But other torture survivors live among us. If you saw one at the grocery store, you wouldn't notice their wounds covered by clothing or the rapid pace of their hearts in response to a siren. You wouldn't hear the cries from their recurring nightmares. You couldn't know about the constant headaches pounding behind their eyes. They are careful to hide the fear in their hearts.
According to the United Nations, torture is employed in 111 countries today. We tend to treat the word lightly, using it to describe unpleasant situations like traffic or a wait on line. But a million known survivors have experienced the World Health Organization's definition: "a deliberate, systematic or wanton infliction of physical or mental suffering..."
The survivors treated in Tucson by the Hopi Foundation's Center for Prevention and Resolution of Violence have been gang raped, beaten with baseball bats, the bottom of their feet whipped with a rubber tube. Some were hung from arms tied behind their backs or like a pig on a spit. Others were incarcerated in tiny cells where they couldn't lie down, hosed periodically so they were always wet. Their bodies were burned by electricity and cigarettes. Some were forced to watch or take part in other people's torture. Several describe the terror of being taken out blindfolded and having a gun put to their head, the trigger pulled and hearing only a burst of laughter.
Who's responsible? According to survivors, violence is perpetrated by those in power who are threatened by those who oppose their views or by poor or indigenous people questioning or seeking human rights in places where they are denied. For each survivor, untold victims have died.
One of them was Antonio's wife, Maria. When she received the threatening letters in their village in Guatemala, she ignored them. After all, she was just a teacher, doing nothing wrong. How dangerous could she be? The fatal answer came six weeks later after the third warning. Maria, nine months pregnant, disappeared. After three horrible days of searching, Antonio found her, a bundle in a sugar cane field covered with branches and leaves. He wonders today if the other bundle nearby was the other teacher who disappeared, or his child, cut from his wife's body. Continued threats forced him from his village. He has lived in Tucson since 1989.
Tucson's torture survivors flee international conflicts, power struggles or civil wars. Some spend time in refugee camps near or across borders from their homelands. According to the UN High Commission for Refugees, 21.8 million people, or one out of every 269 people on earth, have been driven from their homes to become asylum seekers and refugees in other countries. Some are returned refugees, displaced in their own countries.
It's difficult to know the exact percentage of those who've also experienced torture firsthand because of their hesitancy to share. Their silence is born from feelings of shame and fear, or the belief that "no one would believe," says a survivor who prefers her name not be used.
The National Consortium of Torture Treatment Programs estimates conservatively that 500,000 refugees who have survived torture have resettled in the United States. Thirty-one torture treatment centers work nationally to heal the physical and emotional wounds.
Often when the unthinkable happens to an individual, the rest of the family has to leave as a result. "No one in their community wants to have anything to do with them. They're often told 'You bring trouble.' There's a fear that this mark on the family could bring death squads," says Amy Shubitz, director of the Center for Prevention and Resolution of Violence.
Refugees find the center in Tucson through the International Rescue Committee, Jewish Family and Children's Services, Catholic Social Services' Asylum Program of Southern Arizona, as well as referrals from doctors and attorneys. In the early days, the waiting room was filled with survivors from Central America. Today, that room holds patients from Bosnia, Iraq, Mauritania, Sudan, Angola, Kenya, Cameroon, Togo, Columbia, Chile, Iran, Pakistan and Gaza as well.
Health concerns are mixed and include pain and broken bones healed incorrectly. Many suffer from depression, anxiety, post-traumatic stress symptoms like flashbacks, nightmares and insomnia. Anger and grief are common emotions. Some survivors must cope with amputations, deafness, blindness, anxiety and feelings of betrayal. Substance abuse, suicide attempts and dysfunctional family relationships sometimes haunt them along with the memories. Most find it difficult to learn to trust again.
Separation from family compounds a survivor's recuperation. "It's very hard. Often times they have no news from home and the family is in as much danger as the survivor is," says Giovanni Panza, a counselor at the Tucson center. "They come from family-oriented cultures. They identify themselves as part of the family." When they are forced to flee "they lose their identity as a mother or father. Mothers especially feel guilt for having left their children behind. Reunifications seldom do well, in part because the kids don't understand why the parent left them behind."
