PTSD Among Migrants: Trauma, the Balkan Route, War and Mental Health Rights

There are people who cross borders without ever truly escaping war. They walk for thousands of kilometers, surviving deserts, informal prisons, traffickers, pushbacks, torture, hunger, shipwrecks, and the constant fear of disappearing without leaving a trace. Yet once they arrive in Europe, they are often seen only as "migrants" — statistical numbers, administrative cases, bodies to be identified or expelled. Rarely as deeply traumatized human beings.

There are eyes that always seem alert, even in safe places. Hands that tremble at a sudden noise. People who sleep very little, who tense up when someone raises their voice, who constantly check doors and windows as if danger could enter at any moment. People who isolate themselves, who rarely speak about their past, or who seem emotionally "switched off." Some startle when they hear footsteps behind them; others are afraid of uniforms, dogs, sirens, or closed rooms. Some sleep fully dressed, ready to flee. Others can no longer truly distinguish the present from traumatic memories.

Many migrants who undertake the so-called "game" — a term used along the Balkan route to describe attempts to cross European borders clandestinely — are not simply experiencing migration. They are enduring one of the most devastating psychological experiences a human being can face. And it is precisely in these contexts that Post-Traumatic Stress Disorder, more commonly known as PTSD, takes on enormous yet often invisible dimensions.

PTSD is an internationally recognized psychiatric disorder that may develop after exposure to extreme traumatic events: torture, war, sexual violence, persecution, kidnappings, arbitrary detention, terrorist attacks, shipwrecks, the violent death of loved ones, extreme hunger, or inhuman and degrading treatment. It is not simple sadness or emotional fragility. It is a profound injury to the mind and nervous system, capable of altering the way a person perceives the world, time, danger, and even themselves.

Clinically, PTSD can manifest through a very wide range of symptoms, often differing from person to person. Not everyone shows the same signs, and among forced migrants the condition can become even more complex because of repeated and prolonged trauma over time.

The most common symptoms include sudden flashbacks — the sensation of reliving the traumatic event — recurring nightmares, night terrors, the constant fear that something terrible may happen, continuous hypervigilance, obsessive monitoring of the surrounding environment, difficulty relaxing even in safe places, chronic insomnia, sudden awakenings, tachycardia, palpitations, intense sweating, tremors, permanent muscle tension, stress-induced spasms, panic attacks, breathing crises, feelings of suffocation, dizziness, gastrointestinal symptoms, abdominal pain, nausea, stress-related diarrhea, and persistent migraines.

Many individuals also develop deep cognitive and emotional symptoms: concentration difficulties, memory gaps, loss of time perception, mental confusion, dissociation, the feeling of being disconnected from reality, inability to feel joy, emotional detachment from others, loss of trust in human beings, extreme survivor's guilt, pathological shame, and the belief that they do not deserve help or happiness.

In many cases, severe irritability, sudden outbursts of anger, disproportionate reactions to noises, defensive aggression, social withdrawal, avoidance of places or conversations linked to the trauma, fear of physical contact, and difficulty maintaining eye contact may emerge. Others appear completely emotionally numb. This is often mistaken for indifference, when in reality it may be an extreme form of psychological self-protection.

Among migrants who have survived wars, torture, imprisonment, or the Balkan route, there are also less-known but highly significant symptoms: obsessive fear of police officers or uniforms, terror reactions to dogs, traumatic activation caused by metallic noises or shouting, the compulsive need to always keep documents and phones close at hand, difficulty sleeping in closed rooms, the need to sleep fully dressed and ready to escape, and the inability to truly feel safe even after arriving in Europe.

From a medical perspective, trauma also manifests through the body. The nervous system remains in a permanent state of alert, as though danger were still present. This is why many people suffer from tachycardia, palpitations, gastrointestinal disorders, tremors, muscle rigidity, sudden sweating, chronic insomnia, and severe sleep disorders. In some cases, symptoms appear within months of the traumatic event; when they persist over time and significantly impair daily life, the condition is properly classified as PTSD, while shorter-lasting forms may fall under acute stress disorder.

