Did you become a doctor to make a difference? Many of us did.
I work as a volunteer at Freedom from Torture seeing clients seeking asylum who say they have been tortured. I spend many hours with them, hearing their stories and examining their minds and bodies for the evidence that torture may have left.
That is the short version. But this is what it’s actually like.
THE CLIENT’S STORY
The building is an airy, friendly, multinational space, with a water feature and a bleached wooden floor. In my room I read the Home Office papers on my client including their screening interview on arrival here. ‘Where are you from?’ ‘What did you pay for a space on the dinghy?’ ‘Which way did you come?’
This is followed by a more detailed interview with an immigration officer. With no papers, people have to prove their nationality: ‘Which countries border yours?’ ‘Whose picture is on the bank notes?’ I wonder, suddenly, if I could prove my own nationality if washed ashore among strangers. Whose picture is on the £5 note?
‘Why did you leave your country?’
‘I was tortured.’
‘How?’
‘I cannot bear to say.’
Next, a witness statement. The client says they were raped, suffocated, beaten, burned, electrocuted. They describe escaping, the journey to seek safety, leaving their family and future, crossing continents, sinking neck deep into the Aegean, all in the hope of freedom and safety …
Then comes the refusal letter from the Home Office. The client must be lying: they incorrectly named the face on the 50 dinar note, and, moreover, they did not tell the first immigration officer at Heathrow, in their first breath on British soil, that they were sexually violated by five uniformed men in a small dark cell. One can understand why this might not be the first thing you would tell a stranger.
This person is the hero of their own story, the Frodo Baggins, the Aragorn, the Revenant … their solicitor wants to know what we think. The client arrives wary, scared, and uncertain. They told the immigration officer everything, they say. Actually, even under torture there was no more to say. They look at me through eyes that are furious, terrified, or simply blank.
They tell their story, slowly at first, then more confidently as the hours pass. They show anger, pain, sorrow, fury, and dissociation. They tell of fractured childhoods, routine discrimination, being forced at gunpoint to be a soldier. Some chose bravery, making speeches, delivering leaflets. Others had no choice, swept into the turbulent storms of world events.
The translator is so experienced as to be almost invisible, as they hear clients’ descriptions of being questioned while suspended, while naked, sometimes even upside down. They tell me how it feels when electric shocks are applied to your fingers and toes, what rape does to your soul, how you think you must kill yourself but, when they promise they will kill you, you realise you do not want to die. They tell me about survival.
DEFINING AND PROVIDING PROOF OF TORTURE
Then the examination, of mind and body. Every mark is recorded, and for each we must make a judgement as to how certain it is that their attribution is correct. Not consistent, consistent, highly consistent, typical, diagnostic. The definitions, taken from a document called the Istanbul Protocol (the UN manual on investigation and documentation of torture), have legal meaning. And sometimes, often, you can find the evidence of what happened to them written clearly in the marks on their skin, and in the damage to their psyche — the PTSD, depression, anxiety, and pervasive fear. And when you do, it feels really important. With the weight of your training and your colleagues’ experience behind you, you have provided evidence that this person was tortured. This happened. This may still be going on.
I spend hours writing it. The report is reviewed, returned, reviewed, returned, and then goes to the client’s lawyer. The report becomes evidence.
But it has another purpose too. Anonymised aggregated data from these medico-legal reports go into a country report, a targeted, specific, evidence-based report that says, ‘We know what you’re doing, because we can prove it.’ These reports are seen by the people who challenge states that torture, and who hold them to account. They go to the UN. They power justice and accountability.
Being a doctor at Freedom from Torture requires the skills that you, as a BJGP reader, already possess. If this sounds like making a difference then it could be for you.
Freedom from Torture is a charity that helps survivors of torture through therapy and rehabilitation, provides medico-legal reports on evidence of torture for their asylum claims, and aims to ensure that states responsible for torture are held to account.
Read more about them at https://www.freedomfromtorture.org/.
- © British Journal of General Practice 2017