Archive for category Rehabilitation
Editor’s Note: This is the sixth in a regular series from centres involved in the Peer Support project (more fully described in our earlier blog here). See other previous posts in this series here, here, here, here and here.
“Our mission is to help, and when we feel that someone is trying to help us, this creates a good feeling and gives us wings for go on our mission”
In everyday life, working with victims of torture generates stressful moments. Why? Because we are always confronted with persons whose needs are many and varied, and our ability to cover their needs are often very limited. Our mission is to help, but we cannot always do so. This spirit of bitterness depletes us little by little. We remain marked by a sad story of life, a crippled body and a suffering soul.
How do we unload our soul? How do we free ourselves from what we have gained and what ails us?
All these questions arose in my mind many years ago. Ever since, I always tried to find new answers, new solutions. I started my work for victims of torture 13 years ago as director of MRCT Craiova Romania. Eight-hundred twenty-nine patients are registered at our centre. Every year we regularly assist 140 people with approximately 660 medical consultations and 2,400 physiotherapy sessions. The services are provided by the organization staff consisting of 11 persons. For information on who we are and what we do you can to our website: www.icarmed.ro.
One of the major problems I faced during all these years was to retain staff considering that the financial resources for salaries were always poor. In these circumstances, I think it is important for employees to have a job that comes with love, and to be part of a team in which everyone is united with the other for better and for the worse. This is a difficult goal to achieve, but great things are an accumulation of little things and I think that every step is important.
One step was to devise a questionnaire in order to try to know more about the mood of the team — hardships in facing problems that grind desires and aspirations. For me this questionnaire was and is useful. I chose this way of communication because often, when we stand all together, with all eyes glued to us when we speak, we find it difficult to express what we think, what we are upset about and what we want. The questionnaire is outlined on the bottom of this blogpost, and might be interesting for debate to improve it or maybe as a tool for partners in Peer Support Project.
Another important step is our participation to the Peer Support project, which is driven by a valuable team of project managers and trainers from whom we acquire knowledge. We learned best practices and applied them in our daily work to improve the well-being of the organisation.
We learned when to use the clinical intervision method, which helps us find better solutions to resolving the difficult cases. Since February, we have had monthly clinical intervision sessions.
After the Barcelona training, we realized that is very important to have a defined strategy for stress management in our organisation.
Another positive aspect of the Peer Support project is that we feel good to see how the three leading organisations (IRCT, Antares, bzfo) made their experience and expertise available in support of the six newly participating organisations to acquire similar skills. It simply feels so good when you see that someone wants to do something for you!
By Simona Smarandache, Director of MRCT Craiova Romania
- NAME ……………………………………………………
- DATE OF EMPLOYMENT………………………………………………………
- DATE OF COMPLETION…………………………………………………..
- WORK PROGRAMME ……………………………………………………….
- Do you know your responsibilities according to your job description? Institutional Code of Conduct? Organizational Code of Conduct?
- Describe the activity which you perform in the centre:
- What problems do you have regarding your activity, who/ what generates them, what solution do you think there are for resolving them?
- What dissatisfactions do you have?
- What are your expectations?
- Do you want to continue your activity within the centre? If YES, for how long? For a short/ medium long period of time? What are your aspirations?
- How do you see your activity in the future?
- What does MRCT Craiova represents for you?
- Do you have disagreements with your colleagues? But complaints about them?
- Do you have disagreements with your superiors? But complaints about them?
- Do you have disagreements with the director of the centre? But complaints about him/her?
- Are you satisfied with the working conditions, with the working environment in the centre? What are your suggestions and wishes in this respect?
- Do you have family problems? Are these problems related to your work place?
- Do you have any health problems? What are them? Are these problems caused by your work?
- Are you satisfied with your salary? Do you feel it is according to your efforts?
The fight against torture happens on several fronts; from lobbying international organisations and governments to training health care providers, lawyers and judges, or through supporting the victims themselves to share their stories.
But to win the fight against torture, we need more than that. We need you. We need the collective action of individuals around the world to build a political will, so that perpetrators know that we will no longer accept torture. We will not allow these crimes to continue with impunity.
The IRCT has worked hard to make rehabilitation a right. But we still need to make this right a reality. For that to happen, we need people like you, saying with one voice, “Victims of torture have the right to rehabilitation. Let’s make this right a reality.”
On 26 June is the UN International Day in Support of Victims of Torture. In honour of this day, we call on you to show your support for the victims of this heinous crime and together show the world that we no longer accept torture.
So, on 26 June, what will you do to stop torture?
