can be seen in the medical
certificates. In a context of generalized skepticism, the writ-
ten testimony is the highest form of truth telling. However,
obviously, the ultimate recognition of the victims of perse-
cutions and their most efficient therapeutic remains, in the
end, obtaining the precious grail: the document asserting
their refugee status.
CONCLUSION
No matter how marginal their presence may be in the Eu-
ropean world—both quantitatively and qualitatively—the
condition of the asylum seekers is crucial to the contempo-
rary human condition. One could even suggest that, if the
refugee was the historical subject of the 20th century, as
Hannah Arendt (1951) asserts, the asylum seeker might be
the anthropological figure of the 21st century. Not so long
ago, the refugee represented the individual fleeing violence
or oppression from his or her home country and often be-
coming a stateless person. The asylum seeker now represents
the individual in quest of a legal status and often being de-
nied a citizen’s identity. This new figure tells us not so much
about the wandering of the stranger as about the expecta-
tion of the foreigner, “on the verge of politics,” in Jacques
Ranci`
ere’s words (1998). This distinction is not only tempo-
ral but also geographical—and the Western world here rad-
ically differs from the Third World. Whereas Allen Feldman
(1994:407) sees an “anonymous corporeality” in the mas-
sive displacements on the African continent, whether con-
sidered through media representations or in aid policies,
the European situation can, by contrast, be conceived in
terms of an overindividualized corporeality. Asylum seek-
ers are expected to unveil themselves, to recount their his-
tories, and to exhibit their wounds. The casuistry underly-
ing the supposedly fair processing of applications is itself
based on an extreme singularity of situations. Each case is
different, we are told, and therefore justifies distinct treat-
ment. Accordingly, it is each biography that is explored,
each anatomy that is searched. As in the case of other dom-
inated categories—the poor or the foreign—the government
of refugees in French society operates through “a dual pro-
cess of subjectification and subjection” (Fassin 2004:259)—
in other words, of production and submission of the subject
whose body is supposed to deliver the “ultimate truth.” The
medical certificate, a modest object in asylum policies, is
far more than a mere expert’s assessment. It is the tenuous
thread on which hangs the entire existence—both physical
and political—of the asylum seeker.
DIDIER FASSIN University of Paris North and Ecole des hautes
´
etudes en sciences sociales, Centre de recherche sur la sant´
e,
le social et le politique (Inserm), 74 rue Marcel Cachin,
93 017 Bobigny Cedex, France
ESTEL L E D’HAL L U IN University of Paris North and Ecole des
hautes ´
etudes en sciences sociales, Centre de recherche sur
la sant´
e, le social et le politique (Inserm), 74 rue Marcel
Cachin, 93 017 Bobigny Cedex, France
NOTES
Acknowledgments. This study has benefited from a grant of the
CNRS, Inserm, and MiRe (Ministry of Social Affairs). Didier Fassin
designed the research and wrote the present article. With Estelle
d’Halluin, he conducted the fieldwork and analyzed the empirical
material. Both authors are grateful to the members of Comede, in
particular Arnaud Ve¨
ısse, for their help; we are also indebted to the
anonymous AA reviewers for their useful comments. The article
was translated from French by Liz Libbecht and revised by Didier
Fassin and Dac Nelson.
1. Comede Memo, P. Szylagyi and P. Lamour, regarding Synth`ese de
la Commission sur les certificates, Le Kremlin Bicˆ
etre, November 18,
1991, 2 pages.
2. Comede archives, medical certificate, May 19, 1987.
3. Comede archives, medical certificate, May 19, 1987.
4. Comede archives, medical certificate, February 22, 2002.
5. Comede archives, medical certificate, May 19, 1987.
6. Comede archives, medical certificate, February 22, 2002.
7. Comede archives, medical certificate, February 22, 2002.
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