Chronic pain in refugee torture survivors

The number of refugee torture survivors worldwide is accelerating given violent global conflict, and healthcare providers are more likely to encounter refugees in their practices. The World Health Organization has declared the existing refugee migration an international humanitarian disaster, considering it the worst humanitarian crisis since the Second World War. The United Nations High Commissioner for Refugees in 2015 documented over 65.3 million forcibly displaced people worldwide, including more than 21 million refugees; this number will undoubtedly increase considerably given the acceleration of violent global conflicts and the resulting numbers of displaced people [1]. Despite a universal ban by the United Nations, 50% of all countries, including 79% of G-20 countries, practice systematic torture, affecting an estimated 5%-69% of refugees in the world [2]. Physicians in developed countries will typically encounter survivors of torture as refugees or asylum seekers [3]. Medical anthropologists have highlighted the importance of evaluating non-medical factors such as economic and social determinants of health, during the process of refugee assessment [4]. Experienced physicians in the field recommend taking a multimodal, interdisciplinary approach to refugee treatment, such as the use of alternate therapies including acupuncture and t’ai chi [5]. Yet the holistic paradigm of assessment and rehabilitation is incomplete without considering the potential of chronic, debilitating somatic pain experienced by survivors of torture.