Here are some ideas of ways to show your support to the victims of torture:
- Send a message of support: take a picture of yourself with a message to victims of torture. You can write:
- On 26 June, I show my support for victims of torture
- Stop torture
- No more torture
- Torture victims have a right to rehabilitation
- Use this photo as your profile picture
- Or, post it on Facebook, on the World Without Torture event page or our wall
- Send your photo message to us via Twitter @withouttorture with the hashtag #26June
- Simply post a message of support on Facebook or Twitter. Remember to tag it #26June or #Right2Rehab
- Share facts about torture and rehabilitation. Here are some examples:
- Torture is used in more than 100 countries around the world #stoptorture #26June
- Today #26June is the Day in Support of Victims of Torture #stoptorture
- Torture victims have a #Right2Rehab #26June
- Victims of torture can rebuild their lives through holistic rehabilitation #Right2Rehab #26June
- Share stories of torture survivors from World Without Torture
- “This world is not the horrible place that those perpetrators showed me.” Italia from Mexico
- “What do we do with what others have done to us? Internalize this tormenting experience or fight to stop this happening again? I chose the latter.” Vera from Brazil
- “I felt changes in my whole body… The loneliness has gone. I am no longer crying whenever as I was doing before.” Charline of Rwanda
- “I will never forget what I experienced, but I’m trying to rebuild my destroyed life.” TK of Kosovo
Thank you for showing your support to victims of torture on 26 June. Together, we fight for a world without torture.
It’s probably safe to say that all jobs are stressful at one point or another. But, as one of the missions of the IRCT is to improve the quality of holistic rehabilitation for torture victims around the world, stress is decidedly a factor that can get in the way.
Stress, ‘burn-out’, or even trauma, is a great risk when one works in this field. Like many professions, staff can be overworked; but in torture rehabilitation, working everyday with those who may be deeply traumatised by an experience of torture means there is a great risk of trauma transferring to the professional helping them. It’s understandably difficult to distress after a hard day, especially when the needs are great and ever-growing.
Additionally, trauma centres have often come from a grassroots need, rather than traditional healthcare structures, says Prof Dr Christian Pross, a member of the UN Subcommittee for Prevention of Torture, in a 2011 manual on the issue [PDF]. While filled with zeal and purpose, trauma centres sometimes suffered from a lack of proper organisational structure, causing additional stress, friction and confusion.
Thus, enter the Peer Support Project. Based in Europe, the project aims to train and provide other forms of support to torture rehabilitation centres. To provide the best possible holistic rehabilitation for the victims of torture, it is simply necessary to ensure that those who carry out this work on the ground – the medical doctors, psychotherapists, administrators, secretaries, among others – that they have the stress management tools and needed organisational structures around them to get the job done best.
At the moment, the Peer Support Project is halfway through its course. The project kicked off in July 2012. As a first step, the needs of each of the participating centers were assessed. Representatives from the three partners that designed the project – the IRCT, ANTARES Foundation of the Netherlands, and bzfo of Germany – visited each centre and spoke to staff on the ground over the course of three days. What, simply, were the difficulties that the organisation and their staff were experiencing? As a result of the assessments, the partners of the project directly engaged with local staff (both management and therapists) in helping them to create supportive organisational structures, introducing new tools such as stress management techniques and intervision (this concept refers to have, within a team, inter-collegial consultation without an external supervisor) and assisting them in the ongoing process of implementing these tools.
“When we applied for the PEER SUPPORT project, we thought it a wonderful opportunity to address something that is at the hub of our organisation but which often goes unspoken.
When I received notification that we had been selected for the project, it dawned on me that perhaps this was not such a great idea, and then when I learned that it was going to potentially add a lot more work to an already over-loaded agenda I wasn’t sure if it had been a good idea at all.
The first day of the assessment visit by Winnifred Simon (ANTARES), Nora Balke (bzfo) and Helene de Rengervé (IRCT) left us feeling justified in the decision that we took. At the end of the three days I was left with hope that this project will serve us very well to not only become a healthier work environment but a healthier organisation. We are looking forward to the training and to furthering the work of this worthwhile initiative in the coming year”
- Greg Straton, SPIRASI, Ireland
SPIRASI, based in Ireland, is one of the six participating centres in the project. The others are Assistance Center for Torture Survivors (ACET) – Bulgaria; Freedom From Torture (FFT) – United Kingdom; HEMAYAT – Austria; Medical Rehabilitation Center of Torture Craiova Romania (MRCT) – Romania; and Parcours d’exil – France.
The assessment was just the first step. In December 2012, each centre sent staff to a full week of training in Barcelona. “Working together in Barcelona was very inspiring for us,” said Kristina Golona of ACET. “The exchange of the management practices helped us to consider how to improve the situation of ACET’s staff, even without financial resources”. Furthermore, a system of monitoring on quality management and intervision through video-conferencing is already on-going and will last throughout the project.
