Terrorism or Insanity? Attack Underscores Need To Address Refugees' Mental Health

In 2015, Ahmed A. was an unremarkable Palestinian asylum applicant with dreams of a new life in Germany. Two years later, he went on a deadly stabbing spree in a Hamburg supermarket. His transformation highlights a growing problem among refugees in the country: mental illness.

REUTERS

By , , , , , Andrew Moussa and


At the end of his asylum hearing on July 29, 2015, Ahmed A. wanted to get something off his chest. He had actually said everything there was to be said in the hearing, which had been underway for about 90 minutes. After a six-year odyssey across Europe, he must have realized that what had transpired in the hearing wasn't enough to gain asylum in Germany.

He uttered just two more sentences, in the hope that they would help his cause: "I would also like to say that I have never caused any problems, neither in Norway nor in the other countries I was in. You're welcome to make inquiries if you want to make sure."

Two years later, one thing is clear: Ahmed A. was the man with the knife on a street in Hamburg's Barmbek neighborhood. The man who stabbed five people on Friday, July 28, killing one of them. The Islamist who praised Allah as he tried to indiscriminately kill people with a 20-centimeter (8-inch) knife he had ripped out of its packaging in a local Edeka supermarket.

In two years, Ahmed A. had become a problem -- a deadly one.

The bloody Hamburg knife attack came as a shock to a Germany that was largely on summer vacation. Chancellor Angela Merkel said she mourned "the victim of this horrible attack." Yet another "terrible attack has struck our society," said Interior Minister Thomas de Maizière. Both politicians avoided the expression "terrorist attack."

There is in fact some question as to whether the Saudi-born Palestinian, who came to Germany as a refugee in the spring of 2015, is a terrorist with Islamist motives, or someone who killed because he is mentally ill.

A team of DER SPIEGEL reporters has reconstructed the Palestinian's journey from the Gaza Strip to the European Union, and has reviewed files and spoken with witnesses. It is clear that the authorities had learned through tips and warnings that Ahmed A. had radicalized and that he was in an unstable mental state. Employees at a counseling center where he was receiving care said they were overwhelmed. And a police detective even tried to recruit him as an informant in the Islamist community.

There were numerous conversations and emergency meetings, but apparently no one who consistently paid attention to the young man and his apparent psychological problems. Counselors and government officials neglected to obtain professional help -- no psychologists, no doctors.

Ahmed A.'s case casts a light on a growing problem with Germany's refugee policy: the growing number of mentally unstable asylum-seekers. Studies show that the longer an asylum procedure takes, the greater the susceptibility to mental illness. Iris Hauth of the Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology warns that there is a lack of adequate counseling services for refugees. Most importantly, she explains, counselors in refugee homes have to be trained in how to address these problems.

At first, Ahmed A. seemed to be open and approachable. DER SPIEGEL and SPIEGEL TV have an unpublished video interview, completed a year and a half ago, in which he seemed thoughtful and harmless as he spoke about his expectations and concerns. There was no sign of hate, but rather a sense of hope for a better life.

Unable to Convince Authorities

Ahmed A. was born in Al Baha, Saudi Arabia, in January 1991. When he was a child, the family moved to the Jabalia refugee camp in the Gaza Strip. That's what he said at his hearing in July 2015, in an office of the Federal Office for Migration and Refugees (BAMF) in the Hamburg neighborhood of Hammerbrook.

According to his account, Ahmed A. attracted the attention of Hamas, the radical Islamic group, because he was active in the youth organization of the rival Palestinian group Fatah, distributing flyers and openly criticizing Hamas. He claimed that Hamas had shot one of his fellow Fatah members in the leg. When Hamas summoned him for an interrogation, he said, he became deathly afraid. In late 2008, he used traffickers to flee to Greece, via Egypt and Turkey, and eventually made his way to Scandinavia.

