IRCT Exchange Programme Publication by IRCT International Rehabilitation Council for Torture Victims

Exchange Programme Global Capacity Building Programme

International Rehabilitation Council for Torture Victims

Exchange Programme • Global Capacity Building Programme

Exchange Programme Global Capacity Building Programme International Rehabilitation Council for Torture Victims (IRCT) Borgergade 13 P.O. Box 1022 1022 Copenhagen K Denmark

Phone Fax E-mail Website

+45 3376 0600 +45 3376 0500 irct@irct.org www.irct.org

ISBN 978-87-88882-24-7 (paperback) ISBN 978-87-88882-25-4 (PDF) Printed by the International Rehabilitation Council for Torture Victims (IRCT) 2009 © International Rehabilitation Council for Torture Victims (IRCT) This publication was produced with the generous support of the Dutch Ministry of Foreign Affairs. The views expressed in this publication are those of the authors and can in no way be taken to reflect the official opinion of the IRCT or the Dutch Ministry of Foreign Affairs. Authors: Brandy Boston, Monica Shepley and Annette Nordstrøm.

List of content Introduction ............................................................................................................................... 3 First Exchange Programme trainee concludes internship .......................................................... 8 The Exchange Programme: an eye opener................................................................................ 10 The Exchange Programme: from the US to South Africa to learn about communitybased interventions .......................................................................................................13 Exchange Programme provides many ideas for strengthening centre .......................................16 Reaching out to victims of the Khmer Rouge Massacre in Cambodia.........................................19 Providing treatment to torture survivors from Arab countries: lessons from a peer super-vision ........................................................................................................22 From Bolivia to Uruguay to exchange practices about care for torture survivors ......................25 Improving services through statistical knowledge ....................................................................27 Assisting survivors of state-inflicted violence .......................................................................... 29 Healing traumatised indigenous communities..........................................................................32

Introduction

Introduction The exchange programme was part of the Global Capacity Building Programme 2005 – 2008 funded by the Dutch Ministry of Foreign Affairs. This programme was designed to decentralise IRCT activities while securing sustainable development of capacities in the regions. Over a three year period a series of peer supervisions and internships were conducted between both IRCT member centres and non-member centres across the globe. The knowledge and skills to be exchanged include treatment and rehabilitation, client registration and statistics, fundraising, financial management and legal assistance. The first call for applications was sent out in March 2006. Twenty-eight applications were received of which 9 internships and 1 peer supervision were conducted. The

second call in 2007 brought in 58 applications, of which 10 internships and 2 peer supervisions took place. The third and final call was even more favourable with 82 applications received, of which 15 internships and 11 peer supervisions were held. The exchange programme has been a very successful and popular programme for the IRCT and the participating centres. It has enabled face-to-face, on-site professional trainings and it has allowed the staff from rehabilitation centres to receive constructive feedback on the quality of work they are doing. Moreover, it has helped mainstream the best practices across the IRCT network and consequently improved the quality of rehabilitation services provided for victims of torture.

“The exchange visits acted as an eye opener for many of the staff at the three centres involved as it was discovered that information sharing is an important tool of organisational development and growth.” Ann Wekesa of IMLU, Kenya

Exchange Programme โ ข Global Capacity Building Programme

Internships and peer supervisions in 2006

INTERNSHIPS (IS) NO. IS-1 IS-2 IS-3 IS-4 IS-5 IS-6 IS-7 IS-8 IS-9

FROM Argentina, EATIP Argentina, EATIP Bolivia, ITEI India, TOP India Trust Kenya, IMLU Morocco, AMRVT Turkey, TOHAV Turkey, TOHAV USA, PSTT

TO Bolivia, ITEI Guatemala, ECAP Mexico, CCTI Sri Lanka, FRC Uganda, ACTV and Zimbabwe, AMANI Trust Switzerland, UMVM Argentina, EATIP Sweden, Malmรถ Red Cross South Africa, TCSVT

PEER SUPERVISIONS (PS) NO. APPLICANT CENTRE PS-1 Cameroon, CRAT

PEER SUPERVISOR Jaak Le Roy, independent consultant, Belgium

Introduction

Internships and peer supervisions in 2007

INTERNSHIPS (IS) NO. IS-1 IS-2 IS-3 IS-4 IS-5 IS-6 IS-7 IS-8 IS-9 IS-10

FROM Bolivia, ITEI Brazil, GTNM Bulgaria, ACET Cambodia, DC-Cam Chile, CINTRAS Georgia, Tbilisi State Med. Univ. Pakistan, SACH Sierra Leone, CAPS South Africa, TCSVT Turkey, HRFT

TO Argentina, EATIP Argentina, EATIP South Africa, TCSVT USA, Torture Treatment Center of Oregon Germany, BZFO Turkey (Istanbul), Dept. of Forensic Medicine Turkey, HRFT Uganda, ACTV Cameroon, TCC Myopain 2007 conference, USA

PEER SUPERVISIONS (PS) NO. APPLICANT CENTRE PS-1 Cambodia, TPO PS-2 Georgia, GRCT

PEER SUPERVISOR Fiety Meyer-Degen, ICTEP, Netherlands Christian Pross, bzfo, Germany

Exchange Programme • Global Capacity Building Programme

Internships and peer supervisions in 2008

INTERNSHIPS (IS) NO. IS-1 IS-2 IS-3 IS-4 IS-5 IS-6 IS-7 IS-8 IS-9 IS-10 IS-11 IS-12 IS-13 IS-14 IS-15

FROM Bolivia, ITEI Brazil, GTNM Cambodia, TPO Colombia, AVRE Egypt, El-Nadim Center Honduras, CPTRT Mexico, CCTI Moldova, Republic of, RCTV Peru, CAPS Peru, CAPS Romania, MRCT Russia, Compassion Centre Russia, Compassion Centre Russia, INGO CAT USA, ASTT

TO Uruguay, SERSOC Uruguay, SERSOC Philippines, Balay Guatemala, ODHAG South Africa, TCSVT Mexico, CCTI Guatemala, ECAP Switzerland, UMVM Australia, STARTTS Guatemala, ODHAG Greece, MRCT Germany, Caritasverband für die Stadt Köln Germany, Caritasverband für die Stadt Köln Bosnia and Herzegovina, CTR Cameroon, CRAT