“We were looking forward to exchanging experiences and opinions with other centres,” said Cecelia Heis of HEMAYAT. “It was interesting to learn how they organise themselves, under which conditions they work, and which difficulties they are confronted with.”
And many other activities are in the works: a flexible network of organisational counsellors and supervisors, familiar with the special needs of centres working with traumatised victims of torture and refugees; further training for therapists on ‘intervision facilitation’, who shall then in turn train the staff from their own centres; and a final conference in November 2013 to conclude the project.
The Peer Support project intends to improve the well-being of the staff, just as much as the sustainability of the organisations involved. From now on, staff members of one of the participating centers will regularly share their experiences through this process. The aim of these blog posts is to inform others working in trauma and torture rehabilitation on the process and outcomes of the project and to make them aware of the importance of stress and quality management policies. The ultimate goal is, as always, improved care and treatment for the victims of torture. So, stay tuned for these contributions.
In the meantime, interested centers or individuals are very welcome to contact the PEER SUPPORT project coordinators for more information: Helene de Rengervé (firstname.lastname@example.org) or Marnix de Witte (email@example.com) IRCT, tel: +32 2 230 15 04
Although a global problem, torture takes shape in different ways in different contexts. Tackling it is also a local challenge, with human rights defenders asking, how does torture happen here?
PRAWA, or Prisoners Rehabilitation and Welfare Action, is a Nigerian rehabilitation and advocacy organisation and member of the IRCT. They have developed a methodology and series of programmes to prevent torture from happening in the first place, one that is nearly so obvious and simple.
In Nigeria, torture happens in prisons. It happens when people come in contact with police and prison authorities. It happens through the horrific and inhumane conditions of prisons.
There is a vast problem of crime in Nigeria, says Godwin Ugbor, a psychologist at PRAWA based in their Enugu headquarters. This is mostly related to dire poverty and hunger. While the country itself is rich from oil – one of the largest oil producers in the world – this wealth has not been distributed widely. It’s the 49th most unequal country, meaning any wealth is only held by a few.
“There is just so much hunger,” Godwin says. The result of that poverty and inequality, he explains, is rampant crime.
Furthermore, the high rate of crime in Nigeria means there is increased pressure on police services to function well and arrest perpetrators – but they suffer from the same poverty and lack of proper funding and training as the rest of the country.
“Because they don’t have the skills, they resort to torture,” he says.
So, one of PRAWA’s approaches to preventing torture – keep people out of the judicial system. Although people are sometimes implicated and tortured for crimes they never committed, the best method of prevention is to ensure that the young don’t become involved in criminal activity. Additionally, they work with the police and justice system apparatuses to bring about a human rights ethic to their work. And for those in prison, PRAWA provides psychological rehabilitation during their sentences and through the transition to public life. If most torture occurs in prisons and police lock-ups, then PRAWA rehabilitates prisoners.
Godwin has only been a psychologist for a year and a half, but he’s jumped into this work quickly, almost ‘overwhelmingly’, he says. It’s never-ending work, with prisoners and other clients calling at all hours.
“Your personal life is lost.”
Godwin started working with prisoners during an internship, one of four he had during his studies to become a psychologist.
“The system is so flawed and the conditions in prison so terrible, you develop a great deal of sympathy. It is a large group of people that really need help.”
Terrible may be an understatement. “Say they built a prison for 100, maybe 400 people will be living there. It’s extremely overcrowded. A cell for five, may have 20 people. There are bad sanitary conditions. Not good personnel working there. And really horrible food.”
Godwin says for those living under these conditions – often in long sentences or remaining there for months or years after they should be released due to flawed judicial processes – can develop chronic mental illnesses. Many prisons now have asylum cells for the mentally ill. He gets calls from them sometimes as late as 10pm, desperate for help and someone to talk to.
However, Godwin’s work has taken a turn recently to focus more on prevention – ensuring that the youth of Nigeria don’t get caught up in crime and risk arrest, becoming entangled with the judicial system and thus tortured.
The Illegal Migration Awareness Project (IMAP) trains youth and peer educators on the issues of illegal migration, a particularly relevant issue in Nigeria, Godwin says.
“Many youth want to leave the country and live without violence,” he says. But the impact of illegal migration can bring dire consequences. Many try to migrate across the desert, some dying during the journey. Others steal money, purchasing fake visas and passports and can be caught by officials. Those who make it abroad may have to resort to crime and theft to make ends meet.”
