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Traumatized Young Refugees Present New Challenges For German Doctors

For psychiatrists at Munich's Heckscher Clinic, underage migrants who have fled war and violence, often alone, represent a difficult new group of patients.

Refugees arriving in Munich's train station in September
Refugees arriving in Munich's train station in September
Von Bernd Kastner

MUNICH — Mohamed has destroyed his cell phone's SIM card, for his own emotional protection. He can't handle any more horrible messages from home — like the one about his older brother being shot.

Mohamed fled from Afghanistan, one of the thousands of unaccompanied minors who spared no effort to ultimately reach Germany. He first arrived in Iran, where he worked for a couple of months. Then it was on to Turkey, where he was imprisoned for a time before boarding a boat in Greece that capsized, killing many on board.

Two and a half years later, Mohamed (not his real name) reached Munich. He was just 16 years old but had already suffered many traumas. That's how the doctors from the Heckscher Clinic, who treated him from that day on, characterized it. He suffered from a sleep disorder, nightmares and horrible memories from his escape.

Munich's psychiatric community, one of the biggest of its kind in Germany, receives a growing number of young refugees with badly damaged souls. The Heckscher Clinic physicians have gotten to know a whole new group of patients over the last couple of months. And sometimes, when interpreters aren't available, they have to read their patients' eyes.

Since the refugees crisis, the Heckscher Clinic has become a kind of integration laboratory. About one in five or six patients hospitalized here is a refugee, and they live here with local teenagers as part of big patchwork family.


Sometimes doctors, therapists and teachers are able to stabilize their young patients, making the clinic a stepping stone into a new life. Mohamed, for example, is slowly starting to open up and is becoming more and more stable, finding his way back toward a normal life.

The Heckscher Clinic opened its doors for us to discover what their day-to-day work is like. Two young doctors in particular, Eva Reisinger and Vincent Eggart, impress us with their calm and sensitivity, taking time for each of the patients. They talk to them like a parent would talk to a child. "Normal days" are not spectacular — no flying tables, no screaming. But there are the other kinds of days too.

Reisinger and Eggart cannot predict, on any given morning, what the day will hold. A girl with suicidal thoughts has been admitted, and her stepfather speaks of her disparagingly. A helpless mother calls because her mentally disabled 14-year-old daughter has a boyfriend who is four years older. A young Albanian threatens to jump out the window of his sixth-floor room, so the police have brought him here.

The day before, a 17-year-old named Ali used a bread knife to hurt himself. Like Mohamed, he fled Afghanistan on his own. Eggart, 31, is in charge of Ali, who is in a so-called "time out," alone in a room with nothing but a mattress, where agitated patients are supposed to calm down.

Because of the clinic's location in southern Germany, many young refugees land here. About one in three adult refugees arrive in Germany traumatized, and the number is significantly higher among the younger ones.

"Life isn't about waiting for the storm to pass — it's about learning to dance in the rain." Someone has written this as inspiration on one of the windows during an hour of therapy, painting clouds and a sun next to it. Therapists with different specialties work in the clinic, using various methods for stabilizing their patients — music, sports or art. The doors of the clinic are open most of the time.

Gentle treatment

Samir has just arrived. The 16-year-old — his parents are from Africa, he was born in Germany — has been standing here for a while now, not saying a word and seeming a little unsteady.

Reisinger needs a blood sample, which is part of the reception process, but Samir is hesitant. "I'm a doctor," Reisinger says. "You don't need to be scared." Reisinger pronounces each word carefully. "We need to check what's wrong with you. I know you're very scared. But the pills will help you." Samir remains seated, the doctor touches him lightly on the shoulder. Carefully Samir responds, "I don't believe that."

Once the young refugees leave the clinic, the kids are often on their own because it's difficult to track down their parents. They generally qualify for asylum status.

Therapists need no medical instruments. Words are their equipment. But when the police bring in a refugee as an emergency, their instruments don't work. It's like an orthopedist trying to find a broken bone by feeling instead of using an X-ray. Without an interpreter, the psychiatrists have to read on their patients' faces whether they're sad, scared or prone to harm themselves.

The clinic director wants to help the refugees, but he doesn't want to neglect the other children. Adolescents from all over the world live together here, sharing the kitchen and couch, bathrooms and showers. Obviously, there is the normal friction that comes with people living together, but "all in all, it's a lot less problematic than we have feared," the director says.

Giving voice to trauma

Sometimes a German teenager takes a refugee by the hand and teaches him German. What worries them more is how much more time-consuming it is to take care of the refugees compared to the other patients. There's so much to organize — the youth welfare office, legal guardians, interpreters.

Eggart talks to Ali and wants to know what has happened. "I almost blew up," the boy tells Eggart. Ali doesn't really want to talk, but then he says: "I'm scared — of myself." Eggart says then that he needs to stay in the time-out room. "But I don't want to," the boy answers.

It's as if an impatient father is explaining to his son that he must first do his homework, then he can go play with his friends. What looks like defiance is instead Ali's disease. After an hour, the angry boy leaves the room. There is the sound of breaking glass because after leaving the boy picked up a table and threw it toward the window. Now a table leg is missing, and Ali is back in "time out."

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