Archive for category Rehabilitation
“I am tired of it, tired of my body. Tired of my soul. I can only see that it’s getting more and more sick as time goes by.”
Much research has been done on the link between physical exercise and mental health. So far, focus has largely been on how an active lifestyle may help alleviate symptoms such as depression and chronic pain, but a group of Danish researchers have gone in a different direction, introducing traumatised refugees to the relatively unknown Basic Body Awareness Therapy.
Basic Body Awareness Therapy (BBAT) is a form of physiotherapy that is often used for psychiatric patients in Scandinavian countries. Stemming from different movement systems of Western and Eastern traditions, it focuses on movements related to posture, coordination, free breathing and awareness.
Over a period of 14 weeks, four physiotherapists at the Competence Centre for Transcultural Psychiatry in Copenhagen took a group of traumatised refugees from Iraq, Saudi Arabia and Lebanon through weekly 90-minute BBAT group sessions.
A mainly nonverbal therapeutic process supported by short talks, BBAT is believed to strengthen the patients’ confidence in their own resources. Echoing this, the Danish sessions led to a growing self-confidence among the participants, with some even beginning to feel a sense of control over their own bodies.
“I have learnt how to concentrate myself away from pain. It starts by lying and thinking about
the skin and about something nice. Then everything goes away,” explained one of the participants.
“After all the traumas my body has been through, I feel good that it is still working,” said another.
Traumatised refugees are likely to suffer from (symptoms related to) Post-Traumatic Stress Disorder (PTSD). As a consequence, their interest in participating in activities they once enjoyed has diminished.
For some participants, being part of a group not only motivated them to go to the sessions, but also helped them through the exercises.
“In my case, it’s better to be in a group. When we start doing the exercises, I am focusing on how the others are doing them and my attention is there. I don’t think about my pain during that moment. The thought of pain is distracted by their presence, because they are there.”
Others, who were initially cautious of group sessions, were positively surprised by the unity and solidarity that came from being part of a group.
“In the beginning we were wary of each other, because we didn’t know each other.
Afterwards, when we got to know each other, it got better. I was scared of receiving therapy in
a group, but I think it was a good experience.”
So what can we take away from the Danish study?
After the 14 weeks, the majority of participants expressed satisfaction with BBAT. Some felt happier while others had experienced increased body awareness helping them to reduce or cope with the pain.
“The physiotherapy that we are used to normally involves you going to a physiotherapist to get a massage. And this is something totally different, that you should learn to know your body and react according to the problems you have.”
In terms of participants, the study was small, but what it lacked in numbers it made up for in depth, enabling participants to express any progress or regress they experienced during the BBAT sessions. The encouraging results of the qualitative study suggest the need for further research on BBAT and traumatised refugees.
A bigger study could give us the certainty. But for now, it seems that BBAT could be a key component in the treatment of traumatised refugees.
To read the latest issue of Torture Journal click here.
Around the world, conflicts and humanitarian crises result in migratory flows of millions of asylum seekers, refugees and internally displaced persons every year. According to health professionals and researchers, as many as 35% of refugees worldwide could be victims of torture.
It used to be that those lucky enough to be near a torture rehabilitation centre were able to seek treatment, but in many places the number of victims of torture has now reached a point where the need for rehabilitation exceeds the services available.
To support victims of torture, the International Rehabilitation Council for Torture Victims (IRCT) last year adopted and promoted a policy on the Right to Rehabilitation in accordance with the United Nations Convention against Torture (UNCAT) Comment 3.
The policy highlights the obligation of states to ensure that victims of torture have free and prompt access to rehabilitation services. Sadly, as the rehabilitation sector is facing a funding crisis, this commitment is more important than ever.
For many rehabilitation centres, the future is not looking bright. They operate in situations where their fate is continuously uncertain and because of a reduction in funding, some of them are even at risk of closing.
Yet, getting states to fully commit to the rehabilitation of victims of torture is not an easy task. This is something that becomes particularly apparent in countries where torture is carried out by the state, and where health professionals and rehabilitation service providers are constantly under threat.
Whether it is doctors being arrested and tortured simply for trying to save lives in Syria or rehabilitation centres in Latin America being exposed to threats and other intimidation tactics, it is clear that access to health and in particular, the right to rehabilitation is far from a reality in many parts of the world.
So how do we face these challenges?
An important step is to change the way that everyone from states and governments to the people they govern perceive torture and rehabilitation for torture victims. Those who believe that the practice of torture can be justified must be reminded that it is a serious human rights violation that can never be tolerated.