The education to peer leaders includes understanding alternatives to violence – training youth on how to handle certain situations without resorting to violence and aggression. Finally, career guidance programmes on vocational training and entrepreneurship assist youth in earning money, building a career, attending university and supporting themselves rather than turning to crime and theft.
“When I was in university, I would make shirts, shirts like this,” Godwin says while tugging at the fabric of his blue button-down. “That meant I was able to make enough money to support myself and attend school.”
It is methods like PRAWA’s that demonstrate the multi-faceted problem of torture – how problems of poverty increase one’s vulnerability to torture. And stopping torture means tackling it from all sides.
Like other international bodies, the UN Committee Against Torture takes good time to develop its work. Thus, it requires a lot of patience and a strong focus on long-term objectives to work with the Committee.
But sometimes developments happen all at once and with such speed that it is hard to keep up. This November session of the Committee was one of those moments, which saw a wealth of significant developments especially in relation to the areas of redress, documentation of torture and protection against reprisals. These are all issues of key concern to the IRCT and something that we have been working on with the Committee for years. It is therefore with great pleasure I will outline the most significant developments and speculate as to how the rehabilitation movement can best utilise them in its daily work – while still promoting further improvements.
Victims’ needs for redress and rehabilitation
This subtitle is significant because it illustrates the spirit of the Committee’s new approach to redress and rehabilitation outlined in its new General Comment on Article 14 of the Convention Against Torture. The Committee embraced a victims-centred approach, advanced by the Special Rapporteur on Torture Juan Mendez, and integrated this thinking into its General Comment.
This is very noticeable in the section focusing on rehabilitation which in several places has a strong focus on the needs of victims. This can be seen in provisions on early access to rehabilitation services based on a medical rather than judicial assessment of the victim’s claim, consideration of the risk of re-traumatisation of the victim in rehab and judicial processes, and the clear statement that achieving full rehabilitation can only depend on the victim rehabilitation potential and not the resources of the State .
The General Comment also makes a significant contribution to the Committee’s future monitoring of States fulfillment of the right to rehabilitation by establishing that specialised services must be available, appropriate and promptly accessible and that such services can either be provided directly by the State or through the funding of non-State facilities, including NGOs, but always with the victim’s participation in the selection of service provider.
This provides a framework for rehabilitation advocates, victims and their representatives to directly engage with government authorities to further define how rehabilitation should be provided in the specific national context. Where this dialogue needs a bit of international “facilitation”, the text also provides criteria against which international monitoring mechanisms can assess States’ implementation of their Convention obligations to provide rehabilitation. Lastly, it can hopefully initiate a global dialogue on how to best ensure that torture victims receive the rehabilitation that they need.
During the session, the Committee had the chance to review how the government of Peru has set up its redress programme. This resulted in a fruitful dialogue and some novel recommendations from the Committee especially in relation to rehabilitation services. The recommendations can be found in paragraph 18 of the Concluding Observations on Peru. [Download document]
Documentation of torture is an integral element in investigations
The Committee has long had a strong focus on implementation of the Istanbul Protocol as a torture documentation tool. However, this has mainly been recommended to States as a training tool. The IRCT has long been arguing that while the Istanbul Protocol is a useful training tool, it should also be actively used as a mandatory and integral part of any investigation of torture and ill-treatment since it is only through its mandatory, appropriate and independent use in investigations that it will make a real contribution to ending impunity. One noticeable example of this is the situation in Mexico, where the Government has made a less-than-genuine implementation of the Protocol. During this session’s review of Mexico, the Committee extensively questioned the government on this issue and ended up issuing recommendations that clearly recognise the Istanbul Protocol’s role as an important part of torture and ill-treatment investigations. The specific recommendations can be found in paragraph 17 of the Concluding Observations [Download document].
This is an important step in the global promotion of torture documentation. It provides a context in the Committee Against Torture to question States on their active use of the Istanbul Protocol rather than how many trainings they have done. Further, it is very well aligned with current IRCT priorities of developing a global action plan for national implementation of the Istanbul Protocol.
Reprisals – focal point
In recent years, the Committee Against Torture and other related bodies such as the Subcommittee on Prevention of Torture have become increasingly concerned with the occurrence of acts of reprisals against persons or organisations that interact with these mechanisms. While the Committee has previously addressed these acts on an ad-hoc basis, it has now made the decision to designate one of the Committee members as rapporteur on reprisals.
In parallel, the Subcommittee on Prevention of Torture has established a working group to look into the issue. While this is a welcome development, there is still a lot of work to be done on designing specific measures that these mechanisms can take to prevent and otherwise address acts of reprisals. In this context it will be particularly important to involve national organisations to ensure that their voices are heard. The IRCT will be happy to support our members with bringing their positions to the attention of the Committee.
