Fourth Case Conference Report

The fourth case conference of the I.I. took place on March 27, 2025, with the participation of 13 people from seven organizations: Greater Victoria Police Diversity Advisory Committee (GVPDAC), Vancouver Island Counselling Centre for Immigrants and Refogees (VICCIR), Victoria Sexual Assault Centre (VSAC), Refugee Program of the Anglican Diocese, and VCST in Victoria; Cowichan Intercultural Soceity (CIS) in Duncan; Central Vancouver Island Multicultural Society (CVIMS) in Nanaimo.

This case was presented by Hosam Abou Ali, Team Lead of the resettlement program with CVIMS. Hosam has a background in Global Studies with a focus on human development and social governance, and he is currently seeking graduate studies in Community Development.

Hosam’s journey with CVIMS began in 2017 as a volunteer, leading to various roles before taking on managing the Resettlement Assistance Program (RAP) for the past three years. Hosam’s humanitarian work started in 2012 in Syria, working with internally displaced people. He later continued in refugee camps and various locations in Turkey before arriving in Canada in 2017. 

Confidentiality

Confidentiality and security of survivors’ personal information are key components of a trauma-informed approach to case conferencing among colleagues. 

VCST requires all confirmed participants to accept a confidentiality agreement to register for the conference. Once participants accept the agreement, they are sent a confidential Zoom link to attend the conference. 

To maintain the privacy of any individual whose story informs a case conference, presenters anonymize the personal details of the case. 

The following guidelines were observed during the conference:

1. This session was not recorded.
2. The identity of each participant was confirmed by video camera.
3. Slides and resources were not shared.
4. Personal information of the people involved in the case was not shared.
5. No screenshots were allowed.

Background about Drug Trafficking, Substance Use Disorders, Migration, and Torture

Before the case conference, VCST wrote and distributed among participants a background paper about some of the context of the case, with links and resources for further reading. The paper is included at the end of this report. 

Welcoming and Land Acknowledgement

We welcomed participants and shared our land acknowledgment. Our land acknowledgement expresses VCST’s awareness of the connections between torture and Canada’s history of colonization:

VCST recognizes that torture is deeply connected to the brutality of colonization. Torture is one of many colonial tools used to dispossess the lək̓ʷəŋən-speaking People, W̱SÁNEĆ Peoples, the Snuneymuxw First Nation and the Snaw-Naw-As First Nation from their land, language and culture, along with the Indian Hospitals, Residential Schools and the Indian Act of 1876. Many newcomer survivors of torture living in our communities also come from countries that have experienced colonization.

We commit to understanding the immeasurable ways that colonization shows up in our daily lives and in the communities we serve. We honour the First Nations who have directly experienced colonization – both past and present – on these lands where we now have the privilege to reside.

We then asked participants to check in using the following exercise.

Introductions & Check-in

Please add your name and your organization in the chat! Talking about traumatizing experiences and sharing about our work with survivors of torture can bring up a lot of emotions and feelings.

What’s your emotional weather as we get started on our topic for today? 

Please use the Zoom annotate tool to mark how your feeling, or feel free to share in the chat.

This exercise helped us get a sense of the emotional state of the participants at the start of the conference. Generally, participants’ reactions landed in the center column. 

Summary and Introduction

Hosam presented about Sky (a pseudonym), who had endured severe torture, including kidnapping, abuse, and forced drug dependency in their home country. Their family – including young children – endured similar treatment.

Before arriving in Canada, Sky and their family had lived in prolonged isolation with no social or community access, and their children were coerced into drug trafficking.

The family escaped from their home country to neighboring countries without living resources, surviving for several months through community aid and informal labor. They were finally granted refugee status and resettled in Canada.

Initial Observations upon Resettlement in the Nanaimo Area

After years of isolation and exile in several countries, Sky and their family experienced difficulty navigating social and support systems, and they struggled to understand the technology and social services systems in their new community on Vancouver Island. 

The CVIMS team observed trauma symptoms in Sky, including Post-Traumatic Stress Disorder (PTSD), sleep disturbances, and suicidal ideation. Sky expressed fear of being found by the people who originally harmed them and showed ongoing physical health issues from past abuse.

