Recognizing that torture victims' agony endures long after the period of physical abuse, a group of Danish doctors, nurses and physiotherapists has pioneered a method of treatment for the tortured involving extensive rehabilitation of both body and spirit.
"The purpose of torture is not primarily to obtain information," said Inge Kemp Genefke, medical director of the program based at Copenhagen's University Hospital. "It is to destroy the victim's personality, to break him down, to create guilt and shame, to assure that he will never again be a leader. These psychological consequences are even worse than the physical ones, although those are often serious also."
Victims suffer from deep depression, chronic anxiety, poor concentration, severe headaches, sexual problems, fatigue and other symptoms. Many have been beaten badly on the head, heart and stomach and are fearful, usually unnecessarily, that they will be permanently debilitated. Most of these aftereffects can be eased over several months with specially designed sensitive care. But left alone they can linger for a lifetime.
Since 1980, Genefke and her colleagues have treated several dozen torture victims from a broad spectrum of countries including Chile, Iraq, Afghanistan, Iran and several African states.
Most simply arrive in Denmark as refugees and learn of the program from the grapevine. They are handled two or three at a time, as limited space allows. Their political opinions, Genefke said, are irrelevant.
Surprisingly, the team found that little research had been done with this particularly vulnerable category of patient, similar in some ways to survivors of World War II concentration camps. But those earlier victims were not subjected to the more advanced torture methods.
Experience shows, for instance, that standard hospital tests such as electrocardiograms and CAT scans, in which the patient has to be immobilized, or therapeutic devices like the whirlpool can induce terrible memories of electrical torture or submersion to the point of drowning in vile liquids.
The tortured find waiting intolerable, Genefke said, since they associate it with the time in prison when the anticipation of pain filled them with dread. They are uncomfortable in small rooms and find it exceedingly unpleasant to have their blood tested.
"They have seen enough of their own blood," said a nurse.
Dentistry is occasionally used as a means of torture, so this, too, needs to be handled carefully.
Even sympathetic doctors or physiotherapists need to prove that they can be trusted, since victims say that in the more sophisticated torture chambers, techniques designed to cause maximum harm with minimum evidence are often supervised by white-coated "specialists."
The aim of treatment is not to enable victims to forget. That is impossible, according to Finn Sommier, who is, like Genefke, a neurologist.
"But we can change the way they remember." he said, "We can help them understand that it is not they who should be ashamed, not they who are guilty. It is the torturers who are defeated, the ones who tried to destroy them."
Buoyed by its apparent success on a relatively small scale, the program is about to embark on a new phase. On Tuesday, in a modest office building near the hospital donated by the Danish government, the International Rehabilitation and Research Center for Torture Victims will open its doors as a separate institution.
Although raising operating funds from other governments and foundations has been a problem, Genefke and her associates say that with about $1 million a year--they have raised only about $200,000--they could treat 200 patients.
Even that would represent only a small fraction of the world's torture victims. Amnesty International, the human rights group, estimates that torture is used in 60 countries. Each year, about 500 political refugees arrive in Denmark, and about a hundred of them have been tortured. This is the group from which the patients have been drawn.
"Every day we have to turn away letters that come in looking for help," said Genefke, a doctor-administrator who became interested in the field a decade ago when Amnesty asked her to interview victims.
The long-term hope is that the center can help train others in the treatment of torture victims. Toward that goal a U.N. voluntary fund for aiding the tortured has been established, with limited funds mainly from Scandinavia. The first seminar, for people from 10 countries, took place here recently, and others are planned for later in the year.
Genefke said that there are three basic principles in the treatment of torture victims. The first is that psychotherapy and physiotherapy, such as massages or care for old wounds, must be done at the same time.
For this purpose, patients spend several weeks in the hospital. They are extensively but gently interviewed while a treatment plan is developed. No drugs are used to counteract the nervous symptoms, she said, because these merely mask the problems.
Secondly, victims should never be separated from their families. Often, spouses or children have suffered nearly as much as the victims themselves from fear and humiliation. It is hard for couples to reestablish their relationships, while so much of the suffering remains trapped inside. A special unit works with the children and sometimes with spouses.
"As father gets better," Genefke said, "we find that the children tend to get better also."
The third principle is to avoid anything that might imitate or recall torture. This appears to be a major insight of the program because doctors and therapists were unaware of how much that goes on in a hospital atmosphere can be reminiscent of torture--straps, electrodes, the need to provoke pain in search of physical damage.
Privacy is also important. One of the victims recently suffered a severe setback after a long and emotional interview by a journalist. As a result, the doctors decided to end that sort of access to the patients.
The recovery rate is very high, Genefke said, because as a rule the victims are strong people and relatively young. They tend to be political activists in the 20- to 45-year age bracket with a clear sense of purpose. Their response to the torture experience is to feel shattered, she explained, which is normal.
"We don't have to search for the causes of their psychological problems," said Sommier. "We don't pity them. We talk to them at length to find out exactly what has been done to them to best decide how they should be treated. The fact that they have clear political goals, a desire to change their country, is a big help."
Researchers have found that as the victims regain their confidence, they show greater curiosity and begin to adjust to Danish life, including learning the language. Few have jobs when they enter the program, but Genefke and the others say that victims are usually able to begin working in a matter of months.
Reviving the spirit also permits the victims to reassert their political identities.
"This allows them to justify what has happened," said Sommier.
For Genefke in particular, the satisfaction of guiding the tortured back to a reasonably happy life is tempered by her frustrations with the difficulties of raising money.
While her program is firmly ensconced at University Hospital and has enough money to begin its work in the new building, mainly with outpatients, funds remain in very short supply.
"Much more money is being spent in the world today on torturing people," she said plaintively, "than it would cost us to help them recover."