A psychologist ponders: “What can I do for the refugees with internal scars? “

On the Greek island of Lesbos, people who have sought safety in Europe are being pushed to the brink, with no way to begin rebuilding their lives, and no information about their futures. Johanna Bogren is an MSF psychologist who has been working in the camps where people are contained, and shared her experience…

“What does a psychologist do?” This is a question I've tried to answer many times in recent months. Actually it’s a question I’ve been asked many times since I graduated and started my work in this field. But here it’s different. How do I explain what a psychologist does to someone who is sinking deeper and deeper in an endless hopelessness?

“What can you as a psychologist do for me?” This is perhaps an even more difficult question to answer, when the person I’m talking to has been through hell on earth, when their third application for asylum has just been rejected.

The crossing, and what came before and after

I’m working with MSF on the Greek island of Lesbos, in a camp for people seeking asylum. The passage across the Aegean Sea is in itself very dangerous and costs many lives every year. Many of the people I meet in this camp have both witnessed other people drowning and come close to dying themselves. Many have lost a child, a sister or a friend in the Aegean Sea. 

Here, I’ve learned that crossing the Aegean Sea in an unsafe boat creates wounds filled with horror inside the human being. As a psychologist, I can try to work with that experience, to make the wound shrink and perhaps heal, even if the scar will remain. 

As I talk to people, it becomes very clear that the passage across the Aegean Sea is just a very short part of the flight towards a life. A life to live. This crossing comes after horrifying experiences that are often difficult for me to comprehend. And it is followed by this: being stuck in a refugee camp, waiting for the asylum process. I have seen first-hand how this limbo brutally affects a person's ability to handle their current lives and the memories of their past experiences.

Internal wounds  

As a psychologist, I meet people who are in pain, but the pain is not caused by a physical injury. It comes from these internal wounds. Being human sometimes hurts. The pain can be excruciating, like a physical wound, full of pus, trapped under the skin. Here on Lesbos, I meet people who have so many old wounds that it is difficult to understand where one ends and another begins. These psychological wounds grow together and impair the person's ability to deal with everyday life, just as a physical infection can destroy the body's tissues and abilities. In my work with people seeking asylum here, it is difficult to know where to begin to reduce the pain in the very innermost part of the human.

Lesbos island in Greece. Photo taken on May 2018. © Robin Hammond/Witness Change

An example  

I provide mental health care to children, men and women who have deep scars on the inside. 

A woman may have lost a friend in the Aegean Sea. She may have spent time in prison during her journey as she lacked valid documents in a country she was passing through. She may have been forced into prostitution to come this far. The reason for the escape from her country may have been one or more rapes, followed by subsequent orders to be forced to marry the rapist. During her upbringing, she may have been continuously abused, and prevented from going to school. Now she sits across from me with her newborn baby, whose father is an unknown man who assaulted her during her journey. As a mental health professional, where do I start? 

It’s easy to be paralyzed by all these human fates, to get stuck trying to understand a world in which this has happened. The woman in front of me may have had her second, third or perhaps fourth rejection in her asylum process, and is now again at risk of being sent back to a forced marriage with her abuser, or worse. I wonder what I can do for her. What does a psychologist do…?

The change 

Sometimes I have met the woman, or the man, or the child, shortly after their arrival on the island. Where possible MSF teams are there to provide immediate medical assistance and psychological first aid. The man is full of distress, worried about his uncertain future. I have seen the terror in his eyes be replaced by calm when he understands that we will not expose him to more horror-filled experiences. Getting the hunger and thirst satisfied, getting medical care and feeling safe for a while does some good to a human being. At that moment, even if the wounds are many, they are not all open, they are not everything he has inside.

But. After a few weeks or months, often I meet this person again, a person who has now lost his hope. It’s painful. He has been through uncertainty, worry, insecurity and the challenging living situation in the refugee camp, and these new wounds contribute to the old wounds flaring up. Kara Tepe camp on Lesbos Island. Photo taken on Sept 2021. © MSF

What we can do

Often, the fear of being forced to return to the situation that caused the original wounds is overwhelming. This fear, and the uncertainty around the future, is so great that it is difficult to begin a healing process. So, what does a psychologist do, and what can I do for the person in front of me?

I listen. I listen to their stories. We share feelings, not infrequently of helplessness, fear and sadness. I see the person in front of me. I try to sow a seed of hope, and highlight their own inner strength. The force that brought them this far. I try to lift away the shame and guilt around the shamefulness of what they have been exposed to. I try to show them that I think they are valuable.


Then I take a long walk along the water and try to get the wind to blow away some of the pain that stays with me from these conversations. My circumstances are so different from those of the people I meet here, with my Swedish upbringing and my Swedish citizenship. 

As I approach my accommodation, there are restaurants and bars. Music plays in the distance, and I try to find the balance in the lottery of life.