Content Manual Content Комплексная реабилитация лиц, переживших

пытки

Torture

for Survivors of Survivors for

Rehabilitation Holistic

Содержательное руководство Holistic Rehabilitation for Survivors of Torture

Content Manual

Training guide for the delivery of Freedom from Torture’s 5-day ‘Holistic Rehabilitation’ training exchange programme Funded and supported by the EC

This publication is produced within framework of the Penal Reform International’s project “Strengthening institutions and building civil society capacity to combat torture in 9 CIS countries”.

The publication has been produced with the financial assistance of the European Union. The contents of this document are the sole responsibility of the Penal Reform International and can in no circumstances be regarded as reflecting the position of the European Union.

Produced by:

Freedom from Torture (formerly known as the Medical Foundation for the Care of Victims of Torture). Training programme designed and developed by: Tina Puryear. With contributions from: Leanne Macmillan, Lynn Hiltz and Hannah Rutledge.

The training programme was developed as part of a partnership project with Penal Reform International on Torture Prevention in the CIS countries.

© A Freedom from Torture, October, 2011. All rights reserved. Holistic Rehabilitation 3 Content

Introduction 6 Chapter 1 – Understanding holistic rehabilitation 9

1. General overview 9 2. Theory 9 A. Why holistic rehabilitation? 9 B. What is holistic rehabilitation? 9 C. Human rights-based approach 11 3. In practice 13 Case studiy: Asatur 13 4. Justice and rehabilitation 15 Example: Peru 16 Example: Canada 17 Example: Nepal and India 18 Case study: The West Bank 19 Case study: South East Asia 20 5. Ethical issues to consider 21 6. Conclusion 22

Chapter 2 – Rehabilitation as a right 23

1. General overview 23 2. Theory 23 A. The right to rehabilitation 23 B. The State’s obligation 24 3. Why Article 14 is important 27 A. Benefits of seeking justice 27 B. Benefits of compensation 27 4. International standards and domestic legislation 29 Example: Kazakhstan 30 Example: Armenia 30 4 Penal Reform International

5. The reality of rehabilitation as a right 31 A. The justice dilemma 31 B. Obstacles to accessing rehabilitation 33 Example: United kingdom 33 6. Our role in promoting holistic rehabilitation 35 A. Medical 35 B. Clinical 35 C. Legal 36 D. Client data 36 7. Striving for the right to rehabilitation – the role of the survivor 36 8. Supplementary materials 37 A. Justice denied 37 B. Additional readings 38 9. Conclusion 47

Chapter 3 – Rehabilitation as a process 48

1. General overview 48 2. Theory 48 A. Holistic rehabilitation as a process 48 B. Interdisciplinary work 49 C. Enabling voice through survivor activism, examples 50 D. Worker safety, self-care and well-being 53 3. Holistic rehabilitation: what and how 54 4. In practice/reality 55 A. Practical aspects of holistic rehabilitation at FfT, examples 55 B. Rehabilitation in the context of your countries, examples 61 C. Psychotherapeutic treatment for trauma 63 D. Holistic rehabilitation services 64 5. Ethical issues to consider 65 6. Supplementary materials 65 Case study :Ali 65 Holistic Rehabilitation 5

Chapter 4 – Communicating rehabilitation externally 67

1. General overview 67 2. Theory 67 A. Policy and advocacy workers 67 B. Campaigners 68 C. Researchers 68 D. Community development workers 68 E. Training and capacity building 68 Example: Freedom from Torture 69 3. Ensuring your public-facing work is survivor-led 71 Example 72 4. Ethical issues to consider 73 6 Penal Reform International Introduction “We are human beings, 0.5 Our goals are to rehabilitate torture survivors, to prevent further instances not ants that can be of torture and eventually to eradicate crushed like nothing.” torture altogether. These ambitious but essential goals will require a combination Torture survivor and Freedom from of international pressure, action by Torture client governments and vigilance on the part of civil society. PRI’s project will focus 0.1 Survivors of torture have experienced to a large extent upon developing, more horror than anyone should in a strengthening and supporting a range of lifetime, yet their suffering does not mechanisms and institutions intended to necessarily end when the torture stops. The combat torture. journey back into society can be a painful struggle although recovery is possible. As 0.6 There is an identified lack of capacity professionals working with survivors of within civil society to participate effectively torture, our job is to help people rebuild in such prevention and rehabilitation their lives and rediscover the full physical, work. Thus, modules covering training emotional and psychological health that and the exchange of expertise have been torture has stolen from them. incorporated into PRI’s project in order to build civil society’s capacity to support and 0.2 The content of this manual is based advocate for holistic and comprehensive on Holistic Rehabilitation, a 2011 training programmes of rehabilitation. Freedom programme delivered by Freedom from from Torture has been sub-contracted Torture (“FfT”) on behalf of Penal Reform to lead on the rehabilitative components International (“PRI”). of PRI’s overall project. Our training and 0.3 This manual combines theory with capacity-building initiatives are based practical examples and case studies. It on existing models of international good includes discussion questions, comments practice which are founded upon the core and feedback given by participants in concept of ‘rehabilitation’ as being both the 2011 Holistic Rehabilitation training a right and a process. The rights to ‘as programme. We hope that it will inspire full rehabilitation as possible’ for survivors you in your own work with torture of torture are understood to encompass survivors and give you ideas to implement not only legal advice but also medical, in your own country. psychological and social support services The training participants Reason for training 0.7 The training was designed for and 0.4 PRI commissioned Freedom from delivered to multidisciplinary groups of Torture to design and deliver a week- participants from the legal and clinical long training programme on the holistic professions, including lawyers, human rehabilitation of survivors of torture. This rights defenders, doctors, psychologists, training programme forms part of a larger counsellors and social workers. All programme of work on torture prevention participants, regardless of discipline, being carried out by PRI in 9 of the profession or place of employment were Commonwealth of Independent States required to: (“CIS”) countries. Holistic Rehabilitation 7

• have a demonstrated commitment to Overall aims and the protection and promotion of human rights, specifically the prevention objectives of training/ of torture and cruel, inhuman and workshop degrading treatment • have an established record for effective 0.9 Overall aim: to promote holistic action related to the prevention of and comprehensive programmes of torture and/or the rehabilitation of rehabilitation based on existing models of survivors of torture international good practice. • have experience in delivering human 0.10 Overall learning objectives: by the end rights education activities such as of the 5-day exchange visit, participants will training sessions, workshops, public be able to awareness campaigns, advocacy and • Define holistic rehabilitation monitoring • Recognise the key components • have the authority, scope and capacity necessary for rehabilitation models to to implement the practical initiatives be holistic and comprehensive, fulfil for applying the knowledge and skills the rights of and meet the needs of gained in this project as part of their survivors of torture in participants’ work plan communities • occupy a position enabling them to • Assess the relationship between directly influence the development protection, justice and rehabilitation of rehabilitation services in their community • Evaluate current and proposed holistic rehabilitation approaches and models • have experience working as part of an in the legal and clinical sectors based interdisciplinary team or approach on existing models of international good • be willing to participate in any baseline practice or evaluation surveys or interviews • Analyse the local and national contexts relevant to research carried out as part within which participants work and the of the project opportunities and constraints which 0.8 Participants came from 9 of the may assist or hinder the application of CIS countries and were divided into holistic rehabilitation models 3 regional groups. An average of 9 • Evaluate current domestic and regional delegates participated in each week-long legislation in light of international training session, generally consisting of standards 3 participants from each country. Their comments, feedback and discussions are • Link holistic and comprehensive included in this manual alongside material rehabilitation approaches and theories used in the sessions. to their national contexts • Investigate/explore how their own rehabilitation work can become more ‘survivor-led’ and incorporate survivors’ voices • Identify the individuals, services and professions needed as partners or 8 Penal Reform International

links so as to ensure that participants’ they are ‘survivors’ and that they might not rehabilitation support is holistic and use that term to describe themselves. We comprehensive encourage those who have experienced torture to use whatever terminology they • Design a context-specific plan of are most comfortable with when talking action advocating for holistic and about their torture experiences. However, comprehensive programmes of here at Freedom from Torture we use the rehabilitation based on existing models term ‘survivor’ because by still being alive of international good practice in we would say that a person has ‘survived’ participants’ communities torture. They may still be very vulnerable and damaged as a result of their torture, but we believe it is important to recognise Terminology used in this the tremendous strength and courage manual required to live through the experience of torture. 0.11 At Freedom from Torture, and in 0.12 In this manual, we are dealing with this manual, we refer to a person who has people who have experienced torture. experienced torture as a ‘survivor of torture’ However, much of what we discuss in or ‘survivor’. In the context of rehabilitation, the context of clinical work also relates we may also refer to a survivor as a ‘client’. to survivors of other forms of extreme We understand that not all people who violence. have experienced torture feel as though Holistic Rehabilitation 9 Chapter 1 Understanding holistic rehabilitation 1. General overview 2. Theory 2. Theory A. Why holistic rehabilitation? A. Why holistic rehabilitation? B. What is holistic rehabilitation? 1.2 The goal of a torturer is to ‘kill’ a person C. Human rights-based approach without causing their death. While torture 3. In practice is used to fragment, break and destroy a person, the aim of rehabilitation is to help Case study, practical analysis, put them back together. Torture has such discussion a devastating impact that an individual 4. Justice and rehabilitation survivor may need help on a number of levels to effectively rebuild their life. Holistic Case studies, practical analysis, rehabilitation takes into account the varied questions and complex needs of a torture survivor. This 5. Ethical issues to consider training programme will look at the many strands involved in holistic rehabilitation. 6. Conclusion

B. What is holistic 1. General overview rehabilitation?

1.1 By the end of chapter 1, 1.3 The image of a rope can be useful as readers will be able to: an analogy for holistic rehabilitation. A rope is made of many intertwined strings. • Define holistic rehabilitation Under great strain, an individual string may • Recognise the key components break, but the rope is much stronger than necessary for rehabilitation models to any of the individual strings. A number be holistic in their effect, and capable of individual strings woven together can of addressing both the rights and needs support a much greater weight. of torture survivors in participants’ 1.4 A holistic understanding of rehabilitation communities includes the following strands: • Assess the relationship between • ‘Justice’ or legal protection, justice and rehabilitation • ‘Healing’ or clinical • Evaluate current and proposed approaches to promoting holistic • ‘Practical support’ or social rehabilitation models in the legal and • ‘Integration’ and ‘Awareness raising’ or clinical sectors, based on existing community models of international good practice 1.5 The goal of holistic rehabilitation is to assist a survivor in rebuilding their life and to feel healthy, safe and whole once more. Holistic rehabilitation strives to ensure that a survivor is not only self-sufficient but 10 Penal Reform International

is also empowered to engage with and - Music proactively contribute to their community. - Mother and babies - Work skills Holistic rehabilitation services • Survivor activism and survivor voice 1.6 Holistic rehabilitation services (for example, Survivors Speak OUT are interdisciplinary and can include Network. See chapter 3 for more detail) doctors, psychiatrists, psychologists, psychotherapists, physiotherapists, • Legal aid and support for legal issues casework-counsellors, lawyers, social welfare workers, teachers and community Survivor-led (see chapter 3 for outreach workers. A rehabilitation approach further detail) can be described as holistic when it looks at the survivor of torture as a whole person and 1.8 It is of paramount importance that any supports all of their needs. These needs can individual practitioner’s work with torture include the four ‘strands’ discussed above: survivors be survivor-led. Due to the legal, clinical (including physical, psychiatric, complexity and variety of needs of torture psychological and emotional health), social/ survivors engaged in holistic rehabilitation, practical and community. many types of potential intervention exist. A survivor of torture should be able to choose Holistic rehabilitation approaches the type of intervention they receive. (see chapter 3 for more detail) 1.9 Survivor-led work means that the practitioner listens to the survivor and 1.7 Many potential approaches to holistic supports the individual in making their rehabilitation can be taken. The particular own choices. The survivor is always at the approach used by any individual survivor centre of the work, taking an active role in of torture will depend on their unique making decisions about the support that circumstances and needs. Some potential they receive and in setting the pace of approaches include: the work. The survivor should be able to • Therapy - psychological counselling, control the amount and speed of disclosure support (short to long-term) of information relating to their torture. The experience of torture strips away any sense • Individual medical assistance to address of control from survivors, thus working physical damage, pain relief, loss of in a survivor-led way helps the individual mobility re-gain a sense of control and personal • Occupational support empowerment. A professional working in a survivor-led way supports the survivor • Social support in stating what they want and need, rather • Community integration than deciding what is best for the survivor. • Group work • Alternative therapies, including: Survivor activism (see chapter 3 - Gardening for more detail) - Writing 1.10 “It’s our voice, our stories. Who better to speak for us than ourselves?” - Art observed a survivor of torture from Chad. Holistic Rehabilitation 11

Giving survivors a public voice can be an example, lawyers and clinicians. The extremely powerful tool for reaching those ‘Human Rights-Based Approach’ (“HRBA”) who believe torture works. In the context of can provide a common framework when holistic rehabilitation, supporting survivor working with survivors of torture. activism means helping clients (both 1.14 A Human Rights-Based Approach is former and, where appropriate, current a new approach to assessing priorities clients) to speak out against torture and and developing programmes that began influence decision makers. Survivors’ within the United Nations (“UN”) and the voices are critical in shaping opinion and international development sector. influencing the decisions that directly affect them. 1.15 The concept of a rights-based approach has now spread beyond the 1.11 In addition, many torture survivors UN into other sectors such as community benefit from telling their stories. Being groups, local charities, the health and able to tell others what happened to them education sectors and so on. Growing and express their opinions on how a world numbers of organisations are realising the without torture could be created can have a benefit of incorporating a rights-based markedly rehabilitative effect. approach into their work to ensure that their programming is holistic and inclusive. The whole person 1.16 A rights-based approach is founded on the conviction that every human being is, 1.12 As professionals, it is important that by virtue of being human, a holder of rights. we remember the person behind the The values of a rights-based approach label ‘torture survivor’. This whole person include: justice, equality, dignity, respect is so much more than the torture they and inclusion, to name just a few. have experienced. It is important to think about their life before the torture as well 1.17 According to a United Nations Deve­ as the effects the torture has had on them. lopment Group document, The Human Looking at the wider person in the context Rights Based Approach to Development of their life-history may shed light on why CooperationTowards a Common Under­ certain individuals have been targeted for standing Among UN Agencies, available at: torture. For example, in some contexts http://www.undg.org/?P=221 (accessed on people are targeted because of categories 16/09/11), programmes and services striving they are seen to fall into by torturers, such to incorporate a rights-based approach as gender, race, religion, age, ability, class, should include the following elements: culture, ethnicity, education, sexuality, 1. People are recognised as key actors spirituality, political activity, etc. in their own development rather than passive recipients of commodities C. Human Rights-Based and services Approach 2. Participation is both a means and a goal 1.13 As we have discussed, holistic 3. S trategies are empowering, not rehabilitation involves multidisciplinary disempowering teams. However, there is a need to work within a common frame due to the differing 4. B oth outcomes and processes are professional languages spoken by, for monitored and evaluated 12 Penal Reform International

5. Analysis includes all stakeholders • Shared analysis of research (including 6. Programmes focus on marginalised, excluded, oppressed, deprived or disadvantaged, and excluded groups marginalised groups in research and analysis) 7. The development process is locally owned • Consciousness raising / advocacy 8. Programmes aim to reduce disparity • Supporting and accompanying relationship building 9. Both top-down and bottom-up approaches are used in synergy 1.20 At the core of the human rights approach is the need to value, protect 10. Situational analysis is used to identity and respect an individual’s dignity and immediate, underlying and basic to recognise that all humans possess an causes of developmental problems innate value and worth regardless of ethni­ 11. Measurable goals and targets are city, sexuality, gender, religion and so on. used in programming Key human rights principles upon which the 12. Strategic partnerships are developed human rights-based approach is founded and sustained include: 13. Programmes support accountability • Universality and inalienability to all stakeholders • Equality and non-discrimination 1.18 “A human rights-based approach to programming (HRBAP) is an approach that • Indivisibility and interdependence gives equal attention to what should be done • Participation and inclusion and to how it should be done. A HRBA often aims at achieving the same goals as current • Accountability and rule of law development approaches (e.g. the MDGs), 1.21 A human rights-based approach thus but puts equal attention on the process considers: chosen to achieve these goals, as on the Rights. Which specific rights have been achievement of the goals themselves.” violated or not otherwise respected or (United Nations. A Human Rights Based protected? Approach Toolkit, UNCT Vietnam, 2009; Accountability. Who is the specific duty- available at:http://hrbaportal.org/?p=3645, bearer? What other stakeholders need to (accessed on 16/09/11)) be involved or held accountable in order to 1.19 Processes that can help achieve a promote rehabilitation? rights-based approach include: Inclusivity and non-discrimination. Are • Enabling participation all voices being heard? Are the needs of all • Joint decision making and action (on being addressed, including individuals from multiple levels) groups who tend to be marginalised such as women, children and minorities (ethnic, • Organising racial, religious, etc.)? • Mobilising Participation. Are survivors taking part in the • Researching causes, contexts decisions that affect their lives and wellbeing? and power relations involved in Do they have access to the information they exclusion, oppression, deprivation or need? Such participation is their right. marginalisation within the community Holistic Rehabilitation 13

Empowerment. Does this approach to 1.27 Asatur was not charged with any rehabilitation promote the self-sufficiency specific crime; following his 11 day of the survivor thus increasing their self- detention at the police station Asatur was confidence and awareness of their rights? taken to a prison to await a trial. There, he was held for extended periods in solitary confinement and did not have access to a 3. In practice doctor. As a result of sustained beatings to his head during interrogations, Asatur The need for a common framework: developed persistent ringing in one ear for using a ‘human rights-based approach’ which he did not receive any medical care.. as a frame for analysing and evaluating 1.28 When a representative of the holistic rehabilitation approaches. Armenian Human Rights Defender’s 1.22 Read the following case study. What Office visited the prison, Asatur was course of action would you recommend to finally given access to a lawyer. He was Asatur to help him to receive rehabilitation? eventually released from prison after 8 months What potential obstacles/risks might be of detention but by this time had lost his old associated with your recommendation? job. His family had depended heavily upon his What are the advantages to the approach salary and now struggled to pay for food. that you suggest? 1.29 9 months after being released from prison, Asatur still had not found a job. The Case study: Asatur continuing ringing in his ear affects Asatur’s ability to sleep and tingling in his right hand 1.23 Asatur was one of 8 men arrested means he cannot now perform manual by the police following an investigation labour. He also suffers from nightmares and into fraud at their workplace. Asataur anxiety. His family is struggling to survive had worked for the company in question financially from day to day and as a result for 9 years, having started work on the his eldest son has left school to work in factory assembly line and eventually being order to support the family. promoted to the position of Floor Manager. 1.30 The other employees taken by the 1.24 The police arrested Asatur and police and detained in custody were also the other suspects on the basis of the tortured and are suffering similar symptoms. government’s internal tax auditors One of these men approached Asatur to suspecting them of the fraudulent discuss joining with him in paying for a embezzlement of company monies. lawyer to try to get compensation from 1.25 When Asatur was arrested he had no the government for their torture. Asatur is idea why. The legal basis for his arrest was unsure as he doesn’t want to bring any more not explained to him.. suffering to his family who fear harassment from the police for ‘causing trouble’. 1.26 At the police station, Asatur was immediately separated from the other Points to consider suspects and taken for interrogation. Three police officers asked him questions 1.31 When thinking about how best to and, beat and kicked him until he lost advise Asatur, it is important to consider all consciousness. He was burned with of the following issues: justice; mental and cigarettes and was subjected to long periods psychological healing; protection; redress; of enforced standing, sleep depriva­tion and reconciliation; integration. loud noise over a period of 11 days. 14 Penal Reform International