He had already given this account to officials in Norway, where he had applied for asylum but was denied. To be recognized as a refugee in Germany, he had to present something new. But when questioned by an official in his asylum hearing, Ahmed A. was unable to provide any convincing new information. "And everything you have said here today you already said in Norway?" the official asked. "I said the same thing there," Ahmed A. replied.

His statements were also riddled with contradictions. He admitted that he had remained in the Gaza Strip for more than a year despite his supposed fear of persecution, and was able to finish high school. "I studied economics. My siblings also attended school. We are all educated," he said. The official asked if his family had had any trouble with Hamas. "No, there were no longer any difficulties with Hamas," he replied. The only piece of new information he could think of was that his parents' house was damaged in the 2014 Gaza war. "I need to help my family now. I have to try to get them out of there."

After two hours and 10 minutes, the case seemed clear. Everything pointed to a quick decision, and to his asylum application being rejected. It seemed likely that steps would be taken to deport him to the Palestinian territories. But nothing happened.

This was taking place in the summer of 2015, just as the tensest phase of the refugee crisis was beginning. Hundreds of thousands of migrants would arrive in Germany in the ensuing months. An internal order at BAMF stated that the many cases from the Balkans and Syria were to be given priority processing.

Two weeks after the hearing, there was a serious failure at BAMF, as DER SPIEGEL reported earlier this week. Because he had already applied for asylum in Norway, the German authorities should have sent him back to Norway immediately in accordance with the Dublin Regulation of the European Union, which Norway observes even though it is not a member of the EU. A BAMF official filed the necessary request on July 14, 2015, politely asking the Norwegians to take back Ahmed A. But the Norwegian migration authority, UDI, wrote a prompt and brief response the next day, stating that the deadline had expired -- one day earlier. We regret to inform you, officials wrote, that Norway is not willing to take back the above-named person.

The Ahmed A. file was shelved at BAMF, where it remained on file for almost a year and a half.

A Period of Uncertainty

As long as the case was pending before the federal agency, Hamburg state officials could not get involved and, for instance, request replacement documents for deportation. Their only option was to house Ahmed A. in a refugee hostel and wait.

It was a period of uncertainty, which typically contributes to mental illness in refugees, according to psychotherapist Mechthild Wenk-Ansohn. She works in the outpatient clinic at the Center Überleben in Berlin, a facility that counsels about 1,000 migrants and refugees a year. Those who simply sit around at the hostel, without permission to work or take courses, quickly begin to feel humiliated and angry, making them more susceptible to a mental crisis. "The best prevention," says Wenk-Ansohn, "is having a clear outlook for the future."

At first Ahmed A. seemed to believe that he had a future in Germany. When he telephoned with his mother, he proudly told her that he was regularly attending German lessons. In January 2016, nine months after his arrival, he agreed to a video interview with Christian Weissgerber, a Berlin refugee activist. They had met briefly in Hamburg, in the Refugees Welcome Café at the university, which A. often frequented. The Palestinian invited Weissgerber to visit him in the container housing unit where he lived, and cooked him a meal of rice and peppers. Deniz Rau (*), 25, a law student, also met A. at the refugee café. They sang songs, played the guitar and had fun together.

A short time later, A. took a long-distance Flixbus to Berlin to film the interview. They met at a café in the Prenzlauer Berg neighborhood, the Kombinat Schmackofatzke. In the one-hour interview, which was never released, A. looked tired. Still, he seemed reflective, open and hopeful in the interview, speaking in English. He brought a book to the interview, The Plague by Albert Camus, and said he was using it to learn German. "It's really very difficult," he said.

In his conversation with the activist, Ahmed A. spoke at length about his failed attempts to gain asylum in Europe, not just in Norway, but also in Spain and Sweden, where one of his brothers lived. He talked about the attacks in Paris and the New Year's Eve assaults on women in Cologne. He said that he regretted what had happened there, and that it was not at all representative of Muslims. He also said that the men who had committed sexual assaults in Cologne should be punished or deported.

A. also said that he was not religious. "I was born as a Muslim, but I am not religious. I believe in values, in good values," he said, adding that he had Christian and Jewish friends. "I hope for peace, and I hate no one."

