Friends of Refugees

A U.S. Refugee Resettlement Program Watchdog Group

Posts Tagged ‘torture’

Recasting Freedom Fighters As Terrorists?

Posted by Christopher Coen on February 4, 2012

A federal grand jury has indicted an Uzbek refugee living in Denver for alleged material support to an Uzbekistan group that the U.S. State Department designates a foreign terrorist organization. But the group is fighting the Uzbekistan dictatorship that U.S. diplomats spoke out against for its indiscriminate use of force after police mowed down hundreds of pro-democracy demonstrators in 2005. The regime practices torture of activists and ordinary citizens using electric shock, boiling water and the threat of rape and sexual humiliation, thus radicalizing many Uzbeks. A professor calls the Uzbek dictator one of the world’s worst human-rights violators. (Reminds me of the US government’s help in creating the Iranian Islamic regime via support for the Shah of Iran’s widespread repression and human rights abuses.) Human Rights Watch claims that the material-support law is overbroad and that it’s a problem if our government uses the law improperly against anybody who was not actually involved in terrorism. An article in The Denver Post explains the story:

AURORA — The Uzbek refugee facing terrorism charges in Denver was a merchant turned human-rights activist who tried to defend farmers, opposed Uzbekistan’s dictator after a 2005 massacre, endured a detention that left him bloody, saw his sister arrested on a false murder charge…

The plight of Jamshid Muhtorov, 35, looked so bleak that the United Nations and U.S. government rescued him, along with his wife and two small children. U.S. authorities gave Muhtorov a comfortable new perch in Colorado…

But now the same government that rescued Muhtorov is prosecuting him under a law that prohibits “material support” for terrorists.

FBI agents arrested him in Chicago on Jan. 21 while he was en route to Turkey. A federal grand jury indicted him for allegedly providing material support to the Islamic Jihad Union — which the U.S. State Department has designated a foreign terrorist organization — and attempting to provide material support.

It’s a complicated case that raises questions about the fine line between freedom fighter and terrorist. The portrait of Muhtorov that emerges from State Department reports — including a leaked diplomatic cable, and from interviews with human-rights colleagues — is one of an idealist forced to flee for his life. He — like Libyans, Egyptians and others — remained keenly aware of the continuing repression and fight for freedom back home…

 …A federal affidavit does not reveal much about the substance of his alleged material support...

The law [that prohibits “material support” for terrorists] is controversial.

“Human Rights Watch definitely has concerns that the material-support law is overbroad,” said Laura Pitter, an adviser on counterterrorism for U.S.-based Human Rights Watch, which worked with Muhtorov inside Uzbekistan. “If the material-support law was being used improperly against somebody who was not actually involved in terrorism, then that would be a problem.”…

 …In 2005, U.S. diplomats spoke out publicly against Uzbekistan’s indiscriminate use of force when police mowed down hundreds of pro-democracy demonstrators at Andijan, near where Muhtorov was working.

Since then, [Uzbekistan’s dictator, Islam Karimov’s] repression has intensified and includes torture of activists and ordinary citizens using electric shock, boiling water and the threat of rape and sexual humiliation, said Hugh Williamson, director of Human Rights Watch’s Europe and Central Asia division...

“The longstanding dictator of Uzbekistan is one of the worst human-rights violators in the world,” said Nader Hashemi, an assistant professor at the University of Denver who studies Middle East and Islamic affairs.

Ruthless torture and oppression by Karimov “have radicalized a lot of Uzbeks who are seeking a revolutionary change. The IJU emerges out of that political context,” Hashemi said.

While union members have been charged with attacks on U.S. and German targets overseas and could have links to al-Qaeda, “Muhtorov may not have any intention of committing a terrorist act against Americans. It depends on where he was flying to and what the objective of the mission was,” he said.

“My sense is the target of his ire and his angst is back in his native country. If he was targeting Western forces, that would raise serious concerns,” Hashemi said. “But if one wants to be objective, it would be highly irresponsible for someone to render a judgment on this case without bringing it back to Uzbekistan and the political regime there.” Read more here

Posted in Denver, FBI, Human Rights Watch, Muslim, police, security/terrorism, Uzbek | Tagged: , , , , , , , , , | 1 Comment »

Resettlement program still confused about how to screen refugees for mental health symptoms

Posted by Christopher Coen on October 22, 2011

Wouldn’t you think that the US, which has now been resettling large numbers of refugees here from around the world since the end of World War ll, would have figured out how to screen refugees for mental health problems? After all, we screen every refugee for physical health conditions, supposedly within 30 days of their arrival. It turns out that our resettlement program still hasn’t worked out the nuts and bolts of the screening process — let alone treating them for these conditions — though we have long known that many of these people are survivors of torture, abuse, deprivation, dislocation and other hardships associated with the process of becoming refugees. Minnesota Public Radio News has an article discussing the (still disorganized) process of directing refugees to the basic mental health care that many of them so desperately need. An emerging theory is that we should use community health workers to screen refugees.

According to the Minnesota Department of Human Services, our state is home to more than 70,000 refugees.