In addition, decision makers need to understand that rehabilitation should not be a service provided mostly by civil society organisations if and when international agencies and philanthropists decide to fund it. In fact, each and every state has a responsibility to ensure that torture victims everywhere have free and prompt access to rehabilitation services.
Without this change in attitude, political will and appropriate funding, we cannot guarantee that victims of torture receive the rehabilitation services they need.
And without offering rehabilitation to victims of torture, we are denying hundreds of thousands of people worldwide their last and only hope to reclaim their life and dignity, lost at the hands of perpetrators.
“Emotionally I felt so much rage. All I thought about was revenge. I was constantly in a defensive mood. Everyone who knew me had to walk on eggshells.”
For A.M. in Armenia, torture did not just take its toll on his body, but on his mind too. The trauma from being tortured made him an angry and defensive person who mistrusted almost everyone with severe consequences for his family and community.
A.M.’s story is far from unique. Across the globe, torture rehabilitation centres help thousands of victims of torture each year.
What makes torture such a heinous crime is the fact that its impact goes far beyond the immediate physical or psychological pain. Torture can have serious long-term physical and mental health consequences for the victims.
Here are six ways that torture can affect a person:
The story of A.M. illustrates how torture and abuse can leave a victim angry and defensive years after the crime took place. The smallest things can trigger a reaction and start an argument. Family and friends will often be fearful of the victim, leaving the person isolated and ostracised. Social isolation and loneliness can have a negative impact on a person’s physical, mental and social health.
An anxiety disorder differs from normal stress and anxiety.
Torture survivors who suffer from an anxiety disorder are likely to feel a constant and unsubstantiated worry that causes significant distress and interferes with daily life. They will often struggle with recurring nightmares or flashbacks.
For some, certain sounds or sights associated with the trauma can trigger severe anxiety attacks or emotional numbing. This could be the sight of a person in uniform or the sound of footsteps approaching. As a vicious cycle, an anxiety attack is worsened by the fear of having another one.
A person suffering from anxiety will try to avoid social situations for fear of being judged, embarrassed, or humiliated.
Depression is widespread among survivors of torture. People suffering from depression often lose interest and pleasure in activities and are unable to work, sleep, study, eat, and enjoy life. They also feel worthless or find it hard to concentrate. At its worst, they may experience recurring thoughts of death and suicide.
For different reasons, torture victims suffering from depression are often reluctant to seek treatment, which can have serious consequences for their health, including self-harm and insomnia. Research also shows that the longer a person waits before seeking treatment, the greater the damage can be in the long-term.
Emotional numbing and avoidance
A torture survivor suffering from emotional numbing and avoidance will go to great lengths to avoid any thoughts, conversations, activities, places or people that trigger a recollection of the trauma. The survivor may be profoundly emotionally constricted and detached. This can lead to social withdrawal and isolation.
A person suffering from hyperarousal symptoms has an extremely heightened alertness of his or her surrounding environment and can easily be startled.
Hyperarousal symptoms are usually constant and not triggered by an event or episode. The symptoms can leave the torture victim feeling stressed and angry, and not able to sleep, eat or concentrate. In addition, the person will often struggle with carrying out simple daily activities, such as getting dressed or going to the supermarket.
A person suffering from hyperarousal symptoms may also experience irritability or have outbursts of anger.
Some 51% of torture victims suffer from sexual dysfunction, which is particularly common among those who have suffered sexual torture or rape. It can also be linked to depression and post-traumatic stress disorder (PTSD) or it can be a direct result of an assault.
Sexual dysfunction affects not only the relationship between victims and their partners, but may also affect the way victims interact with family, friends and colleagues. In addition, it is likely to affect their confidence, their enjoyment in life, and their morale. Instead, they will often feel isolated and alone.
Many of the symptoms mentioned above are common in torture victims who have been diagnosed with PTSD. Other PTSD symptoms include insomnia, intrusive thoughts, nervousness and feelings of helplessness.
This is, however, just a small part of something much more complex. The psychological effects of torture vary from person to person which means that treatment should be the result of an individual assessment. Many torture rehabilitation centres offer holistic treatment that takes into account the individual needs of their clients.
In the case of A.M., he was able to rebuild his life and cope with his anger after seeking help at IRCT member centre FAVL.
“Thanks to FAVL, I have been granted a new spirit in life and have dampened the raging anger I had inside me,” said A.M. “Therapy has played a major role in getting me better again, rebuilding my relationships and becoming who I want to be.”
Girls and boys. They go by no name, but their faces are marked by scars from bayonets, whips or knives. Some escaped hatred and indifferent smugglers, others survived shipwrecks and overcame barbed regulations protecting the borders.
