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‘ In his early twenties he was arrested and faced the choice of avoiding the expulsion of his family by registering as a " volunteer " for deployment in Syria .’ from our foreign correspondent

In Germany , refugees from Syria , Iraq , Iran and Afghanistan already traumatised by war and upheaval are seeking treatment for substance dependence . What are the lessons for the UK , asks Dr Chris Ford

I WAS LOOKING FORWARD to hearing my friend and colleague , Hans-Guenter , talking about the issues of caring for refugees who have already been traumatised by war , violence and upheaval when they presented seeking help with their substance depend - ence . When Hans had told Mr A ’ s story there was complete silence in the room . ‘ Mr A was in his mid-20s and was born and raised in Iran . His family was originally from Afghanistan , from where they had fled to the neighbouring country . When Mr A was 17 , the family was expelled by the Iranian authorities and returned to Afghanistan . There the father was killed and the mother once more battled her way with the children to Tehran . At this time Mr A began to consume theriac , as opium is called in this part of the world , and then after a while to smoke heroin . In his early twenties he was arrested and faced the choice of avoiding the expulsion of his family by registering as a " volunteer " for deployment in Syria . There he fought in the Iranian military units on the side of the Assad

government . When the heroin supply he brought along was getting low , his comman - der supplied him with morphine . After a shrapnel injury he returned to Iran , continued taking heroin and , for the first time , metha - done . He took some methadone with him when he fled to Europe , where some months after arriving in Hamburg he relapsed and came to our clinic and asked for treatment .’

Hans-Guenter explained that over the past 25 years the clinic in Germany had seen people from at least 50 countries , including migrants and asylum seekers from Afghanistan , Iran and Turkey , partisans from the mountains of Kurdistan , refugees from the Balkan wars and from the conflicts in the former republics of the USSR .

He explained that many were treated , and had been able to establish new roots and become members of the community in Hamburg . From January 2015 to August 2016 , however , one million people applied for asylum in Germany – two out of three were from Syria , Iraq , Iran and Afghanistan , and many of the men had grown up in an opium / theriac / heroin culture .

How did Hamburg cope with this large influx of refugees ? It responded quickly , setting up a model system , which included consultation hours in the refugee reception centres , uniform screening for all and special places reserved for children and women .

All departments are working together , with prevention available in key languages and the police supportive . Sadly the situation isn ’ t like this in other areas of Germany .

Hans-Guenter then posed a number of questions , which I now pose to you : Can we manage to gain transcultural competence in treating refugees ? Do we need special teams ? When is it the right time to take a detailed medical history of traumatic experiences ? How can we bring trauma therapy and addiction medicine together ? How can we reach the female refugees with a substance problem from these countries ? In the context of migration , should integration be defined as the fifth pillar of drug policy ? Should we develop recommendations , guidelines and best practice models for treating refugees with substance use disorders ?

And in the UK : what do you provide in your area for refugees ? Which are the main groups you are seeing ? How do you manage with translation ? What additional skills would you like ?

Dr Chris Ford , IDHDP with Dr Hans- Guenter Meyer Thompson , Hamburg

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