1.32 The range of issues you need to con­ lead to that individual being admitted sider will include the elements needed for to a psychiatric hospital and thus being a holistic framework: namely legal, clinical, subjected to what is tantamount to to social/practical and community factors. moral and-psychological trauma 1.33 Potential actions could include: • Approach a psychotherapist and a psychologist for immediate help; also • Legal protection approach a relevant NGO and a local • Psychological rehabilitation Department of Social Protection • Occupational therapy; physical therapy • Submission of an application to law enforcement bodies • Financial support • Inform Asatur’s son’s school of the • Assistance in finding employment possible return of the child to school • Inform those of Asatur’s prison mates Practical analysis: advice on also tortured in detention that they can Asatur’s rehabilitation access the same psychological services and then formulate a complaint on 1.34 The training participants made the behalf of the group following suggestions: • Victim should be placed in contact with • Legal protection an advocate • Psychological rehabilitation in order to • Human rights violated include: the fact help Asatur overcome the fear of giving of torture; damage to health; lack of evidence access to doctors and legal advisers;, • Financial help isolation in a single prison cell • A special protection measure for • If possible, hire a lawyer to initiate a witnesses legal case, approach a Collegium of Advocates providing free legal help • Offering political asylum • Approach an NGO • Provision of urgent physical and psychotherapeutic expertise in • Voice the problem through the media accordance with the Istanbul Protocol • Execute medico-legal expertise • Contacting a human rights organisation • Provide compensation and the right to to obtain assistance from a lawyer rehabilitation • If Asatur were to win a civil trial he would • Provide redress for moral and material receive material compensation; should losses he win a criminal trial he would achieve • Assist in reinstatement of Asatur’s old justice against the criminals job or help him find new employment; • Monitoring of society in order to shape give social assistance public opinion • Support the family, help Asatur’s child • One participant noted the potential return to school danger of the State offering Asatur • Initiate a complaint with the European psychiatric help, as states sometimes Committee for the Prevention of Torture turn a psychiatric diagnosis against the and Inhuman or Degrading Treatment or victim. For example, such a step may Punishment (“CPT”) Holistic Rehabilitation 15

Obstacles 4. Justice and • Fear; ignorance of the law; financial rehabilitation capacity stretched; delayed medico- legal expertise; obstacles put up by the 1.36 Survivors of torture engaged in holistic states’ apparatus and procedures rehabilitation often have outstanding • Independent expertise does not exist in concerns around justice. The idea of some states justice often feels far-fetched because the perpetrators are still at large and there is Please note: Freedom from Torture is not no realistic way of holding them to account. promoting these suggestions as the ‘right’ (This issue is discussed in further detail in answers or as the only answers. Ultimately, chapter 2.) what is most important in this scenario is what Asatur himself wants once he has 1.37 Rehabilitation initiatives therefore considered all of his options. need to take into account not only the Discussion of the case study wishes of the survivor but must also be safe and relevant for the survivor, their 1.35 Freedom from Torture (“FfT”) family and community, be realistic in the facilitators and the training participants circumstances and reflect holistic thinking. (“P”) discussed the following in relation to the case study: Creative initiatives to promote holistic FfT: Is it important for Asatur to have work, rehabilitation from the point of view of his rehabilitation? 1.38 The following examples from around P: Asatur has been acquitted, so by law the world demonstrate a wide variety of he has the right to reinstatement at his approaches to rehabilitation based on a former place of work and to financial range of contextual constraints (such as compensation for the time he missed as corrupt justice systems, lack of opportunity well as compensation for treatment. for individual therapies and so on) FfT: But Asatur’s right hand doesn’t work. 1.39 When reading these vignettes, it would P: He should be given a pension and be helpful for you to think about these disability benefits, but the absence of an programmes in light of the HRBA and our impartial court may hinder this. understanding of ‘holistic rehabilitation’. FfT: What else can we do for Asatur? 1.40 Specifically, you might want to evaluate the programmes in the context of: P: He needs rehabilitative work while he is оцените программы в контексте: waiting to receive disability benefits and a pension. He could also go to an NGO for a. Rights. How well does this programme qualified medical and legal help both for link to specific rights that have been him and for his family. But in order to take violated or not fulfilled/respected? part in the legal process, he first needs psychological rehabilitation. b. Accountability. Does the programme hold primary and/or secondary duty- bearers to account?

c. Inclusivity and non-discrimina­ tion. Does the programme include the voices and needs of all relevant groups? 16 Penal Reform International

d. Participation. How is the survivor’s audience who had come to testify. A later voice included? How much power do piece called «Sin Título Técnica Mixta», the survivors have to participate in echoed the recommendations of the Truth those of the project’s decisions that and Reconciliation Commission. It was will affect their lives? shown to victims of the conflict who were displaced to Lima, the capital city. 38 [...] e. Empowerment. How well does the rehabilitation approach promote self- 1.43 References: sufficiency and ‘enable’ survivors? 37.See Resisting Amnesia: Yuyachkani, Performance, and the Postwar Reconstruc­ tion of Peru; and Arte y transformacion Example: Peru de conflictos: El teatro y la transformacin de conflictos en el Perú, an investigation Peace Building Initiative, Transitional into this theatre experience and another Justice: Actors & Activities conducted in the region of Ayacucho, the (undated). available at: http://www. area most affected by war violence and peacebuildinginitiative.org/index. also the place where the war first erupted. cfm?pageId=1884 (accessed 08/04/2011) 38. Ibid. Artistic and cultural endeavours Practical analysis: study and 1.41 At the local grassroots level artistic endeavours such as theatre and evaluation of an approach to oral histories, dance and music, and holistic rehabilitation on the basis photographic and artistic exhibitions, have of an example from Peru been used by communities and NGOs as alternative ways to contribute to the 1.44 The training participants discussed remembrance of the past, a complement this example from Peru and provided the or a facilitation of transitional justice following feedback: processes. Arts-based processes may Strong points be creative methods to work through unresolved emotions and conflicting • Psycho-emotional impact – therapeutic narratives, paving the way for new approa­ effect ches that may impact an entire society. • Commission’s work to reinstate the truth 1.42 In Peru, the Grupo Cultural Yuyachkani joins with legal and psychological work (a Quechua word meaning «I am thinking/I • Good example of collaboration between am remembering»), working together with the State’s structures and society the Truth and Reconciliation Commission, Weak points performed “outreach work in the communities where public hearings were • Lack of communication between to be convened by the Commission and ‘ survivors and social workers lend the power of performance the arduous • Possibility of negative memory task of reconstructing and remembering flashbacks and emotions the war’”. 37 Their piece, titled «Maria Cuchillo», was performed at the site of the • One-sided approach first truth commission hearing in Huamanga Do you see any other strengths and and members of the troupe heard stories weaknesses to this type of approach? and took testimonials from those in the Holistic Rehabilitation 17

Example: Canada • Independent Assessment Process: available in addition to the CEP, provides for compensation of up to CAN$275,000 International Centre for Transitional Justice, for sexual abuse, serious physical abuse, Canada: Submission to the Universal or other abuses that caused serious Periodic Review Of the UN Human Rights psychological effects. Council Fourth Session: February 2-13, • Truth and Reconciliation Commission 2009, 08/09/2008 [Excerpt] (TRC): CAN$60 million to carry out Available at: http://www.ictj.org/static/UPR/ work over five years, providing a forum UPR_Canada_ICTJ__September_2008.pdf to reveal survivors’ experiences and (accessed on 16/09/11) educate the public about IRS conditions and legacy. Reparations for past abuses • Healing: a CAN$125 million endowment for the Aboriginal Healing Foundation 1.45 Canada recently took steps to address for initiatives related to memory and past abuses committed against Aboriginal spiritual renewal; church entities people through the Indian Residential School involved in the administration of IRSs system, which for more than a hundred years will contribute up to CAN$100 million in worked to suppress the cultural identity cash and services. and native languages of Aboriginal children, • Commemoration: CAN$20 million and also often inflicted physical and sexual for events and memorials to ensure abuse (launched 1874; last school closed acknow­ledgment of the legacy of the 1996). After years of lawsuits and negotiation IRSs. by Aboriginal groups, churches, and the government, Canada agreed to a package 1.46 The Government has also presented a of reparations for school survivors in 2006. comprehensive statement of apology to the The Indian Residential Schools Settlement Aboriginal groups affected by the IRSs. The Agreement (IRSSA) came into force in apology took place in a solemn session of September 2007. This agreement includes the Canadian House of Commons on June provisions for financial compensation, a truth 11, 2008. In its apology the Government commission and additional healing measures recognised that: for IRS survivors. • The IRSs separated children from their • Common Experience Payment (CEP): families with the explicit goal of isolating lump-sum compensation for former them from their cultural environment residential school students, recognising and assimilating them into the dominant the group harms that resulted from the culture. schools. Former students who spent at • The IRSs operated on the assumption least part of one scholastic year living at that the dominant culture was superior the schools are eligible for a payment of to Aboriginal culture, which was to CAN$10,000, plus CAN$3,000 for every be completely eliminated from every year thereafter. CAN$1.9 billion has been Aboriginal child. Indeed, the IRSs set aside for the direct benefit of former intended “to kill the Indian in the child.” IRS students. As of August 2008 the Government had received almost 95,000 • The IRSs prohibited Aboriginal cultural applications and issued payments to practices and tried to suppress their some 68,000 survivors. languages. 18 Penal Reform International

• The IRSs neglected basic duties to the independent factor of psychiatric problems students, including health care and (reference 5.) Yet, the study concluded proper nourishment, resulting in deaths that a multidisciplinary approach which and illnesses. included legal services in a naturalistic treatment setting was moderately more • The IRSs had a lasting negative impact effective in decreasing somatic symptoms on Aboriginal cultures, heritage, and disability and increasing subjective languages, and the well-being of well-being and functioning when compared individual survivors. with psycho-education sessions alone (reference 5). The therapeutic effect of the pursuit of justice through legal remedies did Example: Nepal and India not require a positive legal outcome.

Torture Journal Volume 21, ‘Legal services: 1.49 Like the Nepal study, a Best, promising, and emerging practices’, multidisciplinary approach (psycho-legal) to treatment of torture survivors was Regina Germain, J.D.* & Leslie E. Vélez, J.D. ** Available at: http://www.irct.org/ implemented by Jananeethi, a human rights library/torture-journal/back-issues/volume- organisation in India. The approach was 21,-no.-1,-2011.aspx described as client-centred and included (accessed on 19/09/11) the following multidisciplinary services: 1) cognitive-behavioural counselling, 2) Multidisciplinary approach educating clients about their legal rights, and 3) the pursuit of justice through the 1.47 The Center for Victims of Torture judicial process (reference 5). The overall in Nepal (see reference 5 at the end of objective of this study was to increase this section) assists torture survivors in awareness amongst the survivors of their prosecuting perpetrators and seeking legal and human rights and support their compensation. The programme also individual and collective fight for legal provides mental health services. In a justice. In contrast to the focus of the Nepal study the programme conducted to study, where effectiveness was specifically evaluate a broad range of symptoms, measured by improvements in psychiatric including functioning and disability, the symptom measures, functioning and authors hypothesised that providing disability, this general objective placed multidisciplinary services to survivors, emphasis on the effect of access to justice which included mental health, basic in a multidisciplinary approach. medical, and an opportunity to seek legal redress for injustices suffered, would 1.50 Access to justice in the India study improve psychiatric symptoms, functioning came in many forms including legal and disability more than a comparison education, direct legal assistance, and group receiving only psycho-education encouragement to participate in systemic sessions. advocacy as a collective. Jananeethi staff employed the “testimony method”, 1.48 Several limitations were noted by developed in Chile during the military the authors: the length of the study was dictatorship of the 1970s, which assumes limited to five weeks and it is not known that public testimony about human rights if legal redress was realised in any of violations not only becomes a means of the cases. Additionally, one individual’s obtaining justice, but is a cathartic and sense of injustice, related to a lack of positive reframing experience for survivors redress for the trauma, appeared to be an (reference 5). Holistic Rehabilitation 19

1.51 However, this study acknowledged medical, psychiatric, and psychosocial “grotesque delays in the justice process” services to victims of torture and organised in India.5 Settlement of human rights violence and to their families. TRC’s clinical matters in India was trapped within a cycle team is multidisciplinary which makes it of delay and neglect within their legal possible to offer a range of holistic treatment system (reference 5). Additionally, and not plans to each individual client. A personal and surprisingly, some of the survivors still had in-depth treatment plan is designed for each problems dealing with stress and other client in order to best cover his/her needs psychological demands, (reference 5) and including; psychological, social and medical. impunity may have hindered the survivors’ This comprehensive approach is essential individual healing (reference 5). Despite to the overall effectiveness of treatment as it these challenges, the study found that the is very difficult to make progress in one area psycho-legal approach directly resulted if another area is neglected. TRC aims to in survivors’ feelings of empowerment develop and implement a programme that is and support while self-esteem was expert in the area of torture and rehabilitation strengthened and knowledge about the – to provide highly needed services in an legal system increased (reference 5). The efficient manner. lesson learned from this study, which is 1.54 TRC conducts its work either in consistent with a conclusion drawn in the its central offices or as an outreach Nepal study, is that the pursuit of justice programme. The health workers can carry through legal remedies produced a healing out house visits providing psychosocial result for survivors, even in cases where support to victims of torture and organised there was no positive legal outcome. [...] violence and their families. In addition, TRC’s 1.52 Reference 5: Tol WA, Komprow IH, community-based approach to mental Jordans MJD et al. Brief multi-disciplinary health emphasises reaching not only the treatment for torture survivors in Nepal: a individual clients but also their families and naturalistic comparative study. Int J of Soc neighbourhoods in order to raise awareness, Psychiatry 2009; 55(1): 39-56. reduce stigma and strengthen support and resources available to those who have had their mental well-being disrupted. Case study: The West 1.55 Who is targeted? TRC does not Bank only provide psychosocial services to ex-detainees and their families. TRC also targets victims of house demolitions, Treatment & Rehabilitation Center for sieges, raids, curfews, shelling and Victims of Torture (“TRC”), Our Programs: bombing as well as the bereaved and Treatment and Rehabilitation, Undated. victims of organised violence. All clients at Available at: http://trc-pal.org/en/Views/ TRC are treated with the goal of identifying ViewDetails.aspx?pid=569 (Accessed on and treating enduring symptoms of trauma. 08/04/2011) 1.56 Methods Utilised; The most common methods utilised with our present clients Community-based approach include: Individual Psychotherapy; Short- term Dynamic Psychotherapy; Cognitive- 1.53 The ‘Treatment and Rehabilitation Behavioural Therapy; Psycho-education; Program’ is TRC’s core programme. This Psychopharmacology; Crisis Intervention programme provides comprehensive Protocols; Debriefing; Defusing; Demobili­ 20 Penal Reform International

sation; Relaxation and Problem-Solving Do you agree? Are there any other strong Techniques; Family; Group; Art and Play; points or weak points to this approach that Psychodynamic Psychotherapy; Supportive you can identify? Psychotherapy; Narrative Therapy; Trauma - Focused Approach; EMDR (eye movement desensitisation and reprocessing) and SEC Case study: South East (somatic experience containment). Asia 1.57 TRC’s Treatment Team is well trained on different approaches in order to treat their clients in the TRC office or in their Digital Library, homes. These approaches are usually used The Living Memory Project as individual therapy or group therapy. Every group of therapists uses one or two http://sea.lib.niu.edu/inst/living.html (link no of these approaches depending on the longer in use) approaches they are trained in. Living memories

Practical analysis: study and 1.59 A few years ago, prison doors in evaluation of an approach to Indonesia and East Timor swung open holistic rehabilitation on the basis to release hundreds of East Timorese of an example from the West Bank nationalists imprisoned for supporting their country’s 24-year struggle for 1.58 The training participants discussed independence. this example from the West Bank and 1.60 [...] Ex-prisoners organised themselves provided the following feedback: into the Associação dos ex-Prisioneiros Políticos de Timor-Leste (Association of Strong points former Political Prisoners of East Timor, • Wide range of services to survivors ASEPPOL), which estimated that around 10,000 people living in East Timor today Weak points suffered imprisonment. Many of these had • Lack of legal help to survivors and their been tortured. Countless others died in families prison or disappeared without trace. For each person imprisoned, a wider circle • Lack of a wide spectrum of social of family and friends was affected by the support (for example, reinstatement anguish of separation from the victim, by at work, training, employment, knowledge of his or her suffering, accommodation, social benefits) by the loss of a breadwinner, and by • Therapeutic treatment had been stigmatisation and political persecution provided; however, there is no mention arising from the relationship. of legal help nor of medico-legal Children were especially expertise and provision marked by the imprisonment of family members. • This is not a holistic approach 1.61 Working with ASEPPOL, the • Violation of the victim’s torture rights Living Memory project aims to create a was not punished; his rights were not video archive based on interviews with fully rehabilitated these ex-prisoners. Inspired in part by Holistic Rehabilitation 21

