Torture is widespread for people migrating via the Mediterranean Sea, according to a new report by Doctors Without Borders/Médecins Sans Frontières (MSF).
“Inhuman: Torture Along the Mediterranean Migration Route, and Support of Survivors in a Fragile System,” published on the International Day in Support of Victims of Torture, shows the devastating consequences for physical and mental health, including physical scars and deep psychological scars that can be persistent and debilitating.
Kalifa’s story: From Libyan prisons to freedom and a new life
Kalifa is a survivor of torture, detention, and violence. He arrived in Italy in critical condition after a long journey that began in Gambia and took him through Senegal, Mali, Algeria, and Libya, where he spent months trapped and tortured, moving from one prison to another. Today, after a heart transplant, he is building his new life in Palermo, Italy.
Kalifa is one of the hundreds of people assisted by MSF through a rehabilitation project for survivors of torture in Palermo. Intentional violence, inhumane treatment, and torture remain widespread and largely unpunished, despite being prohibited under international law in all circumstances. This is fueled by the absence of legal and safe pathways to seek protection and by increasingly restrictive migration policies.
“I thank God because I am still alive, but some people died in front of me,” says Kalifa. "We went through the desert and Libya. 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. 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.”
Today, Kalifa is attending sewing courses, writing songs, and hoping to become an intercultural mediator.
Torture in Libya
From January 2023 to February 2025, the MSF project in Palermo assisted 160 survivors of torture, the majority being men (75 percent) with an average age of 25 years. In 82 percent of the cases, torture occurred in transit countries, with Libya having the highest incidence (108 cases), followed by Tunisia (41).
Moreover, 36.5 percent of the episodes occurred in nine countries listed by the Italian government and the European Commission as safe countries of origin for repatriation purposes: Algeria, Bangladesh, Ivory Coast, Egypt, Gambia, Ghana, Morocco, Tunisia, and Senegal. In over 60 percent of the torture cases patients reported, the perpetrators were smugglers, while30 percent were perpetrated by 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 are often victims of sexual and gender-based violence along their journey to seek safety in Europe. Of MSF’s female patients at the Palermo project, 80 percent had experienced sexual and gender-based violence, often in combination with other forms of torture, and 70 percent experienced sexual violence in their country of origin. Men are not exempt from this form of violence: Some MSF patients reported being forced to witness sexual violence perpetrated against their wives or sisters.
Long-lasting wounds: More than physical pain
“Torture tries to annihilate identity,” says Monica Rugari, MSF psychologist in Palermo. “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. 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.”
The acts of torture and ill-treatment endured by MSF patients include beatings, whipping, burns, removal of nails, electrocution, sexual violence, and strangulation. The effects of these acts 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.
Beyond physical wounds, the most enduring effects are psychological: 67 percent 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 conditions affect 6 percent of female patients, together with anxiety, depression, and PTSD.
“As long as we are alive, there is still a story to write”
Despite the terrible consequences of torture and intentional violence, rehabilitation offers a path to healing identity and rebuilding life for survivors. Since 2021, the service for the rehabilitation of survivors of torture in Palermo—currently run by MSF in collaboration with the Paolo Giaccone University Hospital, Legal Clinics for Human Rights of the University of Palermo, and the University of Palermo—has been offering dedicated care and support for survivors of torture. This specialized rehabilitation project addresses medical, psychological, social, and legal needs, and always includes intercultural mediation.
“When you’ve been tortured, your sense of time breaks,” says Grazia Armenia, MSF psychologist in Palermo. “There’s no before or after—only the moment of violence, which never ends.” As part of the mental health team, she often uses a therapeutic approach that combines clinical treatment with storytelling-based tools, known as the “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,” adds 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,” says Olivier, an MSF patient from Ivory Coast who endured torture in his country of origin and during his journey. “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.”
Today, Olivier lives in Palermo, where he studies and is an activist for human rights.
MSF in Italy
MSF has been working in Italy since 1999, assisting migrants and refugees arriving by sea in reception centers and informal settlements. Our teams provide them with medical and mental health care as well as humanitarian and social assistance in partnership with the Italian authorities.
