Medical case study

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December 10 2024

Bisexuality, gang violence and human trafficking

Kevin* becomes a victim of abuse and violence because of his bisexuality. To protect himself, he joins a gang, but a gang war causes him to flee. During his escape, he becomes a victim of human trafficking and is forced to work in prostitution for years before he is able to escape and seek asylum.

Kevin is a 36-year-old man from an African country. His mother runs a restaurant and his father is a businessman. As an only child, he finds out at an early age that he is different from others. Namely, he falls in love with boys as well as girls. Both at school and by his parents, he is punished for his dealings with boys. In the process, he is beaten with a cane and ruler. His mother sees his bisexuality as a spiritual problem and takes him to different churches to get him cured.

Kevin is smart and goes to college. At college, fellow students catch him with a boyfriend, after which he is assaulted. This involves Kevin being beaten many times and stabbed with a knife in his genitals. There is a group in and around school attacking him. The incidents increase and so do the intimidations.

To protect him, a friend introduces him to a gang. He is sent blindfolded to a forest for a ritual in which he is beaten and stabbed with stones, hoes, knives, machetes, axes and guns by a group of about 40 boys. This eventually renders him unconscious.

Afterwards, he wakes up in his own bed while being cared for by his friend. He now understands that all this time in college he was being harassed by a rival gang. The incidents and harassment cease because he is now protected by the gang he joined.

In his third year of study, violence between rival gangs suddenly flares up. Shots are fired and everyone runs in panic in all directions. Kevin is injured by hail blasts. A traditional healer has been able to remove almost all the pellets of hail.

Soon after, his own gang wants him to take an active part in the fight against the other gang. He does not like this and, in addition, is still wounded by the incident. At this he decides to flee the country. This is difficult because two men are watching him closely. When he can go to the bathroom alone, he escapes and goes on the run. His own gang takes revenge and they kill not only his father but also his friend.

Kevin’s flight goes through Libya where he ends up imprisoned and is severely mistreated. To be released, he must pay a large sum of money. And so Kevin becomes a victim of human trafficking. To pay the debt to the human trafficker, he has to work in a European country in prostitution and as a drug courier. At some point he manages to flee to the Netherlands.

The examination by iMMO identifies many scars. In accordance with the Istanbul Protocol, a number of scars are assessed as typical and highly consistent with the events described. The psychological examination reveals that he has post-traumatic stress disorder-related symptoms and somberness complaints.

The legal follow-up can be found here.

* All names are fictitious.

September 30 2024

Being underage and explaining your asylum claim

Martin Stolk Medical case study, News

Being underage can affect how an asylum narrative develops as evidenced by scientific research. It has been found that the ability to construct a “life story” is not achieved until late adolescence or during young adulthood (early 20s). At the same time, experiences such as significant psychotrauma or depression can negatively affect an adolescent’s autobiographical memory (1). This can lead to less specific memories of events.

To illustrate, the following case study. 16-year-old Oscar* grows up with his mother in a country in West Africa. He does not attend school, but is home schooled by his mother. His mother was disowned by her family when she had Oscar as an illegitimate child. Oscar and his mother are happy together. As a bastard, Oscar does get teased and bullied, scolded and humiliated by children in the neighborhood. This makes him feel different and less worthy than others.

When Oscar is 14 years old, he is assaulted by several men as he walks outside on the street. He is beaten, stabbed in the legs with a knife and dragged across the street. He is threatened with death; the men indicate that, as a bastard child, he has no right to live. Oscar is very afraid they will kill him. When people come to see what the commotion is about, the men run away. Afterwards, the men turn out to be the brothers of Oscar’s mother.

Oscar and his mother go to hide with a friend out of fear. There they hide for several months before fleeing the country with this friend’s help. With the help of people smugglers, Oscar and his mother eventually reach Morocco. Along the way, Oscar experiences many unpleasant things. He witnesses how human traffickers abuse and shoot refugees.

In Morocco one night they are picked up and taken to the sea. Oscar does not know what is going to happen or where they are going. There are lots of people by the water and Oscar and his mother have to get into a boat. In the middle of the sea, the boat breaks down; everyone is screaming and Oscar hears his mother calling his name. All the people end up in the water. Oscar is rescued by another boat and taken to Spain. His mother drowns. Oscar is in shock and feels very guilty for not being able to save his mother. Eventually, with help, Oscar travels on to the Netherlands where he applies for asylum.