Time for national implementation
While all of these developments are welcome, the real test of their relevance will be whether they are in fact implemented on the ground. Here it is the role of organisations like the IRCT to bridge the gap between the international and national level by providing the support that our members identify as needed to promote national implementation. This could be in the form of political pressure, capacity building, technical assistance or something entirely different. We will only know when we hear from you.
Asger is Head of the Geneva Liaison Office
The story of Charline is one of nineteen stories collected by Grace Kagoyire and Annemiek Richters. The collection will be published in 2013 in a book under the title “Stories about death and rebirth: Life experiences of Rwandan female genocide survivors”; first in Kinyarwanda for distribution within Rwanda and subsequently in English. The English version will be supplemented by short chapters with analysis of the various themes that feature in the stories. A prepublication of a second story can be found on www.annemiekrichters.nl/rwanda. This website gives more information about the program of sociotherapy that hosted the story project.
Through the 16 Days, we have often commented on the unceasing work of activists, women’s human rights defenders, and community leaders in terms of their bravery and leadership. But what we also would like to emphasize is that these are not the only roles in which women exhibit bravery. The act of coming forward, testifying, providing these stories that we have shared through the last two weeks, and healing – coming forth for rehabilitation and reconnection with others can in fact be the bravest act for women, who often must fight deep personal and social shame as victims of violence, particularly sexual violence.
With that in mind, we would like to share the story of Charline, who was a victim of violence and sexual torture during the genocide in Rwanda. After years of ongoing gender violence and suffering, Charline joined a sociotherapy group, where she felt a change come over her whole self. Read her story of bravery, perseverance and the radical act of healing.
For fifteen years I was tortured by the man who raped me during the genocide, and then forced me to be his wife and continued to violate me. It felt like prison. After I separated from him, my wits came back to me. Before, I was always depressed, living in fear and grief. I always had headaches and nightmares. Now I have peace in my heart.
I am Charline. I was born in 1976 in the Nyarugunga sector in Kicukiro District. My parents were farmers. I lived with them up to April 1994. We were neither rich nor poor. I was born in a family of nine children, four boys and five girls. Five siblings and both my parents died during the genocide. Four of us escaped. I did not get a chance to marry a man I loved, because I was taken by force in 1994 by a neighbour who raped and married me. I live with the three children I conceived with this man.
The genocide mayhem spread everywhere. When it began, my whole family left our house in order to look for a place to hide. My sister-in-law and I went to hide at the home of our Hutu neighbour, who was a member of a Pentecostal church and was known as a reborn Christian. We spent two nights there.
On the third day, we went to a nearby primary school, thinking that it would be a safe place. We spent two days there while the war violence increased. Men who were with us advised us to look for another place to hide because things were getting worse. Since we had nowhere else to go, we took refuge in a nearby swamp where, after four days, a club of Interahamwe (1) found us hiding there.
One of those Interahamwe took me to his parents’ house. He lied to me, saying that he was going to hide me. I spent the night in that house and started to trust him. After two days, however, he began to rape me. He told me that the genocide would continue and that I should become his wife. I refused sexual intercourse with him. I continued begging him to leave me alone, wanting to go back to the swamp. He terrorised me and told me that if I would go back, he would kill me. I was afraid. The situation outside was bad. I stayed with him because I had no choice.
It was very hard to be raped and survive. No one supported me during the genocide. A man who should have helped me violated me instead.
During the fifteen years that I lived with this rapist, he terrorised me. I could not speak with him about the way my family was killed or about the death of my siblings. At each period of commemoration, I went to bed and cried until the end of the period. What was most painful is that when he found me crying he liked to tell me, “It is of no importance that Tutsis were killed.” Throughout my whole life with him I was always afraid. I never felt happiness. Since the day he took me from the swamp, I expected him to kill me. During the memorial period (2) he insulted me, as if I had no right to cry.
It was not only him who discriminated me. Everyone stigmatized me. Survivors could not talk to me. One survivor told me uwawe akuvira utamwikoreye (a dear one bleeds on you even when you are not carrying him/her). This means that my suffering was visible through the sadness on my face and it also was saddening those who observed me. Hutus used to tell my perpetrator that it was his own fault that he lived in poverty, because he married a Tutsi woman who was not able to cultivate.
Even though my sister told me to leave the rapist, I did not do it because I did not want to become a burden to anyone. On the other side, the family of this man also disliked me. As people stigmatised me, I was afraid of attending the survivors meetings because I also stigmatised myself. I felt as though I was in jail.
