In general practice, one is seldom required to write anything longer than a letter but at Freedom from Torture over the last five years I have written over 250 medico-legal reports on behalf of Freedom From torture.
Formerly the Medical Foundation for the Care of Victims of Torture, Freedom from Torture is the only nationwide organisation in the UK dedicated solely to the treatment of survivors of torture and organised violence. Last year more than 1500 people from over 80 different countries were referred to us for help.
In addition to providing practical assistance and a range of therapeutic services to help survivors of torture begin to rebuild their lives, clinical staff and volunteers – many of whom are practicing or retired GPs –document evidence of the physical and psychological effects of torture in medico-legal reports at the request of survivors’ legal representatives.
The vast majority of torture survivors arrive in the UK seeking refuge and, as asylum seekers, live in fear that they may be returned to their home country to face further torture. The Home Office generally only grants the right to remain in the UK to individuals it accepts would be at risk if returned and this acceptance often hinges on evidence of previous torture. Our medico-legal reports forensically document scars, other signs of torture and the equally common psychological sequelae, evidence that may be crucial to the Home Office decision. They, therefore, play a vital role in providing torture victims with the protection they need.
Another striking contrast between general practice and my work in this field is the use of extended appointments with the help of expert interpreters, allowing a greater understanding of a patient’s overall physical and mental state than may be possible in a few brief GP consultations.
Our patients have a wide range of physical and psychological problems, including conditions endemic in their countries of origin and the diverse effects of the violence they have suffered. Many are depressed and have symptoms of post-traumatic stress disorder, with insomnia, nightmares and flashback memories in which they vividly relive their torture experiences. Most have physical injuries and we see both male and female victims of sexual violence. Often we need to build up trusting relationships over several sessions before these patients are able to fully describe their experiences, as they may have to overcome strict cultural taboos surrounding sexual assault or they may find that flashbacks, triggered by recounting their abuse, interfere with their concentration and make it impossible for them to give a coherent account
A limited command of English may prevent them from disclosing to their GP the fact that they have been tortured and the full extent of their physical and psychological problems but, with their consent, we can liaise with GPs and thus help our patients to access NHS care.
Although the careful history taking and meticulous examination required to produce a medico-legal report can be demanding for both doctor and patient, many survivors tell us that they ultimately find it therapeutic because it confirms that the assaults they have suffered are taken seriously and considered totally unacceptable.
So the writing of a medico-legal report can make the difference between a person being granted protection in the UK or being forcibly returned to a torturing regime; it can facilitate appropriate medical and psychological care and it can prove therapeutic in itself.
The work is challenging but hugely rewarding, offering insights into a variety of cultures but, most of all, providing the opportunity to work with an extraordinary group of people. Many have been detained and tortured for political activities, considered normal in the UK, targeted simply for standing up for their beliefs. Although often distressed and psychologically damaged when they arrive, they are brave and extremely resourceful; the very fact that they have reached the UK is testimony to that.
I recently saw a teacher from the Democratic Republic of Congo, held in solitary confinement for many months after speaking out against the authorities. He was repeatedly beaten, stripped naked and sexually humiliated until he managed to escape during a major prison disturbance. Despite this experience, he remained politically active and was eventually rearrested and subjected to another long period of imprisonment, during which he was burned with cigarettes and his head was repeatedly submerged in water so that he was convinced he would drown. Finally he was helped to escape and fled to the UK. Amongst his numerous scars were some that were typical of deliberate cigarette burns. He was particularly troubled by vivid flashback memories in which he relived his submersion “like watching the same movie again and again.” These flashbacks were often triggered by the sight of a uniform, so he found it almost intolerable to attend the UK Border Agency offices where he would encounter uniformed officers. His medico-legal report has now been submitted and he awaits the Home Office decision.
We have insufficient medico-legal report writers to meet current demands and are, therefore, looking for doctors with a commitment to human rights and a range of clinical experience to work in our offices in London, Manchester, Birmingham, Newcastle and Glasgow. If you would like to know more about this work, please contact VLeggatt@freedomfromtorture.org
Virginia Leggatt is a retired GP in Cambridge