PEER SUPERVISIONS (PS) NO. APPLICANT CENTRE PS-1 Bangladesh/India/Sri Lanka, SOSRAC/CRTS/Survivors Associated Nepal PS-2 Bolivia, ITEI PS-3 Congo DR, SAVE PS-4 Ecuador, PRIVA PS-5 Kenya, MATESO PS-6 Kosovo, KRCT PS-7 Kyrgzstan, Golos Svobody PS-8 Pakistan, SACH PS-9 Palestine, TRC PS-10 Rwanda, Uyisenga N’Manzi PS-11 South Africa, TCSVT

PEER SUPERVISOR Kent Hung, independent consultant and Bidur Osti, PPR, María Silvia Campos and Marcelo Rossi, EATIP, Argentina Rene Tondo, Centrum ’45, Netherlands Felicitas Treue, CCTI, Mexico Soraya Martinez, independent consultant Mytaher Haskuka, independent consultant, Serbia Mimoza Dimitrova, ACET, Bulgaria Ajith Tennakoon, independent consultant, Sri Lanka Husam Abdelkhaleq, ACCESS, USA Jean-Pascal Godfroid, IRCT Craig Higson Smith, People Tree Group, South Africa

Introduction

Applications, internships and peer supervisions in 2006-2008 90

80 70 60

50 40

30 20

15 10

9 10

2006

2007

11 Applications Internships Peer supervisions

2008

Exchange Programme • Global Capacity Building Programme

First Exchange Programme trainee concludes internship Hamiyet Yüce of TOHAV, Turkey visited the Swedish Red Cross Centre for Victims of Torture and War in Sweden as an intern from 10 to 17 September 2006 The physiotherapist Hamiyet Yüce, who works at the Foundation for Social and Legal Studies (TOHAV), based in Istanbul, was the first of the group of ten people selected for the IRCT Exchange Programme 2006 to complete her internship. She spent a week in September in Malmoe, south of Sweden, to take part in a training programme in the Swedish Red Cross Center for Victims of Torture and War. Back home, Hamiyet is pleased with the results of the internship in Malmoe and convinced that the holistic therapy methods she got more familiar with will help her improve the treatment she gives to victims of torture and former prisoners who were submitted to isolation. She intends to immediately start employing these methods in her therapy sessions.

Unknown methods One of the main reasons why she applied for training in Malmoe’s Red Cross was that she wanted to get more familiar with the Basic Body Awareness Therapy (BAT) and the Body Awareness Scale (BAS). Hamiyet had already been introduced to BAT in another training programme run in Turkey by a physiotherapist and the manager of Malmoe’s Red Cross Barbra O’Connor. However, she was not confident about how to use BAS to assess the condition of victims of torture. As Barbra O’Connor explains, BAS is a scientifically proved method used to assess both psychological and physical conditions

of victims of torture. It can be used to evaluate if improvements in the condition of a patient have been achieved. BAS has widespread use in Sweden but, according to Hamiyet, is still unknown in Turkey.

Art therapy In Sweden, Hamiyet took also part in sessions of art therapy consisting of painting sessions and analyses of the pictures made by patients. Similarly to BAS, art therapy has not been employed in the treatment of torture victims in Turkey, which is going to change soon if Hamyiet’s plans succeed. “I believe we can begin to use art therapy between the end of this year and the beginning of 2007. It will depend on when we can get funds to buy art materials,” she says. Hamiyet’s experience has proved that the Exchange Programme is not only beneficial to the trainees but also to the training provider. “Hamiyet has shared her own experiences with us as well. We have learnt a lot about the differences between the Turkish and Swedish systems”, tells Barbra O’Connor. In her opinion, there is a much stronger hierarchy in Turkey, where doctors are much more in charge of the treatment “Here we adopt a more holistic view”, she adds.

Global capacity Barbra is very positive in relation to the Exchange Programme and says that Malmoe’s Red Cross Center is open to receive new trainees. She emphasizes, though, that

First Exchange Programme trainee concludes internship

trainees need to be able to communicate well in English.

Update Since the exchange, Hamiyet has found the knowledge gained from the internship very useful. “Of course this programme has been so useful for my work. I have known Body Awareness Therapy (BAT) before but I didn’t know it perfectly. I learned the BAT with detail in this programme and I have used it on traumatic patients.” Hamiyet applied her new found knowledge of BAT to 19 patients who have suffered from chronic pain, post traumatic stress symptoms, sensory amnesia after long imprisonment and Wernike Korsakoff syndrome after hunger strike. She also applied Art Therapy on traumatized patients, “and I obtained good results,” says Hamiyet. Hamiyet has also been able to share her experience and new knowledge with her

colleagues. Following the exchange she conducted a five-day training on Body Awareness Therapy to 5 of her colleagues (all physiotherapists). She has also shared her knowledge of BAT and Art Therapy with a psychiatrist, a psychologist and two voluntary psychologists working at TOHAV. When a Psychologist friend and colleague from Paris visited Hamiyet at TOHAV, together they treated Wernicke Korsakoff syndrome patients with BAT. Back in Paris, the Psychologist used the experience to write her doctorate thesis. In December 2007 Hamiyet presented two topics at the 5th Annual International Psychological Trauma Symposium. The topics were “The effects of the Body Awareness Therapy (BAT) on physical and psychological symptoms of the patients with Werniche Korsakoff” and “Coping with Trauma through art therapy- case study”.

Exchange Programme • Global Capacity Building Programme

The Exchange Programme: an eye opener Ann Wekesa of IMLU, Kenya participated in an internship at ACTV, Uganda from 6 to 10 November and Amani Trust, Zimbabwe from 12 to 17 November 2006 Despite diverse social and political environments, centres located in different countries have a lot to learn from each other, concluded Ann Wekesa, Finance and Administration Officer, from the Independent Medico-Legal Unit (IMLU), Kenya, after visiting ACTV in Uganda and Amani Trust in Zimbabwe. In November 2006, Ann Wekesa spent almost a week at ACTV (African Centre for Treatment and Rehabilitation of Torture Victims) and the Amani Trust in Zimbabwe discussing with local staff how to develop a finance and administration manual of procedures to be shared with other African centres. Her visits were sponsored by the IRCT Exchange Programme. The need for a standard finance and administration procedural guide became clear during the Sub Saharan African Torture Rehabilitation Centre’s Regional Meeting, held in 2005 in Rwanda. The centres who attended the meeting discussed their difficulty in accessing funds from major potential donors, and lack of adequately documented administrative procedures was cited as one of the reasons for this. Ann Wekesa was then chosen to lead the development of the financial and administration manual which will be circulated among the Sub Saharan network and that centres will be free to wholly or partially adopt. During her internship, Ann Wekesa discussed the content of the manual and developed a draft of the document in collabo-