Initial Support Services for a Family of Survivors

When Sky and their family arrived in their current community, they were immediately offered safety, housing, and basic needs support via CVIMS. Hosam described this as “triage” to get the family stable and supported; the case was flagged as “high needs”. The CVIMS team worked to ensure high confidentiality to build trust with the family. Hosam described this trust-building process as including daily check-ins to prevent isolation, using different communication methods (text messages vs. phone calls vs. emails), and tailoring the program delivery deadlines/timelines to a pace better suited to the family’s needs. In addition, the CVIMS team worked together to develop a collaborative, human-centered approach to working with the family. 

A human-centered and trauma-informed approach is essential when working with survivors of torture and trauma.¹ Features of these frameworks include treating people with dignity, facilitating their agency, and actively listening to them. The team at CVIMS adopted a trauma-informed model of care while working with Sky and their family, which included monitoring for signs of distress and gentle interventions. 

Health and wellness support included medical and mental health referrals. Sky was supported by the Resettlement Assistance Program (RAP), the federal initiative that helps newcomers settle and integrate into Canada by providing basic income support and essential services during the initial resettlement period. However, very limited emergency counselling is covered under RAP. 

CVIMS was able to provide the family with companionship for medical visits and access to addiction recovery and prevention programs.

Challenges in Service Delivery for the Community of Survivors of Torture

Hosam shared that challenges in service delivery for Sky and their family could fit into three categories: Staffing and Training, Language Barriers, and Funding Limitations.

Limited trauma-informed training available for staff affects the agency’s capacity to provide adequate service for clients with histories of torture or trauma. As seen in our I.I. research, many agencies in the settlement sector experience a lack of specialized staff trained to work with torture survivors. In this case, Hosam emphasized that the workers at CVIMS are not mental health professionals, though they had received some training in trauma-informed care. Furthermore, balancing high-needs cases with other client demands puts staff in stressful situations with limited resources; few agencies have adequate support to address burnout and vicarious trauma among staff.

In terms of language barriers, Hosam reported that CVIMS staff did not have the language ability to communicate effectively with Sky initially; similarly, some of the health and wellness resources available, including substance abuse counselling, did not include Sky’s first language. This points to a need for multilingual settlement workers, counselors, and resources in our sector. 

Finally, funding limitations constrain the quality and longevity of services due to insufficient funding for ongoing mental health support. This is seen in the example of Sky, a RAP client, not being able to access adequate funds for mental health resources and counselling. Our clients need access to frequent support sessions, such as individual or family counselling, group therapy, and other wellness modalities. Funding restricts access to long-term mental wellness and health resources, exacerbating the resettlement process for survivors.

Lessons Learned and Best Practices for Working with Torture Survivors 

• Early and consistent trauma-informed approaches help build trust: Even with somewhat limited training in trauma-informed approaches, the CVIMS team focused on building relationships and establishing rapport over time with Sky and their family. This respectful approach to building support fosters a sense of safety for survivors in their resettlement.^{2 3} 
• Confidentiality and safety are critical for engagement: A client confidentiality protocol is essential for developing and maintaining trust. A survivor might be afraid of being found by their abusers in their new country, which may prevent them from feeling safe to engage with settlement workers, counsellors, healthcare providers, law enforcement, etc.⁴ Triage support secured housing and safety for Sky and their family. Once this security is established, it becomes the foundation for working on other facets of settlement, such as language learning and income earning.
• Multidisciplinary collaboration is key for comprehensive support: Cross-sector collaboration helps provide continuity of care and fosters a web of support for survivors.⁵ Healthcare providers, religious/cultural/community groups, schools, and more can be part of this support network for immigrants and refugees. As was the case with CVIMS, building this type of collaboration can take years of consistent advocacy. Hosam shared about his experience advocating with CVIMS over three years for a streamlined referral process for his clients to an urgent care walk-in clinic. This connection now improves access to medical care for the people that CVIMS works with.
• Need for sustainable mental health interventions beyond initial resettlement: This case demonstrates the need for long-term, sustainable funding for counselling services for immigrants and refugees. Though many sponsorship programs and federal funding options provide for limited counselling services during initial settlement, these are rarely sufficient. Furthermore, in the case of counselling or programs for substance abuse disorders, offerings need a multicultural and multilingual approach. 

