Branch 251/
S1E9: After Torture


In this episode, Fritz and Karam speak to two international mental health experts, Dr. Vedrana Mladina and Diana Rayes. They comment on the accounts of survivors we interviewed in the previous episode. And we ask them how exposure to war and torture affects survivors' lives, and what their needs are after torture to lead a healthy life.

  • Dr. Vedrana Mladina

  • Diana Rayes

  • About Alaa M.

In Arabic:

In English:

In German:

  • Recommended by Diana rayes for Survivors

  • On Sara Hegazi

  • Literature Recommended by Dr. vedrana Mladina

The Murad Code;

Narrative Exposure Therapy

Logo design by -- Photo by James Lawler Duggan/AFP/Getty Images.

Episode Transcript

Fritz Streiff: Before we start the episode, we have two pieces of pre-big news.

Karam Shoumali: Yes. Number one, the German authorities made an interesting arrest last week. A Syrian man called Alaa M. He lived and worked as a doctor in Hesse, the federal state where Frankfurt is also located. German prosecutors allege that this is the same man who tortured patients in a military hospital and homes in Syria back in 2011. The details are quite gruesome. We will link to more information in the show notes.

Fritz Streiff: This is the third former Syrian official arrested for crimes against humanity in Germany. After the two accused in the Koblenz trial that are covering, Eyad A and Anwar R and this one, Alaa M. He's seen as an official, as far as I can tell from the reporting because he was a military doctor in Homs. The reports say he was also identified by Syrian survivors and victims similar to our case in Koblenz.

Victims of this same doctor identified him apparently in Germany. There's lots of parallels with our case, including also Anwar al-Bunni, the Syrian human rights lawyer that identified the accused in our case, Anwar R in Berlin, he Anwar al-Bunni apparently again, played a role in this investigation, working with witnesses and delivering information to the investigators and the prosecutor. Yes, so this means that the Koblenz trial really seems to be the first of its kind, but not the last.

Karam Shoumali: We will discuss more on this new case and other similar cases and investigations in a future episode.

Fritz Streiff: While we're already busy with news, we have some fantastic news ourselves to share today. You remember the court reporter we talked to during the episode on the second defendant, Eyad A. Her name is Hannah El-Hitami. Hannah is a freelance journalist based in Berlin, focusing on Arab countries and migration. She's following the trial very closely.

Karam Shoumali: We are happy to announce that Hannah will be contributing to the podcast on a regular basis. With Fritz living in Paris and me in Berlin, we can only go to Koblenz every now and then, but Hannah is there for every session.

Fritz Streiff: Yes, so this is really great for the podcast and hopefully for you listeners. We'll have a reporter from the courtroom and we're really happy about this and we will hear from Hannah already directly today later on the podcast. She called us right after the session on Wednesday with some interesting observations. We'll hear about that later. 

That brings us to the start of this episode. Welcome to the ninth episode of Branch 251, where we dissect for you listeners, the world's first criminal trial against Syrian regime officials for crimes against humanity and everything that has to do with it. I'm Fritz Streiff.

Karam Shoumali: I'm Karam Shoumali.

Fritz Streiff: Last week's episode, we feel like it was a special one. It was a special episode. It was difficult for the two survivors we talked to, to go back into their memory and tell their story again, as they've done so many times before, but that does not make it easier. One of them, Luna said she feels the pain every time she tells the story as if she would be telling it for the first time. It was also a special experience for the two of us as their conversation partners. We discussed this with both of them during the process of recording their stories, because of course, the last thing we want is this experience of telling the story again, that triggers trauma or makes them feel bad in any way.

We think we did it in a sensible way by asking them if they wanted to do it and how and when, in a comfortable setting and really them deciding on these things, not us, them being in the driver's seat.

Karam Shoumali: Our work as journalists and Fritz as a human rights lawyer, this was, of course, not the first time we talked to survivors. Maybe we have even become a bit desensitized, but if you learn one thing again from the experts we talk to, it is that we need to make sure that the balance is right, and that is not us deciding to tell their story, but them deciding that. It is their decision, their accounts.