ration with staff of the host organisations. The document, which is still under revision, will include a broad range of issues such as accounting, asset management procedures, personnel, travel and procurement policies. The drafting process also included the review of the various administrative systems employed by the centres, identification of gaps in the centres’ management and brainstorming on ways to strengthen the organisations.“This was also an opportunity in which the participating centres could learn about how each partner centre works their fundraising strategies as well as how they mobilise resources both locally and internationally,” tells Ann Wekesa. According to her, the host organisations were very receptive and offered a lot of support. “They were always ready and willing to give information whenever requested,” she says. “The exchange visits enhanced IMLU’s relationship with ACTV and Amani Trust and both centres were eager and really looking forward to carry out similar exchanges in the future to strengthen the Sub Saharan network,” she adds. “The exchange visits acted as an eye opener for many of the staff at the three centres involved as it was discovered that information sharing is an important tool of organisational development and growth,” says Ann Wekesa. “Despite the different social and political environments in which we all operate, there are various management issues that run across all centres,” she adds.

The Exchange Programme: an eye opener

Ann Wekesa of IMLU, Kenya Ann Wekesa is still in touch with ACTV and Amani Trust as they work towards finalising the manual: “I exchange a lot of information with the centres through e-mail and plan to disseminate the final manual to the network members by the same means.” She also intends to act as a resource person to help new and upcoming centres put in place good administrative and finance policies and procedures to enhance their financial management. She mentions, for example, the human resource management aspect, especially performance evaluations and management. “I hope we can fully implement this area so that we strengthen the personnel component within IMLU,” she says. For her, the Exchange visits also turned out to be an excellent opportunity to learn about areas that the other centres have not exploited yet, such as motor vehicle usage policies and procedures.

She was also happy to have learnt how ACTV has taken up the rights-based approach to rehabilitation of torture survivors. She tells: “I was lucky to be at ACTV when they were holding a meeting with the survivors who have benefited from their services. At the end of the day, with the assistance of a facilitator, they agreed to come up with a cooperative society, which is one way of helping the survivors be self sustainable as most often they lose their sources of earning a living once they are tortured.” Based on her own experience, Ann Wekesa strongly recommends the IRCT to offer new exchange program opportunities to the Sub Saharan network. “There is a lot of expertise and experienced personnel with different skills and knowledge in different centres and I am sure that it will make a huge positive impact in the Sub-Saharan

Exchange Programme • Global Capacity Building Programme

Africa torture rehabilitation centres if they are given a chance to share and exchange their ideas. Best practices will be learned and an innovative regional way of rehabilitating survivors will be developed,” she affirms.

Update Anne no longer works with IMLU, but her work is being carried on by the new Finance and Adminstration Officer, Wanjiru Gathuru, who took over in July 2007. Wanjiru has prepared the first draft of the finance and administration manual and it

is now being reviewed by the Board of IMLU. Once it is approved, she plans to share it with other centres in Sub Saharan Africa via email. Wanjiru has also made sure that the human resource management aspect is being strengthened. IMLU has conducted its first performance evaluations for staff members in December 2008. “The first appraisal was successful. We are using the outcome to further improve on the appraisal system of IMLU,” states Wanjiru.

“Despite the different social and political environments in which we all operate, there are various management issues that run across all centres.” Ann Wekesa IMLU, Kenya

The Exchange Programme: from the US to South Africa to learn about community-based interventions

The Exchange Programme: from the US to South Africa to learn about community-based interventions Psychologist Dr. Sonali Gupta of PSTT, USA visited TCSVT, South Africa as an intern from 19 February to 2 March 2007 Through a two-week internship at the Trauma Centre for Survivors of Violence and Torture (TCSVT) in Cape Town, South Africa, the psychologist Dr. Sonali Gupta gleaned principles and recommendations that now help her develop community-based interventions within refugee and asylum communities in the United States. The internship, carried out in FebruaryMarch 2007 was a professionally and personally enriching experience, says Dr. Gupta, currently working at the Program for Survivors of Torture and Severe Trauma (PSTT), based in Falls Church, VA and serving clients from Washington DC, Virginia and Maryland, in the United States. The majority of clients served by PSTT come from African countries, which is one of the reasons why she applied for the internship, as she expected that it would enhance her knowledge of culturally appropriate interventions and service delivery. “Although cultures and socio-political histories differ among African countries, there may exist certain similarities that would allow the learning acquired at TCSVT to be applied to the services provided to clients from other African countries,” reckons Dr Gupta. The internship confirmed her reasoning and enabled her to create a series of recommendations on developing community-based interventions and programmes.

Her experience at TCSVT also confirmed her idea that social, political and cultural factors which result in structural violence and affect the individual must be included in the therapy if treatment is to be successful. “A particularly interesting aspect of my work in South Africa was to understand how the joint legacy of apartheid and colonialism continues to impact individuals, families and communities,” she adds.

Common challenges Dr. Gupta found common aspects in the services delivered and challenges faced by PSTT and TCSVT. As an example, the centres experience similar challenges in the delivery of office-based outpatient psychotherapy, including a lack of understanding of mental health services, clients not showing up for appointments, and a lack of follow-through on subsequent appointments. As with the PSTT programme, psychoeducation is an important aspect of psychotherapy at TCSVT as a way of addressing these issues and creating a framework for the therapy. However, while the PSTT programme implements both a short and long-term treatment model depending on the client’s needs, TCSVT staff indicated that a shortterm treatment model is more common due to factors such as the client’s lack of understanding about psychotherapy and funds for transportation to and from appoint-

Exchange Programme • Global Capacity Building Programme

Dr. Sunali Gupta of PSTT, USA

ments. Another reason for the higher incidence of short-term treatment is that TCSVT clients generally have positive social supports (i.e., family, community ties and friends) that may play a crucial role in their psychological recovery and thereby limit the need for extended psychotherapy. On the other hand, PSTT clients, as a result of forced migration, have often lost the familial, social and community ties that could have supported their psychological recovery and health. TCSVT’s experience emphasises the need for psychotherapy to support PSTT clients to create meaningful relationships in their host community. Lastly, both programmes acknowledged the importance of evaluating their services for therapeutic effectiveness.

