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 â€" Mohamed has destroyed his cell phone's SIM card, for his own emotional protection. He can't handle any more horrible messages from home â€" 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 â€" 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 â€" 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 â€" 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 â€" his parents are from Africa, he was born in Germany â€" 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 â€" 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 â€" 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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A check operation in Indian-administered Kashmir, following a spate of targeted attacks on the region's Hindu minority

Anne-Sophie Goninet, Jane Herbelin and Bertrand Hauger

👋 Здраво!*

Welcome to Friday, where Joe Biden vows to protect Taiwan from China, Alec Baldwin accidentally kills a cinematographer, and can you guess what day it is TODAY? We also have a report from a researcher in San Diego, USA on the sociological dark side of food trucks.

[*Zdravo - Macedonian]


Iran-Saudi Arabia rivalry may be set to ease, or get much worse

The Saudis may be awaiting the outcome of Iran's nuclear talks with the West, to see whether Tehran will moderate its regional policies, or lash out like never before, writes Persian-language media Kayhan-London:

The Iranian Foreign Ministry spokesman Saeed Khatibzadeh said earlier this month that Iranian and Saudi negotiators had so far had four rounds of "continuous" talks, though both sides had agreed to keep them private. The talks are to ease fraught relations between Iran's radical Shia regime and the Saudi kingdom, a key Western ally in the Middle East.

Iran's Foreign Minister Hossein Amirabdollahian has said that the talks were going in the right direction, while an Iranian trade official was recently hopeful these might even allow trade opportunities for Iranian businessmen in Saudi Arabia. As the broadcaster France 24 observed separately, it will take more than positive signals to heal a five-year-rift and decades of mutual suspicions.

Agence France-Presse news agency, meanwhile, has cited an unnamed French diplomat as saying that Saudi Arabia wants to end its costly discord with Tehran. The sides may already have agreed to reopen consular offices. For Saudi Arabia, the costs include its war on Iran-backed Houthis rebels fighting an UN-recognized government in next-door Yemen.

Bilateral relations were severed in January 2016, after regime militiamen stormed the Saudi embassy in Tehran. Amirabdollahian was then the deputy foreign minister for Arab affairs. In 2019, he told the website Iranian Diplomacy that Saudi Arabia had taken measures vis-a-vis Iran's nuclear pact with the world powers.

He said "the Saudis' insane conduct toward [the pact] led them to conclude that they must prevent [its implementation] in a peaceful environment ... I think the Saudis are quite deluded, and their delusion consists in thinking that Trump is an opportunity for them to place themselves on the path of conflict with the Islamic Republic while relying on Trump." He meant the administration led by the U.S. President Donald J.Trump, which was hostile to Iran's regime. This, he said, "is not how we view Saudi Arabia. I think Yemen should have been a big lesson for the Saudis."

The minister was effectively admitting the Houthis were the Islamic Republic's tool for getting back at Saudi Arabia.

Yet in the past two years, both sides have taken steps to improve relations, without firm results as yet. Nor is the situation likely to change this time.

Iran's former ambassador in Lebanon, Ahmad Dastmalchian, told the ILNA news agency in Tehran that Saudi Arabia is doing Israel's bidding in the region, and has "entrusted its national security, and life and death to Tel Aviv." Riyadh, he said, had been financing a good many "security and political projects in the region," or acting as a "logistical supplier."

The United States, said Dastmalchian, has "in turn tried to provide intelligence and security backing, while Israel has simply followed its own interests in all this."

Furthermore, it seems unlikely Iran's Supreme Leader Ali Khamenei will tolerate, even in this weak period of his leadership, the kingdom's rising power in the region and beyond, and especially its financial clout. He is usually disparaging when he speaks of Riyadh's princely rulers. In 2017, he compared them to "dairy cows," saying, "the idiots think that by giving money and aid, they can attract the goodwill of Islam's enemies."

Iranian regime officials are hopeful of moving toward better diplomatic ties and a reopening of embassies. Yet the balance of power between the sides began to change in Riyadh's favor years ago. For the kingdom's power has shifted from relying mostly on arms, to economic and political clout. The countries might have had peaceful relations before in considerably quieter, and more equitable, conditions than today's acute clash of interests.

Beyond this, the Abraham Accord or reconciliation of Arab states and Israel has been possible thanks to the green light that the Saudis gave their regional partners, and it is a considerable political and ideological defeat for the Islamic Republic.

Assuming all Houthis follow Tehran's instructions — and they may not — improved ties may curb attacks on Saudi interests and aid its economy. Tehran will also benefit from no longer having to support them. Unlike Iran's regime, the Saudis are not pressed for cash or resources and could even offer the Houthis a better deal. Presently, they may consider it more convenient to keep the softer approach toward Tehran.

For if nuclear talks with the West break down, Iran's regime may become more aggressive, and as experience has shown, tensions often prompt a renewal of missile or drone attacks on the Saudis, on tankers and on foreign shipping. Riyadh must have a way of keeping the Tehran regime quiet, in a distinctly unquiet time.



• Biden vows to defend Taiwan: U.S. President Joe Biden said the United States would come to Taiwan's defense if it were attacked and had a commitment to defend the island nation that China claims as its own. The White House clarified for the second time in three months that U.S. policy on the subject has not changed, and declined further comment when asked if Biden had misspoken.

