Posts Tagged IRCT Scientific Symposium

Treating trauma among refugees and asylum seekers in Sweden

In the heart of Sweden’s third biggest city, Malmø, lies one of the Swedish Red Cross Treatment Center for persons affected by war and torture. Every day the centre provides specialised treatment to torture survivors from all corners of the world. Since the centre first opened its doors in the late 1980s, it has helped nearly 5,000 traumatised men and women who have escaped violence and persecution, war and armed conflict.

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Image courtesy of the Swedish Red Cross. Photographer Ola Torkelsson.

On some occasions, the trauma from torture will not rear its ugly head until decades after the incident, explains Anette Carnemalm, Head of the centre in Malmø, which is a member of the IRCT. She has seen this happening with many of her clients, particularly women victims of torture, who only start to suffer from trauma and depression years later when their children are grown up and their time is no longer filled with caring for them on a daily basis. This shows in the group of clients that the centre treats.

“Of course we have many clients from the Middle East, but there are still many clients from the Balkans, especially women who survived the war,” says Anette. “What happens is that when a family arrives, the woman is consumed with looking after the family. When the children move from home the woman will often experience an existential crisis, which can lead to the trauma and depression that was left dormant for so many years.”

Knowing this, it is perhaps not surprising that Anette predicts that we will see a similar thing with Syrian women 20 years from now.

While the consequences of torture haven’t changed, the refugees coming to Sweden have. Before the war in the Former Yugoslavia, there were the dictatorships in Latin America during the 1970s, which saw an influx of refugees from this part of the world. Today, many of the refugees coming to Sweden are from Syria, Iraq and Lebanon, as well as Somalia and Eritrea.

“It’s been a year since Sweden saw a great raise of influx in refugees arriving in the country, but we only started receiving clients much later, which is a natural consequence of refugees trying to integrate and settle. Not until they’re beyond the acute crisis will they seek help for trauma symptoms,” says Anette and continues: “The real influx in clients will be seen in a year or two from now.”

Unlike other Red Cross centres in Sweden that take many asylum seekers waiting for their case to be processed, the centre in Malmø treats a higher number of people with permanent residency. In fact, Malmø is Sweden’s most multicultural city and in the inner city there are residential areas, which are home to a large number of families with an immigrant background, as well as students and artists.

Despite this, Sweden at present has the lowest denominating standard in the EU when it comes to asylum seeking law, after just recently having introduced increasingly strict legislation on immigration. For many traumatised asylum seekers, this means they face a great deal of uncertainty, which often hinders their treatment.

“It is important to create a safe environment for a client in order for them to seek treatment, but it’s very hard in the present situation to convey that this is not a threatening environment, when it does seem threatening for a refugee who is here alone and doesn’t know if he or she will be allowed to stay,” says Anette, as she points out that the situation for centres like hers is also uncertain. Even though her centre has so far been protected from any funding cuts, there are no guarantees.

“The political climate has changed and we now see political parties objecting to our funding so we don’t know where we’re heading in this sense.” So far, the centre has managed to expand to meet a growing demand for its services and today it has 22 staff, 19 full-time and three part-time. Their work has made a difference to not only many of their clients, but also to the torture rehabilitation movement.

“We see our efforts make a great difference in our work with the Istanbul Protocol, documenting torture, but also when a patient tells us that they are feeling better. It is immensely rewarding working, or even just sharing a coffee, with a person who has survived such terrible circumstances. See them fighting to get their life back, improving their relationship with their family and regain some of the trust that has been lost.”

“It is clear that Anette treasures her work despite the challenges that her and her colleagues face: “From here I don’t know where to go. I’m with the Red Cross and I am doing this job, and I don’t know where I would want to go that could be any better. It’s a very rewarding job, but obviously also very strenuous. As the Head of the centre it is very important to ensure that my staff don’t get too overwhelmed or stressed and stay healthy.”

Röda Korset Malmö.Foto Ola Torkelsson ©

Image courtesy of the Swedish Red Cross. Photographer Ola Torkelsson

Work challenges and strict immigration policies aside, Anette does hope that her centre, as well as the global rehabilitation movement will become better at sharing knowledge and influencing the current political climate.

“I hope that our knowledge will influence the political debates to a larger extent and that we can convey our knowledge about torture and rehabilitation to the rest of the world so we can change people’s opinions and understanding. There is this political movement, which is global, but there is also a growing knowledge of trauma, which is a good thing. We do a lot of lectures and people are always taken aback when they hear about our work. They didn’t know… so we need to be better at sharing knowledge and raising awareness.

“I hope that we continue to build our scientific knowledge about trauma and how best to help. As an example, there is a lot of research on how to treat PTSD among war veterans, but not much research on how to treat PTSD among people in exile – people who are supposed to integrate in a different country. What is it like to suffer from trauma in a different country, without your family and your social network, not knowing the culture nor the language?”