During the iMMO assessment, it is noticeable that Oscar has difficulty talking about the many upsetting events. He falls silent and prefers not to talk about them at all. He indicates that talking about the unpleasant events evokes memories that he wants to avoid. He is troubled by recurring images and thoughts of his mother. In his dreams she is there and when he wakes up, she is suddenly gone. He also suffers greatly from recurring images of the beatings and threats by the men. Seeing the scars on his legs reminds him of this.

In different places on Oscar’s body, dozens of scars are identified. In accordance with the Istanbul Protocol, most of these scars are assessed as typical of the alleged violence that prompted Oscar’s flight. There are also psychological symptoms that can be related to Oscar’s asylum story. The avoidance, specific re-experiences and triggers for these re-experiences are also typical of Oscar’s alleged asylum story. iMMO’s medical assessment reveals clear supporting evidence for his asylum narrative.

The IND objects to Oscar’s testimony as being insufficiently detailed. iMMO’s file review reveals that Oscar was already struggling with trauma and grief symptoms during the interviews at the IND and that he received psychological help. Oscar also seemed to have difficulty understanding some of the questions during the hearings. The iMMO concludes that both Oscar’s psychological complaints and his young age must be taken into account during the interviews and decision making process, as both affect his ability to explain consistently and coherently.

(1) Autobiographical memory: the part of human memory that allows us to recount what we have experienced (specific and general memories about your own life).

(*) Names are fictitious.

June 19 2024

Case study on the paradox of sexual violence

Martin Stolk Medical case study, News

The scars left by sexual violence are often more psychological than physical. This is also the case with 40-year-old Carolina*. She is an only child and grows up with an aunt because her mother was too young to take care of her. Her father dies when she is still young. Conform local custom her family chooses a partner for her, but she decides to marry the man of her choice. Shortly thereafter, her mother dies. Her family blames Carolina for her mother’s death, proclaiming it is the result of her refusal to consent to the arranged marriage.

Carolina and her husband are happy together. In addition to their work, they help street children. These children are regularly assaulted and sexually abused by soldiers. They give them shelter, food and see to their safety. The soldiers try to counter this. They have to be careful because “the soldiers wanted the children for themselves.”

At one point, riots break out in the country. There is unrest in many places. Soldiers invade the premises of their organization in search of her and her husband. During this time Carolina has to flee several times, is arrested, raped and abused. She is beaten with weapons, kicked, burned with cigarettes and other objects. Furthermore, she is imprisoned several times. She has to stay in crowded cells without toilets and sanitation.

The rapes and beatings continue, until a prison chief hears her crying and mumbling in her native language. He recognizes the language because he is from the same area and helps her flee.

Carolina manages to escape but during the flight she is forced into prostitution several times. She is also raped several times by those who say they want to help her. In Europe, she is supposed to pay back the cost of her journey by working in prostitution. At Schiphol Airport, however, she is stopped by the Dutch military police.

Carolina is ashamed about what she has been through. She ends up in jail in the Netherlands, afraid and no longer trusting anyone. Before the assessment at iMMO, she never told anyone about the sexual violence.

During the iMMO assessment, it is noticeable that she falls silent at times. This happens especially while recounting the sexual violence. When the researchers ask about this, she indicates that she is distracted. The images of these rapes intrude on her. She prefers not to talk about it. In daily life, she has difficulty with loud noises and the smell of excrement. These smells and sounds bring up images she wants to forget. Her most unpleasant re-experiences are the memories of the rapes in the presence of her husband.

Scattered over Carolina’s body, several dozen scars are identified from multiple acts of violence, including a scar in the genital area. In accordance with the Istanbul Protocol, most of these scars are assessed as highly consistent. There are psychological problems that can be related to the asylum story. Specific re-experiences, triggers for the re-experiences, avoidance and distrust are typical in content and nature of the claimed asylum narrative as indicated by her.

In Carolina’s case, there is one genital scar to mark the sexual violence suffered. Often rape leaves no visible injuries or scars. This is the paradox of sexual violence, which often actually produces a lot of psychological damage and relatively few visible physical scars. In this case, the scars from the other violence contributed substantially to the conclusion of the assessment. This illustrates the importance of conducting a full investigation.

The iMMO report was introduced in the repeated asylum application. (See case law for follow-up.)

* All names are fictitious.