IRCT REGIONAL REPORT 2016 MFH BOCHUM – BOCHUM, NORTH-RHINE WESTPHALIA The two biggest issues facing torture victims in the region of North-Rhine Westphalia are related to healthcare and reception facilities. A root cause of this is the lack of any procedures or mechanisms to systematically identify torture victims. Asylum seekers are provided with a medical screening, which serves to detect communicable diseases such as tuberculosis but nothing to identify signs of torture and ill-treatment. Asylum seekers at reception centres may be given medical examinations by volunteer physicians at the centres but they are often not specifically trained to detect signs of trauma. In the region of North-Rhine Westphalia, various NGOs run projects to identify victims and these sometimes work in cooperation with staff at first reception facilities. However, once torture victims have been identified, they are not provided with procedural guarantees or special reception conditions, in the experience of MFH Bochum. On occasion, MFH Bochum will receive a referral from staff at a reception centre, who may be particularly concerned about the psychological symptoms an asylum seeker exhibits. This, however, is largely because they are not trained to deal with torture victims and will request guidance on how to deal with the situation. MFH Bochum will normally receive this person, investigate their needs and, if necessary, provide crisis intervention and therapy. On rare occasions, the authorities may finance this treatment but the cost is normally covered by project funds. The Asylum Seekers’ Benefit Act of 1993 restricts access to healthcare to cases of “acute diseases or pain” in which “necessary” medical treatment must be provided. However, the term “necessary medical treatment” is legally vague, which gives the asylum authorities discretion to determine what is and what is not “necessary”. One of the positive aspects of Asylum Package I (2015) was that it allowed the regions to bypass the provisions in the Asylum Seekers’ Benefit Act of 1993, which restricted access to healthcare. Regions are now able to provide asylum seekers with full health insurance, which some cities in the Region of North-Rhine Westphalia do through the issuance of insurance cards. However, the granting of psychotherapy and additional treatment that may be considered “indispensable” to the health of the torture victims, is still left to the discretion of the local authorities. In MFH Bochum’s experience, when they have requested or argued that certain treatment is “indispensable” for their client’s health, it is often denied by the authorities. The regular German healthcare system has been fundamentally unprepared for the needs of refugees and in particular for the special needs of vulnerable asylum seekers, such as torture victims. There are no provisions for interpretation. So while some MFH Bochum clients were seen by General Practicioners (GPs) or specialists at hospitals or clinics, the diagnosis of problems and subsequent prescription of treatment takes place without interpretation or translation. At this stage, MFH Bochum will have to step in to explain the medication and the diagnosis to the client. Lack of translation and interpretation in the regular healthcare procedures creates a lot of knock on issues for asylum seekers. MFH Bochum will often have to check up on clients who are diagnosed with paranoid schizophrenia and PTSD. “Some of our clients received medication without any translation or explanation of their diagnoses, resulting in benzodiazepine addictions in some cases due to a lack of knowledge about what doses to take.” — Christian Cleusters Another major problem for MFH Bochum clients is reception facilities and housing. Under the Asylum I Package of October 2015, asylum seekers must remain in first reception centres for the first six months. In the experience of MFH Bochum, material reception conditions do not provide an adequate standard of living to guarantee physical and mental health of torture victims at these centres. They are mostly staffed by volunteers and usually overseen or supervised by a social worker employed on a part-time basis. Alongside first reception centres, authorities also established emergency shelters – in sports halls for example – with even more austere conditions. There are cases in these emergency shelters with 250 people sleeping on bunk beds in a small, open space. Asylum seekers are only page 24