Fritz Streiff: Today we want to take you listeners along to those two conversations we had with mental health experts, who know so much more on victim trauma. We talked to them in preparation for last week's episode and we talked to them again to look back at what Nuran and Luna told us on last week's episode and told you, listeners. We talked to the two experts about these individual accounts and memories, and also the bigger context, the Syrian context, and the universal parallels that these experts see based on their experience in their field.

Karam Shoumali: We thought it would be interesting for you listeners to get this background as well. We hope you'll benefit from it as much as we do. First, you will hear the conversation hit hard with Dr. Vedrana Mladina.

Fritz Streiff: She is a clinical psychologist based in Dubai, looking back now at 19 years of experience in clinical psychology. For 14 years, she provided support for victims of war crimes worldwide, three years at the United Nations Tribunal for the former Yugoslavia, and 11 years at the International Criminal Court, both in the Hague, in the Netherlands. I started by asking for her reaction to last week's episode, with the stories of the two survivors.

Dr. Vedrana Mladina: There were many parallels with the stories I had the privilege to hear from other victims that always does like two things to me, which is the repetition of how terrible things are that people have to go through and how it repeats itself and with the same intensity and magnitude, but then also how unique each story is, the little details, very personal. What amazes me always absolutely is the amount of courage and resilience that you can hear from the stories.

For both women, I think something that really stood out as a common trend was that as much as they were fearing their own life in those moments and just really not knowing what's going to happen to them next because nobody's of course telling them what's happening, they were actually more scared about what's going to happen to their family members who got implicated because of them. That kind of fear for their loved ones and just that sense of, I am exposing them to something I should have protected them. In one case it was about the children. In other cases, it was about the mother of the victim.

This is something that's very difficult for women to care about others more than themselves. I have heard that from men as well, male victims, and I just give that additional respect one has for the person on a human level.

Fritz Streiff: Is this something you've heard from victims who have told similar stories about psychological torture and the element of family members being used and abused to torture them indirectly?

Dr. Vedrana Mladina: Yes, absolutely because it's one of those terrible but perfect mechanisms to get into people's heads and psychologically break them. I've even heard that from abducted children in Uganda or child soldiers in the Congo, they were just fearing for their families, so even children fearing for their parents and how their parents and grandparents will be affected by them and their actions. If a child already thinks that way, you can only imagine an adult.

It's really fascinating in a way and terrifying because I've worked across different cultural contexts and including my own region where I come from, there we also had the war next to Yugoslavia and you can see that no matter the geographical distance and absolutely no way these warlords could have communicated in any way that they really all have the same modus operandi. I do believe that it's part of the human psyche fabric.

In the right conditions, it just comes out, but like one of your interviewees said was that she believed that all these men were doing all these things because they themselves were scared to lose power and control. Right? It's like that twisted way of imposing control because you are so scared of being on the other side that really, that creates monsters out of humans.

Fritz Streiff: There is something in the human psyche you're saying that enables these individuals or these groups, structures and organizations and regimes to really get to their victims' psychological breaking point in a very parallel way in conflicts all over the world.

Dr. Vedrana Mladina: It is and it's really bad obviously to know that this exists, but on the other hand, in my work, it helps a lot because the trauma seems to be universal and the way people go through it and how it affects them and how they come out of it is also universal. Then on that level, we can connect no matter where they're coming from, but the conversation always seems to be the same along the same lines.

Fritz Streiff: The topic of memory and the value of survivor victim-witnesses in the courtroom, what can you tell us from your experience are the main issues in that regard?

Dr. Vedrana Mladina: Well, memory is such a fragile concept, yet so many things on this earth are based on memory or rely on memory. Everything we remember-- the memory itself is always reconstructing. They lose the original the moment it happens and so every memory is somehow contaminated. Now with traumatic memory, the main issues are that it's fragmentary so it's not chronological. This is the main problem because in the courtroom you want chronology, you want the sequence of events, and you want precision. What is captured in traumatic mind is very precise snapshots of the most difficult moments but you can't put them together. It’s like a broken puzzle. That is very difficult then for people to put into a narrative.