• Call on China to respect Uyghurs: A statement from 43 countries denounced China's human rights record at the United Nations over the reported torture and repression of the mostly Muslim Uyghurs, as well as the existence of "re-education camps" in Xinjiang. The declaration calls on Beijing to allow independent observers immediate access. In response, Cuba issued a rival statement shortly afterwards on behalf of 62 other countries claiming "disinformation".

• Alec Baldwin fires prop gun, kills cinematographer: U.S. actor Alec Baldwin fatally shot cinematographer Halyna Hutchins and injured director Joel Souza after discharging a prop gun on the set of his new movie, near Santa Fe. The accident is being investigated.

• Berlusconi acquitted: Former Italian Prime Minister Silvio Berlusconi was acquitted of judicial corruption charges. The 85-year-old media mogul had been accused of seeking to bribe guests present at his infamous "Bunga Bunga" parties to lie about the evenings as part of an underage prostitution case.

• COVID health workers death toll: A new WHO working report estimates that between 80,000 and 180,000 health and care workers may have died from COVID-19 between January 2020 and May 2021. The same report also noted that fewer than 1 in 10 healthcare workers were fully vaccinated in Africa, compared with 9 in 10 in high-income countries, and less than 5% of Africa's population have been vaccinated.

• Seven killed in Russian gunpowder factory blast: An explosion at the Elastik gunpowder and chemicals plant southeast of Moscow killed at least seven people, while nine are still missing.



Dutch daily De Volkskrant pays tribute to "sound master" and renowned classical conductor Bernard Haitink, who died at 92. Born in Amsterdam, Haitink made more than 450 records and led some of the world's top orchestras in the span of his 65-year career.


The food truck, a sign that the white and wealthy are moving in

In San Diego, California, researcher Pascale Joassart-Marcelli tracked how in the city's low-income neighborhoods that have traditionally lacked dining options, when interesting eateries arrive the gentrification of white, affluent and college-educated people has begun. In The Conversation she writes:

🥡 In 2016 in City Heights, a large multi-ethnic San Diego neighborhood, a dusty vacant lot on the busiest boulevard was converted into an outdoor international marketplace called Fair@44. There, food vendors gather in semi-permanent stalls to sell pupusas, lechon (roasted pig), single-sourced cold-brewed coffee, cupcakes and tamarind raspado (crushed ice). Just a few blocks outside the gates, informal street vendors — who have long sold goods such as fruit, tamales and ice cream to residents who can't easily access supermarkets — now face heightened harassment.

🤑 Cities and neighborhoods have long sought to attract educated and affluent residents – people whom sociologist Richard Florida dubbed "the creative class." The thinking goes that these newcomers will spend their dollars and presumably contribute to economic growth and job creation. Food, it seems, has become the perfect lure. It's uncontroversial and has broad appeal. It taps into the American Dream and appeals to the multicultural values of many educated, wealthy foodies.

🏙️ My analysis of real estate ads for properties listed in City Heights and other gentrifying San Diego neighborhoods found that access to restaurants, cafés, farmers markets and outdoor dining is a common selling point. San Diego Magazine's home buyer guide for the same year identified City Heights as an "up-and-coming neighborhood," attributing its appeal to its diverse population and eclectic "culinary landscape," including several restaurants and Fair@44. When I see that City Heights' home prices rose 58% over the past three years, I'm not surprised.

➡️


€6.65 million

The remains of "Big John," the world's largest triceratops skeleton ever found, were sold at auction for a European record price of 6.65 millions euros in Paris to a private anonymous collector from the U.S. The 200 pieces of the skeleton were unearthed in 2014 in South Dakota and reassembled by specialists in Italy.


Police bust Mexican drug gang recruiting boys via online video games

Police in Mexico have intervened to rescue three minors, aged 11 to 14, from recruitment into a drug gang that had enticed them through online gaming.

A top Mexican police agency official Ricardo Mejía Berdeja, said the gang had contacted the youths in the south-central city of Oaxaca, chatting through a free-to-download game called Free Fire, which involves shooting at rivals with virtual firearms.

Calling himself "Rafael," another player of the same age, the suspected gang member offered one of the youths work "checking radio frequencies and watching out for police presence" in Monterrey, northern Mexico, reported national daily El Heraldo de México. The pay was unusually good — 8,000 pesos (almost $400) every two weeks — and the youth called two friends who also wanted to get in.

The three boys were set to take the bait, but an anonymous Mexican intelligence agent following the exchange while also posing as youth playing Free Fire, ultimately led police to a safe house in Santa Lucía del Camino, outside Oaxaca.

➡️


"I just want to make China understand that we are not going to step back."

— U.S. President Joe Biden vowed to defend Taiwan if it came under attack from China, an assertion that seems to move away from the U.S. stated policy of "strategic ambiguity." His administration is now facing calls to clarify this stance on the island.


Paramilitary soldiers are conducting a check operation in Indian-administered Kashmir, following a spate of targeted attacks on the region's Hindu minority that have left at least 33 dead since early October. The region, claimed in full by both India and Pakistan, has been the site of a bloody armed rebellion against India since the 1990s — Photo: Adil Abbas/ZUMA

✍️ Newsletter by Anne-Sophie Goninet, Jane Herbelin and Bertrand Hauger

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