Refugees arrive here from countries wracked by political violence. Torture is used intentionally in their homelands to silence opposition and transform cultures through fear. So it isn’t surprising that refugees aren’t comfortable speaking about the atrocities they survived.

Resettlement programs seek to integrate refugees into our communities and to help them achieve economic self-sufficiency. But unless we address their traumatic experiences, we condemn many to live in silence with undiagnosed and misunderstood symptoms of major depression and post traumatic stress disorder.

The real tragedy is that their symptoms are treatable.

Refugees arriving in the United States typically receive a health exam to identify physical problems, but they are not screened systematically for mental health problems…

…The Center for Victims of Torture (CVT) often receives referrals of refugees who are torture survivors after an eight- to 10-year period of difficult resettlement due to undiagnosed and untreated mental health symptoms. Those symptoms make it difficult for refugees to learn English, adjust to community life, learn a new culture and support their families.

Health clinics often tell us they know how to treat trauma, but they lack the language and cultural knowledge. Refugee leaders and groups often tell us they have the cultural knowledge but don’t know how to treat trauma…

…more must be done to include mental health screening along with the required medical exam. CVT is currently collaborating with the University of Minnesota, the Minnesota Department of Health and four refugee groups to develop a culturally appropriate mental health questionnaire for refugees coming to our state. Simple questions in the refugee’s language will identify those who might benefit from mental health services, and allow the health care screeners to refer them to the best resource in the community.

One such resource emerging in Minnesota is community health workers. They are bicultural and bilingual health workers who help link vulnerable populations to the health care system and could be used when larger numbers of refugees are screened and identified for mental health concerns Read more here

Apparently no one has thought to ask why refugee resettlement agencies aren’t already screening refugees for major depression, post-traumatic stress disorder (PTSD) and other mental stress related conditions. Why would refugee resettlement case workers, who do nothing but work with refugees every day, not already be educated in recognizing these illnesses? Resettlement agency case workers are supposedly bicultural and bilingual, and in contact with every resettled refugee already. Aren’t they the refugee experts?

Posted in disabled refugees, Major depression, mental health, Minnesota, PTSD, sexual and gender-based violence - refugees fleeing | Tagged: , , , , , , , , , | Leave a Comment »

Clinic in Boston uses alternative therapies to assist refugee torture survivors

Posted by Christopher Coen on January 24, 2011

A clinic at the University of Boston is offering non-Western therapies to refugee torture survivors, according to an article in BU Today. Movement, acupuncture, cupping, and chanting are some of the alternative, or integrative, therapies offered by the Complementary and Alternative Medicine Refugee Health Clinic (CAM).

Tap tap. Acupuncturist Ellen Silver Highfield’s finger gently nudges the tiny needles out of their tubes and into the mocha skin of Maryan Abdi. Color-coded by size, the metal quills protrude from the 73-year-old Somali woman’s feet and legs as she reclines on the examination table, her ankle-length floral dress a splash of color in the sterile room at Boston Medical Center…

…The exam room is one of four at the one-year-old Complementary and Alternative Medicine Refugee Health Clinic (CAM), staffed by Highfield and Michael Grodin, a psychiatrist and a BU School of Public Health professor of health law, bioethics, and human rights. Every hospital harbors the suffering, but most CAM patients have lived through a particular hell: they are torture survivors, having endured personal abuse or watched loved ones suffer through it. Two-thirds of the patients—CAM has treated about 50—fled war-shredded sub-Saharan Africa, their psyches haunted by memories of family murdered or left behind.

It’s not like a single trauma, like a hurricane,” says Grodin. “These people are trapped, imprisoned, and they can’t escape.”

Grodin began his career three decades ago working mainly with Holocaust victims. He wondered why some torture victims were more resilient than others. In 1998, he helped found with several BU faculty members the Boston Center for Refugee Health and Human Rights, based at BMC, and worked extensively with Tibetan Buddhist monks tortured by Chinese authorities.

Grodin started CAM as an outgrowth of his work at the Boston center because he believes that to best diagnose and treat patients from other countries, physicians must understand their religious and cultural background. The clinic, which sees patients for four hours every Friday morning, gets financial support from BU, the UN’s Voluntary Fund for Torture Survivors, and the federal Office of Refugee Resettlement, as well as private donations from organizations like the Tides Foundation.

A lot of my patients have ‘heartache,’” Grodin says. “They’re not talking about chest pain. They’re talking about homesickness—sadness. In many cultures, people don’t talk about mental health, depression. They manifest it as back pain or chronic body pain.”

He is convinced that psychotherapy—talk—often doesn’t help such survivors. Some don’t trust doctors, who were their tormentors back home. Others, he says, used disassociation to survive the physical agony of torture. “They were sitting in their mind” during the painful events, he says. “They were separate from their body.  Grodin uses Chinese movement exercises to bring those people back into their bodies.

Good chi flow,” he says while examining a Liberian patient. The woman has complained that her knees hurt, but when asked the cause, she says she doesn’t know. Grodin has some clues. He knows that the woman has been beaten, raped, and forced to walk on gravel on her knees, and he also knows that memory loss is a coping mechanism used by many survivors. He asks if her pain has improved from his treatments. “Little by little,” she tells him in accented English.