Then also the voluntary recall like trying to remember something on purpose is very difficult and in some cases impossible but involuntary recall like one of your victims that you interviewed, she described she was like, "I just have these associations with things that happened in prison in my everyday life. It just takes me by surprise every time." That's exactly what's happening. Involuntary recall is just something that becomes a part of your life. It's a very complex issue, but it has a rather simple explanation so in the moments when traumatic events is happening it's not happening outside of the context.

It is in prison, and if somebody is getting tortured they will still perceive the person or persons who are torturing them, they will perceive smells. There's a lot of sensory information coming, it's not being registered in that moment. What is happening is that the fear reaction is being created as a natural response. What then happens because it's such an overwhelming experience is that that fear response becomes automatic and a baseline response to those same sensory triggers. If somebody was in prison, and they were being tortured, and they told they were dying so many times and every time this happened they could hear some of these footsteps coming and they’re wondering who is going to come in and what are they going to do to me?

Every time later in life they hear anybody's footsteps, this is the first story they will have because the trauma is then extracted from that context. Why is it happening spontaneously to people, to one of your interviewees is because the brain just never stops trying to integrate information. That's what the brain does. The brain is like, "No, no, no, I have to make sense out of it" and then that automatic fear reaction. Unless you go to therapy and you integrate it and contextualize it, you will simply have to live with it for the rest of your life.

Fritz Streiff: Just a quick note here in between, Vedrana is mentioning the importance of therapy and mental health support especially for victims of trauma. We will hear more about this from the second expert, the one that Karam talked to in a little bit. 

You did some work with international organizations including with lawyers, with prosecutors, with investigators, and some of your work was really very much about the responsibility that those actors have, investigators, lawyers, prosecutors maybe also journalists. Can you tell us a little bit about that?

Dr. Vedrana Mladina: Our approaches should be unified around do no harm, or at least not to cause more harm that's already been caused to these people, victim-centered approach, and just victim informed or survivor informed to make sure that they are not going to get re-traumatized, that this is not going to damage them in any way let alone in a significant way.

What we have, for example, at the International Criminal Court, where I've worked at the office of the prosecutor was prior to any investigative interview with victims conduct a so-called psychosocial interview assessment to talk to the person and assess their level of vulnerability and then see if they can go through the interview without being harmed.

Then also we would stay present for most of the interviews just to be there, and intervene if there's a need for crisis intervention during the interview especially with children and victims of sexual crimes.

Fritz Streiff: With everything that you've seen and everything you've heard in your life working with victims and survivors of these terrible international crimes, would you say you are an optimist or a pessimist?

Dr. Vedrana Mladina: That's a really good question and my answer is that I am a cautious optimist if that makes sense. I’m quite a realist really. We always have to look at the circumstances, we have to bear in mind there's so many limits to so many judicial systems, and that justice is mainly symbolic in some ways but what makes me optimistic always is human nature and common humanity and just what connects us on a level of just understanding the suffering. Then also being resilient and wanting to move on, and just holding on to those values that make us go through hardship try to make the best out of it that keeps me optimistic.

Fritz Streiff: Thank you so much, Vedrana for speaking to us on the podcast and helping us understand these complex issues of victim trauma a little bit better.

Dr. Vedrana Mladina: It was really my pleasure, this topic is very close to my heart and I want to thank you for having this podcast and just trying to help people being bold and understand and stay informed, and then form their own opinion. I think that's really important so thank you for doing that.

Karam Shoumali: To understand the situation of mental health care in countries like Syria before and after the conflict, I spoke to Diana Reyes, she's Syrian-American public mental health researcher based in Washington DC where she is also a non-resident fellow with Tahrir Institute for Middle East Policy. She's also a PhD candidate and has worked on the topic of mental health of victims or refugees in Berlin and Gaziantep in Turkey.

Diana Reyes: I want to start off by saying just how inspired I felt having listened to Nuran and Luna’s stories and that they were brave enough to share them with your listeners into the public how they've been able to overcome what they endured and also be able to move on with their lives, but I did want to ask you how you felt when you listened to their stories as a Syrian yourself and as somebody who understands the context of what they were describing.

Karam Shoumali: Oh well, this is a good question. I think I can say as a journalist I try to detach myself from the story, I don't want to be the story. I report on it as best as I can, give victims voices, and tell the world about their accounts, but as a Syrian, at the end of the day, those accounts are very familiar to me, close to home. Those accounts could be the stories of members of my extended family or of my neighbors or friends. I think being Syrian means that you're really part of this conflict regardless of how far you want to go.