Possibility for mutual learning Dr. Gupta says that choosing TCSVT as the host institution was a fortunate decision. “During my internship, I was very grateful

to TCSVT staff for their willingness to meet with me to discuss their programmes and work, answer my questions, make agency resources available to me (such as the library), and involve me in on-going projects and meetings when possible,” she tells. Dr. Gupta stresses the importance of mutual learning in initiatives such as the Exchange Programme: “There should always be an expectation that the host centre will also benefit from the skills and knowledge of the intern and that her/his contribution be discussed and incorporated into the internship schedule when planning the exchange.”

Experience sharing Back home, Dr. Gupta has been exchanging ideas about community-based interventions with colleagues who work with survivors. She is also writing an article about alternative community-based healing practices, such as the community museums that

The Exchange Programme: from the US to South Africa to learn about community-based interventions

document human rights violations, which she became aware of in South Africa. In addition, she plans to put into practice what she learned about communitybased interventions by developing relationships with community providers and leaders and developing collaborative programmes. “The idea is to develop programmes that are embedded in the client’s community, that are self-sustaining and that empower the client and community, such as a community-based programme that helps clients navigate the host culture, access basic needs, develop English language skills,” she explains.

Update Due to structural and management changes at PSTT in 2007 it became very difficult for Dr. Gupta to apply what she had learned about developing community partnerships and implementing community based focused programs, as she intended. “How-

ever, it is my hope to engage in communitybased work once the organization is more stable”, said Dr Gupta. Despite this small setback, Dr. Gupta has managed to implement other new skills. She has “been more attentive to assessing for the presence or absence of social support with my clients. In addition, if social support is lacking I seek to actively address this with my clients and efforts are made to improve the client’s social network if the client is in agreement with this as a treatment goal.” She has also shared her knowledge gained with colleagues during the organisation’s weekly one hour meetings. More recently, in January 2008, Dr. Gupta was able to share the guidelines she had developed from the exchange at a capacity building seminar for the National Partnership for Community Training in Greensboro, North Carolina, USA.

Exchange Programme • Global Capacity Building Programme

Exchange Programme provides many ideas for strengthening centre Joseph Sam of CAPS, Sierra Leone visited ACTV, Uganda as an intern from 18 to 29 February 2007 Joseph Sam, CAPS – Sierra Leone, recounts the lessons learned during ten days as an exchange participant at the African Centre for Treatment and Rehabilitation of Torture Victims (ACTV) in Uganda.

Focus on organisational management “I chose ACTV because their vision – ‘a world free from torture by security agencies and organised armed groups’ – closely relates to that of CAPS,” says Joseph Sam. “With their vast knowledge in working with victims of torture, a visit to this centre could be a step in the right direction in making sure that CAPS develops in a conducive atmosphere in serving their clients better, meeting donor requirements and managing their staff effectively to heal the wounds of individuals suffering from war trauma and torture related issues.” During the first week of his exchange, Joseph Sam spent time in each of ACTV’s departments, learning about everything from administration and financial management, to how the centre counsels victims, to communications and advocacy work. He notes: “ACTV has been successful over the years in the implementation of activities due to its diverse activities... the holistic (medical, physiotherapy, nursing care, legal advice, social and trauma counselling, etc) approach used by ACTV enabled them to gain reputation from the communities they have worked in and the partners they are working with for the elimination of

torture and all sorts of human rights abuses.”

A visit to the field The second week of the exchange permitted Joseph Sam to visit ACTV’s field centre in Gulu. In addition to meeting with staff, he also visited a local camp for internally displaced persons, many of whom are clients at the Gulu centre. The advantage to the field visit for his work, he describes, was that “clients in this region have similar experiences as those of CAPS, as they have gone through years of war”.

Positive outcomes At the conclusion of his exchange, Joseph Sam drafted a series of recommendations for his centre. These covered a broad range of activities, including responsibilities of the centre’s Board of Directors; financial management and reporting; advocacy and training; project planning and budgeting and creating a long-term vision for CAPS. Additionally, he provided several suggestions for ACTV and the IRCT. For ACTV, Joseph Sam made recommendations regarding co-ordination of work with the Gulu centre, evaluation and length of Board members’ tenure, ensuring client confidentiality and working with volunteers. Recommendations to the IRCT focused on improvements to ease the logistics of future exchanges, and the need to facilitate sharing of information between centres on treatment tools.

Exchange Programme provides many ideas for strengthening centre

Joseph Sam of CAPS, Sierra Leone

Joseph Sam concluded: “My relationship with the host centre was very much cordial as I met with all available staff and they were very much cooperative with me in my exploration and work at the centre… I will be in close contact with ACTV to update them on the impact of the visit on my centre.”

Update Based on Joseph Sam’s recommendations following the exchange, several improvements have been made at CAPS. The centre hired a finance manager who, in addition to managing the centre’s finances, has also helped them meet donor requirements. “This enabled us to secure a bridging grant from RCT for six months. Due to the satisfactory report that has been presented, the centre is in negotiation with

the RCT for a future collaboration,” states Joseph Sam. The board of directors have now been given defined roles and responsibilities. Board members who have not performed were replaced by the general membership at an annual conference following the recommendations made by Joseph Sam. “The Board’s composition is now one with a mixture of different calibres with people from different backgrounds.” Another positive change is a documentation system has been implemented at CAPS based on what ACTV applies. The database is used to track changes in clients’ symptoms. Also, as Joseph Sam states, “Networking with other partners and donors has increased tremendously since the visit was made. For Joseph Sam the experience was personally rewarding, “…my knowledge in

Exchange Programme • Global Capacity Building Programme

A camp for the displaced in Gulu proposal writing and budgeting has increased so much that the centre now relies on me in writing, reviewing and giving advice on the centre’s general project. Since I am serving in the capacity of the centre’s

proposal/budget consultant, I have been appointed to serve as the centre’s liaison officer; Public Relations Officer.”

Reaching out to victims of the Khmer Rouge Massacre in Cambodia

Reaching out to victims of the Khmer Rouge Massacre in Cambodia Savina Sirik of DC-CAM, Cambodia visited the Intercultural Psychiatric Program of the Oregon Health Science University, USA as an intern from 3 February to 3 May 2008 Savina Sirik, an IRCT Exchange Programme participant, describes how an internship with a U.S. centre treating Cambodian refugees will help build the capacity of staff at the Documentation Centre of Cambodia to better serve trauma patients. The Documentation Centre of Cambodia (DC-Cam), a non-profit organisation which aims to document the history of the Khmer Rouge and to promote accountability for those who committed war crimes, has run the Victims of Torture (VOT) project since 2003. Assisting DC-Cam with implementation of the VOT project is Transcultural Psychosocial Organisation Cambodia (TPO), an IRCT member centre. However, with limited staff, TPO can only counsel a small number of torture and trauma patients. Ms Savina Sirik, a DC-Cam researcher on the VOT project, applied to the IRCT Exchange Programme to improve her and her staff’s abilities to provide treatment to those suffering from post-traumatic stress disorder (PTSD) and other emotional problems. An estimated 80% of Khmer Rouge survivors suffer from PTSD or mood/anxiety disorders.