A year and a half later, the same man would indiscriminately stab people in Hamburg, allegedly in the name Islam.

None of this could have been anticipated at the time. Looking at the video today, perhaps the only thing that seems unusual about A. is that he appears to be slightly resentful. "Life in the camp is complicated," he said. "It is very difficult, because so many people live there." He also said that the weather in Germany bothers him. "I don't like the cold." In the video, there was snow on the street outside.

The filmmaker recalls that he spent a nice weekend with A. after the interview. A. went to the German Historical Museum in the morning, and in the evening they played poker and smoked marijuana. There was no sign of fundamentalism or aggression.

Signs of Problems

But the refugee activist received disturbing news from friends at the Hamburg Refugees Café in the weeks that followed. Something wasn't right with Ahmed A., they said. He had severed ties with his friends, including the volunteer Deniz Rau.

According to the reports, A. would sometimes withdraw for days, and he had stopped drinking alcohol and smoking marijuana. During these periods, he spent more time at the mosque than usual and berated his Muslim friends for not obeying the rules of Islam. But then he seemed perfectly normal again. The friends were perplexed. Was A. merely "emotionally drained" or had he been radicalized? No one believed that he could have been planning an attack, which is why they did not notify the police. Instead, in the spring of 2016 they turned to Legato, a Hamburg counseling center that deals with cases of "radicalization with religious underpinnings," for advice.

The hostel management also contacted Legato. But after meeting with A., the counselors said the case was beyond their abilities. They said he was exhibiting signs of emotional disturbance, and that they were unable to get through to him. When contacted by DER SPIEGEL, the counseling center said that it did not comment on individual cases.

Apparently, the Hamburg police didn't learn that the refugee from the Gaza Strip had become radicalized in Germany until spring of 2016. On April 1, a concerned man walked into a police station at the back of the main train station in Hamburg. The officers at that particular station normally deal with pickpocketing cases and drug offences, not terrorism.

The man's account resembled that of Ahmed A.'s friends. He said that a man he knew at the Kiwittsmoor refugee hostel in the Langenhorn neighborhood had stopped drinking and smoking, and was talking a lot about religion. The police officer filed a report. It would later emerge that the man in question was Ahmed A. But the police officer noted a different name in his report: Ahmad al-Ahmad.

The report was sent to the State Protection Office of the Hamburg police department. Initially, no one there paid much attention to the suspected case of Islamist radicalization. In May or June, a police officer compared the name to those of the residents of the refugee hostel. He found a 15-year-old boy, but the description given by the man who had made the report couldn't possibly be a match. The case was returned to the files and, once again, nothing happened.

Now, only a few weeks after the controversial police operations during the G-20 summit, Hamburg's Mayor Olaf Scholz, of the center-left Social Democrats, and his administration are once again facing sharp criticism. The chain of mistakes, oversights and omissions in the case is easy to reconstruct. When an officer with the State Office of Criminal Investigation (LKA) visited the refugee hostel in the Langenhorn neighborhood in June, he knew nothing about the report that had been filed in the police station. The LKA officer's task was to train employees at the hostel as part of an Islamism Sensitization Program. The employees told the officer that one of the residents was an asylum-seeker who was behaving strangely and had apparently become radicalized: Palestinian Ahmed A.

The LKA officer wanted to speak to A. immediately. He asked A. whether he could provide information about the Islamist scene in Hamburg. But Ahmed A. was uncooperative, and the attempt to recruit the refugee as a source failed. Apparently the conversation had nothing to do with the Palestinian man's radicalization and his personal problems. Once again, the case was ignored.

It was only after the case was sent to the Hamburg State Office for the Protection of the Constitution, the domestic intelligence agency that monitors possible radicalism, in late August, that someone began to pay attention. It was almost five months after the person had made his report at the police station.

An employee at the state office stumbled upon Ahmed A.'s name while scrutinizing the names of asylum-seekers at the hostel. The tipster from the spring was asked to come in for another conversation. He confirmed that the name was correct, and he said that A. had asked him about the best way to get to Syria. The suspect may have intended to join Islamic State.