Recommendations for Working with Survivors of Torture

The recommendations for discussion outlined by Hosam at the end of his presentation were:

• Increase funding for specialized trauma support and mental health care;
• Hire and train staff in trauma-informed care practices;
• Expand multilingual services and culturally appropriate interventions;
• Develop stronger triage systems to balance complex and general client needs;
• Build and maintain strong stakeholder relationships.

Small Group Break-Out Sessions: Shared Challenges and Lessons

The group was divided into four smaller groups to discuss the findings and recommendations. Each group then returned to the main group to share about their conversation. The small group discussions uncovered many shared experiences across the sector; many participants remarked that their organizations experienced similar challenges and lessons learned from working with survivors.

The groups expressed these commonalities by bringing the following priorities to the larger group:

• Welcoming local practicum students in childcare and related fields to design and deliver arts and recreation programs in settlement agencies could be mutually beneficial. This practice could expand to counselling and nursing to improve access to counselling and healthcare services. 
• Currently, the number of counselling sessions available to survivors through federal funding is insufficient. Advocacy is needed to increase the number of sessions available.
• A holistic approach to working with survivors and people with trauma involves collaboration within agencies and services across the sector. 
• Substance use disorders need to be treated in tandem with mental health support. 
• Be aware of the risk of isolation among refugee survivors of torture and trauma, especially when navigating social and institutional systems (education, health, justice, etc.).
• Offer sensitivity and awareness training to police officers, especially those interacting with children in schools.
• Language barriers should be addressed with sensitivity, with the interpreter verifying responses for clarity. Interpreters must receive trauma-informed training and adequate supervision.
• Art and play therapy can be effective for people who have experienced trauma, especially children. This type of therapy offers children a safe, creative space to express emotions, improve communication, and build self-esteem, fostering emotional well-being and resilience. Culturally appropriate art or music therapy can build on existing art connections within a person or family.
• VCST could potentially facilitate physical and mental health professional opportunities for continuing medical education (CME) designed to promote awareness and understanding of torture and complex trauma.

Closing Questions and Comments

Hosam reported that Sky and family are doing well and integrating successfully into the community. The participants returned to the initial check-in image of “emotional weather”, where most participants circled that they were feeling hopeful at the close of the conference. 

We reflected on the shared challenges between organizations across the sector and the value of VCST facilitating these discussions. Together, we not only highlighted shared challenges but also discussed creative solutions. 

With that, the session concluded on a hopeful note, with participants feeling positive about working together in their various roles in settlement agencies and counseling to help families like Sky’s.

VCST Interconnectedness Initiative 4th Case Conference Background Paper: Drug Trafficking, Substance Use Disorders, Immigrants and Refugees

Drug Trafficking and Forced Migration

Despite decades of global drug control efforts, primarily led by the USA since the 1970s (also known as the “War on Drugs”), illicit drug use remains a significant global threat to health, safety, and security. Drug law enforcement can inadvertently contribute to forced migration by increasing violence and instability in drug-producing regions.

The drug trade impacts individuals at every stage of the distribution chain, from production and trafficking in source countries to consumption in destination countries. Drug trafficking destabilizes local economies, increases poverty, and erodes social and political structures, forcing people to migrate in search of safety and economic stability.

Participation in the drug trade is not always voluntary. Drug cartels use brutal tactics with impunity, including torture and threats to livelihoods, to force people into involvement across continents. Many immigrants and refugees in Canada come from countries deeply affected by the drug trade, including Afghanistan, Colombia, Mexico, Pakistan, and Venezuela. Many have histories of forced participation in drug-related activities.

Migrant and refugee routes often overlap with drug trafficking corridors, making these migrant populations highly vulnerable to exploitation. Criminal organizations subject migrants to torture, extortion, sexual abuse, and human trafficking. Limited resources and legal protections further increase the risks migrants face. Desperation for safety and economic opportunity can push migrants and refugees into high-risk situations, including forced participation in the drug trade. Additionally, exposure to illicit substances during migration can lead to substance use disorders.