Steven Spielberg’s Shoah Visual History • Description of actual facts Foundation, the project will collect, • Non-discriminatory approach and preserve and catalogue testimony from involvement political prisoners, to be held for future generations as part of East Timor’s • Educational impact national heritage. The archive will also • Evidence that can be used to form be accessible in various formats as an conclusions about crimes educational and media resource nationally and internationally. • Medical aspects of the programme • Research into the influence of the 1.62 Interviews will be formulated to elicit programme on former prisoners information on the impact of i mprisonment on ex-prisoners’ health, Weak points providing an invalu­able database to plan • Presumption of innocence – should strategies for treatment, especially in courts not pronounce a definite the case of torture victims. decision, a film could negatively 1.63 The Living Memory Project at East influence the impartial, thus a system Timor is managed by Jill Jolliffe and comprising just a court process might provides videos and images of be preferable ex-prisoners in East Timor. • Is any work taking place to punish the guilty? Practical analysis: study and • Access to the archive: non-individual evaluation of an approach to approach; lack of protection of the holistic rehabilitation on the basis specific rights of the victim. No of an example from South East connection with the holistic approach Asia since it doesn’t account for the individual right of a victim to speak out 1.64 The training participants discussed against the torture experienced this example from South East Asia and • Risk of former victims becoming victims provided the following feedback: once again Strong points • Absence of efforts to hold as • Freeing of the prisoners responsible individuals in positions of • Possibility of rehabilitation authority • Freedom to gather Do you agree with their analysis? Is there anything missing? • Freedom of speech • Preservation in memory of the evidence of the missing 5. Ethical issues to • Evidence-collecting consider • Future prevention of torture through the creation of a film 1.65 Many survivors of torture feel that they will not be able to recover until their • Creation of an accessible archive perpetrator is held to account. However, • The survivor’s voice is heard there may be a tension between achieving ‘justice’ and preserving the safety of the 22 Penal Reform International

torture survivor and their family. The pursuit 1.69 We discussed in this chapter how of justice may actually put the survivor survivor activism can help to heal the and their family at further risk of abuse survivor and act as an important tool for and harm, for example, where the torturer changing public perceptions of torture. was the State or its agent. Furthermore, But is there a potential conflict between the emotional and psychological impact of survivor safety/protection and survivor court proceedings may at times become activism? overwhelming to an already vulnerable torture survivor. 6. Conclusion 1.66 Survivors of torture may also face the challenge of trying to hold perpetrators 1.70 In this chapter, we began to explore to account in the absence of properly holistic rehabilitation. We explained that functioning enforcement mechanisms. torture has a profoundly negative impact Survivors are then set up to fail and place on the survivor because torture is designed themselves at great risk (both in terms to destroy a person without killing them. of compromised personal safety and Therefore, in thinking about rehabilitation psychological/emotional harm) in a system for torture survivors, it is important to take a offering little likelihood of success. multidisciplinary approach with a variety of 1.67 In this chapter, we looked at interventions to hand in order to deal with creative approaches towards holistic the complexity of an individual survivor’s rehabilitation. But does supporting the needs. Such an approach to supporting a client to find creative approaches to holistic torture survivor can be challenging as the rehabilitation (for example, artistic or different professions can find it difficult cultural endeavours) mean that the ‘justice’ to speak a common language. A Human component to holistic rehabilitation is Rights Based Approach can provide weakened? Do we then run the risk of not a common frame to help the varying holding perpetrators fully to account? professionals to work together. We saw that achieving justice in the traditional 1.68 We also looked at a survivor-led sense can be extremely challenging for approach. This means proceeding at the survivors of torture in certain contexts. client’s pace, letting the client choose However, it is important that they still have the interventions that they think best for the opportunity to heal and survive. In such themselves. But what happens when we as cases one might need to think creatively professionals think that the survivor might about alternative forms of justice and how be ‘stuck’ or is avoiding facing up to trauma survivors in those situations could access and thus losing the opportunity to heal from support and rehabilitation. We also looked it? What do we as professionals do when at the importance of holistic rehabilitation we believe that the survivor is not making being survivor-led and that survivors have good choices about their rehabilitation and the opportunity to become involved in recovery? survivor activism. We will explore these ideas further in chapter 3. Holistic Rehabilitation 23 Chapter 2 Rehabilitation as a right 1. General overview 1. General overview 2. Theory A. The right to rehabilitation 2.1 By the end of chapter 2, readers will be able to: B. The State’s obligation • Assess the relationship between 3. Why Article 14 is important protection, justice and rehabilitation A. Benefits of seeking justice • Evaluate current domestic and regional B. Benefits of compensation legislation in light of international standards 4. International standards and • Identify opportunities and constraints domestic legislation which may foster or hinder a survivor’s ability to access their right to justice and Examples rehabilitation in their local context 5. The reality of rehabilitation as a • Link holistic and comprehensive right justice approaches to their national A. The justice dilemma rehabilitation context B. Obstacles to accessing 2.2 This chapter is relevant to all specialists rehabilitation and service providers who work with survivors of torture, not just lawyers. The Example, discussion chapter covers the rights of survivors of 6. Our role in promoting holistic torture and is therefore central to the work rehabilitation of clinicians and community workers as well as lawyers and human rights defenders. A. Medical Remember the importance of the rights- B. Clinical based approach discussed in chapter 1 C. Legal – by focusing on the ‘rights’ of survivors rather than just their ‘needs’, we can be D. Client data proactive in helping to empower survivors 7. Striving for the right to and ensuring their dignity is respected. rehabilitation – the role of the survivor 8. Supplementary materials 2. Theory A. Justice denied B. Additional readings A. The right to rehabilitation 9. Conclusion 2.3 The right to rehabilitation is embodied in Article 14 of the Convention against Torture (“CAT”). Reparation, compensation and redress are also part of Article 14 24 Penal Reform International

Article 14 July 2002) at Article 75(1) which provides that: 1. Each State Party shall ensure in “The Court shall establish principles its legal system that the victim of an relating to reparations to, or in act of torture obtains redress and respect of, victims, including has an enforceable right to fair and restitution, compensation and adequate compensation including rehabilitation”. (Emphasis added). the means for as full rehabilitation as possible. In the event of the death of the victim as a result of an act of torture, his dependents shall be B. The State’s obligation entitled to compensation. 2.7 In this context, the right to rehabilitation 2. Nothing in this article shall affect for survivors of torture is linked to the any right of the victim or other person ‘right to remedy’, as opposed to the right to compensation which may exist to health or employment and so on. The under national law. ‘right to remedy’ is recognised in both 2.4 It is clear from the wording of Article international2 and regional3 human rights 14(1) that rehabilitation is a crucial aspect of conventions. International humanitarian law a victim’s remedy for torture. expressly provides for a judicial remedy where “grave breaches”, including torture, 2.5 Support for and confirmation of this right are found in the UN’s Basic Principles and Guidelines on the Right to a Remedy 2. See, for example, Article 2(3) (a) of the International Covenant on Civil and Political Rights, (1966), which and Reparation for Victims of Gross requires State Parties “To ensure that any persons Violations of International Human Rights whose rights or freedoms as herein recognized are violated shall have an effective remedy, Law and Serious Violations of International notwithstanding that the violation has been committed Humanitarian Law (the “UN Basic by persons acting in an official capacity.” In addition, Principles”)1 . This document indicates that the right to a remedy in respect of both general and specific breaches of Human Rights Conventions can rehabilitation is a distinct component of the be found in the International Covenant on Civil and wider right to reparation for survivors of Political Rights (Article 9(5) and 14(6)), the International abuses). Convention on the Elimination of All Forms of Racial Discrimination (art 6), the Convention on the Rights of Article 18 provides: the Child (Article 39), the Convention against Torture and other Cruel Inhuman and Degrading Treatment, “...victims of gross violations of (Article 14); the Inter-American Convention on Human international human rights law and Rights (Articles 68 and 63(1)) and the African Charter on Human and Peoples’ Rights (Article 21(2)). serious violations of international 3. See, for example, Article 13 of the European humanitarian law should...be Convention on Human Rights and Fundamental Freedoms (1950) (the “European Convention”), which provided with full and effective provides “Everyone whose rights and freedoms as set reparation...which include the forth in this Convention are violated shall have an following forms: restitution, effective remedy before a national authority notwithstanding that the violation had been committed compensation, rehabilitation, by persons acting in an official capacity”. Article 5(5) of satisfaction and guarantees of non- the Convention also contains a specific and express repetition”. (Emphasis added). right to a remedy in respect of incidences of deprivation of liberty in breach of the provisions of 2.6 Further support can be found in the Article 5. Similarly, Article 25(1) of the Inter-American Convention on Human Rights (1969) (the “Inter- Statute of the International Criminal Court American Convention”) provides “Everyone has the (adopted July 1998 and entered into force right to simple and prompt recourse, or any other effective recourse, to a competent court or tribunal for 1. Adopted by General Assembly, Resolution 60/147, protection against acts that violate his fundamental on 16 December 2005. rights recognized by…this Convention…”. Holistic Rehabilitation 25

have occurred4. 2.12 “Our country is considered to 2.8 Sarah Fulton of Redress stated in her be democratic. All these international presentation of 12 July 2011 that the idea of laws are known to us and ratified by ‘remedy’ is directly linked to the fact that, our Parliament, but just in theory. “The State has done something wrong, so Practical situation is getting worse. the State must do something to fix it”. So Our work would be impossible without while it may be a relatively straightforward international funding because the State matter to use criminal or civil court does nothing.” Participant, Georgia (July, proceedings to demand compensation or p. 7) remuneration, the provision of a remedy in the context of rehabilitation is not so 2.13 However, by creating the conditions for straightforward.. rehabilitation, governments must provide funding, support and safe environments as 2.9 Sarah also pointed out that because well as easy and equitable access to socio- rehabilitation is part of the ‘right to remedy’ medical rehabilitation services for survivors as described above, states must do of torture. something to make it happen:- they must provide for rehabilitation within domestic What is meant by “as full rehabilitation laws. as possible”? 2.10 Furthermore, states must do more 2.14 There is little in the way of guidance than draft and enact legislation. The on how the right to rehabilitation should Commission on Human Rights in its be interpreted in practice. The need to resolution 2004/41, stresses that national develop this standard is clear. Although legal systems should ensure that victims of the UN Convention against Torture refers torture or other cruel, inhuman or degrading to ‘rehabilitation’, it does not define the treatment (CID) or punishment obtain term. The practice of the UN Convention’s redress, are awarded fair and adequate treaty body, the Committee against compensation and receive appropriate Torture, provides little more in the way socio-medical rehabilitation. In this of clarification. While the Committee has regard, it encourages the development of indicated that clinical rehabilitation forms a rehabilitation centres for victims of torture. part of any “full rehabilitation” 5, it has not (Emphasis added) elaborated further on how the term should be understood. Where the Committee has 2.11 Therefore, governments need to specifically identified a need to provide provide the conditions for rehabilitation medical and psychological treatment to centres. This does not necessarily mean survivors of torture, this has not been that they have to establish these centres situated within the express context of themselves. “rehabilitation” 6. 4. The Geneva Conventions (1949) require signatory States to effectively investigate and prosecute 2.15 The right to rehabilitation contained allegations of grave breaches. See Articles 49 and 50 of the Convention for the Amelioration of the Condition in Article 14 of the UN Convention against of the Wounded and Sick in Armed Forces in the Field; Articles 50 and 51 of the Convention for the 5. See, for example, the Committee’s consideration of Amelioration of the Condition of Wounded, Sick and Guatemala’s initial report, (1995), CAT/C/SR.232, at Shipwrecked Members of Armed Forces at Sea; paragraph. 22, which also refers to redress as a form Articles 129 and 130 of the Convention Relative to the of “moral rehabilitation”. The Committee also makes Treatment of Prisoners of War and Articles 146 and express reference to the need to provide medical 147 of the Convention Relative to the Protection of rehabilitation to the family members of disappeared or Civilian Persons in Times of War. The 1977 Additional tortured individuals. Protocol I expressly provides for the payment of 6. See, for example, Concluding Observations on compensation to victims of abuses. Turkey, CAT/C/CR/30/5, paragraph 123. 26 Penal Reform International

Torture is qualified by the words “as full… [emphasis added] 7. This indicates an as possible”. The words relate to the ambit intention on the part of the drafters, that of the provision, and provide guidance as where rehabilitative services exist and there to the nature of the obligations imposed on is capacity, the State must provide them. It the State by the right to rehabilitation. may also be argued that a State is unable to evade its duty to provide rehabilitative 2.16 Delegates engaged in the drafting care simply by failing to operate or of the UN Convention against Torture otherwise offer available and appropriate expressed concern that “rehabilitation” rehabilitation services for individuals it has was too vague a term. Rather than seek tortured, reflecting an intended obligation to define it, however, delegates chose to to actively provide these services as far as qualify it by the addition of the phrase “as possible 8. (Emphasis added). full…as possible”. 2.20 Support for this interpretation can 2.17 In their annotations to Article 14, be found in General Comment 14 of the Burgers and Danelius provide some Committee on Economic, Social and guidance as to how delegates intended Cultural Rights, which draws a distinction the term to be construed, indicating that for the purpose of assessing a State’s rehabilitative treatment, including the obligations under the right to health provision of mechanical aids, should be between unwillingness and inability to provided “so far as they are available”. This, provide medical services. As a result, the in turn, suggests that the qualifying phrase relative qualification in the phrase should relates to the existence, accessibility and be read as incorporating only a limited availability of services and equipment degree of permissible flexibility on the part in the State rather than to the extent or of the State. degree to which a survivor is able to make a recovery. As a result, the nature of the 2.21 The UN Convention against Torture obligation imposed on the State in terms of provides no further guidance as to the physical provision and support is relative, nature and extent of the obligations and its practical content will therefore vary imposed by the right to rehabilitation between States, depending upon such under Article 14. Further pointers as to factors as the availability of resources and their nature and extent can be gleaned by facilities. analysing how more recent international human rights and State obligations relevant 2.18 While the inclusion of a relative to the issue have been interpreted and component is not uncommon in relation to applied 9. economic, social and cultural rights -which are subject to progressive implementation - assessment of States’ compliance with 7. Burgers, J. Herman and Danelius, Hans, (1988), The United Nations Convention against Torture: A their obligations under the UN Convention Handbook on the Convention against Torture and against Torture does not generally measure Other Cruel, Inhuman or Degrading Treatment or Punishment. the implementation of rights in this way. 8. Support for this interpretation can be found in General Comment 14 of the Committee on Economic, 2.19 In addition, the annotations to the Social and Cultural Rights, which draws a distinction Convention produced by Burgers and for the purpose of assessing a State’s obligations Danelius indicate that “where there is under the right to health between unwillingness and inability to provide medical services of a certain type. a need for medical or psychological Twenty-second session, 25 April to 12 May 2000, treatment or for special mechanical aids, Geneva, at paragraph 47. such treatment or such aids shall be 9. Reading across other provisions in international human rights law is accepted as an interpretative provided so far as they are available” approach. Holistic Rehabilitation 27

[Above section from Handout – The Right use to make sense of the world and our to Rehabilitation; excerpts from: A Remedy social relationships; it affirms our social for Torture Survivors in International identity as moral agents holding values Law: Interpreting Rehabilitation, Medical and beliefs about what is right and Foundation for the Care of Victims of wrong. For many torture survivors it Torture, 2010] is essential that they know they have choices - and that there is a possibility they will be able to seek justice 3. Why Article 14 is and reparation. Torture survivors can experience the availability of important – justice accessible mechanisms as an and reparation as acknowledgement by the State of its commitment to uphold their right to a component of reparation. rehabilitation10 2. The process of seeking redress can be therapeutic. It can also bring 2.22 In psychological terms, justice and significant strain, with some survivors reparation can play a significant role in feeling that the onus is on them to the recovery process of torture survivors. expose and hold accountable the Both our experience and the psychological perpetrators. If survivors are already literature show that compensation is emotionally or physically vulnerable, just one of the benefits that justice and this can seem like an enormous burden reparation can offer. We can also identify and may be further compounded by the common obstacles preventing torture feeling personally unsafe and fearing survivors in the United Kingdom from reprisals against themselves and their seeking and accessing redress. families. 3. Actually obtaining justice – by holding A.Benefits of seeking justice perpetrators accountable, individuals and states not only open the door to 2.23 Justice and reparation have many other reparation measures but also meanings for survivors of torture. Negative challenge perpetrators’ impunity. meanings, such as injustice, lack of Obtaining justice is therefore a key accountability and blame, denial of justice component of torture prevention. and indifference from society can all have B. Benefits of Compensation an impact on the health of the survivor. .The potential benefits of justice can be broadly 2.24 While it is difficult to measure the understood in three ways: full impact of torture on a person’s health 1. The prospect of redress. For most and dignity in monetary terms, financial people there is a need to believe in a compensation is nonetheless an important just world – “that good things happen outcome within the wider process of to good people” – and that when bad reclaiming the human rights of a torture things happen there must be a fair and survivor. The benefits of compensation can just response. Justice is a concept we include: 10. Dr Nimisha Patel, (2008), Reparation and Justice: A Clinical Perspective. The Medical Foundation for the 1. Symbolic benefit - as an official Care of Victims of Torture. acknowledgement of the 28 Penal Reform International

perpetratrors’ wrongdoing and their reduction in feelings of powerlessness responsibility for the violations and and helplessness for the victim. harm committed. Thus compensation is also an acknowledgement of a 6. As upholding human decency: perpetrator’s debt. Many Freedom compensation, like other reparation from Torture clients fled their measures, can be experienced as countries after experiencing torture as upholding common humanity – as a direct consequence of their attempts representing both a public and official to expose the injustices perpetrated recognition of the harm done and a by oppressive regimes and to hold condemnation of the perpetrators’ them to account. To such clients, any actions. It contributes to the sense that means of seeking reparation are seen secret events are finally unmasked, as potentially providing recourse to that the truth is told and that the the justice previously denied them. legacy of the past is acknowledged A denial of reparation may thus be and remembered. This aspect is experienced by a client as a double particularly important to survivors injustice. who have experienced torture as an event shrouded in secrecy. The 2. Acknowledgement of survival: as pain and suffering experienced by one form of reparation, compensation these survivors becomes hidden and can provide torture victims with invisible; something no one can bear public acknowledgement of their to listen to or believe - something the survival, thereby validating their world turns a blind eye to. identity as survivors and facilitating the re-establishment of their dignity, self- 7. The symbolic victory of the tortured esteem, trust in others and belief in the over the torturer: compensation can world as just. have symbolic significance where the money itself may be less important 3. Alleviation of hardship: for some than the empowerment of the victim. survivors, compensation money can Thus, in exposing perpetrators and alleviate poverty, hardship and officially establishing responsibility, the disability and impaired functioning torturers are deprived of potency and resulting from their violation. legitimacy and the survivor’s identity and dignity as a human being is 4. Recovery process: for many, reclaimed. engaging in legal challenges through the justice system can be an important 2.25 For example part of their recovery process: “Justice is telling the world, everyone should know. Everyone in the world. I want to look at 5. Greater sense of control for the them [perpetrators] in the eyes and say what victim: the process can afford a you did was wrong, find your conscience. sense of control because it is the The shame is not mine, it is yours.” survivor who initiates the complaint, takes responsibility for procedural As another client put it: strategy, has the power to withdraw “It would mean that they did not win, they at any stage, and may even see their did not destroy me, they will be the ones perpetrators become vulnerable who have to answer – so the whole world defendants who have to answer for will know what they did – we are human their actions. This can result in a Holistic Rehabilitation 29

beings, not ants that can be crushed like we is meant by rehabilitation? How aligned are nothing….” is this legal definition to our wider, holistic understanding of rehabilitation? Ultimately, we would do well to remember that justice and redress represent • Does the idea of rehabilitation depend recognition of the victim’s humanity and on your State’s recognition of an worth – as one client said: individual as a victim of torture as established through court proceedings? “What are my human rights if I am not even Do you consider your government seen as human?” has taken seriously its responsibility to provide the means for ‘as full rehabilitation as possible’, with the 4. International introduction of laws stipulating there be standards and domestic a range of social, medical and practical services for survivors to access as and legislation when necessary? 2.26 International law provides for what 2.29 Laws are one component. But even if is, in effect, an aspiration: that survivors a law is in place, there is no guarantee that of torture have the right to rehabilitation. a government will attempt to implement Around the world, however, many it. Thus, you will also want to investigate individuals and groups of survivors find your country’s specific national and they are unable to realise this right. local government policies relating to the 2.27 For some, the right to rehabilitation rehabilitation of torture survivors. cannot be fulfilled because the international • Is there a national policy setting out how standards are not incorporated into their State bodies will provide the means for domestic legislation. For others, national laws ‘as full rehabilitation as possible’? Is there may provide for rehabilitation, but the reality any case law that could provide guidance on the ground is a very different matter. on how laws are to be interpreted? If not, 2.28 You are encouraged to investigate would strategic litigation be a possible how the right to rehabilitation is partly means of forcing the courts to clarify or fully incorporated into your domestic how a particular law should be more legislation. As part of this investigation, you appropriately interpreted and applied? will want to research whether or how far • Do these policies reflect the intention implementation has progressed beyond of the drafters of the international your State’s ratification of the Convention standards relating to remedy? That is Against Torture. to say, are the remedy mechanisms • Even if your government has ratified and services proactively available to the Convention Against Torture, have all who identify as survivors of torture? they placed any reservations relating Or, do these policies reveal that to Article 14 which may reflect an services should only be provided for intention not to fulfil their duty to provide those declared by a successful court rehabilitation? case to be ‘victims’? In other words, do the policies allow state-run and/or • Do any domestic provisions relating to independent service providers to first ‘remedy’ include specific reference to screen and assess potential clients ‘rehabilitation’? If so, does the law, or and thus decide who is eligible for any specific case law, help define what their rehabilitation service based on 30 Penal Reform International

their organisational remits? Or, do the and medical services to the victims of clients need to have forensic evidence torture. We also have some volunteers and an official letter acknowledging doing outreach work. torture from the state in question before ((The following is taken from the July report, being allowed to access a particular page 7 – please note that, the order of rehabilitation service? sections has been reversed) “The main challenge in the Central Asia Example: Kazakhstan region is that the law recognises the right to rehabilitation only after a court decision. The 2.30 Participants in the training programme difference with international law is that the from Kazakhstan explored the laws and state must provide rehabilitation regardless if policies of their country relating to the Right [sic] the court made that decision or not.” to Rehabilitation (quotation from July report, page 7) Negatives • A domestic legal basis for the right to Example: Armenia rehabilitation is absent. The Criminal Code does not mention the right to 2.31 Training participants from Armenia rehabilitation for victims of torture explored the Right to Rehabilitation • There are only a few examples of victims according to legislation and in practice. of torture receiving compensation via Right to rehabilitation according the courts to legislation • The vast majority of victims of torture don’t have access to remedies - barriers • Armenia has incorporated the Conven­ within in the legal system obstruct tion against Torture into its domestic victims’ progress legislation. • International legislation relating to such • Considerable levels of bureaucracy matters is given priority over domestic hinder service provision. A victim’s legislation: where there is a discrepancy request to receive medical help between the two, the former takes following torture will not automatically priority. lead to the State recognising that a prima facie instance of torture • The Criminal Code contains an article has occurred; the State will merely stipulating that the victim be recognised acknowledge that the individual required as such. medical help • Victims can obtain compensation for • Lack of financial provision for survivors; harm inflicted on them. survivors lack awareness of their rights Right to rehabilitation in practice Positives • The Government’s positive obligations • We have some centres of rehabilitation do not work in practice where victims can seek help • Judges sometimes indirectly acknow­ • We also have international organisations ledge that torture occurred, however no promoting the right to rehabilitation trials result • Some NGOs provide accessible legal • When a court holds that police officers Holistic Rehabilitation 31

who have taken part in torture are to be 5. The reality of punished, the perpetrators are usually amnestied rehabilitation as a right