From Cambodia to the United States Ms Sirik identified the Intercultural Psychiatric Program (IPP) of the Oregon Health Science University as the host institution

for her internship. The IPP provides treatment and therapy to Cambodian refugee torture survivors, among others, many of whom suffer severe PTSD. The internship focused on training in understanding primary and secondary trauma symptoms, as well as counselling skills. Further, Ms Sirik sought to strengthen her capacity to assist better those survivors who might serve as witnesses during the upcoming trials of the Khmer Rouge leaders. Activities during her exchange included: • Seminars with doctors in the Intercultural Psychiatric Program • Observations of group counselling and clinical work • Supervision by Cambodian counsellor • Reading class materials • Participating in staff meetings.

The importance of community One of the primary lessons Ms Sirik learned during her exchange was that other services can be just as important in the treatment process as counselling and medical care. In the U.S, she observed how Cambodian refugees benefit from social and language support in addition to psychological treatment. In Cambodia, the lack of adequate mental health services means that VOT must rely on community support. She notes that religion and traditional culture are key

Exchange Programme • Global Capacity Building Programme

Savina Sirik at Oregon’s only Cambodian Buddhist temple, where she celebrated Cambodian New Year during her internship with IPP tools to help Cambodians. Ms Sirik says, “Respected elders, religious leaders, and defined key persons in communities will be our targets to receive psycho-education and training on PTSD and major depression primarily suffered by traumatized people.”

Looking ahead To further build capacity and sustainability of the VOT project, several IPP staff have agreed to act as consultants and offer longterm support through training and evaluation. A psychiatrist and a Cambodian counsellor will make two visits to DC-Cam to monitor and provide training on identification of PTSD and to evaluate the project. Adds Ms Sirik, “We will also keep the programme [IPP] as our resource for studies of Cambodian refugees and mental illness.” Ms Sirik concludes by saying that “the IRCT Exchange Programme provides a great opportunity for students, individuals and NGO members to gain knowledge and experience in one's particular field with other institutions. This programme provides a great deal of advantages to de-

veloping countries to develop their human resources.”

Update One of the objectives of the exchange was for Ms Sirik to strengthen her capacity to assist survivors who might serve as witnesses to the Khmer Rouge trials. Ms. Sirik has been involved in assisting survivors who may be complainants or observers to the trials. The programme provides survivors with training on how the trial proceedings work, and for villagers, how they can participate in the tribunal. The training also imparted some of Ms Sirik’s lessons learned while in the USA by explaining the different coping mechanisms between Cambodian refugees in the US and Cambodians in Cambodia. “It intended to provide incredible view of how their opportunity to participate in the tribunal is valuable.” As planned, DC-CAM and IPP still stay in contact and involved in the VOT project. In December 2008 Dr. James K. Boehnlein, professor of Psychiatry at the Oregon

Reaching out to victims of the Khmer Rouge Massacre in Cambodia

Health and Science University visited DCCAM to conduct a training on PTSD. Then, together with the VOT team, Dr. Boehnlein also conducted a training on stress reactions for villagers and community leaders in the province. In addition to this training, community leaders received a training on the legal courts of Cambodia and interventions related to psychological problems.

Another successful result of the exchange is that DC-CAM has signed a subcontract with the National Programe for Mental Health (NPMH) to refer patients to them for treatment. â&#x20AC;&#x153;Without denial, the programme itself and the experience from the exchange has contributed to the cooperation of Center with the NPMH to treat survivors with mental problems,â&#x20AC;? said Ms Sirik.

Savina Sirik with colleagues at the Intercultural Psychiatric Program (IPP) of the Oregon Health Science University

Exchange Programme • Global Capacity Building Programme

Providing treatment to torture survivors from Arab countries: lessons from a peer supervision Counsellor/supervisor Husam Abdelkhaleq of ACCESS, USA visited TRC, Palestine as a peer supervisor from 27 to 31 July 2008

Through the IRCT exchange programme, Mr Abdelkhaleq spent a week in Ramallah as a peer supervisor with TRC, participating in case presentations, home visits to clients and discussions about documentation, treatment modalities and caring for caregivers.

the happiness of all, such as the family, larger community and the society. We must take this into consideration and develop a model of treatment that includes cultural and social components.” Another challenge to treating Arab torture survivors is a pronounced reluctance among this group to receive mental health services. Through his peer supervision, Mr Abdelkhaleq offered TRC suggestions about how to engage community and other authority figures to counter the stigma associated with mental illness and to become more involved in the decision making and strategic planning for the centre.

Cultural context

“Dedicated and caring”

One important element Mr Abdelkhaleq observed was that both TRC and ACCESS serve torture survivors coming from Arab countries. TRC treats Palestinian torture survivors, while ACCESS works with Iraqi refugees who have been subjected to torture. Treating these survivors requires careful consideration of their cultural values. “The Western style of treatment is more individualistic and insight oriented therapy,” Mr Abdelkhaleq stated. “However, Arabic culture is more collectivist, with the happiness of the individual coming from

Mr Abdelkhaleq calls TRC’s staff “very dedicated and caring individuals”. Yet he cautioned them that burn-out and secondary traumatisation can result from this type of work. He encouraged TRC to put more emphasis on care for caregivers, e.g. through weekly staff meetings to allow staff to express any negative feelings and gain support from their colleagues. He also shared ideas about the holistic approach that ACCESS has utilised over the past eight years with Iraqi torture survivors.

Husam Abdelkhaleq, a counsellor/supervisor at the U.S.-based ACCESS – Psychosocial Rehabilitation Center for Victims of Torture, describes how the IRCT Exchange Programme offered an opportunity to strengthen collaboration and knowledge sharing with the Treatment & Rehabilitation Center for Victims of Torture (TRC) in Ramallah, Palestine.

Providing treatment to torture survivors from Arab countries: lessons from a peer super-vision

Husam Abdelkhaleq, a counsellor and supervisor at ACCESS One suggestion is the formation of a social club, where survivors “improve their social skills, avoid the isolation that most survivors experience, learn skills, and gain more trust in others”.