Some individuals develop severe depression, alcohol or substance addiction, self-harming behaviors, eating disorders, suicidal thoughts, or a complete loss of future perspective. In other cases, trauma manifests primarily through the body itself: chronic pain, functional paralysis, stress-related dermatitis, and constant exhaustion.

In complex trauma, moreover, a person may alternate moments of apparent normality with sudden psychological breakdowns. This is one of the most destabilizing aspects of PTSD: from the outside, some individuals may appear to function normally, while internally they live in a permanent state of survival.

In the case of forced migrants, the issue is even more complicated because the trauma is rarely singular. Experts often refer to "complex trauma" or "cumulative trauma." An Afghan, Pakistani, Sudanese, South Sudanese, Eritrean, Syrian, or Lebanese young man may have witnessed executions, bombings, or torture in his home country; may have suffered violence in Libya; may have been illegally detained in Turkey or along the Balkan route; may have seen fellow travelers die in the Mediterranean, in forests, mountains, or European rivers; and may later have experienced violent pushbacks at European borders. The trauma does not end. It accumulates.

Many testimonies collected along the Balkan route describe systematic beatings, dogs used against migrants, deprivation of water and food, destroyed phones, confiscated money, public humiliation, and physical or sexual violence. In several cases, humanitarian organizations and international bodies have documented practices incompatible with Article 3 of the European Convention on Human Rights, which prohibits torture and inhuman or degrading treatment.

International law also recognizes the centrality of psychological trauma in migration pathways. The United Nations, through the UNHCR, considers victims of torture and extreme violence to be vulnerable individuals requiring enhanced protection. The 1951 Geneva Convention obliges States not to return individuals to places where they may face persecution or inhuman treatment, according to the principle of non-refoulement.

European law also contains fundamental protections. Directive 2013/33/EU on reception conditions provides specific safeguards for vulnerable persons, including those suffering from mental disorders caused by torture or severe violence. Directive 2013/32/EU further requires States to adequately assess the psychological conditions of asylum seekers during administrative procedures.

In Italy, constitutional protection is theoretically very broad. Article 2 of the Constitution recognizes the inviolable rights of the individual; Article 3 establishes the principle of substantive equality; Article 32 protects health as a fundamental right; while Article 10, paragraph 3, recognizes the right to asylum for foreigners denied democratic freedoms in their own country.

Italian and European case law has repeatedly emphasized that psychological trauma must also be considered when assessing the credibility of asylum seekers. A traumatized person may have fragmented memories, apparent contradictions, memory gaps, or difficulty recounting particularly violent events. Expecting perfectly linear narratives from people who have endured torture or war means completely ignoring the neuropsychological functioning of trauma.

There is also another aspect that is rarely discussed: many migrants develop a form of emotional hyper-adaptation. They appear cold, detached, almost incapable of feeling emotions. In reality, this is often a survival mechanism. After years spent in constant danger, the brain enters a permanent defensive mode. Some people can no longer trust anyone. Others live in a continuous state of alarm even in peaceful environments. Their bodies continue behaving as if the threat were still present.

The problem is that Europe often treats these individuals almost exclusively through bureaucratic or security-based categories: identification, detention, expulsion, transfers, controls. But ignored trauma does not disappear. It can evolve into social isolation, extreme marginalization, addiction, severe psychiatric disorders, or self-directed violence.

Talking about PTSD among migrants does not mean denying the need for migration rules or border controls. It means recognizing that behind many forms of behavioral fragility lie stories of unimaginable brutality. It also means understanding that mental health is not a Western luxury, but a matter of human dignity and fundamental rights.

Perhaps this is the most tragic aspect of all: many people survive war physically, but a part of them remains trapped in trauma long after their escape. Some bodies manage to cross borders. Some minds, however, remain forever in the place where everything collapsed.