It is clear that the rehabilitation sector still has work to do in terms of developing and sharing its knowledge about trauma among refugees and asylum seekers and what the best treatment methods are. It is also clear that centres like the one in Malmø have a key role to play in doing so.

Anette Carnemalm was among the presenters at the IRCT 10th International Scientific Symposium, which took place from 4-7 December in Mexico City. The Symposium brought together more than 350 participants from across professions, sectors and countries.

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The power of collective memory to heal

The concept of collective memory can be used to provide psychosocial support to victims of torture, as well as reminding society of past atrocities. Professor Carlos Beristain, who is a physician, specialist in health education and doctor in psychology, believes collective memory can help survivors make sense of the trauma they have experienced.

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Professor Carlos Beristain

“The memory of what happened hurts, because it brings torture victims’ experience into the present day. Yet it also demands that the victim regain their dignity. The key is the psychosocial support. For victims of torture and other human rights violations, memory can help create a social framework for recognising their experiences, which they often have to keep inside or hide in silence. Memory also contributes to insuring the same trauma never happens again.”

This is how Professor Beristain explains the power of victims’ memory when it comes to healing. Having worked with victims since 1988, he has seen first-hand how collective memory can help torture victims understand their experiences better.

Beristain started out by focusing on the diagnosis of injuries caused by torture and the analysis of medical reports of cases in the Basque Country and in other countries. “In 1989 I went to El Salvador to train lawyers, doctors, psychologists and social workers on the documentation of cases, medical aspects of psychosocial care for victims and strengthening the community against the risk of arrest and torture, since this was a systematic practice during the war,” he explains.

He knows only too well the consequences of torture and how it can affect entire communities. “In 1990 I went to Guatemala for the first time because other human rights organisations were interested in my work, even though there were no survivors in Guatemala because few political prisoners survived. Providing support to the relatives of disappeared persons and those killed in the massacres were the most important issues at the time. In Guatemala we learned about other forms of torture, such as acts of torture against the general public during the massacres and survivors who witnessed these acts, as well as the enormous impact of terror on Mayan communities.”

These experiences have reinforced his believe in the importance of collective memory. “It can especially help in expressing their experiences in a positive sense. Because it is not only the pain and what happened that is important, it is also their resistance to it and their fighting spirit.

“Many victims see their experiences reflected in the more global work of collective memory, reaffirming themselves as a person and letting go of the negative image they have of themselves that creates a stigma where they or others feel they deserved to be tortured.”

Beristain was part of the Interdisciplinary Group created by the Inter-American Commission on Human Rights in 2015 that investigated the case of the 43 missing students of Ayotzinapa in Guerrero. A high profile case that attracted press attention from across the globe. He explains that, “Our work consisted of accompanying the victims, investigating the case and what happened the students, restoring a dialogue with the state and supporting them in analysing the reports and allegations about torture.”

Professor Beristain has been working with the relatives of disappeared persons in Mexico for several years. “Some of them have survived kidnapping, and all of them suffered from the impact of the torture of forced disappearances and the lack of a state response to these atrocities. During workshops we ran we made space to share, to cry and to try to understand what had happened, despite the pain of many participants,” he says.

“Through our work and support, many relatives have gone on to lead organisations, to have direct contact with the authorities, to review records or to take action, even in situations of repression or intimidation. The psychosocial support my colleagues and I have provided has played an important role in the development of these processes and organisations.”

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Professor Beristain will speak about survivor participation in research and treatment planning at the upcoming IRCT International Scientific Symposium, which takes place in Mexico from 4 to 7 December. It is closely connected with collective memory and a topic that he feels strongly about. “Survivors should be involved from the start. Firstly, because torture victims are in a process of regaining the control of their lives on their own terms and their ability to make decisions and take an active role is fundamental. Secondly, because of their experiences. Although their memories might be fragmented or limited, they can provide the group with a more positive perspective and act as an example for others,” he says.

During a workshop with women survivors in Columbia, one of the survivors, who is also the leader of a women’s organisation, said, “It’s the first time in ten years that I stopped feeling guilty.” This was as a result of speaking with others in the group. We know that guilt can fill the space where the person tries to make sense of what happened and this guilt has a way of trying to take control of the situation, as well as having an enormous psychological impact on the person.”

While much progress is being made in the sector, Professor Beristain says more is needed to, “Help survivors face the consequences of their experiences, while reinforcing social ties and strengthening the social fabric of communities. In other words, it is not only a question of reducing suffering, but also contributing to the fight by tackling its causes. It is important to support victims and strengthen their psychological state and ability to integrate in society, as well as helping them to take their case to court and strengthen their ties with other victims so they can play an active role and not be the passive victim.”