The slowness of the legal asylum process adds another burden. It takes five months to get a work permit, leaving the survivor with no way to earn money to live. One family's 10-year wait for their papers left them in constant fear of being deported. The children can't help but be impacted by that additional stress.
The center's clinical psychologist, Dr. Kathy Norgard, says, "It becomes physical. The emotional things as well as the memories of the physical things that have happened to these people move into their bodies."
"People move differently after torture," says physical therapist Tracy Carroll. "We see really poor posture and pain is a common complaint. When people are forced to use a lot of the body's protective responses, it results in muscle tension and poor body mechanics. People don't sleep and are into the negative cycle of muscle spasm and pain. With therapeutic touch we try to change that cycle by improving range of motion and flexibility."
The free counseling and medical component of the center takes place at the University of Arizona's Commitment to Underserved Population Clinic. BJ Spire begins his second year of medical school soon, but through this UA program, he's already had a semester with patients. "We see patients two years earlier than our training would normally allow," says Spires. The first- and second-year medical students are paired up with third- and fourth-year students and are supervised by attending physicians. They also have exposure to lab work and administration of vaccines.
The Center for Prevention and Resolution of Violence's roots in the Tucson community are deep. The Task Force for Central America grew from the Sanctuary Movement here that gained national attention in the early 1980s. In 1992, through the vision of the late Dr. Barbara Chester, an international leader in the fields of torture, post-traumatic stress disorder and cross-cultural treatment, the task force evolved into the center under the umbrella of the Hopi Foundation.
This is the only off-reservation program Hopi funds in part because it "supports the Hopi traditions of self-empowerment and the concept of Qa Tutsawinavu, undoing a state of physical, emotional or psychological threats," says Barbara Poley, executive director of the Hopi Foundation. "There's a special place in our hearts for this program which brings healing to people who have suffered unimaginable trauma."
"One thing I've been excited about is to discover in every survivor I've had a chance to meet is an incredible spirit," says Norgard. "People almost to a number get through it all and really believe that their life has some significant meaning after surviving some of these things that would be unsurvivable."
That spirit is evident when you walk into the center office located in a slice of the original sanctuary of Southside Presbyterian Church. Program director Amy Shubitz might be talking a mom through rehydrating her baby, trying to avoid a costly trip to the emergency room, hoping to keep him OK until he can be seen at clinic the next night. She might be consulting with colleagues from around the world. She's often sought out for advice. Having worked since 1982 with political refugees fleeing from the brutal civil wars raging in Central America, Shubitz has seen the results of the worst of what humanity can do. She's also seen the resilience. "The refugee's ability to be joyful and celebrate life even when so much has been taken away from them is remarkable," says Shubitz.
She recounted a story of one of her visits to a village in El Salvador. A fiesta in honor of her birthday was interrupted by machine gun fire. An elder tapped her on the shoulder. With this signal, the entire community hit the ground. No one moved for hours while they listened to the shooting. Finally quiet descended and Shubitz felt another tap on the shoulder. "People got up, the guitar started and the fiesta resumed. No one talked about what had just happened. We went on with our celebration."
In the office, social worker Marianna Neil works on the computer, preparing the clinic schedule for the next night. She arrived in Tucson in 1985. Together Shubitz and Neil serve as the backbone of the center. They network with other agencies to meet needs like job and vocational skill training and serve as advocate for the children in school and provide tutoring (see sidebar). Making use of volunteers, they help clients overcome barriers associated with language, low socio-economic status, legal issues and feelings of isolation. They help refugees develop a sense of community.
Ask those Shubitz and Neil serve such as survivor Dienaba Yaya Ba, who arrived from Mauritania, Africa two years ago. "They offer me a family here and since I know them I don't feel like a stranger anymore. I can go out in peace because I know if I have a problem, they are there for me. Since I know them, I started to believe in me again."
The Salazar family represents one of the families who came in the 1980s. Their story of survival of physical torture, hiding and subsequent flight from Guatemala has inspired others. In 1993, more than 80 friends and volunteers in the local community helped find and secure a location, then clean, paint and decorate Maya Quetzal on North Fourth Avenue, the only Guatemalan restaurant the family is aware of in Arizona. "It's a tangible symbol of what a community can do," says Neil. "Maya has the taste and flavor of a successful refugee resettlement."