Tue, 06/09/2015

Doctors and Torture Victims

Many refugees who come to Germany, had to experience torture in their homeland. And many doctors are overwhelmed with the treatment of traumatized refugees. Not only for lack of time.

Again and again, Hubertus Hospital, which belongs to the network of PGD International admits patients from Syria or Libya whose injuries indicate that they are torture victims.

What exactly had happened to these people – if they had to do without sleep, were exposed to terrible noise, burned with cigarettes or sexually threatened in a cruel fashion – that our doctors cannot say, says Dr. Matthias Albrecht.

Albrecht is the CEO of Hubertus Hospital, the issue of torture is close to his heart for many years. "Of course, these patients are treated by our doctors," says Albrecht, who is also a delegate of the Berlin Medical Association.

However, more most doctors at his hospital cannot do. And the patients themselves are silent, says Albrecht. Often out of shame.

Torture is the most serious form of abuse. Even the Universal Declaration of Human Rights of 1948 contains an absolute prohibition of torture.

Later legally binding prohibitions were adopted as by the United Nations in 1984 and the Convention against Torture which was ratified in 1987.

Many countries introduced national laws against Torture following the UN Convention to send a clear signal against physical or mental anguish by state violence.

Nonetheless, in the period from 2009 to 2014, Amnesty International identified 141 countries, in which torture was practised.

Mostly, according to the human rights organization, by punches and kicks, producing a feeling of suffocation with objects such as plastic bags over their heads, electric shocks or suspension by the arms and legs.

Treatment is not easy

40 percent of the refugees who come to Germany have, according to statistics, experienced traumatic situations. They are all in need of treatment, says Dr. Ernst-Ludwig Iskenius. He is a member of the Action Network of Healers of Amnesty International.

Like Matthias Albrecht Iskenius knows that the diagnosis and treatment of people who had to go through such physical and mental anguish, is anything but easy.

"The victims hardly talk about their experiences and usually do not speak our language," says Iskenius, who worked from 1992 to 1995 as a doctor in Bosnia. Not always interpreters are present in all doctor's offices.

In addition, the German health care system is not designed to treat traumatized refugees, one doctor reveals, it simply lacks the knowledge and money.

Albrecht sees it similarly. "Torture victims are difficult to accommodate, people are pushed back from one place to another and forth," says the CEO of Hubertus Hospital.

Together with colleagues Albrecht brought through a motion at the 117th German Medical Assembly last year. With it the Assembly calls on the Federal Government of Germany to ensure suitably qualified professionals as well as medical and psychological examinations of asylum seekers, refugees and deportees to identify particular psychological effects of trauma. Only then German and European law is fulfilled, the motion states.

The EU Directive 2013/33/EU states inter alia that patients with post-traumatic stress disorder should not be deported, as they rank among the most vulnerable people who therefore enjoy special protection.

Misperception not Uncommon

Many years ago the physician Hans-Wolfgang Gierlichs realized that the skills of professionals in dealing with traumatized refugees are not well developed. "Traumatized patients often have a certain charisma that no one likes to feel," says the former head of a psychosomatic clinic.

An incident almost 15 years ago led the internist to action: In October 2000 a medical officer had classified the Kurdish winner of the Aachen Peace Prize H. Calhan as not traumatized although medical certificates stated psychological trauma as a result of torture.

The medical officer explained Calhan "fit to travel". The Kurd was deported. The report, which was based on the deportation, had professional, legal and ethical shortcomings. The case of Calhan provoked nationwide horror and led among other things to the "Aachen Peace Appeal". Herein Gierlichs and others call for binding guidelines for the investigation of psychologically traumatized refugees.

In 2001 Gierlichs developed a training curriculum together with colleagues. This includes "Standards for the assessment of reactive psychological consequences of trauma in residence law procedures including the Istanbul Protocol".

Document Type Instructions for Medical Treatment of Torture

The so-called Istanbul Protocol was issued two years previously by the "Office of the High Commissioner for Human Rights" of the United Nations. The document is a kind of guide to treatment and documentation of torture and other atrocities. It describes, inter alia, how physicians have to examine victims, what to look for and what psychological symptoms patients can display.

Although this topic was one of the peripheral issues of the German Medical Association at that time, it was well received, reports Gierlichs. Meanwhile, the curriculum is offered by the chambers in North Rhine-Westphalia, Westfalen-Lippe, Berlin, Bavaria and Baden-Württemberg. The other chambers have either no interest or there are not enough refugees in the local provinces to offer such a specialized training, says Gierlichs.

Despite all efforts, another aspect remains unresolved: refugees have no health insurance. In general, only recognized refugees are entitled to regular benefits. Social benefits for asylum seekers, tolerated and partly for other refugees as well, depend on the Asylbewerberleistungsgesetz (Law regulating the benefits for asylum seekers).

For 20 years the benefits under this Act were about 30 percent lower than the unemployment benefit II, which is well below what is considered decent living wage in Germany.

Regulated Medical Care

In July 2012, the Federal Constitutional Court had ruled that the services are "evident inadequate" and raised them significantly. A large part of the services refugees received as non-cash benefit, like shopping vouchers or chip cards so that they can only buy certain things in certain stores.

The health care is governed by the Asylbewerberleistungsgesetz as well. Health care, however, is only available by "acute illness and pain."

On the grounds of this definition, refugees are frequently denied sickness certificates, drugs, medicines and medical aids such as glasses or crutches. Also some complaints are protracted, criticizes Albrecht.

"In Berlin we are far better positioned than many other states," says Matthias Albrecht. But in the end, it is still not enough.

44 Percent Fear Ill-Treatment

According to a survey conducted by Amnesty International almost half (44 percent) of 21,000 people in 21 countries, fear that they could be tortured in their home country.

The vast majority (82 percent) believe that there should be clear legislation to combat torture. More than a third (36 percent) think that in certain cases the use of torture can be justified. 74 percent of Chinese consider torture occasionally as necessary. Americans believe for 45 percent that the use of torture occasionally is justifiable.

Professor Steven Miles of the University of Minnesota massively denounces the behaviour of American doctors in US prisons like Guantanamo. The physician and professor of medical ethics evaluated several thousands of documents for his book on the complicity of military doctors and medical personnel in US prisons. The result: More than once doctors had failed to provide inmates after the torture with medical aid.

In addition, doctors were accomplices of interrogation plans that require medical expertise. In such interrogations sleep deprivation has been arranged or passengers were exposed to extreme cold or heat. The US professor also criticized the behaviour of pathologists. They would have denied death certificates in death by torture and thus were knowingly silent.

link to the original article by Martina Merten on the website of Ärzte Zeitung:



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