Survivors of torture who flee their home countries face a treacherous journey followed by a long and stressful wait for a decision on their status. But lawyers and doctors on Lesbos are working together to make the assessment experience for refugees kinder and more human, as writer and neurologist Jules Montague reveals.
When wounds replace words
Words by Jules Montaguephotography by Steven Pocockaverage reading time 9 minutes
Mambweni’s scars are his stories but they are also his legitimacy. Soon after his treacherous sea crossing from Turkey, a medical official on Lesbos documented his injuries and agreed that those scars supported his account of torture in his home country. But Mambweni* tells me that the rushed physical examination left him deeply distressed: “It made me feel like an animal, like a criminal. I had no dignity.” His trauma had been reduced to a clinical report, to a series of bullet points.
At METAdrasi in Athens – an organisation founded to facilitate the reception and integration of refugees and migrants in Greece – however, a team is trying to change the experience of survivors of torture like Mambweni.
Since 2011 1,200 people have entered this unmarked office in the Greek capital’s south-western suburb, inconspicuously located next door to a car-repair shop, down the street from a grocery store and a bank. They have trudged up the building’s dark, winding staircase to the second floor, where sunlight reappears, streaming through huge windows to unveil a place busy with medics and interpreters filing into training seminars, phones buzzing, and a coffee machine whirring.
Some are sent here by their legal representatives or family doctors, or by frontline refugee agencies or public organisations. Some refer themselves. They have usually had their asylum applications rejected already. They are more likely to come from countries with low ‘recognition rates’, like Somalia, Ethiopia, and Bangladesh, than countries with higher rates, such as Afghanistan and Syria. The asylum ‘recognition rate’ is the share of positive decisions in the total number of asylum decisions for each stage of the asylum process.
Their assessment here is vital to their futures. If it bears witness to their torture, the possibility of asylum – international protection – lies within reach. Until now, they have tried, and failed, to make themselves heard. They hope they will be listened to here.
More than 35,000 migrants are trapped on Lesbos and other Greek islands. Thousands face an interminably lengthy application process for asylum. If that application fails, they will be deported. Yet many survivors of torture lack access to a certification organisation. “At least 20 per cent of refugees have a torture history,” psychologist Elena Christidi says, “so if you think we only examine 20 or so people a month, that’s a drop in the ocean.”
Even for those who do reach identification services (rather than certification ones), the process and outcome can add to the trauma, especially in the overcrowded and chaotic migrant camps. Like Mambweni, Michael* was assessed on Lesbos (although not by METAdrasi). I meet him at an advocacy group for survivors of torture at another unmarked building, this time across the city from METAdrasi’s offices.
Broad-shouldered, his eyes closed, his foot tapping the leg of his red plastic chair, he recalls one of a series of gruelling interrogations: “They threw me into an interview and the interpreter in Athens was on the phone,” he recalls. “In my culture and country, if man is raped he loses his potential authority; he loses face. To tell someone that you have been raped, you have to know and trust someone. To have an interpreter by phone who is a complete stranger – that is not okay.”
The process at METAdrasi is different. Paediatrician and public health physician Agis Terzidis listens to his patients’ stories, accompanied by an interpreter trained in working with survivors of torture for each consultation. The stakes are high, he acknowledges. To miss the signs is to deny the chance of freedom: “If you are trapped on Lesbos or in prison and then certified as victim of torture, then the day after or the week after, you can continue your trip; you can continue your life, theoretically.
But establishing proof of torture isn’t easy. "It is not black or white,” Terzidis says. He takes photographs of injuries, and grades what he sees as providing a high, moderate, or low degree of support for alleged torture.
“It’s only diagnostic when there is no way to have these scars other than [the survivor’s description of] torture,” he explains. So cigarette burns on the back are often seen as consistent with torture, once other causes are excluded, such as scars from childhood chicken pox. In contrast, facial burns are non-specific. However, all physical evidence must be examined rather than evaluators making assumptions based on a single finding, Terzidis says.
The METAdrasi team uses the Istanbul Protocol, a manual of internationally recognised standards for the effective investigation and documentation of torture. This approach helps them directly correlate their medical and psychological findings to torture instead of solely recording them.
Bodies of evidence
He tells me about one characteristic sign he saw this week – frozen shoulder – in a man tied by the wrists and suspended by his arms. These victims suffer extreme overload to their joints, as well as the surrounding soft tissues and nerves. “If you’re hung up for a long time you get inflammation in your shoulder; you cannot move it after, you cannot raise your hand up.” This is diagnostic, he says. “You can conclude they were hung for hours or days.”
