Posts Tagged holistic rehabilitation
Many questions come to mind when thinking about torture. What methods are used? Where does it happen? Who does it? Who are the victims? We have answered many of those questions in this blog.
But how do victims overcome the trauma from torture? Or the physical sequelae left by brutal methods of torture? There are probably as many questions and doubts surrounding rehabilitation as there are about torture itself. Here are some of the answers.
1. What is rehabilitation?
Rehabilitation is simply ridding of the effects of torture – it is to empower the torture victim to resume as full a life as possible. Torture rehabilitation can take a variety of forms. In approaching it through a holistic approach, rehabilitation can include medical treatment for physical or psychological ailments resulting from torture; psychosocial counselling or trauma therapy; legal aid to pursue justice for the crimes; or programmes and activities to encourage economic viability, among others.
2. Why do torture victims need special treatment?
In many contexts, torture survivors seeking rehabilitation can only receive regular care and many physicians will not realise they are in the presence of a torture survivor. The risks associated with that are many and much has been written about that particular issue. In brief, not all therapeutic approaches have been described as useful in the treatment of victims of torture. Also, therapeutic procedures can easily recreate the torture experience, putting the torture survivors at risk of re-traumatisation.
The questioning, the testing instruments used, the physical space, the power relationship between the clinician and patient, etc., all have the potential to recreate the torture conditions, thus undermining the positive benefits of therapy. In some of situations, the treatment administered by non-specialized clinicians can even lead to harmful effects to the survivor.
3. What is the right to rehabilitation and is it an enshrined right by law?
In the first instance, the UN Convention Against Torture and other Cruel or Inhuman, Degrading Treatment or Punishment outlines the rights of an individual, outlaws torture, and promotes respect for the human rights of an individual.
Article 14 defines precisely that rehabilitation of a victim is a state responsibility which should be enforced in every complaint of torture. It reads:
“Each State Party shall ensure in its legal system that the victim of an act of torture obtains redress and has an enforceable right to fair and adequate compensation including the means for as full rehabilitation as possible.”
However, while there is a right to rehabilitation defined on paper by the UN, the right is not necessarily granted – even among the 154 state signatories. Also some countries have not ratified the convention into their national legal systems, and other countries have not signed the convention altogether.
4. What are some of the main forms of rehabilitation?
Rehabilitation programmes vary depending on the context in which the support is implemented, the resources available to the organisation issuing the programmes, and the nature of rehabilitation needed by the torture survivor. However some main forms of psychological and physiological support include: counselling; therapy, individually or group; psychotherapy; social reintegration programmes; medical assistance; artistic classes; exercise programmes; yoga; and much more.
5. Do the rehabilitation programmes work?
Yes. Targeted, tailored programmes of rehabilitation do not only allow the torture survivor to overcome their ordeal, but it can also allow their family, friends, or community to rebuild.
You only have to look at some of the stories from survivors of torture to realise that rehabilitation is fundamental is ensuring a victim of torture can live their life as fully as possible. You can read some stories of survivors by clicking this link.
6. Is rehabilitation ensured across the globe?
No. Even among the 154 state parties (across 80 different countries) to the UN Convention Against Torture and other Cruel or Inhuman, Degrading Treatment or Punishment, rehabilitation is not assured – at least not by the state. Across the world, some statistics point to torture being practiced in around 90% of the countries. Many of these do not provide adequate services for redress and rehabilitation through the state, so the responsibility falls onto anti-torture organisations – such as the IRCT members – who must move survivors past their experiences of torture, often with limited resources and under the watch of authoritarian regimes.
7. What is the IRCT, and what is its role in torture rehabilitation?
The IRCT is the largest membership-based civil society organisation to work in the field of torture rehabilitation and prevention. It is their mission to ensure there is access to rehabilitation services and justice for victims, and to contribute to torture prevention. Currently, the IRCT consists of 144 members across 74 countries.
8. How many people have been treated by the IRCT?
With members spread across more than 70 countries and the risks associated with the safety of torture survivors, accurate data collection is a significant challenge for the IRCT. However, figures gathered in the past suggested that more than 100,000 torture victims have been helped by IRCT member organisations across the globe on a single year.
9. Who can rehabilitation benefit?
The physical and mental after-effects of torture are far reaching but so are the benefits of rehabilitation. The victims but also their families, friends and sometimes their entire communities. There may be different approaches necessary in the rehabilitation programmes, and there may be different obstacles to rehabilitation, but the benefits can be felt by any victim of torture. To be as inclusive as possible, members of the IRCT network therefore tailor their programmes to best suit the contexts in which they operate.
10. Through rehabilitation, prevention and justice, can there be a world without torture?
Yes. The world can be rid of torture just like it was rid of slavery. Undoubtedly, the journey is long and full of obstacles, but with the right mix of rehabilitation, justice and prevention, the vision of a world without torture can be realised.
Editor’s Note: The following blog post comes from José Utrera, Regional Coordinator for Latin America. As a holistic approach to rehabilitation of torture survivors must take into consideration the various cultural contexts and methods of collecting data and reporting as well as healing and treatment, Jose addresses the issue of intercultural approaches in the Latin American context. This is the first of two blog posts from IRCT’s annual Latin America meeting of torture rehabilitation centres.
