Identity surviving torture. MSF rehabilitation project in Palermo, Italy

In the Libyan prisons I saw people being killed and women raped in front of me. In Italy they gave me another heart because mine wasn’t working. There are still many things I can’t do, but I’m alive: I can work, see beautiful places, and enjoy every little moment,” says Kalifa, who is now attending a sewing course, writing songs, and hoping to become an intercultural mediator. “There are many people who went through what I went through and didn’t make it. I now know how lucky I was: I’m still alive.”

Kalifa is one of the hundreds of people assisted by the international organization Médecins Sans Frontières/Doctors Without Borders (MSF) through a rehabilitation project for survivors of torture in Palermo. Intentional violence, inhuman treatment and torture are not isolated episodes along migration journeys — including the Mediterranean route. Despite being prohibited under international law in all circumstances, these practices remain widespread and largely unpunished, fueled by the absence of legal and safe pathways to seek protection and by increasingly restrictive migration policies.

MSF’s new report “Inhuman. Torture Along the Mediterranean Migration Route, and the Support of Survivors in a Fragile System”, published on the occasion of the International Day in Support of Victims of Torture, shows how torture is a structural and widespread element along this route. A practice that has devastating consequences on physical and mental health that leaves not only physical marks, but also deep psychological scars that are persistent and debilitating, often affecting every aspect of a person's life — from the ability to build interpersonal relationships, to pursuing professional goals, and even continuing personal development.

Torture, a systemic practice along the Mediterranean route: more than 60% of tortures occurred in Libya.

From January 2023 to February 2025, the MSF project in Palermo assisted 160 survivors of torture, the majority being men (75%) with an average age of 25 years. In 82% of the cases, torture occurred in transit countries, with Libya having the highest incidence (108 cases),

followed by Tunisia (41). Moreover, 36.5% of the episodes occurred in 9 countries listed by the Italian government and the European Commission as safe countries of origin, for repatriation purposes: Algeria, Bangladesh, Côte d’Ivoire, Egypt, Gambia, Ghana, Morocco, Tunisia, and Senegal. Patients reported that in over 60% of the torture cases, the perpetrators were smugglers, while in 30% of the cases, they were law enforcement officials. Episodes of torture often occurred in formal and informal prisons, in detention centers run by militias, or immediately after failed escape attempts by sea.

Women, along their journey to seek safety in Europe, are often victims of sexual and gender-based violence: 80% of female patients of MSF project experienced sexual and gender-based violence, often in combination with other forms of torture, and 70% experienced sexual violence in their country of origin. Men are not exempt from this form of violence: some MSF patients reported being victims of sexual violence themselves or being forced to witness sexual violence perpetrated against their wives or sisters.

Long-lasting wounds: more than physical pain

“Torture tries to annihilate identity. The body remembers the pain. The mind gets trapped in it. Our work is to rebuild what was broken — to help people feel human again through an interdisciplinary rehabilitation path,” says Monica Rugari, MSF psychologist in Palermo. “We start the therapeutic process with the patients creating a relationship based on trust — a safe space where the patient can once again feel like a human being, free to choose and decide for themselves”.

Beatings, whipping, burns, removal of nails, electrocution, sexual violence or suffocation are among the acts of torture and ill-treatment endured by MSF patients. Their effects on human beings are numerous and profound, impacting physical, psychological, cultural, and social dimensions. They can leave visible physical scars and lead to chronic conditions and chronic pain, or remain invisible, causing lasting psychological harm.

Rebuilding life and healing identity

Indeed, beyond physical conditions (15% of patients report musculoskeletal symptoms, 12% symptoms related to the digestive system, more than 9% display neurological symptoms), the most enduring effects are psychological: 67% of patients suffer from post-traumatic stress disorder (PTSD), often accompanied by anxiety, depression, nightmares, emotional numbness and isolation. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​

Among survivors of gender-based torture, rape, and sexual exploitation, the data shows that gynecological symptoms and conditions are more prevalent than other medical issues, affecting 6% of female patients, together with anxiety, depression and PTSD.

Despite the terrible consequences of torture, rehabilitation offers a path to healing identity and rebuilding life for survivors of torture and intentional violence. Since 2021, the service for the rehabilitation of survivors of torture, currently run by MSF in collaboration with the University Hospital "Paolo Giaccone," the ProMISE Department, CLEDU, and the University of Palermo has been offering dedicated care and support to survivors of torture in Palermo, Italy, through a specialized rehabilitation project that addresses medical, psychological, social, and legal needs, always including intercultural mediation.

“When you’ve been tortured, your sense of time breaks. There’s no ‘before’ or ‘after’ — only the moment of violence, which never ends,” affirms Grazia Armenia, MSF psychologist in Palermo. As part of the mental health team, she often uses a therapeutic approach that combines clinical treatment with storytelling-based tools, known as “Life Line”. The patients are asked to mark their life’s events using stones for trauma, flowers for good memories, and candles for loss. “There are always flowers among the stones, because as long as we are alive, there is still a story to write,” continues Grazia.

Most of the patients of the MSF project in Palermo are currently rebuilding their lives in Italy, piecing together what has fallen apart and recovering their sense of identity despite the violence they went through.

“It was hard to trust people again. Sometimes I feel like I’m not really living, just surviving. When I arrived in Italy, I cried, I was scared. But I’m feeling better now. Therapy is important to me; it helps me rebuild my idea of the future,” says Olivier, an MSF patient from Côte d’Ivoire who endured torture in his country of origin and during his journey. Today, Olivier lives in Palermo, where he studies and is an activist for human rights.

TANVIR – Bangladesh 1TANVIR – Bangladesh 2THE LIFE LINE 1

THE LIFE LINE 2VERONIQUE – CôTe D’Ivoire 2

VERONIQUE – CôTe D’Ivoire 1DOSSO (AND NATHAN) – CôTe D’Ivoire 1

DOSSO (AND NATHAN) – CôTe D’Ivoire 2KALIFA – Gambia 1KALIFA – Gambia 2

KALIFA – Gambia 3MAKA – Gambia

MAMADY – Guinea 1MAMADY 3OLIVIER – CôTe D’Ivoire 1

MAMADY – Guinea 2OLIVIER – CôTe D’Ivoire 2

MSF assistance to survivors of torture

In 2024 MSF assisted 653 people who survived torture in its projects around the world. The main countries where MSF worked with survivors of torture are: Democratic Republic of Congo, Mexico, Italy, South Sudan, Niger, and Nigeria.

MSF in Italy

MSF has been working in Italy since 1999, assisting migrants and refugees arriving by sea, in reception centers and informal settlements, to provide them medical, humanitarian, psychological and socio-healthcare assistance, in partnership with the Italian authorities