This year at The Medical Foundation for the Care of Victims of Torture

Back from the abyss

The waiting room was little bigger than a suburban sitting room, and the young Algerian faltered on the threshold, disconcerted by the dozens of anxious faces suddenly looking up in the hope that he was a doctor or caseworker. Turning beseeching eyes to his wife he broke the tense silence with a whispered: "I don't think I can take this."

A few minutes later, having jostled his way past yet more clients clogging the corridor outside the consulting room, he was in despair as he began his weekly session. "I can't come here any more," he told his therapist, Director of Clinical Services Alex Sklan. "I can't be with so many people in such a small space."

It was not the first time that a Medical Foundation client had voiced such a complaint, but this case was different. Only after months of treatment had the man been able to describe the horrors that haunted him, his repeated rape by insurgents from Algeria's Armed Islamic Group (GIA).

Faced now with the prospect of the client putting an abrupt end to therapy that had clearly been beneficial, Alex sought the views of other clinicians and caseworkers. Many told a similar story. The Medical Foundation's "drop-in service" was being overwhelmed by the sheer numbers asking for help.

The figures proved the point, reflecting as they did the steady increase in the number of people seeking asylum in the UK. In 1997 the number of new referrals to the Medical Foundation stood at 2,210, climbing to 2,873 in 1998, and 3,303 in 1999, before soaring to 5,031 in 2000 and 5,483 in 2001, despite largely static staffing levels, and a dearth of extra space.

Taking control

A tentative control was put in place. Only the first ten drop-in clients to arrive each day would be seen, the rest would have to make an appointment and return later, but this was quickly abandoned when restless queues began forming outside the front door in dawn's cold light, hours before staff started work.

By early 2001 it was obvious that drastic action was necessary and the "drop-in service" was replaced by appointments, and a more controlled referral system to ensure that those seen at the Medical Foundation fell within its remit, in that they had suffered torture themselves, or organised violence in the form of attacks on members of their family, or their community.

However, emergency provision in the form of two intake workers, one a doctor, the other a nurse, was also made in a hall in nearby Courthope Road for cases needing speedy assessment and, if necessary, urgent support while awaiting long term treatment.

Today, clients who arrive at the Medical Foundation without an appointment receive an information pack that includes an explanatory letter in various different languages, and a questionnaire for their doctor, lawyer, or community worker to complete. Details sought include name, address, asylum status, history of imprisonment, nature of torture endured and the help required.

Those invited to help screen potential clients include a number of refugee agencies and two community associations, one Kurdish and the other Rwandan. "If we're told by those doing the screening that the case it urgent, we jump," said Alex Sklan. "It's called skill sharing, and we want more such partnerships in future. It means that cases that are clearly not for us are spotted at the outset, and it helps us plan in advance for those that we do see, in terms of having the right interpreter available for instance, in a way that we could not do before. "

With most potential clients referred to the Medical Foundation by lawyers, doctors and community associations, the number of interpreters employed to service their needs now stands at nearly 50, who among them have command of several dozen languages.

Volunteers

More than 20 lawyers, including high ranking civil servants, city lawyers, and those working for agencies such as Amnesty International and the United Nations High Commissioner for Refugees give their services, worth around £50,000 annually, free of charge to the Medical Foundation.

Medical treatment

Among the 36 paid and volunteer doctors that the Medical Foundation can call on are neurologists, paediatric surgeons, gynaecologists, E.N.T. surgeons, psychiatrists and a dermatologist. Dr. John Rundle, a neurologist of 30 years experience, says the job demands a high standard of medical knowledge and experience. "We practice very sophisticated medicine at the Medical Foundation. We have to," he said.

"People come here after unusual experiences, to put it mildly, and it's up to us to recognise which particular medical problems they have. We have a good diagnosis rate, ranging across a vast field of general medicine. It's no good saying 'that's not my area of expertise'. The work is too urgent for that."

He cites the incidence of post-traumatic epilepsy - a common result of having been beaten around the head - as an example of a medical condition that takes skill to detect. "I have seen a very significant number of such cases, running into the hundreds, but when I first arrived six years ago I didn't know what I was looking at," he said. "It takes experience to spot, because the clients weren't having fits.

"Instead, symptoms can include olfactory attacks of very unpleasant smells, dizzy turns followed by headaches, the hearing of voices for a short period, and 'absences' where the client's consciousness goes into abeyance for a few seconds. I alleviate the condition with anti convulsants, then once it is under control, refer the client to an outside GP for further investigation in a neurological unit."

Other Therapies

While Dr Rundle concentrates on a client's physical state, the Medical Foundation has more than 100 paid and volunteer clinical psychologists, psychotherapists, counsellors, family therapists, art therapists, child and adolescent psychiatrists and psychiatric social workers on hand to try to counter the mental anguish that so often follows torture.

Psychotherapist John Schlapobersky knows only too well the lasting mental scars left by physical abuse. As a young student in South Africa in the 1960s he was arrested, held incommunicado for several months, and tortured because of his anti-apartheid activities. A volunteer consultant at the Medical Foundation, he sees the benefits of group therapy:

"Torture is immensely isolating. When people can speak to others who have been in the same abyss, the results can be profound. In addition, torturers humiliate and debase their victims, who if they survive, can feel a great deal of shame about what they have experienced," says John. "When our clients can discuss their experiences together, they can relieve each other's sense of shame. It can also relieve the guilt they might have at surviving, and provide a forum for repairing some of the lasting and incapacitating changes in personality that often follow torture."

A range of complementary therapies also exists for Medical Foundation clients, including physiotherapy, massage, reflexology, osteopathy and occupational therapy.