Increasing collaboration – locally and internationally Another outcome of the exchange was the opportunity for the centres to discuss scientific research. TRC’s director and the peer supervisor initiated a plan for shared research that

uses common assessment tools, which will enhance knowledge regarding treatment of survivors coming from similar Arab backgrounds. Moreover, Mr Abdelkhaleq invited TRC’s director to present a scientific paper at the Fifth National Conference on Health Issues in the Arab American Community, which took place on November 6-7, 2008 at Dearborn, Michigan.

Exchange Programme • Global Capacity Building Programme

26 June at ACCESS

Update The peer supervision “did have some positive impact in terms of gaining new perspectives and exchange of expertise. It also allowed us to see how others deal with some issues,” reports Mr. Khader Rasras, Programme Manager at TRC. The knowledge and skills introduced by Mr. Abdelkhaleq has mostly been shared internally at the centre, although representatives of local organization have participated in trainings on occasion.

TRC’s General Director, Dr. Mahmud Sehwail attended the aforementioned conference in Dearborne Michigan. He presented a paper on “The Phenomenon of Violence as perceived by Palestinian school children aged 14-17 years”. The conference was an enriching experience for Dr. Sehwail as he was able to exchange expertise and establish contacts. Mr. Rasras explains that Dr. Sehwail was encouraged by the “shared concern and interest in carrying out a research…” The centre remains in contact with Mr. Abdelkhaleq and looks forward to further cooperation in the future.

From Bolivia to Uruguay to exchange practices about care for torture survivors

From Bolivia to Uruguay to exchange practices about care for torture survivors Isabel Chuquima Blanco of ITEI, Bolivia visited SERSOC, Uruguay as an intern from 28 July to 9 August 2008 Isabel Chuquimia Blanco, Assistant of Medicine and Administration at ITEI, Bolivia, describes how an exchange with the Uruguayan centre SERSOC provided valuable observations of theoretical and practical techniques in psychiatry and psychology that will help to improve the quality of care for torture victims in South America.

Improving quality of care The focus of the ITEI–SERSOC exchange was on institutional practices of care for torture survivors. By participating in interventions at the personal, group and community level, Ms Chuquimia gained more knowledge about diagnostics, evaluation and treatment for the rehabilitation of torture survivors. Ms Chuquimia participated in numerous psychological interviews, after which she was able to discuss the cases and associated treatment with SERSOC’s psychiatrists. The 25 years of experience of SERSOC staff were a valuable asset to help answer questions about her work in Cochabamba, Bolivia: “I was able to compare psychosocial, clinical, economic and political contexts that are involved in the violations of human rights and torture in both urban and rural areas,” she noted. Related to the clinical services is the effective management of data on the persons served by the centre. As Ms Chuquimia stated, “It was important that I could observe the database and information system

managed by the organisation. These systems are of much help in the work, and I learned that it is really necessary that one specific person, a bibliothecaologist, take charge of them.”

Elaborating history and culture Ms Chuquimia’s exchange included opportunities to learn more about the political history of torture in Uruguay and its effects on survivors. At the Memorial Museum, she viewed a video of testimonies from former political prisoners and obtained data from the museum’s documentation centre. She also visited a former maximum security prison for political prisoners, where she had the opportunity to watch another video, this time about the return of an exiled person to his family, in which the “transgenerational consequences and effects were made visible”. Ms Chuquimia also met with Bolivian, Argentinean and Uruguayan representatives for a cultural exchange and gave presentations on Bolivian society – “a very enriching experience” according to SERSOC staff. She spoke to a Bolivian user of SERSOC to learn about her personal experience of receiving treatment at the Uruguayan centre.

“Great support and understanding” Ms Chuquimia felt that the “great support and understanding from all the members of SERSOC” contributed to a beneficial exchange experience. She also stressed that

Exchange Programme • Global Capacity Building Programme

Ms Isabel Chuquimia Blanco of ITEI, Bolivia (to the left)

the exchange was useful on more than an individual level: “This exchange should not only be useful for one, but for all members of the teams providing rehabilitation services to survivors of torture.” The staff at SERSOC also had a positive review of the experience: “In the longer term we believe this exchange has paved the way for a dialogue with Ms Chuquimia and others from ITEI, Bolivia, with the possibility of producing joint scientific materials related to our respective areas of expertise.”

Update Through her internship at SERSOC, Ms Chuquimia has learned that treatment and interventions can be applied in an

interdisciplinary manner, combining psychiatric, medical and psychological fields. She has applied this experience while assisting in the care of victims of violence and racism in Sucre, Bolivia. “The exchanges really strengthen us who are working in the field of torture and violence, especially in Bolivia where we really need education and guidelines from other colleagues with more experience. This way we can improve the quality of the care we give to those affected by torture and state violence. She also remains in contact with colleagues from SERSOC, giving them updates about the local situation electronically.

Improving services through statistical knowledge

Improving services through statistical knowledge Mytaher Haskuka visited Kosova Rehabilitation Center for Torture Victims (KRCT), Kosova as from 22 September to 2 October 2008 As part of the IRCT Exchange Programme, the Kosova Rehabilitation Center for Torture Victims (KRCT) received training in organising and analysing statistics from peer supervisor Mytaher Haskuka. By acquiring new skills in data management, the centre hopes to build on its long and successful history in providing needed services to torture survivors. The research unit of KRCT was established in 2006, and remains central to the centre’s functioning. As Director Feride Rushiti explains, “Documentation and research are two interrelated activities of the centre, since documentation leads to research question and research contributes to documenting torture related materials, identification of priorities and clients with special needs”. In consultation with the peer supervisor, it was decided that basic training in statistics and the Statistical Package for Social Sciences (SPSS) would provide KRCT staff with the knowledge necessary for organising data in order to monitor and evaluate the impact of treatment on torture victims. Topics included fundamental concepts in descriptive and inferential statistics – such as operational definition of concepts and creation of measurements tools such as questionnaires, calculation of reliability and scoring of questionnaires, descriptive measures, regression, probability distribution and multivariate analysis.

Hands-on exercises using actual client data reinforced the concepts learned.

Sharing knowledge among the staff Six KRCT staff members participated in face-to-face supervision and training during the 10-day exchange, in order to maximise the impact. Because KRCT also values sharing knowledge and opportunities with students, a psychology student collaborating with the centre also participated. Ms Rushiti stressed that, following the exchange, the participants shared their skills with members of the rehabilitation staff. “Therefore,” she explained, “the impact of the training will go beyond the trained team and will have a broader impact on the quality of KRCT services”.