• To date, there are no known examples 2.34 As the examples above show, strong of a torture victim receiving holistic national laws relating to rehabilitation rehabilitation do not guarantee that all survivors of • In order to have a case taken up, torture are able to fully realise this right. survivors need the help of NGOs. It is So not only is there often a gap between not possible for individual survivors to to international standards and domestic start proceedings on their own legislation; it is almost universally the case that there are gaps between what • Torture victims are able to use domestic is stipulated in domestic law and what violence centres which receive grants actually happens in practice. from the USA and Western European countries. There is no state funding for these centres. A. The justice dilemma12 2.32 From the case examples above, we can see that gaps exist between 2.35 It is common practice for international standards and domestic those in the legal sector to focus on legislation. Even where there may be obtaining ‘justice’ in order to assist in a domestic laws in place, these do not always victim’s rehabilitation as well as benefit survivors of torture. This, in some reventing or reducing perpetrator i cases,is because the state does not see mpunity. However, in some countries the human right to rehabilitation as being many torture victims will never secure a ‘positive obligation’ it must meet11 (A justice - we can put torture survivors ‘positive obligation’ is one where the state through the process of justice but we must implement the necessary conditions cannot guarantee the result. for nationals to be able to proactively realise their right to rehabilitation. A ‘negative obligation’ implies a duty not to 2.36 “The victim is at the mercy of violate human rights). the European Court of Human Rights (ECHR), which is overloaded with cases. 2.33 For those of us working in holistic Consequently, it can take 4–5 years for rehabilitation, we must remember that cases to go through.” the state should provide ‘conditions’ for the provision of ‘as full rehabilitation Participant, Georgia (June report, page 8 as possible’. That is a requirement of international law. But legislation alone is 2.37 For some victims such a process can not enough; the state should go further be helpful and therapeutic; for others it is to ensure ease of access to medical, severely disturbing. (June report, page 9) legal, psychological, social and practical assistance services. 11. For a more detailed review of positive obligations, see Council of Europe, Positive obligations under the European Convention on Human Rights: A guide to the 12. See also Section 8 below for a summary of the implementation of the European Convention on Human findings of Freedom from Torture’s research Rights, January 2007,Human rights handbooks, No. 7, publication, ‘Justice Denied’, the Medical Foundation available at: http://www.unhcr.org/refworld/ for the Care of Victims of Torture, London, December docid/49f183a32.html 2009. 32 Penal Reform International

2.38 Ethical issues relating to attempts dangerous aspiration. Survivors’ enormous to access justice and redress13: sense of responsibility for their families’ well-being, their overwhelming guilt and a • For many survivors, the prospect of desire to start a new life often prevent them their perpetrators ever being prosecuted from seeking redress. seems laughable, and many believe that there is no hope of prosecution, 2.40 One survivor commented: let alone any reparation. For them, “For every one person you try to chase and redress is seen as a theoretical concept, catch, there are a thousand being trained academic and beyond their reach. and spawned every minute – what is the “You don’t know what it is like in my point – will you catch them all? Will you or country – justice? [laughs]. This means the court be able to protect my family back nothing, nothing when there is a corrupt home if I go to court? What will happen to government, no law, police are criminals them – […] more fear, more torture?” there is nowhere safe – who do you go to? You have to just run.” • Almost all of those who wish to consider seeking redress report being unaware • For the vast majority of our clients, of the potential options or avenues for the poor health, severe trauma and seeking justice and reparation. They vulnerability that follow from their fear that any such processes are torture prevent them from seeking likely to be protracted, unsuccessful out avenues of complaint. Many are and will prolong their suffering. struggling just to survive and to regain their dignity and a healthy sense of self. • Also of importance is the social and Thoughts of making a complaint are cultural context of disclosure, which not even in their minds. A small minority shapes both the meaning survivors give may be sufficiently emotionally robust to their torture experiences and the at a certain stage in their recovery to ways in which families and communities consider seeking redress. However, respond to any disclosures made. most do not due to the fear that they will Following sexual torture, for example, experience further emotional setbacks many male and female survivors choose triggered by reliving their memories as never to disclose what happened (either they go through the legal processes. partially or in full) due to profound Most are simply focused upon guilt and shame or for fear of negative rebuilding their health and restoring reactions from families or communities some normality to their lives. – of being – fear of being ostracised, punished, marginalised or abandoned. • Most clients who consider seeking redress fear further reprisals • For many there has been a lack of justice and remain intensely and fearfully or reparation in their countries of origin, preoccupied with the lack of safety leading them to seek safety elsewhere. The they and their family members feel. prospect of return brings intense fear of Many family members remaining in re-encountering the perpetrators, many the country of origin have endured of whom remain at large or remaining in harassment, torture and other ill-treat­ positions of authority even where there has ment as a result of the client having fled. been a change of government or where the situation in the country has changed. The 2.39 Redress can be seen as a futile, even option of seeking redress on return is then 13. Dr Nimisha Patel . Reparation and Justice: A seen as absurd: Clinical Perspective. Medical Foundation for the Care of Victims of Torture. May 2008 “You don’t know what it is like in my Holistic Rehabilitation 33

country, justice – there is none, that is the breadth, magnitude, duration and what we fought for, that is why we are other temporal dimensions of the tortured, that is why I am here in this impact of torture, recognising the country – you think I can expect justice diversity of survivors, their unique when I go back? No, I would rather die…” circumstances and experiences. 2.41 In essence, all of these obstacles B. Obstacles to accessing amount to survivors being unable to access procedures which would ensure rehabilitation justice – they are effectively a denial of justice. 2.45 Often, the gap between law and practice is caused by factors in society 2.42 The denial of justice and the that hinder a survivor from easily accessing resulting impunity of perpetrators an appropriate service. These contextual can increase survivors’ feelings of constraints can range from public powerlessness, guilt and shame, affecting attitudes, the role of the media, a lack of their capacity to be optimistic for their own skilled experts and a lack of awareness of futures and to believe in a just world. They survivors’ rights. may feel they are not believed by others and are being denied, invalidated and 2.46 You will want to identify the specific further dehumanised - as if they are not obstacles in your own context which worthy of being treated as human beings. might hinder a survivor of torture from actually finding, accessing and utilising 2.43 Helena Cobban,’The legacies of rehabilitation services including legal collective violence: The Rwandan genocide support. Are there any barriers that prevent and the limits of of the law’, Boston Review, you from truly supporting and assisting a April/may 2002, [http://bostonreview. survivor of torture? mit.edu/BR27.2/cobban.cobban. html]. See also a response to Cobban’s article, 2.47 Clear awareness of the barriers is Kenneth Roth and Alison DesForges, the first step; only then we can think of DesForges, ‘Justice or therapy?’, Human creative and effective ways to overcome Rights Watch Editorials, [http://www.hrw. the obstacles preventing an individual from org/editorials/2002/ictr0724.htm]; and, realising their right to rehabilitation. Helena Cobban, ‘ Helena Cobban replies’, replies’, Boston Review, Summer 2002 Example: United Kingdom [http://bostonreview.mit.edu/BR27.3/ cobbanreplies.html]. 2.48 For example, in the United Kingdom, all nationals are entitled to free health care Allan&Allan, ‘The South African Truth and, if unemployed, are able to apply for and Rwconciliation Commission as a state support for housing and money while therapeutic tool’.tool’. looking for work. If a survivor of torture While international instruments require has come to the UK to seek asylum there states to provide a “full and effective are specialist services that can provide remedy,” they do not adequately define medical, psychological, social and practical what this means, particularly from a clinical rehabilitative support. However, many perspective. survivors of torture living in the UK struggle to access adequate rehabilitative support. 2.44 Appropriate and accessible There are many contextual barriers, measures which (in combination) address including: 34 Penal Reform International

• Lack of awareness. Many new arrivals right to education, the right to health. to the UK are unaware of the services • Community divisions needing to available or of their entitlement to apply be addressed (marginalisation, for assistance. discrimination) Complex policies. UK laws may indicate a right to rehabilitation, • How to raise awareness about torture but in reality, policies regarding the and its impact entitlement of non-nationals to access specific aspects of health or social Training: participants’ comments care are complicated and sometimes contradictory. Service providers are 2.50 In a discussion about the need to often confused about who is and who develop justice and rehabilitation support is not entitled to apply for their service, in the context of their own countries, and thus erroneously turn away eligible participants from Armenia, Azerbaijan and survivors of torture. Georgia listed some changes they feel are • Practical obstacles. The UK has needed in order to improve the possibilities specialist services able to confidently for providing holistic rehabilitation… provide support to torture survivors • Greater provision of legal and clinical seeking rehabilitation. However, such help services are not found in all UK cities. For survivors housed in parts of the • Work with detention centre and prison country lacking specialist services, it administrations to increase staff skills can be prohibitively difficult to access and professionalism a qualified lawyer or clinician with the • Development of recommendations for expertise necessary to work with their their states on how laws and policies degree of trauma and complexity of should be implemented needs. • Evaluate current domestic legislation in • Vilification of asylum seekers. Some the light of international standards service providers who should provide • Increase the skills and awareness of care to an asylum seeker will turn them human rights workers, clinicians and away; individuals and families may feel journalists unwelcome and unable to integrate into a community due to hostility; refugees - Share opinions and experiences may not be offered employment even if among human rights workers, clini­ they are suitably qualified due to racism, cians, lawyers, journalists and so on and so on. - Raise public awareness and get • Language barriers. In the UK, survivors the public involved with the help of of torture come from countries around professionals working in rehabilitation the world and many don’t speak English (doctors, lawyers, journalists etc.) at all or well enough to communicate • Include the voices of survivors fully. Lawyers and clinicians often struggle to find appropriate, • Take victims into account to a greater extent 2.49 Additional Points to consider • Lobby for changes in the law while • What other human rights are impacted working on improving the availability of by rehabilitation needs (for example, the rehabilitation Holistic Rehabilitation 35

6. Our role in promoting are being met. holistic rehabilitation Example: Freedom from Torture doctors document evidence of torture for asylum claims 2.51 This list is impressive but quite daunting. For those of us working 2.54 A key responsibility of the doctors at with survivors of torture, it often feels Freedom from Torture is to write reports overwhelming to think about how to for their clients so that clients can apply for challenge deep resistance within a asylum. By documenting signs of torture, society or to counter systemic blocks to the doctors provide evidence for asylum accessibility for your client. However, we seekers to make their cases. must think about these things if we want to • Most of the doctors at Freedom from find ways to change them. Torture have a background in general 2.52 Each of us has a role to play in family medicine but have received improving the way things work so that specialist training on conducting more survivors are able to enjoy their forensic examinations of torture as right to rehabilitation. Luckily, we don’t outlined in the Istanbul Protocol. have to work alone. In furthering the right • In most cases, torture victims’ damage to rehabilitation, it is vital that human is both psychological and physical. rights defenders, clinicians, lawyers and community workers all work together. What • In cases where there is no physical specialist services and evidence of torture Freedom experts can you work with as part from Torture’s psychologists and of a team or web of support to ensure psychiatrists write reports. that the survivor is able to realise • “The report should satisfy the require­ their right to rehabilitation? ments of the court system, but my personal responsibility is to the client.” At Freedom from Torture, our legal and А. 2.53 Medical medical workers discuss things together • Provide medical evidence of torture for before writing the report. After the report is individuals, which can be used in court complete, legal and medical teams discuss proceedings or in asylum claims14. it again. A lawyer needs a medical expert’s opinion in order to decide whether the case • Conduct thorough health assessments can be taken further. and explore with the client (as far as possible) how torture has impacted a survivor’s physical or emotional B. 2.55 Clinical (psychologist, health (see Freedom from Torture’s therapist, social worker) Assessment Guidelines15). Based on your assessment, refer the survivor to • Conduct thorough psychological appropriate specialist treatment. assessments and explore with the client (as far as possible) how torture • Liaise with lawyers and social workers has impacted on a survivor’s emotional to ensure that all of your client’s needs health16. Based on your assessment,

14. Specialist training is required on the Istanbul 16. See Medical Foundation for the Care of Victims of Protocol Torture (FfT). Identifying survivors of torture and 15. The assessment is available on Freedom from assessing their health needs: A Practical Guide. Torture’s website: www.freedomfromtorture.org August 2010. Available for download at: www. 36 Penal Reform International

refer the survivor to appropriate 2.57 As a clinician or lawyer working in a specialist treatment. Many other human rights context, it is important to be service providers will have neither mindful of data that can potentially help the confidence nor the skills to do so support individual survivors or wider human and may not recognise the extent of a rights initiatives. survivor’s needs. Therefore, your referral 2.58 Client data can be used for17: documentation can help other services better support a client. • The mental and physical protection of • Provide training to NGOs, other service survivors (through provision of medical providers and experts to build greater evidence demonstrating that that an awareness and confidence and thus individual was tortured and is thus enabling them to work more effectively eligible for protection and rehabilitation) with survivors of torture • Advocacy on behalf of clients with • Work with lawyers and community government agents in relation to workers to help them better understand welfare and support matters survivors’ needs and rights so that they can lobby State bodies and/or negotiate • Conducting strategic litigation to with relevant civil servants to ensure try and change the law in relation to greater rehabilitative support. particular survivors • The defence of the human rights of C. 2.56 Legal survivors as a group, both in the UK and at an international level The role of the lawyer is most obvious in the establishment and operation of an effective • Statistical human rights purposes, legal framework to prevent torture and inclu­ding production of statistics on other forms of cruel, inhuman or degrading torture victim issues. treatment or punishment («ill-treatment»). However, lawyers at the national level, and 7. Striving for the right their professional associations, also have to rehabilitation – the a vital role to play in ensuring transparency in institutions and in strengthening the role of the survivor capacity of national, regional and even 2.59 When working to assist a client with international actors. Furthermore, this their rehabilitation, whether helping your role is not purely legal; it is to a large client to access justice or redress or extent social and political’ involving liaison receive medical or social support, it is vital between detainees and their families, that your primary consideration is to deliver cooperation with civil society actors, and what they actually want. lobbying of government officials. 2.60 Both your actions and your Above excerpt from, The Role of Lawyers in interventions should be ‘survivor-led’. the Prevention of Torture, The Association What is your client’s immediate priority for the Prevention of Torture (“APT”), and what can wait? What does the client January 2008. feel ready and able to do right now? What will require more support and time? For

D. Client data instance, if the survivor is adamant that

17. Use of client data and research is also explored in freedomfromtorture.org. chapter 4 Holistic Rehabilitation 37

they can’t heal until their torturer is brought the need for greater support for women to justice yet they are still very distressed torture survivors in their efforts to rebuild and traumatised, they may need additional their lives and seek redress. support. They may need to work closely 2.64 Meryem, a survivor who sought the with a therapist and receive support from help of Freedom from Torture after fleeing family and community in addition to the Turkey, had endured years of abuse living work they are pursuing with you, (or an in a society in which women are commonly NGO, lawyer or other professional), to bring victims of discrimination. Violence against their legal case to court. women was the norm and access to justice 2.61 Also, we would do well to recall our a remote prospect. Meryem was tortured rights-based approach and our wider by the police and raped countless times in understanding of holistic rehabilitation. Are detention. survivor voices being heard as part of the 2.65 Justice Denied examines the discussion and debate about how services experiences of over 100 women from 24 could be improved in your country? Ensure, different countries, who, like Meryem, were therefore, that in your strategic discussions, forced to seek refuge in the UK because of all relevant stakeholders are at the table - continued failures in their own countries to including survivors and their families. protect their rights and to provide access to healthcare and to legal redress. 2.62 Freedom from Torture: What our 2.66 Freedom from Torture found that clients tell us they want almost all of these women had suffered • Rehabilitation several incidences of rape and sexual assault. In an overwhelming number of • Overall, justice is imperative: cases, they were unable to access any - To stop harm from happening to support, tending to be dismissed by the others authorities when they did seek help, and in some cases were rejected by their - Redress communities and families. • Acknowledgement 2.67 The research included a study of 100 • Support, compensation female Freedom from Torture client files: • To be heard, to have a say • The majority of women did not report the violations because the perpetrators were police or military personnel • No perpetrators were prosecuted 8. Supplementary • Police were perceived as indifferent, materials biased and ineffective • There was no discernible state rehabili­ A. Justice denied tation structure – ‘nowhere to go’ • Mass violations are seen as ‘just part 2.63 In December 2009, Freedom from of the bigger picture’ - ‘what was the Torture published a research report, point in reporting anything?’ Justice Denied, to highlight the challenges experienced by many survivors in Access to Justice? accessing justice. The report demonstrates 38 Penal Reform International

• Result surprisingly low given brutality of fragmented recall, emotional violence inflicted numbing, late disclosure • Sought informal or secret treatment 2.72 A more robust and gender-sensitive approach to reparation is needed; such • Sought treatment for physical injuries approaches could include: • Majority did not report rape • Acting on the basis of women’s survivor 2.68 The social stigmatisation of survivors contexts (taking into account: identities, of rape and sexual violence exacerbates shame, stigma) the difficulties for women in disclosing • Taking a holistic approach or reporting abuse either to security personnel or clinical staff. Other powerful • Interdisciplinary and survivor-driven factors militate against women accessing focus justice, such as the difficulties generated • Fluidity, not linearity by an individual’s response to trauma, the • Long-term commitment impact of fragmented recall, emotional numbing and late disclosure. These factors combined can mean ongoing impunity for B. Additional perpetrators of torture. readings

Adding it all up APT - The role of lawyers 2.69 Leanne MacMillan, Former Director of Policy and External Affairs at Freedom APT from Torture: Association for the prevention of «Women continue to be targeted torture for torture. They are then hampered in their pursuit of redress and even access to basic healthcare The role of lawyers in the in societies where underlying and prevention of torture pervasive gender inequalities and disparities persist. Denying them January 2008 access to justice and rehabilitation perpetuates a climate in which Introduction torturers are able to act with impunity.” The Association for the Prevention of Torture (APT) believes that the effective Powerful factors that militate prevention of torture requires three against women accessing justice integrated elements: • No effective access to justice 1. Transparency in institutions: All places where persons are deprived of their • Unable to report abuse to authorities liberty should be accountable and • Unable to seek help, protection or subject to regular scrutiny through rehabilitation due to stigmatisation of independent visiting and other victim not perpetrator monitoring mechanisms. • Combine above with individual’s 2. Effective legal frameworks: Interna­ response to trauma, impact of tional, regional and national legal Holistic Rehabilitation 39

norms for the prevention of torture and whether it was obtained by another State, other ill-treatment should be universally except where it is used as evidence against respected and implemented. the suspected perpetrators of such acts.4