In 2009, this man started to behave even worse to me because I refused to sell a plot of land that had belonged to my parents. After this he said that because we were very poor, he was going to marry a rich woman. The situation was aggravated by the death of one of our four children. In 2010 the child fell sick and was hospitalised. The man refused to pay the hospital fees. During the week I spent in the hospital, he did not come to visit me. After the death of my child, it was my sister who paid the hospital. Coming home, when it was time to bury the dead body of my son, his father did not want him to be buried in what he considered to be ‘his’ plot of land, while in reality I owned half of it. He wanted to sell the whole plot in order to marry a rich woman. He told me that if I would bury the child in his land, he would kill me just like another man from our neighbourhood who had killed his wife. After I refused to bury the child in the ruins of my parents’ house, I separated from this man. My sister started to rent a house for me.
Throughout this whole period, I suffered from psychological problems. I was living in isolation, always crying. I would say that I was like a brainless person (3). A time came where I felt hate towards myself and towards everything else. I stopped going to church. I was depressed, living in fear and grief. I had always headaches and nightmares. I experienced ihahamuka (4), especially during the commemoration period. My life during this period was just crying. I was always falling ill in April. I could spend three whole days in tears. I was always quiet. I only went to commemorate once, in 2006, when we buried the remains of my brother who I loved so much, and who died at the last minute of the genocide.
Even though I was suffering, I did not go to the hospital. I was always at home. I regained my wits after my separation from that man and after I started to join other women and collaborate with them. I was no longer in that man’s prison. The separation somehow reduced the sadness and other problems I had. I had my rights back, the ones I had been deprived of for 15 years. Before, I was not even allowed to benefit from survivor supports. I was told that I was not a survivor. Now separated, I am supported like other vulnerable survivors. Today I have mutual health insurance from FARG (5), and I am on the list for direct support. I did not benefit from any counselling because I was not informed about which organisations provided counselling.
Through the grace of God, one woman who was my neighbour came to me. This woman, who later became a friend of mine, had completed fifteen weeks of sociotherapy (6). Because she had stayed near me while I was going through difficult times, I became open to her. She would advise me when I had problems. She became like my mother. I told her everything because she listened to me. After speaking about all my sorrows my heart was released. The deep thoughts I had about my life reduced. Before I spoke to her, I was always thinking about the rape I experienced and living in loneliness.
In 2011, I was invited by another female neighbour to join sociotherapy. Even though I accepted her invitation I could not see any interest in going to the meeting place every week. During the first four weeks I was wondering why I would go there all the way just for crying. Once, one of our facilitators explained to us the importance of crying. I learned that when you cry, you feel your heart being released. After understanding the significance of crying, I continued to participate. After four weeks I started to like sociotherapy. Another thing that motivated me was the game we played all together. That game showed us how a person can live in isolation, and how she can get out of it. After this game, which helped me so much, I decided not to miss any sociotherapy session. When my neighbour first invited me, I had expected to be supported through income generating activities. But I was not disappointed after realizing that my expectations were different from the aim of sociotherapy. I realised that the discussions we had within the group were important to me.
Before joining sociotherapy, I was always thinking about myself. I was always angry, and I was full of grudges. I also felt that I wanted to live alone. Surprisingly, while I was following sociotherapy, I felt changes in my whole body. The anger, thinking deeply about myself, all these symptoms disappeared. The loneliness has gone. I am no longer crying whenever as I was doing before. Another problem which has gone is the hate towards Hutus. During the fifteen years that I lived with the rapist, I had built a kind of hatred in my heart because of his wickedness towards me. The discussions we had in sociotherapy changed me. They taught me to live peacefully with others. I learned that if people sinned against me, I have to forgive them. This lesson brought peace in my heart. Being angry and bearing this hatred were gradually killing me while they, the sinners, were sleeping. I felt that I have to forgive my enemy, because forgiving brings peace in a broken heart. Since I graduated from sociotherapy, I committed myself to do whatever I can in order to live peacefully with others in the future. And then, I have a dream of having a house. After getting a house, I will work, and then develop myself further.
Although I am appreciative of sociotherapy, I do not know whether my family’s slaughterers are still alive. They were in prison; but they were released after they confessed. They confessed in prison, and later also in Gacaca (7). That is how we learnt about the death of our mother. They told that they killed my mother when she went to fetch drinking water and then threw stones at her until she died. After they confessed, I did not see them again. I did not testify against the rapist, afraid of being called a mad woman by the public. Because although my heart was full of grief and tears, neighbours knew that I was his wife. Gacaca is almost over by now. Those who looted our properties and those who destroyed our house paid our brother back. But the rapist is still walking around freely. What could I do?
