Is it dried blood tracing the noble outline of Hani’s high cheekbones? Her clothes are rags, her feet are bare. The impenetrable police cell door holds no unfamiliar fear as much of her adult life has been spent in places she was not free to leave, the refugee camps and detention centres she called home after she fled her native Somalia. But tonight her cell symbolises sanctuary not sanction, rescued from running the streets brandishing a rusty blade, desperately warding off hideous demons that exist only in her mind.
Born into civil war and cruel poverty, Hani knew no childhood or education; instead her life lessons were female genital mutilation and sexual violence. As a teen she witnessed unimaginable horrors including the mutilation and murder of her family. She survived childbirth, only to have her child ripped from her arms as she descended into mental illness in a world where heavy chains shackle those possessed by evil spirits.
Hani is real but she is not one person. To safeguard confidentiality she is an amalgam of many patients I see in my field of assertive outreach psychiatry. Patients who, out of fear, have shunned mental health services and the treatments they offer. This is a common theme amongst patients from black and minority ethnic backgrounds, and amongst their number are many refugees and asylum seekers.
Hundreds of thousands formed the Somali diaspora following the government’s collapse in 1991. From the Horn of Africa and the refugee camps of Kenya, young women like Hani travelled, often with their children, first to South Asia and then across Europe before arriving in the UK. Facing ever-present threats of rape and violence along the way - is it any wonder she always keeps her rusty knife so close?
Our crude ethnicity questionnaires would classify Hani as a “black African” but she doesn’t resemble her continental neighbours. An Arabic-speaking Sunni Muslim, her sharp aquiline features and the looser curls of her hair distance her both physiognomically as well as linguistically from her ethnic grouping. As a woman, Hani’s exclusion and isolation are all the greater. She finds no refuge in the barber shops, pool halls or the mind-altering khat that her countrymen favour. Unable to speak English, deeply ashamed of her illness she suffers silently in the darkness of her spartan single room. Refugees and asylum seekers are significantly more likely to experience mental illness than the general population but far less likely to receive support.
Unsurprisingly post-traumatic stress disorder is common and some patients are severely psychotic, wandering an unreal wasteland of paranoia and hallucinations. What they tell me is that they are frightened of psychiatric services which they find hostile and confusing. The experience of many is one of arrest, restraint and forced injections. I have no doubt that these experiences force them to relive past traumas. And to them the tranquillising antipsychotic injections are invisible chains that bind them even more painfully than the metal ones they knew before.
In a climate of burgeoning xenophobia and deafening Islamophobic rhetoric, we are witnessing a heartbreaking dearth of kindness. I work in a healthcare culture which sometimes seems more concerned with counter-terrorist PREVENT training and border guard duties than comforting those who have experienced horrors which far surpass our darkest nightmares. In a compassionate society surely we could offer more? There is a movement towards trauma informed psychological treatment in the UK, but for Hani, this is a distant dream. She has learned that is safer not to speak about her demons but, even if she could be persuaded that it would be safe to do so, she is held back from the psychological help she so desperately needs by her mother tongue. It is surely our duty to find a way to overcome the barriers that race creates and offer her this vital support.
All Hani wants is peace from her pain, a simple happier life and, despite everything she suffered there, to one day go back home.
“There is no greater sorrow on earth than the loss of one’s native land” – Euripides 431BC