By Coleen Kivlahan, MD
Bashar, Emir, Akil, Naser, Jamilla, Hassan, Najib, Hamed, Sabra, Hala, Riad, Khaled, Mahmood, Ali, Abduljamal, Basher, Kamil, Mohammed, Mustafa, Imani, Aisha, Jazmin, Amina*. Since I returned from a Middle Eastern country two weeks ago, I have been systematically (obsessively?) rehearsing the names of the participants. If I can remember all their names by heart, I can remember and tell their stories, and someone will listen.
I recently attended a training of physicians and attorneys held on a secure site in the Middle East focused on injury recognition and documentation of physical and sexual torture and violence in Syria. The participants were Syrian professionals currently living as refugees in another country. Many of the physicians were staff clinicians in Syrian university hospitals, medical schools, or clinics before they left their homes. They were EMTs, obstetrician gynecologists, psychiatrists, surgeons, internal medicine specialists, medical students, residents, and nurses. The attorneys had been engaged in human rights documentation in Syria. Most of the participants had been arrested for their beliefs and their work, and were detained in prisons and tortured. They escaped after witnessing and experiencing tremendous emotional and physical torture and watching their families placed at risk as a result of their clinical and legal work.
For a week, we taught subjects such as international humanitarian and criminal law, injury identification and documentation, use of international documentations standards, sexual violence identification, psychological evaluations and diagnoses, and vicarious trauma. Our training included some didactic teaching, interspersed with competency-based training in interviewing, and challenging case summaries. Some activities included full participant participation, such as mapping the current flow of torture survivors in the midst of multi-sectoral interventions.
The Syrian professionals were well-educated, bright, and articulate. They had left their practices, their teaching, their families, and homes under threat of torture and death. The training was regularly interrupted by stories of their survivor guilt, the extreme circumstances of their current work (refugee camps and “Syrian wings” of hospitals), the inability to be paid for their work with refugees in a country in which they are not licensed, questions about their ability to safely practice treatment and documentation of torture, their descriptions of their own torture including electrocutions, forced positions and human bites, the impact on refugee children, and deep sadness about the conditions in their country. Their desire for peace, human dignity, and democracy was palpable.
During the final training exercise, we were instructed to write their frustrations with this work on a balloon. The class was then instructed to pop the balloons as we began to think of ourselves as survivors, not victims. What shocked me most was, despite the instructions, how many participants chose to write positive, encouraging, and optimistic notes on their balloons. One balloon said, “In my country, we never focused on or learned about human rights. In the future, we all need to know our rights. It is our hope that justice will prevail and be served.” Another drew an olive branch. One person drew a picture of himself smiling (that was his first smile in five days), because he now had skills he could use to document the abuses. Another drew a picture of the world, with highlights on the United States, and said “Syria needs nothing except that good countries follow their stated principles.” And finally, one said, “I’m not good at drawing. I hate it, but I drew a symbol of children of Syria crying, they are not going to school, they wish to go back to their country. Can you see them?”
One doctor had been awake for three nights caring for patients crossing the border into a refugee camp. He said, “The way you delivered your lectures, you were very successful in your work. Now we need to be successful. We can document all the victims of Syria, not forgetting any of them, and disclose all criminals/crimes. The whole country is bleeding.”
The writing on my balloon said: I will share your story.
*names have been changed for security reasons
—Coleen Kivlahan, MD, MSPH, is the Senior Director of the policy and regulatory group in Health Care Affairs at the AAMC. She has been a practicing physician for over 25 years and is a volunteer with Physicians for Human Rights (PHR) in the Asylum Network as a trainer and evaluator. She can be reached at email@example.com .