In a therapy room in Birmingham, Azad*, an asylum seeker from Iran, speaks softly about his journey. The centre, opened in July last year by Médecins Sans Frontières (MSF) to address the "unmet mental healthcare needs of those seeking sanctuary," provides specialised trauma-focused psychological care for refugees and asylum seekers in the city and surrounding areas.

So far, it has received over 300 referrals from the NHS and refugee organisations and held 521 consultations for patients - many of whom have survived conflict, persecution, torture, and other forms of violence and exploitation in their home countries or on their migration journey.

Azad, who arrived in the UK on a small boat, was approached by MSF at the hotel he was being accommodated in Birmingham. He had known for a long time that he needed help, he said, but had nowhere to turn. "It was the only person who didn't see me as a number, listened like I'm a human," he said.

His journey to the UK began several years earlier, when Iranian authorities cracked down on protests that swept the country in late 2022 against the death of 22-year-old Mahsa Amini in police custody. She had been arrested for allegedly violating rules requiring women to wear the headscarf.

Azad, a Kurdish-Iranian civil engineer, took part in the demonstrations and said he witnessed people being shot and others blinded. After authorities spotted him spraying graffiti, his father urged him to flee for fear of his safety. The authorities later ransacked his family home, he said.

He travelled to Germany, where he applied for asylum but was rejected - a decision he said was driven by a "racist" interviewer and delays that prevented an appeal hearing. The decision left him feeling hopeless. "There were times that I was feeling I have nothing to live for," he said, recalling an attempt to take his own life.

The UK was his last and only option, he said. When he arrived, he alleged border officials had sworn at him. MSF staff said the mental health struggles of their patients had been further compounded by the rise in "hostility and anti-migrant sentiment in the UK". Some of their clients had to be moved from hotels far-right protesters routinely targeted. Others described being physically assaulted.

A clinical psychologist at the clinic, who did not want to be named, said: "What they are routinely sharing with us is a lot of fear around the environment in the UK. Attitudes towards migrants becoming more and feeling more hostile. And that's a combination of policy but also the general kind of narrative and rhetoric within the UK."

The charity said it was important for MSF to provide such intensive psychological treatment in the countries where refugees and asylum seekers hoped to settle. "If you open a wound and you cannot heal it, the wound will get worse," said Fouzia Bara, a migration programme manager at MSF. "Birmingham is the safe place where we can start the healing process. This is why we are providing highly intensive care because unfortunately the journey of migration, it's a journey of violence."

Azad, who has been diagnosed with complex post-traumatic stress disorder (PTSD) and is nearing the end of his treatment, described the transformative impact the support has had on his life. "They are lifesavers. I had nothing, there was no life in me. But they showed me, no, you can have a life," he said.

In the UK and Ireland, Samaritans can be contacted on freephone 116 123. In the US, you can call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org