Salvaging Victims of Torture

By John Leo.

In Toronto, a Latin American refugee, 26, froze in terror when a well-wisher brought him a gift basket that included two pineapples. In the refugee's native country, he had been forced to watch as his military captor hacked several prisoners to death, then carved up a ripe pineapple with the bloodstained machete and calmly ate the slices.

For victims of torture, the world is a minefield of horrifying memories. One woman panics whenever she sees a dark Ford like the one that hauled her away to severe beatings and a gang rape. Some survivors have trouble entering bathrooms, because the tile, lighting and smell summon up images of their torture chambers. "How do you cure torture?" asks Genevieve Cowgill, 44, director of the Canadian Center for Investigation and Prevention of Torture. "It's not something you can simply talk victims out of."

Cowgill, originally trained as an academic in English literature, is a pioneer in one of the world's newest and most humane industries: the specialized treatment of torture victims. So far there are two centers devoted exclusively to such survivors, the year-old Canadian organization in Toronto and Copenhagen's Rehabilitation Center for Torture Victims, founded in 1982. A third center may be opened in Minnesota. Last month, Minnesota Governor Rudy Perpich, before visiting the Copenhagen center, named a 20-member commission to study the matter and report by May 1.

Last week, 20 countries signed a United Nations convention opposing torture. But the world has a long way to go. Amnesty International, a London- based human rights group, says 98 nations currently practice torture, more than 30 of them systematically. Among the leading offenders, according to Amnesty International, are Iran, Chile, Libya, Pakistan and Turkey. The number of those affected is said to run into the tens of thousands annually, with perhaps 1,000 survivors reaching safety each year in the West.

The centers are still groping their way toward the ideal form of care. One lesson they have learned is to avoid separating victims from their families, since fear for the life and safety of a spouse and children is usually part of the trauma. Another concern is that doctors may be regarded as the enemy. Many torturers are dressed as white-coated specialists, and some even insist that victims call them "doctor" to help legitimize their physical abuse.

Winning the trust of patients can be painfully slow because of the burdens of their past. "Absolutely everything they had taken for granted and counted on was removed," explains Richard Reoch of Amnesty International's London office. "It's a moral inversion where every human being you encounter has as his purpose to be cruel, to inflict pain, to lie or make you feel worthless." Victims suffer not only from severe injuries but also from survivor guilt, depression and a form of weary aimlessness born of disorientation, sleeplessness and recurrent nightmares. Fear of authorities is so deep that almost any kind of bureaucratic delay can panic a survivor. In Toronto last March, a Chilean torture victim hanged himself the day before immigration authorities were to rule on whether he was entitled to stay in Canada as a political refugee. Delay is the enemy, not only because the survivor may be in shaky psychological condition but also because waiting, and the fear it brings, is one of the tools of the torturer. As a result, workers at rehabilitation centers are taught to be meticulously on time for all appointments.

The first step is usually to get the patient talking. "One of the main jobs is to bring the patient out of his or her shell," says Inge Kemp Genefke, a doctor and head of the Copenhagen center. Through therapy, we have to prove to the patient that whatever decision was made under torture would not have changed the end result of the torture."

The Toronto center has 50 physicians and 20 other volunteers on call, and treated 202 people in its first year of operation. The annual budget is a skimpy $100,000, contributed by the U.N., Canadian labor unions and private donors, but an additional $200,000 in medical bills is picked up by the Canadian government. The Danish center, with 26 full-time doctors and therapists, has $500,000 to spend each year and a promise by the Danish government to help underwrite deficits through 1987. Genefke says her center treated 175 people from the fall of 1983 to the fall of 1984, with a current waiting list of 52. Of the 67 men and women who have completed treatment, she says, nearly all are improved or cured.

Denmark's center is basically a medical clinic, but in Toronto there are 20 volunteers who conduct research and guide victims to normal lives in the community. This includes helping them find jobs and homes and standing by to assist with advice on everything from eating to functioning in a new society.

When one victim, John, 30, arrived from Uganda in poor physical condition, weighing less than 80 lbs., the Toronto center arranged medical and psychiatric help. A nutritionist taught him and his family how to adapt to new foods. To rebuild his strength, one volunteer taught him to swim and got him access to a private pool. Cowgill, who urged John to call any time he needed to talk, got him a job as a telephone installer, the trade he practiced back home. "A job is so central to these survivors," she says, "because it gives meaning to their lives and self-esteem."

Referral to the Toronto center comes from community groups and immigration lawyers. But many survivors still enter countries as normal aliens. One Afghan woman, admitted to a Montreal hospital last year and treated for kidney infection and hysteria, was not identified as a torture victim for months. There are problems of language and culture, says Cowgill, and few doctors recognize the signs of torture. Many patients also are tight-lipped about their ordeals.

Though John and other survivors seem to be doing well, the rehabilitation centers have no clear idea how lasting their help is. Philip Berger, one of the volunteer doctors in Toronto, points out that some Holocaust victims developed severe psychiatric problems decades later. "We just don't know if what we do will make a difference in the long run," says Berger. "We can only hope."

With reporting by Julian Isherwood/Copenhagen and Wilson Taylor/Toronto