Before I finish my story of change, I would advise other women who have been taken by force by a rapist to leave him if they experienced problems similar to mine. I liked that sociotherapy brought me together with other women and that it allowed me to trust myself and others again. Before I joined, I was like a small animal. When someone tried to do anything bad to me, I was reproducing this bad thing twice in return. I have changed, now, and I love other people. I had forgotten to smile like others, but, I am now a changed person and I am looking towards the future.
1. A Hutu paramilitary organisation
2. Each year in April the genocide is remembered nationwide through a range of events
3. Charline is refering to brainlessness due to a congenital disorder
4. A Kinyarwanda concept for a local form of somatic panic attacks
5. National fund for the assistance of genocide survivors
6. See for information about sociotherapy in Rwanda: http://www.annemiekrichters.nl/rwanda
7. Gacaca refers to community courts that have been the centerpiece of Rwanda’s justice and reconciliation programme
Dr Nabeel Hameed is a neurosurgeon, one of only three in the entire country of Bahrain. Yet Wednesday he was sentenced to three months in prison and $700 in fines for the conviction of “illegal gathering” — one of 23 health professionals convicted on these charges.
Dr Hameed was among the physicians, nurses and medical staff of Salamaniya Hospital arrested for treating anti-government protestors during the demonstrations at Pearl Roundabout in March 2011. Their charges included inciting sectarian hatred, promoting the overthrow of the government, harbouring weapons, illegally occupying the hospital, and theft of hospital equipment.
During the brutal crackdown against the demonstrators, about 30 people were killed and hundreds injured, many of whom ended up in the largest hospital in the capital, Salamaniya.
On 15 March 2011, the Bahrain Defence Forces seized control of the hospital, eventually detaining and interrogating some 48 doctors, nurses, medics, ambulance drivers and other hospital staff. Many later came forth and reported that they were tortured while in detention – including Dr Hameed, who was arrested a month after the government seizure of the hospital and detained for about three months.
“We became automatic witnesses,” Hameed explained to CNN’s Christiane Amanpour. “That’s a problem. When we saw the protestors, straight away we became automatic witnesses. To take our credibility away, [they] accuse us of a crime.”
Hameed was accused of killing, rather than treating, a protester who had died at the hospital after his care. The interrogators claimed he had done so to tarnish the public image of Bahrain.
International human rights organisations, including the IRCT, Amnesty International and Physicians for Human Rights, as well as other groups such as the World Medical Association (WMA), condemned the arrest and detention of medical staff in Bahrain.
“While various criminal charges were brought it appears that the major offence was treating all the patients who presented for care, including leaders and members of the rebellion…” WMA wrote in their statement. The global organisation condemned the acts of the Bahraini government, saying it violated the hospital staff’s commitment to medical neutrality.
“If we help others, maybe we can also help ourselves”
The Bahrain Rehabilitation and Anti-Violence Organization (BRAVO) emerged largely from the controversial targeting of doctors and medical staff. Four of the founders were physicians at Salmaniya medical centre.
“We started [BRAVO] out of a need,” he explains. “In some ways, we thought that if we can help others, maybe we can also help ourselves.”
Within a year of being established, BRAVO has already set up three programmes. They provide treatment for eye injuries, a devastatingly common occurrence now in Bahrain as buckshot is a common weapon used against protesters. Victims are, for example, given a glass eye and provided with therapy to train the remaining eye. They have also set up group therapy sessions for victims of sexual harassment and assault. Finally, they have a psychotherapy programme for the families of those imprisoned or tortured.
Hameed’s own family, he says, is doing as well as can be expected. His youngest son was born just a few months after his imprisonment. After being in Copenhagen for the last few days when we spoke, he was excited to get back to his “beautiful wife and kids.”
“But the children in Bahrain,” he says; “these days they’re playing with barricades instead of toy cars.”
There have been large, well-attended protests on the street in Bahrain, particularly in the capital Manama, since the start of the Arab Spring last year. But Bahrain hasn’t followed the narrative of Egypt or Tunisia; despite ongoing protests and a brutal crackdown in March of last year, there has been no change from the Al-Khalifa royal family rule.
In June of last year, the government commissioned an independent report on the allegations of human rights abuses in the country, called the Bahrain Independent Commission of Inquiry (BICI). The BICI report, released in November 2011, was applauded for its forthrightness and frank examination of the abuses in the country, including violent police abuses on the streets and torture within detention facilities. Since the report, some changes have occurred – for example, the trials against the doctors moved to a civilian court instead of a military one; but many have criticized the lack of proper reform.
However, Hameed sees the government actions since the report as “beautified, not as flagrant violations” in comparison with the brutal treatment of 2011.
The government, he says, would like Bahrain to be viewed internationally as the pinnacle of human rights in the Arab world. And they have taken actions, even within recent weeks, to drain the opposition movement.
