Forensic Trauma Evaluation Backlog and Mental Health Symptom Persistence Among Congolese Asylum Seekers: A Target-Trial Emulation of Medico-Legal Report Delays

The medico-legal report that documents torture sequelae for asylum proceedings is routinely delayed by forensic evaluation backlogs, yet the mental health consequences of that delay remain unquantified because randomisation to waiting is ethically impossible. Power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effects of 3, 5 and 8 percentage points. The analysis indicates that 54 clusters are required to detect a 5-percentage-point difference at 80% power, and that designs with 8 or 16 clusters are underpowered across the entire effect range examined. The contribution is a design-level demonstration that the backlog question is estimable, and a specification of the cluster counts at which a credible emulation becomes feasible.