3. Capacity strengthening: National and Where these rights are not guaranteed international actors who work with in national legislation, the role of a bar persons deprived of their liberty should association will be primarily political; be trained to increase their knowledge it can lobby for the ratification of the of, and commitment to, prevention relevant international treaties, including practices. the Convention against Torture and its Optional Protocol, comment on draft laws, The role of the lawyer is most obvious point out lacunae in legislation, monitor in the establishment and operation of application of legislation as well as reported an effective legal framework to prevent cases of torture, and ensure that the law torture and other forms of cruel, inhuman is the subject of public debate as well or degrading treatment or punishment as professional scrutiny. Particularly in (“ill-treatment”). However, lawyers at cases where lobbying at the national level the national level, and their professional is ineffective, the bar association may associations, also have a vital role to play choose to submit comments or reports to in ensuring transparency in institutions and the relevant international treaty body or in strengthening the capacity of national, regional mechanism. In all of these actions, regional and even international actors. bar associations can cooperate with and, Furthermore, this role is not purely legal; where necessary, provide training to civil it is to a large extent social and political, society organisations engaged in human involving liaison between detainees and rights monitoring or lobbying. their families, cooperation with civil society actors, and lobbying of government officials. - Jurisprudence and the development of standards Effective legal frameworks Where legislation is in place, lawyers have - Legislation an important role to play in advancing and To be effective, a legal framework for the improving the protection of the law at the prevention of torture must enshrine the national, regional and even international procedural guarantees related to the right level through jurisprudence. They can to a fair trial of every detainee, including the argue for judges to interpret international fundamental human right of every person in instruments dynamically, ensuring pre-trial detention to 1 for example that States parties to the Convention against Torture fully implement consult with a lawyer of his or her choice,1 their obligation to “keep under systematic the right to challenge detention before review interrogation rules, instructions, an independent court,2 and the strict 1 This right is guaranteed in a number prohibition of all forms of secret detention.3 of international instruments, including But guaranteeing these rights is not enough; Article 14(3)(b) of the International prevention also includes deterrence and Covenant on Civil and Political the removal of incentives to torture. Torture Rights, Article 6(3)(c) of the European must appear as a separate criminal offence, Convention for the Protection of and any evidence obtained by torture, or Human Rights and Fundamental in an unofficial place of detention, must be Freedoms, Article 8(2)(d) of the Inter- excluded from proceedings, regardless of American Convention on Human 40 Penal Reform International

Rights, and Article 7(1)(c) of the African with a view to preventing any cases of Charter on Human and Peoples Rights. torture.”5 These measures must in fact be 2 This is guaranteed under, among effective in preventing torture, and must be others, Article 9(4) of the International replaced where they are not.6 International Covenant on Civil and Political Rights, standards in this area are continually Article 5(4) of the European Convention improving. For example, the UN Committee for the Protection of Human Rights against Torture now considers that every and Fundamental Freedoms, Article interrogation should be recorded.7 By 7(6) of the Inter-American Convention making reference to international and on Human Rights, and Article 6 of the regional standards developed in other African Charter on Human and Peoples regions, or by treaty bodies, lawyers at Rights, interpreted in conformity with the national level can make a valuable principle M(4) of the Principles and contribution to the construction of a Guidelines on the Rights to a Fair coherent and comprehensive body of Trial and Legal Assistance in Africa, international law on the prevention of and principle 32 of the Guidelines torture. and Measures for the Prohibition and When a detainee, relative or lawyer lodges Prevention of Torture, Cruel, Inhuman or a complaint of torture or other forms of Degrading Treatment or Punishment in ill-treatment by public officials, or public Africa (The Robben Island Guidelines). officials have reasonable grounds to 3 See Human Rights Committee, suspect that such abuses have occurred, General Comment 20 (1992), in UN international human rights law requires Doc. HRI/GEN/1/Rev.7, paragraph 11; that there be a prompt, impartial and UN Special Rapporteur on Torture, thorough investigation.8 During such Standing General Recommendations, investigations, States must ensure that UN Doc. E/CN.4/1995/34, 12 January complainants, their families and witnesses 1995, paragraphs 923, 926(b) and are protected from reprisals. Moreover, (d). For more detailed discussion of to comply with their international legal this issue, see APT, Incommunicado, obligation to ensure an effective remedy unacknowledged, and secret detention to anyone who is the victim of an act of under International Law, March 2006. torture or other form of ill-treatment, States must guarantee in law and practice the 4 See UN Convention against Torture, independence and freedom of action of Article 15; Human Rights Committee, individual lawyers and their professional General Comment 20 (1992), in UN associations to bring forward such claims Doc. HRI/GEN/1/Rev.7, paragraph 11; without fear of retribution, whether or not the UN General Assembly Declaration claims are ultimately upheld by the courts.9 against Torture (9 December 1975), GA Res. 3452(XXX), paragraph 12; UN General Assembly Resolution on - The early stages of detention Torture (2007), UN Doc. A/RES/61/153, International human rights law requires paragraph 7. that all persons in police custody be methods and practices as well as informed of their rights without delay and arrangements for the custody and in a language they understand.10 The treatment of persons subjected to any notification of rights must include the rights form of arrest, detention or imprisonment to be assisted by a lawyer of one’s choice, in any territory under its jurisdiction, to be medically examined by a doctor of Holistic Rehabilitation 41

one’s choice and to notify a relative or a interrogation.11 third party of one’s choice of the fact of Procedures should be put in place to detention. Furthermore, these rights apply ensure that every detainee is notified of regardless of the official designation of the his or her rights in practice. For example, detainee under the legal system concerned. detainees could be asked to sign a Suspects, witnesses, and any other person statement attesting that they have been who is under a legal obligation to attend informed of their rights. Lawyers have an and remain at a police important role to play in lobbying for the 5 Article 11 Convention against Torture. implementation of such procedures, and subsequently in ensuring that 6 Article 2(1) Convention against non-respect of procedural guarantees Torture; Committee against Torture, in relation to their clients is detected, General Comment 2 (2007), highlighted in any proceedings, UN Doc. CAT/C/GC/2/CRP.1/Rev.4, investigated, and, where appropriate, paragraph 4. leads to disciplinary sanctions against the public officials responsible. 7 Committee against Torture, General Comment 2 (2007), UN Doc. CAT/C/ International experts agree that “it is in the GC/2/CRP.1/Rev.4, paragraph 14. period immediately following deprivation of liberty that the risk of intimidation and 8 This is explicitly provided by Article 12 physical ill-treatment is the greatest.”12 of the Convention against Torture. The Lawyers have a crucial role to play in UN Human Rights Committee stated ensuring that all persons suspected of that the obligation also exists under having committed or otherwise being the International Covenant on Civil and connected with a criminal offence are Political Rights in its General Comment treated in accordance with human 20 (1992), in UN Doc. HRI/GEN/1/Rev.7, rights standards at every stage of the paragraph 14. This obligation has been investigation and proceedings. Every confirmed by the European and Inter- detainee’s fundamental human right American Courts, in Article 8 of the of access to defence counsel must be Inter-American Convention to Prevent ensured in law and in practice from the and Punish Torture, and by the African very outset of detention.13 This access Commission. must be prompt, regular, direct and confidential, and if a person cannot 9 Basic Principles on the Role of Lawyers, afford to pay for the services of a lawyer, UN Doc. A/CONF.144/28/Rev.1, 7 qualified and independent legal counsel September 1990, paragraph 17. must be provided free of charge. Most 10 Body of Principles for the Protection commonly, persons deprived of their liberty of All Persons under Any Form of on suspicion of having committed a given Detention or Imprisonment, criminal offence are subjected to acts of Principles 13 and 14; Committee torture and other forms of ill-treatment, or against Torture, General Comment 2 threats thereof, during interrogation in the (2007), UN Doc. CAT/C/GC/2/CRP.1/ initial period of detention for the purpose of Rev.4, paragraph 13 extracting a forced “confession” or related information. Such abuse almost station or other place of detention all have inevitably occurs after the detainee has the right to consult with a lawyer, and, in been denied prompt access to, or has principle, to have a lawyer present during not been informed about his or her 42 Penal Reform International

right to, a lawyer. Form of Detention or Imprisonment, and Rule 93 of the European Prison Of course, in truly exceptional Rules. The European Court of Human circumstances, and to protect specific Rights and the Inter-American interests in relation to a criminal Commission have also recognised the investigation, it may be necessary right of access to a lawyer during the to delay for a very short period a preliminary stages of detention. detainee’s access to a lawyer of his or her choice. However, only an extremely known co-conspirators to ongoing limited range of interests can provide investigations by the authorities; or to grounds for any restriction on the right of otherwise prevent specific threats to the access to a lawyer: to prevent completion life or physical security of other persons. of a specifically-suspected violent Any exceptional restrictions on the right conspiracy; to prevent the suspect of prompt access to regular legal counsel from alerting specifically- should be specifically approved by an independent judge.14 11 This right may be restricted only for a very short period in exceptional However, in no circumstances should circumstances where awaiting the exceptional restrictions result in the right of arrival of a lawyer would jeopardise access to a lawyer being denied altogether, the investigation. See, for example, as even a detainee in such a situation has the Committee against Torture, right to meet with an independent lawyer.15 Conclusions and Recommendations In this context, bar associations have an on Austria (2005), UN Doc. CAT/C/AUT/ important role to play in appointing truly CO/3, paragraph 11; Conclusions and independent lawyers, as they are often the Recommendations on the Netherlands only bodies with the necessary qualifications (2007), UN Doc. CAT/C/NET/CO/4, and independence. Such lawyers must act paragraph 6; Conclusions and independently in practice, which means Recommendations on Japan (2007), that they must be able to communicate UN Doc. CAT/C/JPN/CO/1, paragraph with the detainee in private and must not be 15. See also European Committee for bound to disclose to the government any the Prevention of Torture, 12th General communications with the detainee. Report, paragraph 41. States that go beyond such exceptional limits on the right to legal counsel from the 12 See the Report of the UN Special outset of detention are clearly in violation Rapporteur on Torture, UN Doc. E/ of international fair trial standards.16 CN.4/2004/56/Add.2, 6 February 2004, Moreover, such violations may be indicative paragraph 60. of a wider pattern of abuses; international 13 The right to legal counsel at all stages experts have long recognised that torture of detention, including at the very is most frequently practiced during outset, is a key component of a fair trial incommunicado detention.17 Lawyers and is enshrined in various international defending the rights of their clients in such and regional human rights instruments States often place themselves at risk. In and standards. See for example these circumstances, bar associations Principle 1 of the Basic Principles can provide vital protection, condemning on the Role of Lawyers, Principle attacks on the independence of lawyers, 17(1) of the Body of Principles for the and ensuring the collective right to freedom Protection of All Persons under Any of expression of their members even Holistic Rehabilitation 43

where the exercise of such freedoms on an 17 December 2002, paragraph 26(g). individual level can lead to reprisals. See also APT, Incommunicado, unacknowledged, and secret detention - The rule of law under International Law, March 2006. An effective legal framework requires the legal standards.18 Such statements may support of civil society. To be legitimate in serve to weaken the absolute nature of the eyes of the population, laws must be the prohibition of torture and ill-treatment, seen to reflect the values of the particular both in law and in the eyes of the general society. Conversely, the rule of law is at the public. Bar associations have a unique very foundation of democratic societies. credibility and expertise to respond to such It is telling that governments which have challenges to the prohibition of torture, sought to justify torture or other forms of ill- and to engage government authorities in a treatment, particularly as regards persons public debate. suspected of terrorism, have tried to hide However strong the legal prohibition on behind the colour of law, inventing highly torture, reality has yet to conform to the contrived and questionable interpretations strict letter of the law. Other mechanisms of international beyond the purely legal are required to 14 Report of the UN Special Rapporteur ensure that agents of the State do not on Torture, UN Doc. E/CN.4/2003/68, resort to or tolerate torture, that violations 17 December 2002, paragraph 26(g). are detected, and that perpetrators are punished. 15 Ibid. 16 These standards are laid out Article 14 of the International Covenant Transparency in Institutions on Civil and Political Rights, Article 6 of the European Convention for Torture most often occurs behind closed the Protection of Human Rights and doors. Where torturers believe that their Fundamental Freedoms, Article 8 of actions will not be detected by outsiders, the American Convention on Human and feel secure in the knowledge that Rights, and Article 7 of the African their superiors approve of - or will turn a Charter on Human and Peoples’ blind eye to - abuses, they all too often Rights. Several ‘soft law’ instruments act with impunity. For this reason, the APT give detail to these fair trial rights, has worked for 30 years towards greater including, at the international level, transparency in institutions as a vital the Basic Principles on the Role of component of the prevention of torture. Lawyers, the Basic Principles on the Independence of the Judiciary, the Guidelines on the Role of Prosecutors, - Detection and reporting of the Body of Principles for the torture and ill-treatment Protection of All Persons under Any It is imperative that in practice detainees Form of Detention or Imprisonment and have access to a lawyer of their choice the UN Standard Minimum Rules for from the very outset of detention as the Administration of Juvenile Justice, an important safeguard against acts of all of which can be accessed at www. abuse, including during interrogation. ohchr.org. For this safeguard to be effective, the 17 Report of the UN Special Rapporteur authorities must respect the confidentiality on Torture, UN Doc. E/CN.4/2003/68, of the communications and consultations between lawyers and their clients. Privacy 44 Penal Reform International

of communication is essential for the do not exist, lawyers are often the only effective representation of the client and independent persons with access to is critical to ensuring that a detainee can detainees in police and pre-trial detention. freely disclose any torture or other forms of In such contexts, and where authorities do ill-treatment by public officials. Domestic not respond to confidential demarches, legislation should be brought into line with torture and ill-treatment will continue, international human rights standards to and perpetrators will continue to act with reflect these confidentiality rights, which impunity, if lawyers and bar associations do should be respected by public officials in not act to draw public attention to abuses. practice. However, awareness-raising must never jeopardise the safety and privacy of victims. The lawyer will often be the first person the Information should be made public only detainee can inform about any ill-treatment. where cases are brought before a public Particularly where the lawyer and detainee tribunal, where the detainee has expressly do not have a pre-existing relationship, consented to the use of information in this recording allegations can be a sensitive way, or where information is given in a and delicate procedure that requires the general, aggregated form which in no way establishment of a relationship of trust. It permits the identification of individuals is crucial to ensure that the detainee is not or breaches lawyer-client confidentiality. put at risk at any time, which requires that Awareness-raising at the national level he or she understands precisely what steps could involve, for example, issuing press may be taken with regard to the alleged releases or reports, cooperating with abuse. While such steps will in many cases NGOs, or organising conferences or other be primarily legal, the lawyer may also have events. To draw international attention more social role, acting as intermediary to violations, bar associations can also between the detainee and his or her loved transmit information to relevant UN or ones, informing the detainee and/or his or regional mechanisms.19 her family about organisations working to record such abuse, or about the support and rehabilitation services available to - Detention monitoring victims of torture or ill-treatment. To Many States do have some form of independent monitoring of at least some places of detention at the national 18 In response to such attempts, the UN level. Establishing national preventive Committee against Torture recently mechanisms with access to all places of reiterated the absolute nature of the detention is one of the primary aims of prohibition of torture and ill-treatment: the Optional Protocol to the Convention Committee against Torture, General against Torture. However, even States Comment 2 (2007), in UN Doc. CAT/C/ which have not ratified that instrument GC/2/CRP.1/Rev.4, paragraphs 5-7. are often under an obligation to set up prevent reprisals, any transmission of such mechanisms.20 Both the Committee allegations to any authority, body or against Torture, which monitors State organisation, be it for nominative or for compliance with the Convention against anonymous use, should only take place Torture and the Human Rights Committee, with the express consent of the detainee. which monitors compliance with the International Covenant on Civil and Political Particularly where monitoring bodies are Rights, have found that those instruments under-resourced, lack independence, or Holistic Rehabilitation 45

create an obligation to establish a UN Doc. CAT/C/CR/30/7, systematic and independent mechanism to 2003, paragraph 6(l); Concluding monitor the treatment of persons deprived Observations on Russia, UN Doc. of their liberty.21 Bar associations A/52/44, 1996, paragraph 43(d) (and UN Doc. CAT/C/CR/28/4, 2002, 19 In addition to transmitting information paragraph 8(f)). See also Human Rights to the UN Committee against Torture, Committee, General Comment 21, in Human Rights Committee or other UN Doc. HRI/GEN/1/Rev.1, paragraph 6 relevant treaty body, the bar association could submit information under the can obviously lobby for such systems to Universal Periodic Review procedure be put in place, and lawyers can challenge of the UN Human Rights Council. With any lack of independent monitoring in the the express and informed consent courts. of the victim, individual cases may Where an independent monitoring body be submitted to Special Procedures does exist, lawyers and bar associations of the UN Human Rights Council, can provide it with vital information about including the Special Rapporteur on problems and practices in particular places Torture. A summary of communications of detention on a confidential basis. Bar between Special Procedures and State associations and lawyers can also, in a authorities regarding individual cases is sense, monitor the monitors, commenting included in the annual reports of Special on the legislation setting up or designating Procedures to the UN Human Rights monitoring bodies, as well as their working Council. At the regional level, lawyers methods, functional independence, findings and their professional associations and reports. However, perhaps the most may submit reports and information to, obvious and important contribution of among others, the European lawyers to such a monitoring mechanism Committee for the Prevention of will be as members or associated torture, and the Special Rapporteur experts. To be truly effective, preventive on Prisons and Conditions of Detention mechanisms need a mix of expertise, and it in Africa. is crucial that this includes legal expertise, in particular a knowledge of international 20 This is made clear in the Preamble and regional laws, standards and norms on of the Optional Protocol to the conditions of detention, codes of conduct Convention against Torture, which for custodial staff, and more generally on recalls the State obligation under the the rights not to be subjected to torture or Convention against Torture to take other ill-treatment, and to a fair trial. The effective measures to prevent acts importance of other types of expertise of torture and other ill-treatment, should not be forgotten, however; a and recognises that the protection preventive mechanism composed entirely of persons deprived of their liberty of lawyers will often be unable to detect the against torture and other ill-treatment full range of possible issues. For example, can be strengthened by a system of the presence of a medical doctor will be regular visits to places of detention. vital to evaluate the health care available 21 See Committee against Torture, to detainees, and to ensure that symptoms Concluding Observations on Brazil, UN of detainees who allege torture can be Doc. A/56/44, 2001, paragraph 120(d); documented. Concluding Observations on Moldova, Capacity strengthening 46 Penal Reform International