The 16th meeting of the Latin American network of health institutions working against torture and other violations of human rights took place in the last week of September, in the Andean city of Quito, Ecuador. Twenty-seven representatives of 16 organizations, almost all them IRCT members, from 13 Latin American countries met to exchange experiences and discuss strategic issues related to their work.
One of the issues discussed in the meeting was the intercultural approaches to prevention, rehabilitation and access to justice related to victims of torture. This is an important matter because in several countries indigenous people and others as Afro-descendants are significant proportion of the population. Latin American centres are using different methodologies and strategies to face this issue.
A rehabilitation centre in Colombia presented on their experiences of immersion and continuous adaptation of their methodologies and ways of intervention with indigenous communities of Cauca. Before starting the process of collecting and assessing information on the traumatic experiences the communities suffered, staff agree with the population on the purposes and uses the information. Thereafter, the staff live within the communities for some weeks, taking part in their social and religious activities to gain the confidence of people, especially the women, to share their experiences and to understand it as much as possible those experiences and the ways they cope with it. As the team’s comprehension of the resources that communities have to cope with the traumatic experiences— such as, religious rituals, medicinal plants, etc. — and the expectations of the victims and the concrete political context increase, the methodologies for data collection and assessment of individual and collective damage and the approach to rehabilitation are adapted.
The representative of an allied organisation in Guatemala presented their experience on data collection and reporting about the traumatic experiences of indigenous people victims of genocide. They emphasised not only the need to accurately know the language, but also the ways indigenous people express the personal significance and feelings during and after torture, which frequently is difficult to translate in Spanish as it reflects an own worldview (cosmovisión). She also pointed out the need to accompany the victims, especially the women, not only to prepare their testimonies, but also during and after they attest.
The lessons from the regional seminar show the importance of adapting treatment methods to the particular cultural context of victims, one of the fundamentals of holistic rehabilitation.
Different centres presented their experiences, sharing the following issues:
- the methodologies for immersion to gain confidence of indigenous people to share their traumatic experiences and understanding of those experiences;
- aspects related to language, particularly the ways indigenous people express the significance and feelings during and after torture;
- regular adaptation of intervention strategies according to emerging insights of the traumatic experiences and the way persons and communities want to deal with it;
- methodologies to assess the individual and collective damage, including the adaptation and validation of instruments for investigation and reporting;
- adaptation of rehabilitation approaches according to their own resources (traditional medicine, social mechanisms, rituals), their values and the political contexts in which these take place;
- training of professionals to recognise these cultural factors in the processes of assessment and rehabilitation of torture cases.
During the discussion of those experiences, the participants stated that the assessment and reporting of torture cases in the multicultural societies of Latin America aims to a) administer justice, and b) to recognize each person citizen’s rights no matter what his/her culture.
By José Utrera , Regional Coordinator for Latin America and Caribbean
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?
Editor’s Note: This is the second in a week-long series from Lars Døssing Rosenmeier, who is writing from the Middle East – North Africa (MENA) Regional Seminar in Amman, Jordan. The seminar is part of the European Commission-supported project, Non-State Actors, which you can read more about here. Read here for the first post.
The very initial moments of treating a torture survivor – the first interviews and basic data questions – can have greater importance than one expects.
The family in the short video had been arrested and tortured by Israeli armed forces after two members of their family were killed in a demonstration against the seizure of their land. The two phases shown in the film – the initial stages of intervention, and after they had received primary rehabilitation services – testify to the power of rehabilitation.
The family shown had received care at the Treatment and Rehabilitation Center for Victims of Torture (TRC), based in the Occupied Palestinian Territory of the West Bank.
The video was one presented by TRC at the IRCT Middle East-North Africa (MENA) Regional Seminar, which they are currently co-hosting with the IRCT Secretariat in Amman, Jordan this week. The meeting has brought together 20 health and human rights professionals from across this region to discuss some fundamental practices of their respective rehabilitation clinics.
Intake proceedings and documentation were the focus of the regional seminar this week: where health professionals gathered together to learn their respective procedures and processes to work towards determining a standardised form for data sharing. While collecting data and information, such as name, gender, birth date, and employment status, may seem like a simple function of a rehabilitation clinic, identifying the information that is already collected and can therefore most easily be shared across all treatment centres within the MENA region is very important for the fight against torture.
As Wisam Sehweil of TRC said, referring to the set of simple data that can now be shared; “I have been in many trainings, but this is the first time that a consensus is sought and reached in this way”.
It’s important because doctors, nurses, psychiatrists and psycho-social counsellors are also human rights advocates when working in torture rehabilitation. They are fighting for the right to health and rehabilitation for the torture survivors they meet with every week. International human rights treaties, such as the UN Convention Against Torture, the UN Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, oblige states to provide protection from torture and proper rehabilitation for torture victims.
So what can health professionals do? In addition to treating and rehabilitating torture survivors, health professionals have the knowledge and experience on the ground to advocate for states to live up to these obligations. That’s why creating standardised procedures, such as basic data collection, is important in the fight against torture: health professionals, as human rights advocates, can bring this information to the United Nations and inform the UN monitors about the unmet needs of torture survivors in their country.
So this week in Jordan, 20 participants, from 10 different torture rehabilitation centres in 7 countries, are addressing these questions and in the processing reframing the way we think of health care professionals. Lest we forget: doctors, psychologists and counsellors are among those on the forefront of the fight against torture.
Lars assists the membership team, focusing on management of the NSA project. The NSA project is supported by the European Commission.