OK, let’s get to work,” the doctor says, proceeding to array the areas around her knees and some other spots with acupuncture needles. He also proposes to cup her, referring to a traditional Chinese pain remedy that places upside down cups on afflicted parts of the body.

I don’t want cups today,” she tells him.

You’re the boss,” Grodin replies, inserting the green-tipped needles into her skin. The predominance of female patients is not coincidence. “Mainly we’ll see women,” says Grodin. “The men are arrested and tortured and often killed or imprisoned.”

Movement, acupuncture, cupping, chanting: alternative medicine to Westerners, these are conventional treatments to CAM patients. “We don’t see what we do as alternative,” says Grodin. “We see it as integrative. We work together with the primary care doc.” That, he says, is because much of Western medicine, such as pain-killing drugs, works quite well. Grodin says he uses the complementary medicine to decrease the dose of narcotics that patients need.

CAM is currently collecting data to measure the effectiveness of its treatments. Grodin’s Liberian patient and Abdi have both reported that their pain had at least somewhat diminished after their visits. Elsewhere, researchers are investigating why acupuncture works with some forms of pain and not others.

I’m less concerned about the science than I am about people getting better,” Grodin says… Read more here 

Although two patients report that their pain had somewhat diminished after their visits to the clinic, the therapies really should be compared to sugar pills to determine the effectiveness.

Posted in Boston, health, Liberian, mental health, ORR, Somali | Tagged: , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Helping refugee women navigate the health care system in Phoenix

Posted by Christopher Coen on September 8, 2010

The Refugee Women’s Health Clinic in Phoenix is the subject of an article in The Arizona Republic. The clinic set up a system to guide refugee women through each step of the process to show them how the system works, so they can learn to navigate it on their own. Refugees seem to benefit greatly from a hands-on approach to refugee resettlement, rather than a tough love approach that leaves refugees lost – an important lesson for refugee resettlement agencies.

Volunteers…are the lifeblood of the Phoenix clinic, working hands-on to guide refugees through every step of their appointments. Many of them…are refugees themselves. They understand the fears and frustrations these women feel about navigating something totally alien: the American health-care system.

The clinic has served more than 400 patients since it was opened in October 2008 by the Maricopa Integrated Health System as part of its larger women’s clinic. The clinics are funded through the county health system.

Crista Johnson, the clinic’s medical director, said she recognized the need for more hands-on involvement when patients began wandering around MIHS for hours at a time, not knowing where to pick up prescriptions or get blood work done.

The clinic, which now has five volunteers and five translators, is an important resource for Arizona’s refugees, whose population is growing as its demographics shift. There are 3,260 refugees in the state, according to the Arizona Refugee Resettlement Program. Somalis, Cubans and Sudanese historically have dominated Arizona’s refugee population, but since 2008, there has been a surge from Bhutan, Myanmar, Burundi, Iraq and Iran…

…For most refugees, scheduling an appointment is a foreign process – like everything else about their new lives here.

The ultimate goal is to empower patients to navigate the health-care process by themselves, Johnson said.

Until then, patients are guided every step, starting with a knock on the front door.

Employees at apartment complexes remind every patient of her appointment the day before and call for a taxi to pick her up on the day of the appointment.

Once the cab drops a patient off, hospital volunteers accompany her as she waits in the reception area. They help her fill out insurance paperwork and start friendly conversation.

A volunteer or an interpreter stays with every patient throughout the appointment, taking care of her other children while her temperature is taken or translating from behind a curtain in the exam room as she gets a pap smear.

Then, volunteers take every patient to pick up her prescriptions or get X-rays. Before patients leave the clinic, Nizigiyimana schedules follow-up appointments and calls for taxis to take them home.

Georgia Sepic owns and manages a Phoenix apartment complex in which 97 percent of residents are refugees. Sepic said she emphasizes the importance of routine health checkups to her residents…

…Refugee women are skeptical and fearful of authority, Nizigiyimana said, because many of them have experienced rape, torture or trauma. Volunteers like Abdalla try to minimize the patient-provider mentality by approaching the women as friends… here

I notice that at one apartment complex in Phoenix refugees make up 97 percent of the residents, which is interesting following on the heels of refugee housing segregation in Boise, in another article.

The mention that refugee women are often skeptical and fearful of authority is something that is central to refugee resettlement. Countless times I have witnessed resettlement agencies who play with refugees’ fears in order to intimidate refugees not to complain when the resettlement agencies neglect their contractual responsibilities. Another common practice is questioning refugees after they have spoken to community members who are critical of resettlement agencies. Resettlement workers will pepper refugees with questions about who they spoke to, why they spoke to that person, and what they said – sending a clear message that refugees are not to voice any of their concerns or complaints to members of the community. The refugee program should never tolerate any refugee resettlement agency that uses refugees’ fears to coerce them.

Posted in Arizona, Burma/Myanmar, Burundian, Cuban, health, intimidation of refugees, Iranian, Iraqi, Nepali Bhutanese, Phoenix, Somali, Somali Bantu, women | Tagged: , , , , , , , , , , , , , , , | Leave a Comment »