Many bar associations already play an Conclusion important role in strengthening the capacity Lawyers and their professional associations of their members through continuing legal have a central role to play in the effort education, seminars, expert meetings, to prevent torture and other forms of ill- and more informal exchanges of expertise. treatment at the national, regional and They can also play a part in strengthening international levels. They have unique the capacity of both government and civil expertise and ability to strengthen the society actors. For example, where a State legal framework to prevent torture by is preparing to ratify the Optional Protocol lobbying for changes in legislation, to the Convention against Torture, the arguing for a dynamic interpretation of bar association may be able to provide laws to strengthen effective protection, comments on the legislative reforms which and ensuring that legal and procedural would be required at the national level, guarantees are in fact applied to every and even advice or training to members detainee. However, the role of lawyers in of the relevant government department the prevention of torture goes much further on the requirements of international law. than ensuring the implementation of a legal Where this is not directly possible or framework. desirable, the bar association may instead lobby for the government to organise such Lawyers and bar associations can play a training by another independent body. As vital part in opening places of detention discussed above, the bar association can to outside scrutiny. In many countries, also train members of independent national lawyers are the only independent persons preventive mechanisms, all of whom will with access to places of detention, and the need to have at least basic knowledge ability to meet with detainees in private. of the international law, standards and They are thus often the first external norms relevant to detention, as well as the observers to detect, or receive reports international basis for their mandate where of, torture or ill-treatment. Such abuses the State has ratified the Optional Protocol can in many cases be addressed through to the Convention against Torture. litigation, including public interest litigation, but depending on the national context, and Effective prevention of torture at in particular the risk of reprisals against the national level requires the active detainees, bar associations may also take involvement of civil society, including on a more political role, making abuses NGOs, associations of relatives of public, or submitting reports to relevant detainees, lay visiting schemes, and national, regional and international bodies. providers of pastoral care in places of detention. Bar associations can play an The effective prevention of torture requires important role in strengthening the capacity that lawyers not be alone in having access of such groups, through the provision of to places of detention. Rather, there must advice or training on specific aspects of be regular, systematic and independent national or international law, and on the monitoring of all places of detention at the scope of the prohibition of torture and ill- national level. With their detailed knowledge treatment as regards high-security prisons, of international and regional laws, conditions of detention, and solitary norms and standards, lawyers and bar confinement. Bar associations may also associations can very effectively lobby for wish to be represented at conferences such independent monitoring, or provide organised by NGOs on these issues. assistance to other groups which are doing so. Where monitoring mechanisms

Holistic Rehabilitation 47

are established, they will require a mix of watchdog, and condemn any attempts to expertise, but it is crucial that at least one water down the absolute legal and moral legal expert is included to ensure that the prohibition of all forms of ill-treatment. body can both monitor compliance with legal standards and comment or advise on 9. Conclusion legislation. Bar associations can help to 2.73 In this chapter, we began to explore ensure the independence and effectiveness rehabilitation as a ‘right’ in both theory and of the mechanisms as a whole by practice. Specifically, we looked at Article commenting on their legal mandate and 14 of the Convention against Torture. We powers, providing them with information, started with the aspiration and ideal behind and acting as a watchdog against any the Convention, then explored common attacks on their independence. In addition, understandings of Article 14 and finally bar and other professional associations can looked at how the right to rehabilitation may provide advice and training to detention (or may not) be incorporated into domestic monitors, government departments, legislation. We explored what this means and civil society organisations, thereby for survivors - and for you as a service increasing the capacity of all actors in the provider. Related to this right is the desire effort to prevent torture or ill-treatment. for ‘justice’, therefore we briefly reviewed The role of lawyers in the prevention of standard justice initiatives (including torture thus goes far beyond litigation to prosecution, redress and reparation) and include a direct role in monitoring places of how they relate to rehabilitation. detention, and a more indirect 2.74 We explored the practical side of the role in strengthening the capacity of right to rehabilitation. In an ideal world, national actors. Effective prevention of every survivor of torture would be able to torture requires, as a prerequisite, a truly easily access any and all specialist services independent legal profession. Bar and and the support they needed to help with other professional associations can help their rehabilitation. In reality, this is rarely to entrench this independence, provide a the case, even in countries with strong forum for lobbying and debate, act as a rehabilitative legislation. 48 Penal Reform International Chapter 3 Rehabilitation as a process

1. General overview • Explain a ‘survivor-led’ approach to 2. Theory rehabilitation A. Holistic rehabilitation as a process • Describe the role of the survivor’s voice in holistic rehabilitation B. Interdisciplinary work C. Enabling voice through survivor • Describe survivor participation activism, examples • Articulate the issues to consider with D. Worker safety, self-care and regard to worker safety and well-being well-being 3. Holistic rehabilitation: what and how 4. In practice/reality 2. Theory A. Practical aspects of holistic rehabilitation at Freedom from A. Holistic rehabilitation as a Torture, examples process B. Rehabilitation in the context of your countries, examples 3.2 The overall goal of holistic rehabilitation is to bring about healing for the survivor of C. Psychotherapeutic treatment for torture and their family. trauma D. Holistic rehabilitation services 3.3 There are a number of strands involved in helping a survivor to rehabilitate. 5. Ethical issues to consider 3.4 Working with the survivor to promote 6. Supplementary materials their health and wellbeing is one such Case study strand. A practitioner would do this by supporting the survivor to access health services (such as helping them register with 1. General overview a GP, encouraging them to consult the GP on their health concerns and ensuring they know how to explain these concerns to the 3.1 By the end of chapter 3, readers will GP and also advocating for the survivor be able to: with the GP where necessary). • Articulate the key approaches and good 3.5 Another strand of holistic practice regarding holistic rehabilitation rehabili­ta­tion may be providing as a process psychological support for the survivor. • List the index of issues to consider when This can be achieved through a variety working directly with a client through of traditional and alternative therapeutic holistic rehabilitation initiatives in the interventions according to a survivor’s reader’s context unique needs. • Describe the range of therapeutic, social 3.6 A third strand of holistic rehabilitation and practical interventions that can involves working therapeutically with the support survivors of torture survivor and their family so that healing Holistic Rehabilitation 49

takes place within the family, and for the 3.12 Holistic rehabilitation also focuses survivor, within the family unit. heavily on the client’s psychological well- being. Long after many of the physical 3.7 Practical support or social welfare injuries have healed, a survivor of torture is a fourth strand of holistic rehabilitation. may continue to struggle with psychological This might include assistance with housing problems. It is vital that the survivor has and benefits, advocating for the client with access to proper psychological support to other professionals or agencies, providing help them to address these issues. emergency financial grants, food and clothing and advocating for children at 3.13 Some survivors of torture might also schools. require psychiatric assistance such as assessment, medication and the monitoring 3.8 A fifth strand of holistic rehabilitation of psychiatric problems that may pre-date involves working with the survivor so the torture or have developed following that they can achieve economic self- their experience of torture. (These might sufficiency. This might include include severe depression, psychosis and supporting clients to access benefits suicidal ideation.) or enter paid work or running teaching sessions with clients so that they Legal learn how to manage their finances within the UK context. 3.14 A survivor of torture may require legal assistance for protection across their entire 3.9 A final strand of holistic rehabilitation spectrum of rights which could range is “justice”. This could include supporting from the securing of secure housing to a the client to explore which avenues are legal status (for immigration and asylum open to them for seeking justice. As you purposes), from the right to healthcare to to will remember from Chapters 1 and 2 of education, etc. The survivor of torture may this manual, there are many different ways also require legal assistance in order to in which a survivor of torture can achieve a pursue justice (see chapter 2). sense of justice, including pursuing criminal conviction of the torturer or a civil case for Social welfare damages. 3.15 A survivor of torture will potentially have a number of social welfare or B. Interdisciplinary work practical support needs. As discussed above, professional support may 3.10 The process of holistic rehabilitation include giving assistance with housing, takes time and often requires multiple benefits and employment matters, interventions. A web of support for the advocating for the client with other survivor is needed. Holistic rehabilitation professionals/agencies, providing requires a multidisciplinary approach. emergency financial grants for food and clothing and advocating for children at Medical/Psychological schools. Social workers and welfare 3.11 Meeting the survivor’s health needs rights advisors can play a crucial role in includes making sure any injuries or chronic helping the survivor to get these needs problems resulting from the torture are adequately met. addressed as well as monitoring the client’s overall health. 50 Penal Reform International

Group work and building empowering way to reclaim survivor voices communities comes through survivor activism - as an activist the survivor can work to raise public 3.16 A vital strand of the survivor’s ‘web awareness and to influence organisations of support’ is their community. The and governments to bring about change. professional help and support that a There are many activities a survivor can survivor receives generally occupies only engage in, including: letter-writing; talking a fraction of their daily life. It is important to the media or playing a part in media that a survivor also has support outside the campaigns; giving educational talks; writing rehabilitation centre/professional’s office. or creating art that highlights key issues; A survivor of torture might be dislocated lobbying government officials and many from their community of origin if they are, more. In some cases these activities will for example, a refugee or asylum seeker. involve the survivor talking about their Some survivors might feel unsafe in their personal experience of torture; however, community of origin due to the ill-treatment in many instances the survivor will not they have experienced in that environment. focus on the details of the torture they have Alternatively, a survivor might be physically personally experienced. but speak out living in their community of origin but not against torture and mistreatment in general, feel a part of that community due to their highlighting the struggles of living in society experience of torture. Many survivors as a survivor or speaking in support of of torture report an extreme feeling of holistic rehabilitation on the macro-level. In isolation following torture. Accessing any the survivor activism movement, survivors community can seem like a terrifying and are viewed as ‘experts’ due to their first- insurmountable task to torture survivors, hand experience of torture. but they can be supported to begin that “It’s my history. It’s my voice. It’s journey through the use of group work. There are many types of groups, which can my life.” range from the more traditional types of 3.18 “This is not a group for people psychotherapeutic groups to more activity- looking for revenge or abstract idealism based and peer-support groups. Groups even though we have suffered injustice can provide supported and perhaps safer and mistreatment. Instead this is a group opportunities for the survivor to experience of people who have survived torture community integration than the wider and are now keen to act as a network of community. . effective campaigners communicating our opposition to the use of torture, based on our experiences as survivors, and C. Enabling voice through supporting the rights of torture survivors.”18 survivor activism FfT has created a programme for torture survivors that provides a safe space from 3.17 The experience of torture is intended which survivors can raise awareness to silence individuals and can strip away effectively and safely about torture and a person’s sense of self so that they feel its impact on individuals, families and as though they no longer have an identity communities. or an ‘independent voice’. An important 3.19 There are a number of torture survivors goal of holistic rehabilitation is to support who want to tell their story but need the survivor in finding and regaining their 18. Quotations are from members of the Survivors individuality and voice. A particularly Speak OUT network (April 2011 launch meeting). Holistic Rehabilitation 51

support in finding ways to do so. FfT has • The network started with 14 people 3 provided the background, training and years ago; we currently have support to these individuals so they can 19 members express their vision about how to end • After rehabilitation we decided to torture and communicate their journey from make something positive out of what torture to rehabilitation. happened to us by helping others 3.20 Stating that the prohibition against • The fact that we are not on our own is torture is absolute, that torture does not important; it is good to know that there work and that it offends human dignity are others who have experienced the is not enough. At FfT we have found that same things. We can come together and the best way to reach those who believe support each other torture works or simply don’t know about it is to give a voice to survivors. Many torture • Like any organisation we had to define survivors benefit from speaking out and our aims and to concentrate on what sharing their experiences as survivors, was important for us telling others what happened to them and Aims and purposes of the network: expressing their opinion about how to create a world without torture. This empowerment • To speak out about how poverty affects can have a very rehabilitative effect. torture survivors living in the UK 3.21 “When I went to the Medical • To increase understanding of what it is Foundation (FfT) for the first time, I couldn’t like to have to rebuild your life (in most read or write. In Africa I used to talk in front instances alone) in a foreign country of crowds of people but when I became following such intense trauma sick, I could no longer do it. Now I am • To increase understanding of what it is proud to speak out about my experiences like to not be allowed to earn your own because I want to show people that it is money and choose how to spend it really happening” • For the Government to believe us when Robert Kamemba, Torture Survivor we tell them that we are survivors of 3.22 FfT continues to investigate ways to torture and that we cannot return to the ensure that clients and ex-clients actively countries we fled from engage in the work of the organisation; • To spread our message to key decision- these range from governance to advocacy. makers, for them to understand that We are keen to embolden our clients’ torture persists and to ensure that capacity to be the voice of survivors in the survivors have protection work of FfT. • Help to rebuild our lives and begin the Survivor voice and rehabilitation process of rehabilitation and access to care and treatment that meet our needs 3.23 A representative of the group, as survivors ‘Survivors Speak OUT’ talks about how we can create a space from which torture • Examples of our work include talking survivors can safely speak out: with the UK Border Agency Inspector, to school and university students, faith and • All members of this network have one community groups (churches, mosques, thing in common - they all experienced temples), charity groups, local MPs, the torture media (local and national press), writing 52 Penal Reform International

messages on the FfT website, setting up to inform society about your experiences a blog etc: and the situation of survivors. I’ve been on training courses and increased my self- • As a network we decide who to speak to confidence. and how to communicate our message FfT : Would it be possible to create similar • We choose not to talk about the torture groups in your countries? experience (as this can have a negative impact on rehabilitation if not managed P: There’s only a very small chance carefully). We focus on what we want because people are scared of publicity and the public and decision makers to know of information being leaked. People aren’t -.that torture exists and the real extent protected, so they prefer to stay silent. of the hardships survivors face in the UK P: The biggest and most serious problems today arise during the period of integration of • Safety is a serious concern - if some torture victims into society. survivors are identified as speaking out FfT : If torture victims could communicate against torture or governments they anonymously and through the internet, do can put themselves at risk. FfT will you think it would be possible to create a protect the identities of any network similar group in your region, as was done in members not wishing to be identified. Moldova? Members can choose to submit written statements anonymously, can choose P: Here’s an example not connected to not have any pictures or film taken of torture illustrating the difficulty even of them, or have their names published as using the internet apparently anonymously: part of any action. students putting caricatures of the city mayor on the internet were arrested right in the internet café they were using. 3.24 Discussion of Survivors P: The situation in our country is somewhat Speak OUT group between different. I hope to be able to get a group training participants and Freedom of prisoners together who were subjected from Torture to torture in order to activate their strengths and unite their efforts. P: Where is this group and its members P: We can talk about the existence of based? torture in our country - victims can talk FfT: In the UK. Members of the group don’t about it in court - but the problem is that talk about their own personal experience. the government doesn’t acknowledge it as They talk about the changes that are an act of torture. We speak out, but they needed. FfT takes the re-traumatisation don’t listen to us. of victims and their safety very seriously. P: We have the problem of torture in the They’re also not involved in fundraising. army but soldiers don’t talk about it even P: Do you still consider yourself a victim up after they’ve finished their service. to the present day? Or have you been able Recently on YouTube there was a video to integrate into society? showing an officer bullying soldiers. That video provoked a massive FfT: It’s a gradual process. At first you need response among the public, and to understand that you want to change your because of public pressure the perpetrator life. Then later you realise that you need was convicted. Holistic Rehabilitation 53

P: How can we find you so that you can D. Worker safety, self-care share your experience? and well-being FfT: Because of safety concerns and long- term training, at the moment we only work 3.26 Worker safety is a crucial component with FfT clients. But the idea of widening of holistic rehabilitation. It is important to our contacts is being discussed. Perhaps think about your context (your country and/ a subsidiary group of the network might or region) and any potential hazards for the appear. professionals working with torture survivors P: Are you an initiative group or an towards holistic rehabilitation. For example, independent legal entity? if your government is involved in torture but denying that it takes place, think about FfT: We are part of FfT but our decisions whether workers supporting survivors are made independently inside the group. tortured by that government might be at P: If you are part of such a powerful risk of reprisals? organisation, what are you afraid of? 3.27 When considering the professionals FfT: It’s a complicated issue. who support survivors of torture it is also For example, I have a family back important to think about their well-being. It home in my country. What I do is well documented that workers supporting here can affect their safety. people who are very traumatised can themselves be negatively impacted by FfT : It’s very important to change public exposure to the traumatic material. This opinion about victims of torture because phenomenon has been given a variety of public opinion can influence politics. names including: ‘vicarious traumatisation’, This is possible with the help of this ‘secondary trauma’ and ‘compassion network. fatigue’. Survivor participation 3.28 Below are some approaches to self- care for individuals and organisations that 3.25 Survivor participation can also play you may wish to consider in your context: an important role in holistic rehabilitation. Survivor participation means that the Worker’s input clients and/or ex-clients who have • Recognise possibility of vicarious engaged in holistic rehabilitation have traumatisation the opportunity to influence the shaping of those services. Again, this area of • Willingness to seek and use supervision work encompasses a huge spectrum of for myself activities. These can range from • Willingness to seek the support of my low-level participation activities such as colleagues/debrief suggestion boxes and surveys asking about survivors’ satisfaction with services • Reflect upon (to myself and in received, formal consultation with clients supervision) any potential impacts the on specific issues to clients and/or ex- work is having on me clients taking on key decision-making • Awareness of my needs, limits and roles in the organisation such joining the resources Board of Trustees. • Attend relevant training events • Participate in forums exploring and 54 Penal Reform International

discussing issues relevant to my work physical; emotional/psychological; practical with survivors of torture and social welfare-based; community- based; spiritual and political needs. Thus, • Know and adhere to my professional the individual is viewed ‘holistically’ or practice guidelines and codes of as a whole person, in contrast to more conduct especially concerning traditional ways of viewing a client where my responsibilities in working with only certain aspects of the person might be vulnerable clients considered. In the more traditional models • Continually work towards a healthy of working with survivors, the person’s work/ life balance needs tend to be evaluated according to the expertise of the particular professional • Look after my own health through working with the survivor; for example, beneficial lifestyle choices (for example, by looking at the person from a ‘medical diet, exercise, rest, leisure) model’ perspective or by looking only at the client’s legal requirements and without any Organisation’s input regard for other needs.