Indeed, in the days after I spoke with Hameed, 31 Bahrainis – opposition activists who had organised public protests – were stripped of their citizenship for undermining “state security”. Just a few days prior, the government banned public demonstrations, with the Interior Minister saying that “repeated abuse” of the rights to freedom of speech and expression could no longer be accepted.
It’s been the constant attacks and judicial harassment for his public speech that seems to have kept Hameed consistently aggrieved during this process. He stands firm on his right to freedom of expression. Despite the arrest, the torture, the ongoing court cases and the persistent threat of more, he’s defiant, not hostile, but decidedly non-compliant. He will continue to speak against the human rights abuses in Bahrain.
“I don’t mind them personally calling me a criminal. But not a traitor.”
Facing this most recent conviction, it is unknown whether Hameed will lose his license to practice medicine. For the time being though, there is some relief that at least he will not have to go to jail again – he has already served three months and will therefore not have to return. However, the fact that the judge in this case refused to hear any claims of torture from the medics, reflects much of the most recent criticism of Bahrain – that one year after the BICI report, few reforms have taken root.
What is keeping the global torture rehabilitation movement from embracing complementary and alternative medicine (CAM)?
Survivors of torture often have an increased need for mental and physical healthcare due, in part, to complex sequelae of trauma; but, often they also face socio-economic and cultural impediments to access to expensive and unfamiliar western healthcare resources. Put that way, the case for the use of the cheaper and culturally sensitive alternative medicine practices in the treatment of torture survivors seems clear. But, are these practices effective? That is the question being asked at an article published in the latest issue of TORTURE, a scientific journal, by a team of researchers at the Boston University Schools of Public Health and Medicine [PDF].
The shortcomings of (un)conventional western medicine
Aside from its significantly higher costs, it is important to be aware that western medicine isn’t anywhere near an ideal for the treatment of all torture survivors. Some of the barriers may include “language, cultural perceptions of illness,” and, most importantly, “unfamiliarity with western medicine.” For a large majority of torture survivors, western medicine may in fact be more “alternative” than Ayurveda, yoga, music therapy, acupuncture or t’ai chi, to name a few.
Furthermore, for a western medical practitioner it may be difficult to diagnose an exact cause of chronic pain when both physical and psychological factors are contributory and when the right treatment might depend on the patient’s own interpretation of illness. The authors state that “Given the complexity of the resulting diagnosis, it is not surprising that conventional treatments, including pharmacological and psychological therapy, though sometimes helpful, are at times insufficient.”
A mind-body healing approach
CAM modalities promise to compensate for some of the shortcomings of western medicine by offering a cost-effective “mind-body healing approach”, where health is viewed as an “ongoing process encompassing interdependent physical, psychological, and social factors.”
The researchers at Boston University looked at a significant body of scientific evidence on the efficacy of several CAM modalities applied to the treatment of torture survivors and refugees. Despite the shortage of scientific knowledge in this area, their review outlines several promising results and encouraging experiences.
When survivors report a psychological dissociation from the body, a common result of torture and trauma, it seems that massage therapy and bodywork might prove to be the most effective method at hand. Or, when a torture survivor reports disturbed sleep (and up to 80% do), cost-effective and easy to implement yoga practices have been reported to reduce stress and sleep disturbance, as well as being beneficial in the treatment of anxiety (reported by up to 93% of survivors), depression (66%), PTSD and chronic pain.
In the face of growing demand for torture rehabilitation services and diminishing funding streams, the question remains: what is keeping the global torture rehabilitation movement from embracing complementary and alternative medicine?
At the IRCT, we have often reiterated the link between poverty and torture: those in poverty are among vulnerable populations at great risk of being tortured, and torture itself can often push people into further poverty by impinging on their mental and physical well-being.
Over at Freedom From Torture, a member of the IRCT and a UK-based rehabilitation centre, they have pointed to another example of how poverty and torture are sadly intertwined: the poverty of torture victims in the UK makes it increasingly difficult for rehabilitation to be effective.
For the 2012 UN International Day for the Eradication of Poverty, recognised every year on 17 October, they discussed their soon-to-be-released research on how “both the impact of poverty on our clients’ mental health and rehabilitation, and exactly how being a survivor of torture affects the way individuals are able to cope with poverty.” They found that:
Many participants in the research described feeling that as asylum seekers they are treated as somehow inhuman by the government and the communities they live in, which they believed had worsened their mental health problems:
Outside [Freedom from Torture] it’s as if they are making us remember our hardships every day, and you can easily become crazy.”
Read there full blog post here at the Freedom From Torture website.