Outcomes Utilising previously gathered client information allowed KRCT staff to turn the concepts of the training into measurable objectives and goals for their future work. During the exchange period, the trainees were able to import information about 25 clients into SPSS, which will help them to monitor progress and assess the outcomes of psycho-social treatment provided. Moreover, the centre’s existing database “has revised an update according to international standards”. The peer supervisor also discussed how to evaluate work already completed as well as guided the group in thinking about fu-

Exchange Programme • Global Capacity Building Programme

Six staff at the KRCT participated in the training

ture programming and project development. The exercises and discussions, he noted, led to defining “clear cut measurable objectives both at the organisational level of KRCT and at the individual level on staff performance measures”. In this way, Mr Haskuka felt that the training made excellent progress toward its two objectives – to increase the institutional sustainability of the KRCT and to improve the quality of services provided for victims.

Update The exchange appears to have achieved the expected results. KRCT has able to optimize necessary knowledge and organize data more efficiently. The centre is able to monitor and evaluate the impact of treatment of torture victims. Ms. Rushiti

reports that “the knowledge gained also supported research unit to update and bring new instruments in the data bases. The outcome of the data served for client progress reports as well as KRCT policies and advocacy tools.” KRCT has continued to share knowledge gained from the exchange. Even the psychology student who participated in the training has, as planned, shared the experience within her association of psychology students. As a result, “a team of rehabilitation and research staff is currently working on the hard flies in order to improve the gaps we identified during the training,” explains Ms. Rushiti. Since the exchange, KRCT’s research unit has had continuous support from the peer supervisor in order to respond to challenges identified during the exchange.

Assisting survivors of state-inflicted violence

Assisting survivors of stateinflicted violence Neurologist Natalia Dzhirikova and psychiatric nurse Anastasia Cherenkova from Compassion Humanitarian Centre, Russia visited Caritasverband für die Stadt Köln, Germany from 24 to 30 November 2008 An internship under the IRCT Exchange Programme offered neurologist Natalia Dzhirikova and psychiatric nurse Anastasia Cherenkova the opportunity to acquire new therapeutic skills to deliver comprehensive, patient-centred care to elderly survivors of torture from Stalin’s repression and Nazi camps in Russia. The two women work at Compassion Humanitarian Center in Russia, one of the first post-Soviet non-governmental organisations, with 17 years of experience in the rehabilitation and recovery of the health and dignity of victims of torture and cruel and inhuman treatment. Compassion Center provides medical, psychological and social help for elderly victims of political repression; serves women and children in the Moscow vicinity who have escaped from war zones; and promotes a culture of nonviolence through public activities across Russia. Both women interned at Caritasverband für die Stadt Köln, Germany (Caritas). While each had specific goals related to building skills in their particular specialties, they both sought to learn how to help survivors of state-inflicted violence to return to fulfilling personal and public lives. The internship included visits and observations of several Caritas programmes, including the Therapy Center for Torture Victims, St. Lazarus Geriatric Center and Der Halbe Stern Society. Throughout the

week, the women were able to observe therapeutic practices, attend seminars and speak with Caritas staff about their interventions and approaches.

Support to elderly survivors of past abuses One portion of the internship that both women found particularly inspiring was the visit to St. Lazarus Geriatric Center, which accommodates senior immigrants who fled totalitarian regimes. Each patient at St. Lazarus is monitored around the clock, and offered comprehensive psychological support, respectful attention and care. This visit was especially relevant given that the general target group of the Compassion Center’s services are elderly victims of Stalin and Nazism who experience postponed consequences of torture and inhuman and degrading treatment. The compassion of staff toward these patients was noteworthy, Anastasia Cherenkova observed: “Their patients are very old and frail: political repression, long detention in prisons, camps and prison-like orphanages profoundly traumatized these people. It was particularly important for me to see how the staff treat the old people with respect, mutual trust and sensitivity”. Natalia Dzhirikova noted that she experienced “excitement and inspiration” whilst observing the care of the senior patients. “The staff know their patients’ life stories and explain specific behaviours of

Exchange Programme • Global Capacity Building Programme

Anastasia Cherenkova of Compassion Humanitarian Centre, Russia the old people by the traumatic events of their youth, even when the patients are bedridden and cannot speak. The staff are familiar with personal habits and preferences of patients with severe dementia, including their past and current interests and favourite activities”, she stated. “Importantly, the focus of treatment and care is not to ‘correct’ or ‘adjust’ the patient’s condition, but instead to understand and respond to their specific actions and behaviours”.

The value of human dignity During her exchange, Natalia Dzhirikova also was able to observe therapies she had not encountered before, including aromatherapy, music therapy and iridotherapy. But regardless of which type of therapy is used, she also saw “that successful application of the observed methods used for rehabilitation of torture and ill-treatment victims relies heavily on whether the care professional is sensitive, respectful and open to the patient. To achieve successful rehabilitation of my patients, I should value their human dignity, appreci-

ate their desire to be independent from outside intervention (including health care), and to enjoy their personal space and free choice. The provider’s attitude towards the patient makes all the difference, no matter how many different methods of therapy the provider may have learned”. Anastasia Cherenkova echoed her colleague’s sentiments: “To assist in rehabilitation of a torture victim, providers must treat the patient with respect, establish a relationship of trust, approach and treat physical and mental symptoms as a whole, and be sensitive about anything which may remind the patient of the torture. Mental problems suffered by torture survivors are a normal reaction to abnormal events”.

Sharing lessons learned Both women felt that the IRCT Exchange Programme further solidified the relationship between Compassion Center and the IRCT network. Having had its first contact with the IRCT in 1993, they noted that Compassion Center “has the possibility to have operative information on new methods of treatment of victims of torture and has ac-

Assisting survivors of state-inflicted violenceAssisting survivors of state-inflicted violence

Natalia Dzhirikova of Compassion Humanitarian Centre, cess to the experience of all of the IRCT rehabilitation centres”. The two health professionals had specific ideas to share the knowledge and skills acquired during the internship with their centre, including engaging colleagues in informal discussions of the care professionals’ role in protecting patients’ dignity. Both women also stated that they hope to translate the informational materials they were given into Russian and to disseminate it to all mental care hospitals in Moscow and on Compassion Center’s new website. “Russian doctors are not sufficiently aware of methods combining medical and psychological care”, Natalia Dzhirikova observed. “At the moment, a holistic approach to “treating the body and soul” has only been adopted by a limited number of providers, and I am honoured to be one of them”.