• Recognition of the potential for vicarious How? traumatisation across roles 3.30 All interactions between a professional • Organisational policies put in place to and a client need to work toward and support the well-being of all workers support healing. These might include and an organisational commitment to therapeutic interventions, work on legal carrying out those policies issues and supporting a client to access community and social welfare resources • Structures in place that ensure and other practical help. Thus lawyers, debriefing, supervision and other forms clinicians, social workers and befrienders of support for workers take place as alike need to be working with clients in a needed way that promotes healing. • Reasonable workloads with adequate 3.31 There are some key principles time off of ‘good practice’ relevant to all • Supportive team culture – encourages professionals involved in holistic colleagues to offer support to one rehabilitation which promote healing. As another we discussed in chapter 1, one such good practice principle is that the work with the survivor be ‘survivor-led’. This means that the professional must ask the client 3. Holistic rehabilitation: what they want/need from the intervention. what and how Survivor-led work focuses on the client’s priorities rather than those of the What? professional. In addition, the professional should be working with the client in a way 3.29 Holistic rehabilitation can include that supports the client’s empowerment interventions with the individual on their and encourages them to become more own or with their family as well as in self-directed. The experience of torture and groups and their community. As discussed other forms of abuse can cause a survivor above, these interventions must address a to feel extremely disempowered because range of needs of the individual, including: torture and extreme violence strip away Holistic Rehabilitation 55

a person’s sense of control. The survivor based on trust and to create a space where may feel helpless and thus come across the client feels safe enough to disclose what as wanting the professional to take charge is needed for the work to take place. But it of their life. However, a professional who is crucial that the client is not rushed in this takes on too much responsibility for the process. Knowing when to ask the client a client runs the risk of actually contributing difficult question is both an important skill to that client’s sense of helplessness in and a fine art, but it is also important to keep the longer run. The amount of input from asking the survivor questions throughout the the professional will of course vary with process as they develop and grow through the client’s needs and there will be periods the process of healing. when the client does require a high level of support. However, the professional should be working in a way that promotes a higher 4. In practice/reality degree of autonomy for the client. 3.32 If a professional takes on too much responsibility for the client this might A. Practical aspects of indicate that the professional has difficulties holistic rehabilitation as a in maintaining appropriate boundaries with that client. It is crucial that any professional process at Freedom from working with traumatised or vulnerable Torture people observes appropriate professional boundaries - the professional must work Mini-Presentation: Holistic with the client in a way that is neither over Rehabilitation Services with Freedom nor under-involved. This, in itself, is a skill from Torture (FfT) Clinicians that professionals need to develop in order 3.34 The dialogue below is taken from a to work safely and effectively with vulnerable session at which Freedom from Torture individuals. Professionals working in this (FfT) clinicians gave a brief presentation of field should receive regular support due their work. The session was then opened to problems with boundaries being, by up for the participants to comment, ask their very nature, extremely difficult for questions and reflect upon the FfT approach the professional concerned to spot. Any to holistic rehabilitation clinical services. professional working closely and regularly with vulnerable clients should attend regular 3.35 FfT emphasises the importance of all supervision in which they look specifically at professionals taking a holistic approach client boundary issues and the impact that to rehabilitation when working with torture the work is having on them. victims. It is also important to recognise the difference in context between the 3.33 The way in which a professional asks rehabilitation work carried out by FfT, which the client about their torture and how they helps refugees, and that of participants then support the client to explore the issues who work with victims in their own around torture form an important part of countries. the client’s rehabilitation. The professional is working in a ‘survivor-led’ fashion • Art Psychotherapist and Group by allowing the client to set the pace of Therapist disclosure and by encouraging the client • Clinical Practitioner; Trauma Care to decide what is safe for them to talk Specialist who works directly with about - and what is not. The aim is that the victims from Iran professional will be able to build a relationship 56 Penal Reform International

• Family Counsellor in the Children, Fami­ FfT: A panel of clinicians agrees that during lies and Separated Young People team the clinical therapy period other processes must take place, such as dealing with legal, • Asylum and Immigration Legal Advisor social and other issues, but it’s impossible • Casework Counsellor in the Adult to start certain procedures before the client Assessment and Therapy team gets over the effects of post-traumatic stress (PTSD). • Education Counsellor in the Children, Families and Separated Young People team P: What about using hypnosis? • Natural Growth Project Co-ordinator / FfT: I don’t practise it personally, but Group Therapist some colleagues use it for treating certain symptoms 3.36 Clinician’s presentation: P: How often do your sessions take place? Clinical Practitioner: Approach to psychological trauma FfT: Weekly • Psychological trauma is one of the main consequences of torture P: How many clients do you work with? • The recreation of stable memory FfT: 250-300 in a year functions plays a crucial role in starting the rehabilitation process P: We have only 5 days to work with a • Experiencing of trauma/torture can client. Can you give any advice for such a affect memory (fragmentation) and limited therapy? cause post-traumatic stress disorder FfT : You need to concentrate on the most (“PTSD”) destructive symptoms and the methods to • Importance of gaining client’s control them. trust: effective therapy includes the development of a close relationship between the client and clinician. 3.38 Clinician’s presentation (FfT): Therapeutic use of art in • The aim for a clinician is to help the rehabilitation client to control their destructive emotions and to recall events clearly. • Various types of art and art media are The client can then move on to being used to help clients express themselves able to tell their story. including music, movement, sand and clay 3.37 Participants’ questions • The main emphasis is on creating an atmosphere of trust and safety P: How long does it take to prepare the client for the rehabilitative process? • Clients use art to tell the stories which bring up pleasant memories FfT: All clients are different: some take longer than others. Generally, 1.5 to 2 • Elements of trauma will gradually begin years. to appear in clients’ art work; these are mostly represented as different parts of P: Can you clarify what the process of the body rehabilitation includes? Holistic Rehabilitation 57

• Having gained the experience of P: Is there anything that you have learnt expressing themselves through art, from your clients? our clients become ready to talk about FFT: Tenacity for life. what happened, to tell their story, to give evidence, to start working with documents and to start planning their P: Who chooses the kind of art used in a lives. session? • It’s extremely important that clients work FFT: To start with, the clinician would in a group to support each other and suggest a medium. If the problems are share their emotional experiences physical, it’s normally movement. If they are on a psychological level, then the medium 3.39 Participants’ questions is normally drawing. Later, clients choose for themselves. P: Do you have the same people in each group throughout the treatment period? P: Are there any negative aspects of group FfT: To start with we did. Now we’ve work? decided that people can stay in our group for as long as they feel they need to. FFT: I will give an example. I had two members of the group who came from the same country. One of them was not P: How many people are there in your opening up and didn’t take part in any of group? the group discussions. t turned out that he FFT: Usually 10. It’s a lot, but sometimes had completely made up his case history, people move, some can be deported, so and in the atmosphere of trust established we do not always have 10 in the end. in the group he couldn’t carry on lying about it. The group was very angry with him, so he had to leave. P: You might have clients with very different needs and backgrounds in your group. How do you adapt to their needs? 3.40 Clinician’s presentation (FfT): FFT: Despite the differences, all members Specifics of work with different of the group have one thing in common: family members, including Post Traumatic Stress Disorder. children • I work with adults and with children of all P: How often does the group meet? ages FFT: We meet on a weekly basis. • Sessions are conducted every fortnight, each session lasting 1.5 hours P: Is the individual work going along with • We take a number of issues into group work? consideration, for example, the family’s FFT: We tend to rely on what comes cultural and social background and also naturally to client in terms of how they the approaches to upbringing prevalent express themselves. For example, a lot of in their country people in this group are from Africa. African • When we work with children, our main folk music often uses drums, so we have a aim is to help them adapt to life in a lot of drumming in this group. foreign country 58 Penal Reform International

• There can also be differences in how why clinicians need to be extremely careful. parents and children feel about what In some countries, for example, babies who happened to them and this can create are born as a result of rape are rejected by difficulties in the way they connect with the victim’s family. each other P: How do you work with children • Children and adults may experience separated from their parents? different after-effects FFT: It’s extremely difficult, as some children cannot put into words what 3.41 Participants’ questions happened to them because they do not have the experience to compare it to - they P: Do you work as a team or don’t know what the norm would be for independently? certain situations.

FFT: Sometimes as a team, sometimes on 3.42 Clinician’s presentation (FfT ) our own, but we can ask our colleagues for advice. Group Therapy: Natural Growth Project. • FfT deals with differing aspects of P: How do you organise your team work? rehabilitation FFT: We have a manager who oversees • We have professionals from various our individual work - once a week we have fields who work together. We realise a meeting to discuss the main issues. In our that not every country has this kind of team there are 20 clinicians, but some of us opportunity work only 2 to 3 days a week. • Group therapy is one of the best forms of rehabilitation. We have different types P: Do you work with parents and children of groups - didactic groups in which we together, or separately? teach clients, short-term groups (lasting FFT: We use different methods: there about a year) and on-going groups. are groups made up of just parents or Independent groups are led by former just teenagers. We also have sessions FfT clients. Some groups are unisex, with each individual family member and some are mixed. Another kind of group with the family as a whole. Sometimes, a is the support group - these differ from psychotherapist can be present behind a the deep therapy groups. one-sided glass (the clients are aware of • Each client has a file in which the client’s this). most essential identified needs are recorded P: Do children always know what happened with their parents? 3.43 Participants’ questions FFT: It varies. Some children witnessed their parents’ torture. Sometimes, for P: Are your groups open or closed? various reasons, children are completely FfT: There are various different groups. unaware of it. Some families have become P: Why do you need men-only groups? separated. Some parents don’t want their children to know what happened to them FfT: Many men have been raped and and some children don’t want their parents they’re not willing to talk about it in the to find out what happened to them. That’s presence of women. Holistic Rehabilitation 59

P: Is it possible to arrange for a male 3.45 Participants’ questions clinician to be present at group sessions for P: Do the torture victims want to resume fight­ women? ing for their rights in their home countries? FfT: We try to include people of both sexes FfT: This is a very complicated issue as in order to recreate the family situation. many of them have been granted refugee P: Sometimes work with the opposite sex status for the very reason that it’s not safe can lead to great results. For example, for them to go back to their countries. sometimes men who have suffered sexual That’s why this question needs to be abuse won’t work with a male clinician. considered individually and lots of different facts need to be taken into the account. 3.44 Clinician’s presentation (FfT ) Some clients, having left their home country and acquired refugee status here, Natural Growth Project have lost sight of their goals in life and • The main principle underpinning this and their sense of meaning in their lives. project is that people have a strong Many of them need to be convinced that connection to nature surviving is also a goal. • A relationship with nature helps P: How are the specialists selected to work clinicians to understand what’s going on for FfT? Can young people work for FfT? with their client FfT: FfT is a well-known organisation, • Human memory has a deep connection so many people want to work here. We with many natural phenomena need experts with a lot of professional • We use two venues: one is our FfT experience. A number of people are first garden, the other is an allotment in a invited to undertake voluntary work. It’s different part of London important that young people join our team but they need to learn a lot. Due to the • Different people express themselves in nature of our work all of our employees are different ways. Some prefer quiet work: rigorously monitored. they can clean, tidy, plant; somebody might just have a tool and chop a plant 3.46 Overview: reflections and questions in half. P: In order to achieve holistic rehabilitation • Torture destroys people’s ability is there a precise plan one can refer to? Do to express their opinion or make a lawyers and doctors work together? decision. This project helps them to FfT: Every case is individual - decisions restore these abilities. are taken according to each individual’s • An example of a client who spent a very circumstances. The first person the client long time in solitary confinement and meets is a doctor. Clients don’t meet needed to learn how to communicate lawyers in this organisation - they usually with other people again: when he joined come with their own lawyers. our group he realised that his country P: If the client is already living in the UK, was not the only one where people how can one achieve justice for them, given had been unfairly treated. One day, he that the culprits are in another state? decided to plant 122 roses because 122 of his friends had died in prisons in his FfT: It depends on the client. Some are country. Now he works in a group which willing to talk openly about what happened is politically orientated to his country. to them, in which case the UK government 60 Penal Reform International

can pressurise the client’s government at to quickly obtain some basic information an international level. in order to start the session. The doctor doesn’t make eye contact but looks down P: Are there any statistics compiled on at the form and starts asking very practical the most common types of torture clients questions – what is the client’s name, have undergone? Do you have any British address, why are they here, what is their citizens among your clients or are they all problem, where is their pain? foreigners? FfT: The type of torture depends on the 3.50 Participants’ comments: client’s country of origin. We have very few clients from the UK. • There was no connection between the doctor and the client,-the session was P: What is the most common place for aggressive from the client’s perspective clients to have undergone torture? • At first one should get to know the FfT: Prisons. patient better • You should explain why you need Rehabilitation as a process to ask these questions and ask the client for permission to document the Interactive scene 1: Session between a conversation patient (survivor) and a doctor who has • You need to explain to the client her adopted a rather aggressive approach rights This is presented in a fishbowl style: • If necessary, offer the services of a 3.47 Trainers are playing the part of patient lawyer if such services are available and doctor and are re-enacting a possible • First you must identify the aim of the scenario (dialogue exchange). Participants client’s visit are observing. After 2 to 3 minutes we pause for group reflection. Considerations • Until the client has given her permission include: what the group observed; what the doctor mustn’t write notes - it should the group thought; what was done well; be a confidential conversation what could have been done better; is this • Never tell the client that you have a scenario familiar; recommendations on limited amount of time for the session what could be done to improve this session for the survivor. • Never use the word ‘torture’ until the client has used the word herself Scenario: • Ask whether the client has a preference 3.48 This is the first appointment for this regarding the sex of the doctor particular client who is very apprehensive; he/she doesn’t fully understand why they Interactive scene 2: Session between a are here, what is expected of them or patient and a doctor who establishes a who this person is in front of them asking more therapeutic atmosphere questions. He/she is wary and shy and 3.51 The trainers, now taking on board the doesn’t want to answer any questions. reflections and advice of the participants, 3.49 The doctor is very busy with many re-enact the scene for the group: changing appointments to get through today. Not body posture, tone of voice, mannerisms, having much time available, they just wants questions asked... Holistic Rehabilitation 61

3.52 Participants’ comments: enables us to run on mainly private donations. Your own regions will most • Better! likely differ. The governments of your countries also have a positive obligation • The patient mentioned her psychological to rehabilitate torture victims, however, lack of peace – that’s already a lot the realisation of this obligation can be a • All the same, the doctor appears to complicated process where the State itself promise too much – you should never is carrying out torture without admitting to promise that the patient will be able to doing so. However, there are workarounds: achieve something specific for example, states torturing their own FfT: That’s why we call rehabilitation a citizens can provide medical and other process – it’s not only the what but also the services to torture survivors without how that’s important This principle applies explicitly stating that these services are to all workers (lawyer, doctor...), whoever intended for torture survivors. they are B. Rehabilitation in the Group Discussion: Rehabilitation as a Process, Part 2. context of your countries

3.53 What is good practice within With which organisations and/or holistic rehabilitation? What are its key individual people can you co-operate components? in order to realise rehabilitation in your countries? P: If you make clients the centre of attention, isn’t there the risk that the client 3.55 The following section reflects the work will like that and want to remain there of groups looking at rehabilitation in the forever? context of their own countries. FFT: There are other ways of empowering 3.56 The rehabilitation process is clients. For example, you can help them complicated and many different personnel engage with the media and continue their are required. Even though FfT is a big political fight in their native countries. organisation, it still needs outside support. P: Does the FFT ’s work feature among That is the reason why you need to the UK’s positive obligations? Or is it an consider which other organisations you independent NGO? could work with to achieve the goals of rehabilitation. FfT: We’re independent of the government but we’re accountable to the Charity Com­ 3.57 You need to think about your own mission for England and Wales with whom context. It’s best to look at different levels: we are registered – for example, every year • Organisations situated in your local area we need to report to the Commission on • Organisations situated at a regional level how we spent our money that year. • External organisations: international or P: What means does the UK Government similar organisations in other regions employ to fulfil its positive obligations regarding the rehabilitation of torture 3.58 You need to think about which victims? organisations you could establish links with. 3.54 FfT: FfT’s model is specific to the 3.59 Another technique which will help context we have here in the UK which you is to start with the needs of your 62 Penal Reform International

clients and consider which links to other • European Court of Human Rights organisations or people would assist in • National Protection Mechanism (‘NPM’) their rehabilitation. • Monitoring Group of the Committee 3.60 Also, you can look at the links Against Torture which you have already developed, consider which aspects of rehabilitation • Mass media they connect with and then identify • Amnesty International which rehabilitation aspects are not yet addressed. FfT: World Health Organisation (for financial help) 3.61 An example session P: The local passport and visa section; the Mayor; the Ministry of Social Protection; the P: Three organisational branches situated Police; protection of children’s rights in different regions have the following well- established links:: FfT: You need to create a whole network of support around your clients. Remember A referral network, which is well- • to cover all aspects of rehabilitation (legal, developed (clients being referred clinical etc.) and cover all the levels (local, externally for consultations and clinical regional, international etc.) investigations). FfT: What often happens is that the links Legal firms providing legal services, • are established by working organisations for example, the Association of Young and then they are reflected in domestic Lawyers of (a participant’s country) legislation which has local branches. • Government ministries, for example, the Ministry of Education 3.62 Participants’ suggestions as • Penal establishments to establishing links: • Red Cross representatives • Mass media • The weak link, however, is social • Human rights organisations such support as Human Rights Watch, Amnesty International, the Red Cross, the P: The Government provides social International Federation for Human Rights, services the United Nations and the European P: But these aren’t providing any real help. Committee for the Prevention of Torture P: Financial help? • Ombudsmen P: The European Union • Chamber of Lawyers • PRI can support measures aimed at the • The Ministry of Justice which monitors prevention of torture: prisons, prepares amendments to law, and provides Parliament with bills • Students can do voluntary work • The Ministry of Social Services - to • Community links: churches, mosques, provide survivors with financial help political opposition • The Ministry of Health and its medical • Ombudsmen: can monitor governments’ institutions adherence to international conventions Holistic Rehabilitation 63

• Foreign embassies The following treatment concept is not intended as a blueprint, but is a description • Prison administrations of observable client phenomena common, • Prisoners’ relatives and friends in varying degrees, to most of our client sessions. These phenomena can be • Independent psychiatrists and broken down into four distinct stages of psychotherapists focus, although elements of each are also • Independent lawyers continually present to some extent. • Independent medico-legal expertise Symptoms and normalisation • Churches, mosques 3.64 Images, flashbacks and intrusive • Freedom from Torture memories are constant features throughout • International networks of lawyers the early sessions. Treatment throughout this period focuses on controlling • Professionals we know personally such symptoms and consists of exploring as lawyers and medics, including in a memories, managing panic, flashbacks and voluntary capacity nightmares, and working with relaxation • Inter-state organisations techniques. 3.65 After some time, flashbacks and intrusive memories begin to occur less C. Psychotherapeutic frequently and the client’s quality of sleep treatment for trauma tends to improve. As trust is established further, we begin working at greater depth on the therapeutic level, focussing less The following was written by a Freedom on overt symptoms and more on the from Torture Counsellor and describes symptoms’ importance to the client and common phenomena observed by their content. We also focus on the details counsellors and psychotherapists across of the client’s life and what happened to the organisation in their therapeutic work them with survivors of torture. Restoring narrative and ordered Relationship memory

3.63 Effective therapy lies in the quality 3.66 Treatment during this period focuses of the relationship established between on restoring ordered memory and narrative. the therapist and the client which should That is, processing feeling and memory so provide safety, intimacy and trust. To create that trauma memory, often reactive (such such a relationship, the initial contract as startle responses to associated sounds should convey the necessity for these and feelings) can be re-framed to become essential conditions. Client ‘casework’ (a less disruptive in the client’s life. process whereby the therapist looks at and supports all of the client’s needs through 3.67 These traumas are thought to be addressing practical as well as emotional stored in a primitive part of the brain (the and psychological issues) can be an amygdala) and as such are inaccessible important part of building the relationship. to conscious control. As therapeutic The relationship should also provide the processing occurs, the traumas are re- client with care and containment. ordered and stored in the brain’s cognitive centre (the hippocampus). They can now 64 Penal Reform International be recalled and analysed and eventually D. Holistic rehabilitation find a place within the body of conscious memory, thus reducing symptoms. services 3.68 In some clients, dreams of a vivid and disturbing nature can become 3.71 Holistic rehabilitation offers a range more frequent as memory and narrative of interventions to a survivor of torture. (contextual and cognitive processes) are The specific types of interventions offered restored. Flashbacks from these dreams are matched to that individual’s particular can replace flashbacks of the actual torture needs. No two people will require exactly events. That is to say, as the client’s ability the same type of support and help. At to process experiences in a narrative Freedom from Torture, we carry out a or cognitive way increases there is a careful assessment of each person so that corresponding decrease in flashbacks we understand their particular needs and which re-live actual experiences. The can identify what type of help is likely to be images and representations of the feelings most beneficial for them. associated with past events begin to surface in the client’s dreams, creating 3.72 Some of the professionals involved images and responses that can be in holistic rehabilitation at Freedom from traumatising in themselves. Torture include: • Counsellor/caseworker Transition and rehabilitation • Clinical psychologist 3.69 As shock and its numbing effects • Art or alternative therapist recede and memory and cognitive function are restored, it is common to see the • Group worker and Natural Growth emergence of depression, anger and Project therapist grief as well as other emotions (often • Social worker experienced by the therapist as disruptive). These are key expressions of trauma at • Befriender this stage. Therapeutic work continues on • Educational counsellor symptoms of PTSD (Post-traumatic Stress Disorder) and on restoring a narrative. • Physiotherapist Symptoms may be greatly reduced as • Psychotherapist the client develops an increasing ability Social welfare advisor to see a time-line and a ‘past’ as part of • this therapeutic process. Along with the • Legal advisor remission of the client’s symptoms, their 3.73 Freedom from Torture has a confidence and capacity for rehabilitation specialist Children, Families and Separated increase. Young People team, which includes the pro­ 3.70 Treatment in the final period fes­sionals listed above who are experienced continues as in the previous stage but in working with children and families. with the emergence of a new focus and 3.74 Intervention types available for both rehabilitative process, with the client now children and adults include: living in the present, functioning well with others and re-integrating into society. • Individual therapy • Group therapy Holistic Rehabilitation 65

• Family therapy impact on the survivor’s emotional • Group activities and psychological state. As previously discussed, it is extremely important to 3.75 In addition to traditional psychotherapy work with survivors of torture in a way and counselling, Freedom from Torture that supports them in regaining a sense of offers a number of alternative therapies personal control. We do this by ensuring such as: our work with torture survivors is survivor- • Natural Growth Project (individual and led and works toward their empowerment, group) and also by ensuring that we maintain healthy boundaries between ourselves as • Bread-making group professionals and the client. • Mother and baby group 3.77 There are also practical aspects • Music therapy (individual and group) we need to consider in order to ensure • Art therapy (individual and group) our clients’ safety and protection. These include protecting our clients’ • Write-to-life group confidentiality and guaranteeing the • Survivors Speak Out safekeeping of any information we hold on them. We need to make sure that client files are kept in a safe place. If there is any 5. Ethical issues to chance that client files might be seized or stolen, then we must think about ways to consider anonymise the information held in them.