(All photos are kindly provided by Pierre Duterte)
In his latest photo book, Le Phototherapeute, French author and medical doctor, Pierre Duterte paints a portrait of young victims of torture through his conversations with one of them, a patient known as “Junior”.
Like Junior, the children have escaped countries riddled with war and conflict. Safe in France, they no longer fear for their lives, but being alone in a strange country, they are met by a new threat: the loss of identity. Confronted with a new language and a new culture, they are lonely souls with no family nor friends to turn to.
As Duterte writes, battling traumatic memories that have since turned into nightmares, they risk becoming the forgotten children in a society that believes it has met its duties by giving them a place to stay and food to eat.
Duterte has worked with torture victims for more than 20 years and throughout his career, he has treated thousands of clients. In 2007, he released a book about his experiences as a therapist working with torture victims.
In Le Phototherapeute, Duterte, who is also a photographer, uses photos of nameless children to illustrate the complexities of his patients. As to reiterate that Junior could have been any of the young victims of torture he has met, the book has no photos of Junior.
Perhaps frustrated with the way that institutions have failed to treat these children, Duterte points to the trauma and horror that young victims of torture struggle with, before and after their escape. With his patients in mind, he describes the unexpected effects of placing the young shattered souls in front of a mirror. Looking at themselves, some of them are unable to recognise their own reflection.
Le Phototherapeute gives the reader an insight into the troubled life of young torture survivors and what it takes to restore both their physical and mental health. It is a compelling read that also serves as a reminder to us that these children have a very lengthy rehabilitation process ahead of them and that they need all the support they can get. If we have any hopes of them recognising themselves in the mirror we need to start by helping them rebuild their identity and escape their nightmares.
To find out more about Le Phototherapeute, click here.
Recently, the IRCT and two of its Danish member centres spoke with Copenhagen-based monthly newspaper The Murmur about their work with torture victims in Denmark.
Torture is something that most of us assume only affects those in developing nations, where civil wars still rage, governments are heavily corrupt and poverty plagues the masses. But while it is more prevalent in these nations, Amnesty International found evidence of torture in 79 countries, all of which had ratified the UN Convention Against Torture.
The IRCT is a leading organisation that helps rehabilitate these individuals, with 144 rehabilitation centres providing holistic treatment to torture victims in 76 countries.
Asylum seekers arriving in Denmark often bring with them scars from their encounters with torturers. In Copenhagen, the Oasis rehabilitation centre has just 15 staff members tending to approximately 130 victims, mostly hailing from Afghanistan, Iraq, Palestine and Somalia. Its sister organisation, Rehabiliteringscenter for Torturofre (RCT) in Jutland, treats many people from the Balkans, Chechnya, Syria, and the Post-Soviet Republics.
Both organisations treat the victims using a range of services and personnel, including social workers, psychologists, physical therapists and psychiatrists.
“We treat many civilians who have been victims of, or have witnessed organised violence against others, either during armed conflicts or under terror regimes, but we also treat perpetrators, as many from the Balkans were forced into military service against their will,” explains Mikkel Auning-Hansen, an RCT psychologist.
“Chechen refugees are damaged in many ways. Some were hunted, interrogated or tortured by paramilitary groups. Most of them have family members missing, hiding away from home or hunted for their political views. Some still feel that they are being hunted in Denmark.”
Ruth Lauge, the Director of Oasis, says soldiers are often the perpetrators. “We’ve treated a number of people who were kidnapped by the Taliban. For example, young children who were beaten and forced to put on suicide vests and being psychologically prepared to die, before they escaped,” she explains, adding that many victims have been living in Denmark for years, even decades, before they seek treatment.
“Many people come from being on the run and they just want a normal and safe life, with a home, family and work – just like anyone else,” Auning-Hansen says.
“Most cope for a limited time, but eventually, stress at work, problems in the family, loss of job or other unforeseen stresses tip the load and that’s when people reach out for help.”
Read the full article in the latest issue of The Murmur or click on this link.
A circus is a show featuring colourful, entertaining and often daring acts. A circus aims to amuse, to entertain and to joke. And a circus is also a method of rehabilitation.
Despite the fun factor, circus acts and similar physical activities are used by IRCT members to encourage confidence, creativity and cooperation among torture survivors.
One particular example of this is the ‘Body Movement Reconnect’ programme, a joint initiative between Australian member STTARS and the group Uniting Care Wesley Bowden.