Diana Reyes: Absolutely, and I'm so glad you said that because that plays a huge role in how we overcome the collective trauma that we've experienced as Syrians, as Syrian diaspora, as people who are connected to the crisis and invested in it, that's a healing process on its own and it's something that we can continue to rely on each other to do and to build ourselves up in order to overcome a lot of the trauma that we've collectively experienced.

Karam Shoumali: Diana Reyes, could you please describe to our listeners the landscape of mental health in Syria?

Diana Reyes: The dearth of resources in terms of mental health service provision in countries like Syria and across the region are so vast. For example, before the war inside Syria, there was only 70 psychiatrists serving a population of 22 million. Now in areas that are particularly prone to violence, and where you were seeing a greater need for mental health resources such as the northwest part of Syria, there are only 2 psychiatrists serving a population of 4 million. This gives you a snapshot of just how vast the need is in terms of mental health resources.

There's also a lack of understanding of culturally specific ways in how mental health manifests in populations across the Middle East and particularly those who have been affected by conflict. There's a lot of work that needs to be done and unfortunately, it's only been filled in recent years by the presence of NGOs who are attempting to scale up mental health services in the region. This is done from a very western-centric point of view and doesn't really take into account the culturally and in my research interests that the religiously specific needs that these communities require.

Karam Shoumali: Can you tell me how exposure to conflict and all the results in crisis function as triggers for trauma?

Diana Reyes: Research shows that individuals who have been exposed to prolonged conflict struggle a lot with mental health problems including symptoms of depression, anxiety, and post-traumatic stress disorder, and this is no exception in the Syrian context especially those who have had to leave, the upheaval of leaving their homes and their families behind and the psychological burden of their journeys to a new country. In a new host country, this distress is often exacerbated by various social, economical, and legal barriers that refugees and asylum seekers face as soon as they arrive. One of the main reasons I pursued this line of work is because my own family, my father specifically, was exiled from Syria in the '80s. He came to the US at a very young age and had to integrate very quickly and learn English and adapt. This has always been a point of fascination for me, how did a 17-year-old, who his my father, how did he adapt to this new country so quickly and was able to bounce back despite the atrocities he had witnessed in his hometown of Hama.

This goes to show just how important it is to welcome refugees and migrants into host countries who have significantly contributed to countries like the United States, to Germany, to Canada in the long term. As soon as they arrive, it's really important to invest in providing them the mental health support and psychosocial resources so that they are able to integrate properly and to contribute to society.

Karam Shoumali: How prepared do you think are these host countries in terms of providing culturally sensitive mental health care to migrants and refugees?

Diana Reyes: I think there's a lot of work that still needs to be done, especially in providing access for refugees and migrants to mental health services that are culturally sensitive and linguistically accessible. What do we mean by those? Culturally sensitive mental health care it doesn't have to be provided by an Arabic speaking psychiatrist or somebody from the region, but at least by somebody who understands the sociopolitical circumstances that have led to the displacement of the refugee clients seeking services as well as what it means to be Syrian or what it means to be from Iraq and have experienced generations of conflict and turmoil in your home country.

I think there's still needs to be a lot of work done. As we've seen in the last week the unfortunate passing of the LGBT activist Sarah Hegazi who was in Canada having sought asylum from Egypt for being persecuted there as an LGBT activist and a survivor of torture and detention. She was in a host country like Canada and she was suffering from mental health issues which led to her unfortunate death. The country hadn't provided the kind of resources that she might've been able to utilize and could have prevented her death. This is a very important issue that also sheds light on the significance of the mental health of refugees and migrants and the impact it has on their integration in host country context.

Karam Shoumali: Do you think the lack of mental health care for survivors prevents them somehow from opening up and coming forward to testify against their victimizers? For example, this trial in Koblenz.