Connections between Torture, Migration & Drug Trafficking:

• Kerwin, D., & Martínez, D. E. (2024). Forced Migration, Deterrence, and Solutions to the Non-Natural Disaster of Migrant Deaths Along the US-Mexico Border and Beyond. Journal on Migration and Human Security, 12(3), 127-159. https://doi.org/10.1177/23315024241277532
• Perocco, F. (2023). Torture, Structural Violence and Migration. Migration and torture in today’s world. Università Ca’Foscari Venezia. Linked here.
• Runde, D. F., & Bryja, T. (2024). Mind the Darién Gap, Migration Bottleneck of the Americas. Center for Strategic and International Studies. https://www.csis.org/analysis/mind-darien-gap-migration-bottleneck-americas

Substance Use Disorders among Immigrants and Refugees

Substance use disorders add another layer of complexity to the well-being of immigrants and refugees in Canada. While some individuals have prior exposure to drugs due to their home country’s involvement in the drug trade, others encounter increased access to illicit substances in refugee camps or host countries, leading to new substance use disorders.

For example, respondents in the 2024 Inter-Cultural Association of Greater Victoria (ICA) settlement client survey reported that “homelessness and substance abuse” were among the most surprising aspects of their experience in Victoria. This suggests that exposure to drug use in Canada affects newcomers, particularly those in vulnerable situations. This aligns with research indicating that increased access to drugs in host countries can contribute to substance use disorders among immigrants and refugees. Many turn to substances as a coping mechanism for the stress of migration and resettlement.

About Substance Use Disorders among Immigrants and Refugees:

• Elkholy, H., Tay Wee Teck, J., Arunogiri, S. et al. (2023). Substance Use Disorders Among Forcibly Displaced People: A Narrative Review. Current Addiction Reports, 10, 341–352. https://doi.org/10.1007/s40429-023-00467-6
• Saleh EA, Lazaridou FB, Klapprott F, Wazaify M, Heinz A, Kluge U. (2023). A systematic review of qualitative research on substance use among refugees. Addiction, 118(2): 218–253. https://doi.org/10.1111/add.16021

Drug Policies and the Need for a Comprehensive Approach

In 2024, the United Nations Office of the High Commissioner for Human Rights published a statement asserting that the “‘war on drugs’ has failed to prevent drug production and consumption.” The UN advocates for evidence-based approaches that place human rights at the center of drug policies. Recommended strategies include:

• Decriminalization of drug use;
• Involving affected communities in policymaking;
• Harm reduction strategies, such as safe consumption sites and access to treatment;
• More research into substance use among diverse communities to develop culturally appropriate interventions.

About New Approaches to Drug Policy and Substance Use Disorders:

• Canadian Public Health Association. (2025, January 28). Public Health Approaches to the Toxic Drug Crisis. https://www.cpha.ca/toxic-drug-crisis
• UN High Commissioner for Human Rights. (2023). Report on Human Rights Challenges in Addressing the World Drug Problem. UN Human Rights Council. https://www.ohchr.org/sites/default/files/documents/hrbodies/hrcouncil/sessions-regular/session56/A-HRC-54-53-summary.pdf

Open Society Foundations. (n.d.). Why We Need Drug Policy Reform. https://www.opensocietyfoundations.org/explainers/why-we-need-drug-policy-reform

1. Aroche, J., & Coello, M. (2022). Towards a systematic approach for the treatment and rehabilitation of torture and trauma survivors: The experience of STARTTS in Australia. Torture, 32(1-2), 133–143. https://doi.org/10.7146/torture.v32i1-2.132684
   
2.  Aroche, J., & Coello, M. (2022). Towards a systematic approach for the treatment and rehabilitation of torture and trauma survivors: The experience of STARTTS in Australia. Torture, 32(1-2), 133–143. https://doi.org/10.7146/torture.v32i1-2.132684
3. Duffy, R. M., & Kelly, B. D. (2015). Psychiatric assessment and treatment of survivors of torture. BJPsych Advances, 21(2), 106–115. https://doi.org/10.1192/apt.bp.113.012005
4. Duffy, R. M., & Kelly, B. D. (2015). Psychiatric assessment and treatment of survivors of torture. BJPsych Advances, 21(2), 106–115. https://doi.org/10.1192/apt.bp.113.012005
5.  O’Brien, C., & Charura, D. (2024). Advancing transculturally informed, humanistic therapeutic practice for refugees and asylum seekers presenting with embodied trauma. Counselling and Psychotherapy Research, 24, 1612–1631. https://doi.org/10.1002/capr.12808