In a so-called Palestinian hanging, torturers force victims’ arms behind their backs, leaving the brachial plexus (a network of nerves) vulnerable to injury. And so Terzidis asks his patients about resultant arm and shoulder pain, pins and needles and numbness, and looks for physical signs such as weakness or a protruding shoulder blade.
Terzidis also searches carefully for the lingering signs of falanga (repeated blunt trauma to the soles of the feet) that remain long after the bleeding and swelling settle. “Even after months or years you can see atrophy of the muscles,” he says. These patients endure excruciating burning or cramping foot pain; some are unable to walk again.
The modus operandi of many torturers is to leave no mark... Sexual assault remains a widespread weapon of torture but does not always leave a visible trace.
However, the modus operandi of many torturers is to leave no mark. And so Terzidis cannot privilege scars over stories. Sexual assault remains a widespread weapon of torture but does not always leave a visible trace. And even if injuries are evident, his knowledge of torture practices from nation to nation helps him to contextualise his findings.
“You have to know the scene of the torture and what kind of torture happens in each country. You already have a picture in your mind of a Syrian torture room. You know what groups are doing there.”
In Syria victims’ bodies are contorted to fit into a rubber tyre and beaten. Survivors from sub-Saharan Africa are likely, in his experience, to endure electric shocks from a car battery or beatings with cable wires or planks of wood. “I have been doing this for eight years now, 30 patients a month, almost 3,000 cases, and the human mind always surprises me. Each month I find a new thing, a new torture, a new fantasy of the torturer, which is unlimited. It’s endless.”
Consultation and certification
Elena Christidi ensures mental wounds are respected as much as physical ones. We speak about torture in a bright, white-walled consultation room lined with children’s drawings of Disney characters and castles. There’s a self-portrait by a young boy called Mohammed, resplendent in checked shirt and waistcoat. Christidi’s role, she explains, is to determine whether her clients’ problems, such as depression or post-traumatic stress disorder, are “linked chronologically in a timeline with torture”. It is a search, she says, for a “correlation between act and consequence”.
But trauma can impair our capacity to recollect. “Sometimes survivors don’t remember the time or place of torture, they can’t recall exactly how long they spent in detention, they cannot put traumatic events in a row.” Many are understandably reticent to recall and retell, but others speak with a forthrightness that initially surprised her.
“They describe things we cannot imagine with a tone and attitude like they’re describing something simple. They say, ‘I’ve been tortured or raped,’ but their attitude is almost like saying what they had for lunch.”
After their respective consultations with a patient, all at least an hour long, the METAdrasi team – doctor, psychologist, social worker, and lawyer – meet to conclude whether the patient can be certified as a victim of torture. If certified, that document is crucial to their asylum application and provision of services such as rehabilitation.
Even though a claim of torture might be accepted by the asylum service, it does not inevitably guarantee asylum will be granted, if, for example, the torture happened long ago, under a different regime, or in another country, rather than the country of origin.
Keep telling the truth
Kimon Panagiotopoulos, METAdrasi’s Assistant Project Manager, says the organisation recognises that not all potential torture victims can be certified using their intricate interdisciplinary process. Instead, certification should be requested only in very difficult or ‘borderline’ cases, he says – those without obvious physical signs, for example, or with a complex legal context.
That’s why they train other frontline organisations in the process of identification. “Under no circumstance should certification be a universal prerequisite for asylum procedures.” Ultimately, survivors themselves need to choose whether to undergo the certification process.
Hassan* has been waiting for his asylum decision since 2014. What advice does he have for others in the same situation? “Be sure of who you are,” he answers. “Believe in yourself, keep telling the truth until people believe you.”
At METAdrasi that truth is documented. It is certified. And for Hassan and others, one day it might become a truth that is finally recognised.
* Mambweni, Michael, and Hassan (not their real names) are members of an advocacy group called Survivors2 – they speak out for the rights and recognition of survivors of torture.
About the contributors
Doctor Jules Montague is a former consultant neurologist, and the author of ‘The Imaginary Patient: How Diagnosis Gets Us Wrong’ (Granta 2022). It explores how the practice of diagnosis is tainted by the forces of imperialism, politics, discrimination and Big Pharma. She also writes about health and science for the Guardian, the BBC, and New Scientist. Her first book, ‘Lost and Found: Why Losing Our Memories Doesn’t Mean Losing Ourselves’ (Sceptre, 2018), explores what remains of the person when the pieces of their mind go missing.
Steven is a photographer at Wellcome. His photography takes inspiration from the museum’s rich and varied collections. He enjoys collaborating on creative projects and taking them to imaginative places.