Dr Juliet Cohen: Helping torture victims on the road to recovery

Working daily with victims of torture is among the toughest jobs in medicine. Dr Juliet Cohen talks to Neil Roberts about how rewarding her vital role can be.

Dr Cohen: critical of treatment of victims of sexual violence (Photo: Freedom from Torture)
Dr Cohen: critical of treatment of victims of sexual violence (Photo: Freedom from Torture)

Behind the security doors of a modern, curved building on a busy north London street, art covering the walls and a water feature in the large, well-tended garden suggest a place where environments really matter.

Head of doctors at the Freedom from Torture charity, forensic physician and GP Dr Juliet Cohen, is clearly proud of these headquarters, which have been designed to meet the needs of survivors.

Despite the grimness of the events that bring patients here, the gardens and colours suggest hope.

Dr Cohen says it is survivors' ability to recover and rebuild their lives that helps her cope with dealing daily with victims of torture, sexual violence and trafficking.

As well as the consulting rooms where her team examine patients, collecting evidence of the brutal crimes inflicted on them, the centre hosts a range of holistic rehabilitation therapies and welfare services.

'One of the nice things here,' says Dr Cohen, 'is where people are referred into therapy groups; you can find out how they progress longer-term, and that they do recover and pick up a life again.'

Dr Cohen's team of about 70, mostly volunteer, GPs working a few hours a week, deals with patients at a more vulnerable stage. Instructed by lawyers, the team examines and interviews asylum seekers, gathering medical evidence of torture for use in claims for UK asylum.

Working in a refugee camp in Hong Kong, where she began her career as a GP after training in London, Dr Cohen befriended a Vietnamese refugee who served as her interpreter.

Dr Cohen asked why he did not give more prominence to his experience of detention, punishment and beatings in his asylum application. He replied: 'I don't want people to pity me, I want to be judged on what I said and did, not what they did to me.'

'I have never forgotten that,' Dr Cohen says.

After a stint as a GP for the Australian Navy, she came back to work in UK general practice in 1997 and took up part-time work with Freedom from Torture, becoming its full-time head of doctors in 2005.

Refugees

Refugees arrive here having fled many backgrounds and countries. But all have been subjected to some form of physical or psychological torture, usually in detention conditions, at the hands of a state. Most have been politically active.

She reels off a list of common forms of torture patients have survived - blunt trauma (batons or gun butts), sharp trauma (knives, glass, razor blades) burns (cigarettes or heated metal objects), prolonged stress positions (suspended with their arms pulled up behind them, or suspended upside down), and various water tortures, including forced immersion in filthy water.

The psychological damage is often the worst, including mock executions, or being forced to watch while family members are tortured.

And then there is sexual violence. It is Dr Cohen's experience with survivors of sexual violence that brought GP to meet her. This month she attended a global summit in London with UN special envoy Angelina Jolie, to discuss sexual violence in war.

'It's really important,' Dr Cohen says, 'because the whole problem with sexual violence is the culture of silence around acknowledging it occurs, and that people can and should be held to account.'

The summit launched the first international protocol for documenting sexual violence, developed by the UK Foreign Office, and which Dr Cohen contributed to as a member of the expert reviewers group, giving advice on interviewing survivors.

Foreign secretary William Hague said the document would 'play a vital role in shattering the culture of impunity for sexual violence in conflict'.

But Dr Cohen recognises the contradictions. She is critical of the UK's treatment of asylum seekers. While the UK treats them 'a lot better' than many other countries, many have 'suffered living in this country', with poor access to justice and health.

At the initial asylum screening interview, refugees are not asked in detail about their claims and have no legal representative, leading to many being detained. The procedure for safeguarding against continued detention 'doesn't work well', she says.

Detaining survivors of torture and sexual violence is 'retraumatising', and makes it difficult for them to collate evidence for their claim and to access specialist forensic clinical support, she says.

'The whole process is decided very quickly. They can be refused and on the plane before they even get a chance. I think that is wrong.'

GPs' vital role

Her team is made up of mostly GPs because, she says, they have the breadth of experience vital for the work, and are used to looking at the interplay of physical and psychological problems.

But it is difficult to attract busy GPs who can give up half a day a week to volunteer. 'We are always looking for new doctors,' she says. 'It's more difficult than any other medicine I've ever done and yet far more rewarding.'

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