The State Office for the Protection of the Constitution contacted the federal police force to request that Ahmed A. be detained at the border. But A. did not leave the country.

He was confronted with the Islamism allegations during his next appointment at the aliens' registration authority. A. was apparently close to tears, an employee of the State Office for the Protection of the Constitution later noted in his report, insisting that he was a peaceful person. But he was emotionally agitated, according to the report, and his facial expressions and gestures also caught his attention. These are all signs of an emotionally unstable personality.

But Ahmed A. was never seen by a psychologist or a psychiatrist, neither in the fall of 2016, when he appeared increasingly disturbed, nor at a later date.

A Common Problem

Iris Hauth of the Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) is only too familiar with the problem. She is the chief physician at a psychiatric hospital in Berlin's Pankow district. There are about 5,000 refugees in the district, and last year 80 of them were admitted to the hospital with symptoms of acute emotional crisis. According to Dr. Hauth, the same number was already reached in the first six months of this year. "And those are only the extreme cases," says Hauth. The goal should be to intervene much earlier, she explains, but it remains an elusive one. Many counselors lack the necessary knowledge, she says, and many have inhibitions about contacting a psychiatric facility.

To address the problem, DGPPN issued a position paper in March of 2016, proposing that asylum-seekers be tested for psychological disorders during the initial medical examination, and that personnel at refugee intake and counseling centers receive the necessary training. There were ambitious concepts at first, says Hauth, but the enthusiasm quickly dissipated, and only a few were implemented. As is so often the case, it ultimately came down to a lack of funding.

Beginning in November 2016, there were growing signs that Ahmed A. was becoming radicalized. A tip from an employee of the refugee café at the university in Hamburg reached the security authorities. The employee said that she had seen the Palestinian at the café a number of times. One day, she said, Ahmed A. turned up at the café dressed in a djellaba, a traditional Arab robe. "Terror will come to this place, too," he allegedly threatened.

A. was also exhibiting strange behavior at the Kiwittsmoor refugee hostel. He was knocking on the doors of other residents at night, shouting, "Allahu akbar," or God is great.

Crazy, out of it, strange -- these were the words counselors and fellow residents were now using to describe the young asylum-seeker. But who could speak with him if even professional counselors were unable to get through to him? There was a lot of discussion in late 2016 and early 2017, but very little was decided. As a result, Ahmed A. was left on his own, and he increasingly began to drift away.

The State Office for the Protection of the Constitution collected the individual incidents and wrote a report. The document, dated January 10, 2017, describes a personality change in A., who was 25 at the time. The authors recommended bringing in the city's social psychiatric service to assess him.

But it never happened. Why no one at the LKA acted on the recommendation of the State Office for the Protection of the Constitution is currently the subject of internal investigations. In the spring of 2017, the director of the hostel for asylum-seekers and a Legato employee also recommended bringing in experts with the social psychiatric service.

But the lead LKA official assigned to the case apparently felt that this was unnecessary. According to his assessment, the service should only be asked to intervene if Ahmed A. presented a concrete threat to himself or others -- a threshold the LKA official did not believe had been crossed. He reportedly said that if anyone else in the group felt differently, they should take steps on their own. But it didn't happen, even though social psychiatric services are designed to address such cases: to counsel people with psychological issues, as well as people associated with them, even if there is no acute threat.

There is no credible answer to the question of whether psychological counseling would have helped the Palestinian regain his footing or averted the stabbing attack. Conversely, says trauma therapist Cornelia Reher, doing nothing was the worst option of all. Reher is the chair of Segemi e.V., a Hamburg association that advocates for improving counseling or refugees and migrants. In her experience, the majority of refugees who need psychological counseling "tend to be depressive and anxious, but they are certainly not aggressive." According to Reher, once a person is radicalized, he or she has usually lost interest in therapy. By then, it is too late for psychological intervention.