Update Both Anastasia Cherenkova and Natalia Dzhirikova continue to work for Compassion Humanitarian Centre. Ms. Dzhirikova reports that since the exchange

she is able to communicate with patients more openly, more sincerely and with more tolerance. “I see their sufferings…it is better than earlier”. She also admits, “I have learnt to take pleasure now in my work through I surrounded by ill and even dying patients, every day.” Ms. Dzhirikova has shared her knowledge with colleagues and patients who are victims of Stalin camps through lessons on “preventative maintenance of neurological infringements and posttraumatic consequences for nervous system” and the connections between neurological infringements and the consequences of living in a concentration camp. Ms. Dzhirikova remains in contact with staff from Caritas for guidance on an experimental project for establishing a day centre for patients with Alzheimer’s disease. Ms. Dzhirikova expects to apply the lessons learned at Caritas “to set an example of tolerant relations to victims of torture and cruel treatment, having problems with memory and nervous system.”

Exchange Programme • Global Capacity Building Programme

Healing traumatised indigenous communities Psychologist María Silvia Campos and psychiatrist Dr Marcelo Rossi from Argentine Team of Psychosocial Work and Research (EATIP) conducted a peer supervision at Institute of Therapy and Research about Sequelae of Torture and State Violence (ITEI) from 10 to 17 December 2008. In December, mental health professionals from the Argentine Team of Psychosocial Work and Research (EATIP) travelled as part of the IRCT Exchange Programme to Sucre, Bolivia to collaborate on a treatment project with the Institute of Therapy and Research about Sequelae of Torture and State Violence (ITEI). Their mission: to provide clinical and psychosocial care to dozens of persons brutalised in attacks by the opposition to the Bolivian government. On 24 May 2008, the day before the Bolivian President was scheduled to attend a demonstration, autonomist right-wing university students attacked several dozen indigenous people, mostly farmers, who’d come to Sucre to receive ambulances sent to their villages by President Evo Morales Ayma. In addition to being beaten, insulted and threatened, the farmers – whose money and possessions were stolen by those groups – were forced to remove their indigenous clothes and watch as these were burnt along with other cultural symbols.

Reaching out with a treatment approach ITEI, an IRCT member centre that provides treatment to survivors of torture and other political violence in Bolivia, visited those places with the highest concentration of

victims to collect information about the attacks and understand better the needs for assistance. ITEI requested support from colleagues at EATIP, who have significant experience providing psycho-therapeutic services to those affected by human rights violations. Psychologist María Silvia Campos and psychiatrist Dr Marcelo Rossi from EATIP agreed to collaborate with ITEI in offering treatment to those affected. To ensure they reached those who needed care the most, both organisations made a last call through radio transmitters Aclo and Sucre inviting persons to receive services. The team also made a presentation to the Only Federation of Workers from Native Populations of Chuquisaca, an organisation that requested the collaboration of human rights groups and that has offered care to the primary victims, logistical support and contact with the populations concerned. During an intensive four-day period in December, the joint ITEI-EATIP team provided care to 72 persons in Sucre and in four rural mountain zones at 4000 meters altitude: Zudañez, Redención Pampa, Mojocolla and Icla, in the department of Sucre, Chuquisaca. Intensive attention was given in both individual and group processes, taking into consideration the limited amount of time and the great number of persons that received assistance.

Healing traumatised indigenous communities

MarĂa Silvia Campos of EATIP, Argentina (left) with a client (right) and an interpreter at the ITEI in Bolivia

A welcome response to the caregivers Even after seven months, both physical and psychological sequelae remain significant in the affected population, due to the seriousness of the harm and/or a lack of medical and psychological care. As part of the investigation 41 victims with physical injuries received medical examinations; 37 had multiple injuries including cranium traumas, wounds requiring sutures, burns, thoracic and lumbar traumas, joint pain and loss of weight. Many persons also exhibited symptoms of post-traumatic stress disorder, with symptoms such as nightmares, insomnia, nervousness, paralyzing fear, difficulty keeping jobs, relationship problems, etc. A significant affectation of entire families was found.

After the field activities the professionals from ITEI and EATIP gave a press conference to disseminate the results and conclusions of their examinations. Radio, television and graphic media assisted. Despite their ongoing trauma, those affected by the May events welcomed the ITEI and EATIP professionals and expressed to them that their services were greatly valued and considered essential. Though many of the affected persons have yet to fully recover following the trauma they suffered, they have all expressed a will to obtain justice, and that the victims and their families receive a moral reparation in order to re-establish their dignity as human beings.

Healing traumatised indigenous communities

One of the communities receiving assistance

â&#x20AC;&#x153;There should always be an expectation that the host centre will also benefit from the skills and knowledge of the intern and that her/his contribution be discussed and incorporated into the internship schedule when planning the exchange.â&#x20AC;? Ann Wekesa IMLU, Kenya

The International Rehabilitation Council for Torture Victims (IRCT) is an independent, international health professional organisation that promotes and supports the rehabilitation of torture victims and works for the prevention of torture worldwide. Based in Denmark, the IRCT works in collaboration with a global network of nearly 200 rehabilitation centres and programmes worldwide. The IRCT also works in partnership with governments, human rights organisations, health professional organisations and intergovernmental organisations. The IRCT strives to promote a world that values and accepts shared responsibility for the eradication of torture. In support of this vision, the IRCT: • raises awareness of the rehabilitation needs of torture victims, • promotes and support the establishment of treatment facilities around the world, • works for the prevention of torture and an end to impunity, • documents the impact and consequences of torture, and • works to increase funding for rehabilitation centres and programmes worldwide. The organisation has special consultative status with the UN Economic and Social Council and the UN Department of Public Information, and participatory status with the Council of Europe. The IRCT works closely with health professional organisations, including the World Medical Association (WMA), the World Confederation of Physical Therapy (WCPT), the World Psychiatric Association (WPA), the International Council of Nurses (ICN), and Physicians for Human Rights (PHR).

International Rehabilitation Council for Torture Victims Borgergade 13 P.O. Box 9049 1022 Copenhagen K Denmark Tel +45 3376 0600 Fax +45 3376 0500 E-mail irct@irct.org Website www.irct.org ISBN 978-87-88882-24-7 (paperback) ISBN 978-87-88882-25-4 (PDF)