Diana Reyes: We expect people who have endured such atrocities to want to seek justice immediately if they have the chance but often as you mentioned, Karam people have buried away so much and have moved on essentially without addressing some of the root causes of this trauma. I think the concern is that it doesn't really go away and that if it's kept inside, then it will explode at some point. It's important when considering the specific population of victims who are participating in a trial against their perpetrator to provide support to them before, during, and after the trial and making sure that they feel that they have access to mental health resources should they need them.

Also, there's other considerations than ethical considerations that go into victims or survivors participating in a trial, which is they are free to disclose as much as they like and to participate as much as they'd like, but without feeling the pressure to just because they are in this particular position. To end on a hopeful note I think that the Syrian conflict and other traumatic incidents in the region have actually allowed an opportunity for people to talk about their mental health in a way that isn't stigmatized in a way that feels collective like, "I was a victim of this conflict and I endured this. Well, you also endured this so you understand where I'm coming from."

People have found it easier to speak about their mental health issues openly and including with their family members and to take those very first steps, which are the hardest in seeking mental health care and treatment. This is something that's very empowering and I think people are seeking help. As long as they know where to find these resources then there is a light at the end of the tunnel.

Karam Shoumali: Thank you Diana Reyes for this helpful comment and thank you for coming on our podcast.

Diana Reyes: Thank you. It was a pleasure to be here.

Fritz Streiff: As always with our guests, we will link to some of her work and links she shared with us in the show notes for those of you who want to find out more. Now it's time for the court update. The court is in session as we record this episode, but we did manage to get a hold of our court reporter in Koblenz, Hannah El-Hitami, for just a quick update in between.

Hannah El-Hitami: We heard a witness who used to work for the Secret Service in Syria. The witness told the German police officers about seeing Eyad A on at least one occasion. He talked a lot about dead bodies being delivered by Eyad A and his troop to the department where the witness worked. However, the problem was that in court, the witness was not willing to repeat that information that he had given in the police interrogations. The judge and federal prosecutor grew increasingly frustrated and even angrily told him, "Hey, you really have to answer our questions. You're going to incriminate yourself if you keep on lying, or if you make a false statement."

After a while, it turned out that the witness's family in Turkey was being threatened by members of Eyad A's family. Then we all understood why he, in the meantime, changed his mind about giving a really honest statement and perhaps incriminating Eyad A with the evidence that he gave.

Fritz Streiff: Next week, the court will be in session again so we will catch you up on that. We will also talk about something that has been on our minds. Both of us have worked for a while on the topic of Syria and accountability for crimes committed there doing the conflict that has now lasted almost 10 years already.

Karam Shoumali: We have observed something that we wanted to dive into a bit deeper with you listeners. Something Fritz and I call Syria Fatigue. Our people and media and diplomats and donor countries, are they getting tired of Syria? Are they getting tired of the conflict, of reporting on it? We will be discussing this phenomenon on the podcast next week. What does it actually mean? What is it? Is there even such a thing as Syria fatigue?

Fritz Streiff: We will also discuss the question of how has the Syrian regime taking advantage of this phenomenon.

Karam Shoumali: We will take you along to a conversation that I had with Syrian activist Wafa Mustafa.

Wafa Mustafa: My relationship with my dad's absence is very complex. After seven years, it doesn't get easy. It always gets harder.

Karam Shoumali: She hasn't stopped campaigning for the release of her father and thousands of Syrians disappeared in prisons, but are people still listening?

Fritz Streiff: We'll discuss more on that next week. For now, it's time to wrap up this episode.

Karam Shoumali: You can support this podcast by subscribing, and reviewing it in our podcast app.

Fritz Streiff: By sending us a donation, if you feel so inclined. To do that, hit the Support This Podcast button on our website or the podcast player. Thank you kind donor of last week. You and the other friendly supporters keep this podcast running.

Karam Shoumali: Yes. Thank you.

Fritz Streiff: Branch 251 is listener-supported. It is created, produced and presented by the two of us from our home studios. Karam from Berlin and me from Paris.

Karam Shoumali: The trial is taking place in Koblenz, which is somewhere in the middle between us. Pretty convenient.

Fritz Streiff: Thank you to Maarten van Doornmalen for his production feedback.

Karam Shoumali: Hannah El-Hitami is our court reporter. We're out for this week and back next. See you then on Branch 251.

Fritz Streiff: See you then, take care.