With the assistance of trainers at the South Australian Circus Company, this six-month program from February 2014 helped female survivors of torture body awareness, develop social connections, improve fitness and build self-esteem to reduce the impact of chronic pain.
For Katie, whose name has been changed to protect her identity, the STTARS programme restored happiness and a sense of belonging, missing after years of fear during the Russian invasion of Afghanistan, her subsequent move to Iran and her experience of rape as a child.
“When the Soviet Union invaded Afghanistan [in 1979], I was 11 years old. At this time, the Soviet soldiers were catching girls and disappearing with them. They would also come after the young boys taking them in the name of military service,” Katie explains.
“At the time, I didn’t feel that affected because I was young. But I remember many girls disappeared. If you left the house then you could be taken. So we did not leave the house.”
In 1980, Katie and her mother, four sisters, three brothers and grandmother fled to Iran. Her father stayed in Afghanistan to fight. He was killed.
“In Iran, I didn’t go to school. Half of the children did not go to school because of the expense, the rent of the house, and living in a country illegally,” says Katie.
“It was only after we moved that I began to recall trauma I suffered in Afghanistan. I had been lying to people to stop them finding out.”
While bringing a meal to her brother-in-law, Katie was imprisoned in his home and raped.
“I didn’t know anything about being a woman,” Katie says. “I did not know what had happened to me as I passed out. I felt ashamed and embarrassed.”
“It was hard to forget the memories when I was 11 years, but my husband was a good man. We had a beautiful son together, but when my son was five-years-old, he became sick and died. That was the saddest time of my life.”
This culmination of sadness from fleeing Afghanistan and her rape began to takes its toll on Katie.
“My life during those times was coloured with sadness. I came to Australia with hopes for a better life. I was very scared in the beginning. Everybody spoke a foreign language and everything was unknown,” Katie says.
“When I came to STTARS three years ago, I met ladies from my country, it was here that I began to feel safe.”
Katie soon joined the Body Movement Reconnect programme, participating in a range of circus activities accompanied by therapy and group counselling.
After six-months of support from STTARS, Katie feels reinvented.
“For me it was like being with my sisters again, there were women laughing, having fun, exercising. We shared lunch and talked about our countries and background. It always felt like a safe space and I knew the women there understood me and I understood them. I am a strong Afghani woman, and that makes me feel proud.”
Eating, showering and getting dressed. Most of us do these basic activities every day. Many of us also use a phone or some other form of technology on a daily basis and housework and grocery shopping are part of our weekly chores. Performing these and other daily activities come natural to the majority of us, yet for some, even a simple task like brushing your teeth is a daily struggle.
A recent study in Denmark has established a link between exposure to torture, trauma and post-migration stress in newly arrived asylum seekers and a decreased ability to perform activities of daily living. The researchers behind the report Activity of Daily Living Performance amongst Danish Asylum Seekers: A cross-sectional study used a number of different measures to first determine the health of 43 asylum seekers and then look at their ability to perform basic everyday tasks. The result showed an overwhelming 62% struggled with completing some of their daily tasks.
Across the world, health professionals often refer to activities of daily living (ADLs) when measuring the functional status of a person. While there is much information on how well individual groups such as the elderly or people with disabilities perform ADLs, no larger studies have addressed ADL issues encountered by traumatised asylum seekers and refugees. Although relatively small, the Danish study is a good indicator of what to expect from future studies addressing this issue.
When it comes to measuring a person’s ability to perform ADLs, it is impossible to ignore their health and well-being. Pain in particular, is an important factor when discussing ADL ability, as it is well documented that persistent pain interferes with a person’s ADL performance and social participation.
In the Danish study, which involved asylum seekers from Syria, Iran and Afghanistan, a staggering 72% of the participants reported that they suffered from a pain problem. Alarmingly, most of them had been exposed to torture and many of them showed signs of stress and depression, both of which can contribute to a low ADL score.
Most people arriving in a new country after fleeing war and mass conflict need urgent treatment and rehabilitation to help tackle the trauma and other physical and mental after-effects. Yet, unlike other groups in Denmark that struggle with completing everyday tasks, asylum seekers, tortured or not, do not instantly have access to treatment or rehabilitation.
Many of the specialised rehabilitation centres simply do not offer rehabilitation before the asylum seeker has been granted asylum just as health care and social subsidies remain a privilege for the resident population. Until their pending case is decided and they receive refugee status, asylum seekers only have access to acute medical needs, unless they apply to the Danish Immigration Service for further medical attention.