A Deadly Turn

Terrorist or psycho-killer? Or both? Last year's attacks in Ansbach, Würzburg and Munich prompted questions about how society should react to these kinds of perpetrators.

In his work with radicalized young men and women, Berlin prevention expert Ahmad Mansour has repeatedly found that mental crises increase susceptibility to Islamist ideologies. Of course, he adds, this is not only the case with refugees, but also with many Germans who have joined groups like Islamic State.

But he says there are unique aspects to the psychological counseling of refugees, who are confronted with the trauma of war and escaping war-torn regions, the feeling of being overwhelmed in a place far from home, a foreign language and crowded conditions in a refugee hostel. All of this can encourage radicalization in a small portion of refugees. "We need much more dedicated psychological and psychiatric care," says Mansour. "The police and social workers alone are not enough to cope with the problem," says Kerstin Sischka of the Diagnostic and Therapeutic Network for Extremism in Berlin, which works with the Hayat counseling center.

A psychiatric expert will probably evaluate the extent to which Ahmed A. is mentally disturbed as part of the criminal trial. After his arrest, the Federal Prosecutor's Office was initially hesitant about taking over the case. It wasn't clear whether an arrest warrant should be issued for the attacker, or if it would be better to admit him to the forensic department of a psychiatric hospital.

Although employees at the Foreigners' Registration Office noticed, in December 2016, that Ahmed A. was nervous and constantly chewing on a toothpick, they felt that he was polite and cooperative until recently. To their surprise, when his asylum application was denied he said he would return to the Gaza Strip voluntarily. He spoke with his mother by telephone a day before the attack. "Ahmad wanted to come back," she told DER SPIEGEL.

The prospects of forcibly deporting a Palestinian without a passport are normally poor, and it had not happened a single time this year or the last. It was all the more surprising that A. reported, in February 2017, that he had already been in touch with the Palestinian diplomatic mission. Soon afterwards, he traveled to Berlin, bringing along photos for the necessary passport replacement documents. The Palestinians contacted him a short time later to say that everything was in order, except that the photos were the wrong size. A. then traveled to Berlin a second time to deliver new photos. After that, the Palestinians told him that the documents would be ready by this summer.

This explains why no one in Hamburg thought of requesting detention pending deportation for Ahmed A. Under these circumstances, no judge would have approved such a request. A.'s case was considered largely closed. For the officials involved, he was already halfway to Gaza.

A. had an appointment with the Foreigners' Registration Office on the Friday before last. He wanted to inquire about the status of his case. He said that if there were still problems with his papers, he could have his father send him his passport. He seemed calm. There was no vacant look in his eyes, no sweat on his forehead.

At 3:10 p.m., he took a kitchen knife from a shelf in an Edeka supermarket in Hamburg-Barmbek and ripped off the packaging. A trainee was straightening up rice packages when he heard loud noises in the next aisle. Thinking that some customers were fighting, he ran over to break it up.

When he entered the next aisle, the trainee saw a man with a crazy look in his eyes and knife in his hand, only two meters away. He turned and ran away, hiding in the employee bathroom. An employee working behind the meat counter watched as A. approached another customer and, without hesitation, stabbed him in the chest. The 50-year-old man collapsed immediately and intially survived, but eventually succumbed to the severe injuries. Ahmed A. ran outside, shouting, his face red with anger. He stabbed passersby outside the supermarket, until young men managed to stop him with chairs, rocks and sticks. Like Ahmed A., most of the young men were migrants. They are now being called the "heroes of Barmbek."

When he was questioned, A. said that he wanted to die as a "martyr." Investigators have not been able to determine if he was in contact with IS or another terror organization. IS has also not claimed responsibility for the attack, as it often does in such cases. Still, during his interrogation Ahmed A. insisted that he is a terrorist. When they searched his room at the refugee hostel, the investigators found a self-painted picture with the seal of the Prophet in his locker, the same kind of picture used by IS. There were also traces of cannabis in his blood.

Translated from the German by Christopher Sultan

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