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Fighting Torture: Q&A with Jens Modvig

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In our Fighting Torture series, we speak with people from around the world and from a number of professions who work with and support survivors of torture. What does their work mean to them and what are the biggest challenges they see in the anti-torture and rehabilitation movement?

Jens Modvig was unanimously elected as the Chair of the UN Committee against Torture in April 2016. He has worked in the torture rehabilitation sector for more than 20 years, from his time as a medical doctor to his current role as Director of the Health Department at DIGNITY, the Danish Institute Against Torture. We find out what challenges he has faced in his new role and how the Committee relies on having close relationships with civil society.

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Jens Modvig

Q: How long have you worked in the field of torture rehabilitation and human rights?

I started working for RCT (Rehabilitation and Research Centre) /IRCT (International Rehabilitation Council for Torture Victims) – RCT is now DIGNITY – in 1994 so it has been more than 20 years. It has been a great privilege for me to use my professional background in such an important field. I do not think that many people are as blessed as I am to have such a meaningful occupation.

Q: Can you describe a typical day in the office/field for you?

When I am in DIGNITY, I mainly work with matters related to medical knowledge of torture. This could be drafting or reviewing research papers or manuals for health professionals. When I am in Geneva for sessions of the Committee against Torture, we are in session all day, considering reports from state parties through an interactive dialogue with a delegation from the country in question.

These sessions are public and webcasted. During this session, which unfortunately prevents me from attending the IRCT Scientific Symposium in Mexico, we consider reports from Sri Lanka, Turkmenistan, Armenia, Monaco, Ecuador, Namibia, Finland and Cabo Verde. In between sessions I have meetings, internal or with ambassadors from countries being considered, or I prepare for the next day.

In the field, I most often engage in training or awareness sessions to build capacity or raise awareness of the problem of torture and the need to prevent torture and rehabilitate victims.

Q: Can you give us an example of how you have seen your work make a difference?

In a recent meeting in Ghana organised by the Convention against Torture initiative, initiated by the governments of Chile, Denmark, Indonesia, Ghana and Morocco, representatives of Kenya and Uganda explained that they had engaged in large legislative processes to have anti-torture legislation in place, and in both instances, this was prompted by recommendations by the Committee against Torture after consideration of these two countries.

Another example is when NGOs have assisted the Committee with a country review, for instance, by submitting a shadow report or having a private meeting with the Committee ahead of the public meeting, in some cases the NGOs fear reprisals once the session is completed. In such cases, I may issue a public warning to the state party delegation that such measures are unacceptable and will be reacted to immediately. In these cases I believe that the NGOs are just a tiny bit more secure, just as they often solicit and appreciate such messages from the Committee.

Q: How has this work changed since you started?

I think the anti-torture movement in general has been much better organised, and the professional level of fighting torture has increased considerably.

Q: What do you think are the biggest challenges facing the torture rehabilitation sector?

The biggest challenge is to get state parties to the Convention against Torture to assume their responsibilities laid down in article 14 of the Convention, i.e. the right to rehabilitation. If they did, we would not have the symptomatic problem of funding difficulties for the rehabilitation centres, and the sector would thrive, to the benefit of the victims.

In this regard, the IRCT Scientific Symposium a unique opportunity for the movement to take stock of its scientific achievements. In my opinion, scientific achievements are of great importance to the movement and give strength and legitimacy to the anti-torture movement as a whole, but are also a way of creating respect and maybe even protection for the individual NGOs that deal with torture victims.

In addition, it is clear that the right to rehabilitation is not enforceable in all state parties to the Convention against Torture and a lot needs to be done in this respect. The Committee is certainly working on this during its dialogue with state parties, but I believe that state representatives who will participate in the Symposium will obtain a much deeper understanding of why rehabilitation is needed and necessary and why states should ensure that the right to rehabilitation is available to all victims of torture.

How important is the CAT’s relationship with civil society organisations?

The Committee against Torture relies on close collaboration with civil society, particularly in the field of alternative reporting. If we only had the official government reports available when carrying out our country reviews, we could easily be left with an incomplete or even wrong picture. Civil society organisations like IRCT members often provide crucial information to the Committee, often based on statistics derived from their clinical work with survivors of torture; and the IRCT plays a crucial role in supporting its members and facilitating their dialogue with the Committee.

Q: What are your hopes for the future?

Obviously I hope that the anti-torture movement, both the civil society based and the intergovernmental work gains much more strength and awareness so that we in fact are able to effectively fight torture.

Q: According to various surveys, many people do not think torture is such a big problem; that it is a thing of the past; or some even think that it is necessary. What would you say to them?

Try to imagine yourself in a situation where you were unjustly accused of terrorism. What would be important to you?

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