As the study points out, the right to rehabilitation should in principle be regarded as an obligation to rehabilitate those who are in need. Failing to do so can have far-reaching consequences for traumatised asylum seekers, including social isolation, dependency on others and deteriorating health.
According to the Danish researchers, one way of preventing further loss of ADL ability among traumatised asylum seekers is to provide them with the appropriate rehabilitation upon arrival, and not wait until they have been granted asylum. An argument that is difficult to disagree with when reality is that most asylum seekers have complex health and social care needs that require our immediate attention.
In other words, health impediments that reduce someone’s quality of life must be addressed as soon as possible. After all, something as simple as brushing your teeth should not be a struggle for anyone.
To read the latest issue of Torture Journal click here.
Despite suffering arrest, beatings and forced push-ups on the burning hot concrete of a Thai military camp, Hasan Useng is not entitled to remedies and reparations for this torture.
That’s the ruling made by a Provincial Court in Thailand on 7 October 2014, one which received condemnation from the International Commission of Jurists (ICJ), Human Rights Watch and Amnesty International.
Reporting on the case, Amnesty International explain the ruling was made to prevent remedy to Hasan Useng because the military coup in May 2014 annuls Thailand’s Constitution, specifically Article 32 which assures reparations for victims of torture.
It is not the allegations which are necessarily disputed. It has been well-documented that Hasan Useng was arrested at his house in Narathiwat province. He was taken to the Inkhayuthaborihan Military Camp in Pattani province where “military personnel allegedly kicked him and ordered him to do several hundred push-ups and jumping jacks on the hot concrete in his bare feet,” according to Amnesty International.
What Hasan is being denied is rehabilitation and redress due to a pointless, inconsistent technicality.
Despite the ruling from the Thai courts, the government still has obligations under international law – specifically the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) – to provide redress and rehabilitation to victims of torture, even in a time of martial law.
What this ruling indicates is that Thailand is exploiting the military coup as a way to ignore ongoing torture allegations.
“The Hasan Useng decision highlights the concrete damage to human rights protections in Thailand resulting from the military coup, and the fact that it is now virtually impossible to hold security forces legally accountable for their actions,” said Brad Adams, Asia Director at Human Rights Watch, reporting to Amnesty International.
As already expressed by Amnesty and other human rights organisations Thailand should take immediate measures to ensure all persons alleging torture and ill-treatment should have an opportunity for prompt and effective investigation into their claims, as well as full access to rehabilitation and legal routes in their case.
To read the full article on Amnesty International’s site, click this link.
Nobel Laureate and Archbishop Emeritus Desmond Tutu once said: “Humanity needs organizations like DIGNITY that decade after decade carry out risky, uphill, and often unrecognized work towards a world free from torture.”
More than three decades since its foundation, the arduous journey has made DIGNITY a prominent force in the global fight against torture.
The history of DIGNITY and the IRCT are intimately related — in fact, the two organisations were one at the inception. It was only in 1997 that the two organisations went separate ways, responding to a growing need for global support in the rehabilitation of torture victims.
Today, DIGNITY is famed for its extensive research on torture and its effects. DIGNITY also holds the world’s largest collection of documents on torture and related subjects, with more than 30,000 items. These credentials make DIGNITY “the most famous torture rehabilitation center in the world”, according to former UN Special Rapporteur on Torture, Professor Manfred Nowak.
“In addition to providing hundreds of torture survivors from all world regions with medical, psychological, social and other forms of rehabilitation, DIGNITY is a leading research and documentation center on the methods of torture and its effects on human beings,” he said.
DIGNITY’s main client base are refugees in Denmark who have survived torture. Although potential patients need a residence permit in Denmark and a referral from a physician, the centre offers rehabilitation to people who have been exposed to torture, organised violence or other severely traumatising events such as war and political persecution.
These patients often suffer from flashbacks, sleep disorders and nightmares, isolation, concentration and memory difficulties, among others, making their integration into Danish society much harder.
But, since its foundation 32 years ago by Dr Inge Genefke, DIGNITY’s mission spread far beyond Denmark and the clinical services needed in Copenhagen. The centre works in places such as South Africa, India, Tunisia and Jordan aiming at reducing the effects of torture or preventing the use of torture and organised violence.
With its dedicated group of over 80 experts – and its roots deep in the movement – DIGNITY will go much further.
If you want to learn more about DIGNITY join them on 30 October in Copenhagen’s main square Rådhuspladsen. Outlandish and several other music bands will be performing on the ‘DIGNITY DAY’ to mark the organisation’s 32nd anniversary. DIGNITY will also present their yearly prize to a person who has made a remarkable contribution to the fight against torture.