The asylum process was designed for speed. The regulations require that, absent “exceptional circumstances,” USCIS should adjudicate an affirmative asylum petition within 180 days. See INA § 208(d)(5)(A)(iii). That time frame went out the window with the “surge,” if not before, and these days, cases typically take a few years (and cases referred to Immigration Court can take even longer).

The effect of these delays on asylum applicants is about what you’d expect. I often hear from clients who are suffering from depression, anxiety, and other stress-related illnesses. Some have diagnosable conditions, and we regularly obtain letters from physicians to help us expedite cases. The situation is particularly dire for applicants separated from spouses and children, but few people seem immune to the stress caused by not knowing whether you (or your loved one) will be returned to a place where you fear harm.

Several recent studies have helped shed light on how the immigration process impacts people’s health, including the health of their children and even their unborn children.

One study stems from a well-known immigration raid in Postville, Iowa in 2008. Almost 400 undocumented workers—mostly Guatemalan—were arrested and charged with crimes such as identity theft and document fraud. Most were deported. Researchers at the University of Michigan at Ann Arbor examined the birth certificates of 52,000 children born before and after the raid. They found that “Latina mothers across the state were 24% more likely to give birth to undersized babies in the year after the raid than in the year before.” “The weight of non-Latino white babies stayed constant, suggesting that Latino populations were uniquely stressed by the incident.”

“Low birth weight is associated with developmental delays, behavioral problems and an increased risk of chronic disease,” among other problems.

Another study, currently in progress, will examine millions of birth certificates nationwide to “learn whether similar birth-weight patterns emerge when individual states enact laws targeting undocumented immigrants.”

A third study suggests that immigration raids can have deleterious effects on adults, as well. In November 2013, in the midst of an on-going health study of Latinos in Washtenaw County, Michigan, ICE conducted a high profile military-style raid on the local community. “The 151 people who answered the survey after the raids reported worse general health than the 325 who had already completed it…. Many said that after the raids, they were too afraid to leave their homes for food or medical care, and displayed symptoms of post-traumatic stress disorder.”

After President Trump signed the first executive order, the American Academy of Pediatrics warned that, “Prolonged exposure to serious stress — known as toxic stress — can harm the developing brain and negatively impact short- and long-term health…. The message these [immigrant] children received today from the highest levels of our federal government exacerbates that fear and anxiety.”

These reports focus on undocumented aliens who fear removal and their children, but my guess is that the results would be similar for asylum seekers, who also face uncertainty, especially in light of the Trump Administration’s rhetoric and stepped-up enforcement efforts. The reports also reflect what I am hearing from my clients.

So what can be done to help alleviate stress related to asylum delays?

First, you can try to take some affirmative action. Ask to expedite and/or short-list your case. File a motion to advance. I have written about these options here (for the Asylum Office) and here (for the Immigration Court). Whether such efforts will ultimately make the case any faster is somewhat unpredictable, but taking action may be better than waiting helplessly.

Second—and I often tell this to my clients, most of whom have strong cases—try to live like you will win your case. Learn English, go to school, get a job, buy a house, etc. You really can’t put your life entirely on hold for years waiting for a decision in your asylum case. You have to live. Obviously, this is easier said than done, and I myself would have a very hard time following such advice, but those who can put the case out of their minds and go on with life will be better off than those who dwell on it.

Third, stay engaged. There are support groups for refugees, asylum seekers, and victims of persecution. There are also churches, mosques, and other institutions that can help. Being able to discuss problems, share information, and talk (or complain) to people who understand your situation is useful, and maybe cathartic. For a list of non-profits that might be able to refer you to a support group near you, click here.

Although cases do seem to be moving a bit faster lately, it seems unlikely that the long delays and uncertainty faced by asylum seekers will go away anytime soon. During the wait, it is important to take care of yourself and your family, and that includes taking care—as well as you can—of your mental health.