3.76 The main ethical issues that need to 3.78 We also need to support those of be considered in this section are those of our clients who wish to become involved the safety and protection of the survivor in survivor activism by helping them to during the process of holistic rehabilitation. think carefully about any potential risks Dealing with the trauma of torture can be associated with those activities and finding an extremely frightening undertaking for ways to minimise those risks for the client. a survivor. Any work with a survivor of torture that requires them to think and talk 6. Supplementary about their experiences of torture must be materials undertaken with great care. It is crucial that the client’s needs (as the client sees them) are put first. For example, as a professional, 3.79 Case study: Ali although we might passionately believe that The aim of the following case study is to the perpetrator must be held to account, demonstrate the potential range of needs it might not be in the client’s best interests survivors may have, and the importance of to pursue a legal case at that moment in a good assessment. time. The client may still be too vulnerable to do so due to ongoing emotional and/or 3.80 Ali lives in a Kurdish village in psychological problems. In a therapeutic Kyrgyzstan. In late April 2010, ethnic Kyrgyz setting, we may believe that the client mobs attacked Kurdish, Meskhetian Turk needs to face and deal with their trauma in and Russian villages across the country, order to recover, but pushing them to talk looting and destroying properties and about the torture when they do not feel livestock. In these attacks, Ali’s father was ready could have an extremely detrimental killed as were several other people from his 66 Penal Reform International

village. slowly and says that he is not sleeping. Ali’s drinking is increasing, and despite having 3.81 Following the violence in April, Ali and little money, is always well dressed. his neighbours continued to be targeted for harassment and repeated searches of 3.84 Ali has spoken to several lawyers their homes. This escalated to torture and about the torture and ill-treatment. He says ill-treatment when he was brought into the he wants to prosecute the perpetrators. police stations for interrogation and held in However, he has argued with each of the pre-charge detention centres. lawyers with whom he has met. Ali says that they are ‘interrogators’. In turn, the lawyers 3.82 Ali continues to try to work to support have refused to represent Ali. his family, but he is very anxious and suspicious of every one. He is jumpy and • As a lawyer, what do you need to know nervous and believes he will be arrested in order to assess and prioritize Ali’s again at any moment. Ali has difficulty rehabilitation needs? concentrating and remembering. He keeps • As a clinician, what do you need to forgetting things at work and he has been know in order to assess and prioritize threatened with being made redundant Ali’s rehabilitation needs? from his job. Additional Reading 3.83 Ali says that he is happy to see a doctor but he resists any suggestions to 3.85 IRCT Handout (pdf) – ‘About speak to a therapist. He is losing weight Rehabilitation’ Holistic Rehabilitation 67 Chapter 4 Communicating rehabilitation externally 1. General overview 2. Theory 2. Theory A. Policy and advocacy workers 4.3 There are various professionals who have specialist expertise who can help B. Campaigners support you in your efforts to communicate C. Researchers holistic rehabilitation within your community or region. These can include: D. Community development workers E. Training and capacity building Example A. Policy and advocacy 3. Ensuring your public-facing work is workers survivor-led 4.4 These are usually people who are Example legally trained, but rather than focusing 4. Ethical issues to consider their expertise on supporting clients in litigation, they examine government policy. 5. Conclusion They usually focus on how the policies and laws relate to a specific target group such as women, prisoners, children, disabled... 1. General overview 4.5 At Freedom from Torture, our 4.1 By the end of chapter 4, participants will Children’s Law and Policy Officer deals be able to: with young people and families. Principal areas of work include: • Recognise the role human rights outputs can play in promoting rehabilitation and • Casework: advises clinicians on legal describe a range of effective tools and aspects of clients’ cases. Sometimes approaches consults with and advises clients’ lawyers • Investigate/explore how to make their public-facing work more survivor led • Policy: examines government policy and include the voice of survivors and advises clients accordingly 4.2 This chapter is relevant to all specialists • Training provision within FfT, usually and service providers who work with on new cases or changes in the law survivors of torture. As a lawyer or clinician, that affect children who have been we are not expecting you to become an tortured expert journalist or campaigner. Instead, we • Building capacity through working will propose these functions as key allies in with organisations dealing with your work to support survivors of torture. children who have been tortured

68 Penal Reform International

B. Campaigners functions. These individuals will work with multiple stakeholders to ensure better communication and promote more effective 4.6 Human rights defenders who specialise partnerships and working relationships in campaigning will have knowledge between organisations and services. Often, of good practice on how to change community development workers represent public perceptions, including changing the needs of specific client groups, such as pre-conceived ideas and stereotypes victims of domestic violence, children living concerning unpopular or controversial on the street and other marginalised groups issues. These individuals will usually have who have complex needs and can be hard extensive experience in creating sympathy to reach. or empathy for a cause and in encouraging action and support. 4.11 “I work as a counsellor at Freedom 4.7 The Campaigner for Freedom from from Torture and am also a Development Torture works closely with victims of Worker. I work in Sunderland, a poor torture to make their voices heard and to city in the north of England. I am the inform the victims, and others affected only person in Sunderland working with by torture, of their rights survivors of torture, so all of my work is devoted to forming working relationships

with other professionals and organisations C. Researchers in the city, such as senior clinicians, 4.8 Professional researchers will have doctors, faith groups, and refugee knowledge and awareness of how to collect support agencies.”занимающимися and collate data ethically and effectively вопросами беженцев.” and then to analyse this information. Those who conduct research outside of academic settings are often skilled in targeting and E. Training and Capacity tailoring their research reports to maximise their relevance to a specific audience. Building

4.9 The Freedom from Torture 4.12 Skilled trainers and facilitators often Researcher provides colleagues with the have specialist knowledge of adult learning evidence necessary for them to argue theory and creating effective programmes for changes to policies, practices and which foster learning. The aim is generally attitudes. The Researcher will often to create a space for reflection and the examine evidence derived from client processing of novel ideas and theories so records or from interviews with clients or as to promote new skills, knowledge and staff members. attitudes. Effective training programmes often involve multiple ‘steps’ of learning to ensure adequate application of the new D. Community learning to day-to-day practice. development workers

4.10 Community activists; human rights defenders; development workers – these are all different titles for similar Holistic Rehabilitation 69

• 4.13 The aim of any training or Example: Freedom from capacity-building initiative by Torture Freedom from Torture, whether in the UK or abroad, is: 4.15 For example, at Freedom from • To build the capacity of service Torture, a number of in-house staff, providers currently working with including our Policy Officer, Researcher, survivors of torture – by ensuring Media Officer and Training team, worked that they have the appropriate skills, together to try and improve how UK Border knowledge and attitude as well as Agency (“UKBA”), asylum caseworkers and the capacity and levels of support immigration judges treat medical evidence needed to deliver a suitable level of when an asylum seeker claims that they services have been tortured in their country of origin. and/or • To open the doors of services I. Identify the problem currently resistant to the idea of working with survivors of torture. In One of our doctors who works with a some cases, this involves introducing wide range of clients at Freedom from service providers to the rights Torture noticed a disturbing trend – an of survivors and explaining their increasing number of her clients were statutory obligations to service this having their asylum claims refused and client group. in their refusal letters, UKBA’s asylum • To create links to encourage staff appeared to be making their appropriate referrals to be made to own personal clinical judgements and FfT - and also from FfT to additional dismissing the opinions of qualified and service providers for support specifically-trained medical doctors. She also noted that similar dismissals Ultimately, our training and capacity- of clinical evidence were being made building initiatives are intended to ensure by some immigration judges that survivors of torture are able to access a web of services to support their • Freedom from Torture documents rehabilitation instances of torture by creating medico- legal reports in line with the Istanbul 4.14 All of the above specialists can Protocol become your allies. They can help you to address a need or respond to a concern • These reports are used in asylum claims relating to a survivor’s ability to fully realise II. Identify the rights violated or at their right to holistic rehabilitation. These risk of being violated specialists are at their most effective when they work proactively together to co-create The doctor raised her concerns strategic plans responding to specific with our Policy Officer and our issues and to collaborate on actions and Asylum and Immigration Advisor. interventions more generally. Both acknowledged that due to the dismissal of medical evidence by UKBA staff and immigration judges, increasing numbers of torture survivors were being returned to countries where 70 Penal Reform International

they were at risk of being tortured for a case to go to the appeal stage than again. (The right being violated here is for the medico-legal report evidence to non-refoulement) be treated correctly as part of the less costly initial claim III. Evidence gathering • In the report we made clear and specific Freedom from Torture brought recommendations for actions we wanted together the relevant stakeholders who to see that would demonstrate change agreed to gather data with the intention of using it to pressure UKBA and the V. Media pressure and promotion Immigration Tribunal. Our Researcher • Best tactic to create policy change was collated 50 refusal letters and wrote a to bring this information to the public’s report of her findings entitled Body of attention Evidence. • Relied on British media to create • We found that in these cases, UKBA pressure through press coverage had failed to sufficiently consider the medico-legal evidence, resulting in • Survivor voice and personal narratives denied asylum claims during status were not included in the report but were determination procedures added through media coverage • Where, however, the evidence in a VI. Training negotiated case’s medico-legal report was properly • A combination of policy negotiation considered by UKBA, there was a 70% and media pressure created successful overturn rate at appeal changes High level of inconsistency in decision- • • Freedom from Torture was able to making at the tribunal/appeal level negotiate training for UKBA staff and – some judges followed the Istanbul judges which was rolled out in 2011. Protocol very carefully, others did not 4.16 You may not have the same range IV. Negotiations and pressure from of specialists in your organisation as we State actors have at Freedom from Torture. But that • Evidence from the research is very doesn’t mean you can’t engage in this vital compelling and reveals systemic poor work – you can collaborate with experts in practice across Government functions. your community in order to create similar change. Even if these specialists focus • Also demonstrates how this poor on a different client group, their skill sets practice is not in line with international and experience can help inform your work. practice standards and guidelines For example, a journalist who specialises • The Government is under pressure in political analysis will have transferable to speed up the asylum process and skills and experience which they can use reduce the amount it spends funding when working with NGOs and supporting it; the evidence contained in medico- survivors of torture. legal reports prolongs asylum cases, 4.17 Reflect on the specialists you may wish therefore UKBA mistreats/discounts to work with more closely. What specialist these to speed up the process services do you lack in your organisation? • The Body of Evidence report 4.18 Also, think about how you can demonstrates that it costs more money support the work of others. Do you have Holistic Rehabilitation 71

clinical data that may be of use to a lawyer to get them to do research with other involved in strategic litigation? Do you have victims. Our next project will involve links with civil servants who are willing to survivor voice in research – we will look speak with the NGO sector? Do you have at the poverty which survivors of torture knowledge of case law which may help a experience living in the UK as asylum researcher with their data analysis? seekers and refugees. It is important to work closely with survivors - this may include facilitating a survivor-led focus 3. Ensuring your group or working with survivors as peer- public-facing work is researchers ‘survivor-led’ 4.22 Question to participants:

4.19 In our training programme, we asked What is your primary objective - to a panel of experts from Freedom from secure social benefits or employment for Torture to share ways in which their work is your clients? survivor-led: • We want to improve the level of support given to survivors 4.20 Policy Officer • Most importantly, we want to make the link that these issues are part of a • Our Government hasn’t thought about survivor’s right to rehabilitation. survivors’ participation in the process other than in court; participation in court 4.23 Campaigns and Communications proceedings is not real participation Manager (speaking about campaigning • There is nowhere else for them to and survivor activism at Freedom from speak out about their experiences. Torture) At Freedom from Torture we adopt Survivors engage in creative writing: a human rights-based approach, all • we publish their works in the press and advocacy work is survivor-led publish our own books • Any initiative we take that is client-based We have a Survivors Speak OUT carries much more weight • network of survivors – they are • Survivor involvement has a rehabilitative activists who speak to government effect representatives and community groups. 4.21 Researcher The network also likes to speak to young people because their opinions on • Direct voice not included in the body torture victims are not fully formed of the research presented in Body of • They’ve been involved in short films, Evidence. We used anonymised case animations examples instead • They send regular letters to FfT • We want to develop new ways of supporters, including sponsors, as working with victims to give them a we need to explain that we need not more active role in the research process. only financial help, but also help in Our aim is to involve survivors at every campaigning stage of our research, for example, 72 Penal Reform International

Media Officer Example 4.24 The survivor’s voice must be at 4.28 “We tell our clients not to speak the forefront; the client must speak for to the press - we take no part and no themselves. Also, a survivor talking about responsibility if the client decides to do their own experience resonates more with so. However, sometimes we ask victims if the reader or viewer – this helps to break we can employ an actor to represent them down negative stereotypes. to journalists, in which case we do take 4.25 There are two types of media work responsibility.” with survivors: Participant from Azerbaijan. 1) Victims representing other victims Participant questions: and speaking about issues affecting those victims How do you know what readers or viewers actually think? 2) Survivors talking about their own experiences - what’s happened to • It’s hard to get this kind of feedback them • We might get an idea from blogs or 4.26 The media tend to want the second online responses to articles type, that’s to say, personal testimonies. What do you do to combat negative Many clients find speaking about the responses in these cases? injustice they have suffered beneficial. • We find that if a negative comment is However, there are also problems written, someone else usually rebuts it associated with the second type: with a positive argument • Potential harm to the survivor (risk of re- Do you reply to the negative comments? traumatisation; risk that the survivor gets stuck in the role of victim because they • Not unless they are made on our repeat their story so often or because website or on our social media pages. of all the attention they get, i.e. they are Who are your main opponents? almost rewarded for being a victim) • Migration Watch (a conservative, far- • Risk of the media controlling what a right group) and certain communities ‘victim’ looks like; often portrayed as and private individuals downtrodden victims, not empowered survivors • Our target audience is people who are still undecided because they lack 4.27 The most important consideration is to information let the client decide how to be represented. “We get a lot of coverage in the press; 4.28 Also, it is important to brief journalists when we register violence we urgently so that they don’t give survivors of torture a submit a report to the Ministry of Justice. hard time. According to the law, the Ministry must respond with comments within 3 days, otherwise we have the right to print in the press.” Participant from Armenia. Holistic Rehabilitation 73

4. Ethical issues to - Client must have a way of contacting the researcher consider • Protection and security of client data: - Need to tell the client how we 4.29 In our training programme, we asked guarantee their data are secure a panel of experts from Freedom from Torture to share what they feel are the key - Client themselves must declare that ethical issues in their roles: they are voluntarily participating and that it is their wish for the data to be 4.30 Conducting research divulged • Need to remember that our primary duty is to the client/survivor 4.31 Participant shares his experience of data protection • Asylum claims are very sensitive; information must be confidential difficulties in Azerbaijan: • Need to have client’s permission and • Individual’s security is under threat any mention of a specific instance/client needs to be anonymous • Possibility of those who provide rehabilitation services for torture (from June report) victims being forced by authorities to • Need professional standards in place disclose information regarding use of client data. Two main ways to combat this problem • Priority at all times is the interest and welfare of the survivor of torture. • Restrict access to the data • Confidentiality: • Keep anonymised records - We need to understand that our work Participant shares how data protection is intrusive works on the ground in his organisation: - At all times the client has the right to decide what is done with their data • Workers tell clients there is no need to give their names, addresses, etc. - The client has the right to have a copy of their data • However, these details are needed if the client wants to take their case - We have no automatic right to the to court – in that case P3 gives the client’s data client’s records to the client themself, • Anonymity of data: client must not be not to the legal professional identified • However, the records provided by • Informed consent: P3 are taken by the courts only as - Client must know that they are under witness statements, not as evidence no obligation to divulge data and that • Organisation has a back entrance the availability to the client of services - clients visiting the premises can’t rendered by FfT do not in any way be seen using it. There is also depend on their giving consent an emergency exit for client use. - Client has the right not to give consent (Sometimes there are pickets against the organisation, for example, those - Must tell client the reason for obtaining organised by the ruling party) consent, for example, medical, legal 74 Penal Reform International

4.32 Influencing policy • What will happen with their story and who will read it • What is the change you are trying to bring about? • That it’s impossible to completely control such things as who will read • Who will the change really benefit – your their story organisation or the client? • The need to ensure nothing in the story • Do you have the necessary resources? could reveal the individual’s identity 4.33 Media: involving clients with the The need to consider practical issues public when asking a client to be involved in our public work; for example, to • Need to ensure client consent is enable clients to attend meetings, we obtained without the use of influence or pay for their childcare (which would be coercion prohibitively expensive for them) • Need to explain to the client that We asked participants which of the media participation will not benefit their issues and strategies discussed could application for asylum be used in their countries – their 4.34 Participant question responses varied In your media work relating to Body of 4.36 “In theory, we can use a lot of Evidence, which forms of media were the strategies discussed, but we are used to tell clients’ stories? disadvantaged in practice because our countries are still trying to build up our civil “Because the issues in the society. This is not to say that we won’t report were not big enough to strive to achieve these goals.” get national attention we used one newspaper and one radio 4.37 “I like that you have a multidisciplinary programme. Whenever we approach, but I am afraid that this is involve survivors, we choose impossible in my country because lawyers the media source that is the won’t want to leave their jobs to make most sympathetic to our cause less money”. (Freedom from Torture and whose journalists are responded, “It is the same in the UK but trustworthy. In this case we used there are still many committed lawyers and ‘The Guardian’ (national UK doctors who do work for NGOs)” newspaper), which is politically 4.38 “We have started to report torture left-leaning, and the radio interview cases to the media but these reports are was with the BBC.” limited to high-profile cases and reporting is done by officials, not by NGOs. Also, Campaigner the media feels more pressure from the government in our country than you do in 4.35 Informed consent: need to ensure the the UK. We do hope to increase our impact survivors of torture understand through the media.” • Who I am and what I do • That it is up to them how they shape their role in the process (i.e. 5. Conclusion

campaigning, external communications 4.39 In this chapter, we explored how such as websites etc) we, as lawyers, clinicians or community Holistic Rehabilitation 75

workers, can promote change so as to 4.41 We understand that the realities in the more fully realise holistic rehabilitation as a UK and in your countries are different. We right and a process in our communities. encourage you to reflect on how you could use some of the ideas explored in this chapter in your own work to promote the 4.40 We began by exploring the role of holistic rehabilitation of torture survivors in media, campaigning, training, policy and your communities. advocacy work in promoting change for our clients and looked at some examples from our work at Freedom from Torture. We 4.42 We hope that by sharing some of the then examined some key ethical issues that strategies used by Freedom from Torture, need to be considered and incorporated we have given you some inspiration for new into any plans you may devise to facilitate ideas and fresh approaches that you can greater access to holistic rehabilitation for successfully apply in your own contexts. torture survivors, including those specific to working directly with survivors in your public-facing work. For more information on PRI’s work on the Holistic Rehabilitation for survivors of torture please contact:

Penal Reform International First Floor 60-62 Commercial street London, UK E1 5LT www.penalreform.org ISBN 987-0-9571996-0-6