Refugees as torture victims
Torture victims are a particularly vulnerable group within the refugee community whose needs frequently remain unrecognised or overlooked
Amnesty International (1987) reported the use of "brutal torture and ill treatment" in over 90 countries in the 1980's.
Torture as a definition is problematic, The United Nations (1984) Convention against Torture, defines it as;
An act by which severe pain or suffering (physical or psychological) is intentionally inflicted on a person for such purposes as; (a) obtaining information; (b) obtaining a confession; (c) punishment; (d) intimidation or coercion; (e) any reason based on discrimination.
Torture can also be perceived as
"the forceful persuasion of an individual/group out of their natural bodily, physical and psychological state, through the infliction of severe (either or both) physical and mental suffering... for the purpose of strategically silencing l repressing people who hold opinions contrary to those in power.'
Torture is designed to destroy the individual's ego/personality, reducing them to an infantile state where they can experience
`fear of annihilation, absence of sense of self, and difficulty in separating self and other. . . (As a result) survival in exile, estranged from familiar people and culture, (becomes) especially difficult. These individuals lack a sense o, f internal security" (Freud 1992)
However the need for support and the psychological effects of torture on each individual will vary as each will adopt and develop different coping strategies these in turn will be dependent upon the success of these strategies. Families and individuals who lose their position within society tend to be the worst affected exhibiting the most serious psychological difficulties.
In addition, further consideration is needed for the term `torture victim', which despite its usage in the report, deserves some thought. To talk of refugees who have experienced torture or trauma associated with torture as `victims' ignores the fact that these people are actually 'survivors' who live and cope with the long-term and daily effects of torture.
In repressive countries where torture is used, it is common that victims will report torturers using any one of the methods below. However, there are methods which are used more widely in some countries in comparison to others. These are as follows: beating, head injury, direct genital injury, phalanga, electrical torture, burning, light torture, pharmacological torture, dental torture, sleep deprivation > 48 hours, isolation > 2 weeks, starvation and thirsting > 48 hours, death threats against relatives, witnessing/hearing torture, sham executions, mental torture (threats, humiliation, mental exhaustion, etc.), suspension, water torture and physical exhaustion. (Lunde, Rasmussen, Lindholm and Wagner )
The fear of re-experiencing torture forces many survivors to seek refuge far from home. This can often prove to be both dangerous (i.e. crossing borders) and costly. (Bracken and Gorst-Unsworth 1991)
Many refugees in Britain have been tortured, some systematically others arbitrarily. It is estimated in the USA that between 30-60% of refugees have been victims of torture. (Martinez and Fabri 1992)
Refugees experiences can present a number of psychological problems. However refugees can often express a reluctance to see mental health professionals for fear of being labelled `crazy'. To be labelled in this way, they fear, could result in stigmatisation and institutionalisation, social isolation from their communities; or possibly effect their chances of employment. These factors can make early detection of mental illness a difficulty. (Clinton Davis and Fassil 1992)
In the majority of refugee cultures and societies psychological problems are stigmatised and there is a reluctance to seek help. Instead, refugees are more inclined to somatize their emotional problems i.e. reporting them as physical complaints thus creating a situation where their underlying problems can be misdiagnosed, not diagnosed or expensive and inappropriate medication is prescribed. This is also common in situations where standard mental health services are inadequate, cultural/linguistic barriers exist and when the history of their past traumatic experiences are not documented. (Clinton - Davis and Fassil)
Torture is frequently perceived and restricted to the `direct' experience of torture. Conceptions like these can often result in the health implications of the `indirect' wider impact i.e. traumatising effect that torture can have on social networks, i.e. community friends and family (especially) being either neglected or ignored. (Martinez and Fabri 1992)
Children who have experienced torture lose their innocence and belief in their parents as protectors. Children in families where parents have experienced torture are also vulnerable and under stress developmentally. Fear can interfere with the adult's parental role and capacity to provide emotional support to children. Parents may appear emotionally absent to children. This can be interpreted by children as a consequence of their own actions provoking feelings of over protectiveness, fear and guilt. Growing up in this environment can have an effect on their ability to interact with their peers or adults to offset the pathological effects of family life. (Martinez and Fabri 1992)
Torture victims and access
Most refugees have become established and resettled in countries of asylum. As a result the specific social and health problems of refugees are becoming ever apparent. These cannot be dealt with on a short-term basis but require the development of comprehensive and long-term health and rehabilitation programmes.
The psychological and physical suffering of torture victims is profound and is frequently compounded by their inability to speak or understand English. This lack of meaningful communication with health professionals can lead to suspicion particularly among torture survivors whose experiences are mirrored in their interactions with health care professionals who in some countries participated in torture. (Please see Amnesty appendix)
Information on specific health problems of refugee is not available neither is there information on the scope of the problem. The lack of proper needs assessment and background information, the absence of basic medical screening, cultural and language barriers to access health and social services all add to the difficulties. (Clinton - Davis and Fassil 1992)
In order for mental health services and rehabilitation programmes to be successful, they need to address the mental health issue of refugees in culturally appropriate ways, to accommodate varying cultures among different refugee groups. Further, these specialised services should be provided within mainstream services to avoid the possible effects of service isolation. (Arsdale)