Lara Mahmood tries hard each day to be a lighthearted person. But whenever the Iraqi refugee closes her eyes, she said she can’t avoid seeing images of her cousin lying dead in the road. Her cousin was gunned down while trying to buy milk for her infant child; her killers wouldn’t even allow the family to retrieve her body for burial.
Mahmood also lost her father in the war; he died after terrorists prevented hospital workers from treating his wounds. Although Mahmood and the rest of her family resettled in Vermont a year ago, they all still suffer psychological wounds from their ordeals, she said, especially her brother, who cries whenever he talks about life in Iraq.
“My mom still suffering from many, many pain,” Mahmood tearfully told a roomful of strangers in Burlington last week. “She does not know where that pain come from. Is it from getting old, or is it that she cannot forget?”
The casualties of war can seem far removed from Vermont’s peaceful landscape. But Mahmood’s story, and others like hers, are grim reminders that many survivors of rape, torture, genocide and other atrocities live, work and attend school in our own communities.
Mahmood was one of four recent immigrants whose personal narratives opened a three-day conference designed to introduce Vermonters to a new organization called NESTT — New England Survivors of Torture and Trauma  — and build a local network of professionals who are trained in recognizing and treating the physical and psychological scars of war. Organized by the National Partnership for Community Training  and Vermont Immigration and Asylum Advocates , the conference was billed as one of the most comprehensive of its kind ever held in the United States.
The original 100 attendee slots quickly filled, and another 50 were added to accommodate social-service providers from around the state, including doctors, nurses, lawyers, teachers and social workers.
The response reflects the growing need for such services in Vermont, which has become home to more than 5000 refugees and asylees over the last 20 years. It’s estimated that between 5 and 35 percent of them are survivors of torture, rape, genocide or other atrocities.
Although most refugees and other new immigrants adjust well to their new lives, some continue to suffer from major depression, anxiety, panic attacks, heart palpitations and other symptoms of post-traumatic stress disorder, or PTSD. Their symptoms can go untreated for years because many new immigrants are unaware that services are available for them. Others don’t seek counseling due to language or cultural barriers, or are afraid of being labeled “crazy” “damaged” or “impure” by members of their community.
Sometimes, problems associated with past traumas don’t show themselves for years or even decades. Abraham Awolich, who also shared his story with conference-goers, recounted his arrival in Vermont in 2001 as part of the wave of Sudanese refugees who were labeled the “Lost Boys.”
“It’s a name I don’t agree with because, as you can see, I’m a big man now,” Awolich told the attendees. “And, I was never lost to begin with. I had to run away because the situation was too dangerous to stay.”
Awolich said he feels fortunate to have adjusted to life in Vermont. But he acknowledges that some of his fellow Sudanese ex-pats haven’t been so lucky. Some, who’ve been in the United States for years, are just now starting to show signs of untreated past traumas.
For example, Awolich said he has noticed more cases of children being removed from African households due to domestic violence or other crimes. Divorce is also on the rise. Such stories are consistent with reports from the Chittenden County State’s Attorney’s office, which has noted a recent uptick in violent crimes among Vermont’s new African population, especially among survivors of brutal and bloody conflicts.
The scope of the three-day conference was expansive and highly detailed. For example, one seminar explored the benefits and challenges of working with foreign-language interpreters. Those challenges can be especially acute in small communities, where interpreters often know the immigrants they’re translating for.
Another seminar, hosted by Dr. Kathleen Allden , provided local health care providers with guidelines for evaluating and documenting cases of torture and other human rights abuses among asylum applicants. Allden, a psychiatrist from Hartford, Vt., has more than 20 years experience evaluating and treating torture survivors; in the 1990s, she helped develop the international guidelines for documenting torture and its consequences for the United Nations.
As Allden explained, sometimes it’s difficult to identify torture victims. Exposure to extreme trauma doesn’t necessarily produce psychological problems, nor does the absence of psychological problems necessarily mean that someone wasn’t tortured.
Allden emphasized that some of the most common forms of torture worldwide — beatings to the head, starvation, dehydration, sleep deprivation, and near drowning — may cloud a victim’s recollection of events. Allden also noted that Awolich’s observation about past traumas not revealing themselves immediately is consistent with her own experiences. Simply put, many torture victims have a delayed onset of PTSD. Major depression can take years to emerge.
The conference didn’t just address the psychological wellbeing of torture survivors but also the caregivers who treat them. Dr. Karen Fondacaro , cofounder of NESTT and director of the Behavior Therapy and Psychotherapy Center at the University of Vermont , gave a seminar on recognizing and avoiding “vicarious trauma,” which can occur from hearing clients’ horrific stories day after day. Its symptoms can include insomnia, nightmares, depression, over-identification and over-involvement with clients, burnout, even substance abuse and suicidal thoughts.
One caregiver who works with torture survivors remarked afterward, “Having Karen do this presentation suddenly explained my life and why I feel this way.”
Patrick Giantonio is executive director of Vermont Immigration and Asylum Advocates and one of the cofounders of NESTT. Although he expressed his appreciation to all the experts who participated in last week’s conference, he reserved his highest compliments for his “client-partners” who are “illuminating so many positive and undeniably compelling aspects of the human condition.”
Indeed, one of the most powerful messages to emerge from the conference was the ability of survivors to regain their voices, which are often silenced by the shame and humiliation of torture, and to heal themselves and one another.
Adelit Rukimangana, a refugee from the Rwandan genocide, sat silently next to the young Iraqi woman as she recounted her story. When she finished, he offered her simple but profound words of advice:
“The first thing I would say to Lara Mahmood is that there is hope,” he said. “I speak from experience. Don’t give up.”