The Legacy of Torture and the Right to Rehabilitation

Leanne MacMillan is the Director of Research Development at the International Rehabilitation Council for Torture Victims.

26 June marks the UN International Day in Support of Victims of Torture. Globally, service providers, survivors, and a cross section of civil society will unite to call for torture survivors’ right to rehabilitation and to be recognised. They will also call on the very states that continue to torture, to adequately resource the medical, psychological, social and legal services for survivors, their families and in some instances where torture is rife, entire communities.  

According to a recent report by Amnesty International, torture and ill-treatment continues in 141 countries. This is a shameful record of hypocrisy considering that the vast majority of states have agreed not to torture or ill treat people under international law and have promised that torture victims have a right to reparation – which includes rehabilitation. 

26 June provides a focal point to call for the prevention of torture and the rehabilitation of its survivors in its entirety. The grim reality of torture and the scars it leaves on its victims are seen every day in the 144 torture rehabilitation centres that are part of the global movement – the International Rehabilitation Council for Torture Victims (IRCT). Thousands of survivors receive treatment at clinics that have been established to provide for their needs and to assist them on the long path to rehabilitation.  

There are many gaps in the provision of services to survivors and the IRCT membership advocates for a holistic approach to the rehabilitation of survivors. The needs of survivors directly engage mental health providers across contexts – ranging from countries which torture survivors flee to for protection, to countries where torture persists.

Many victims suffer from post-traumatic stress disorder (PTSD), which includes symptoms, such as flashbacks (or intrusive thoughts), severe anxiety, insomnia, nightmares, depression and memory lapses. 

The consequences of torture are likely to be influenced by many internal and external factors. Therefore, rehabilitation needs to employ different treatment approaches, taking into account the victims' individual needs, as well as the cultural, social and political environment.

Rehabilitation centres in the IRCT network commonly offer multi-disciplinary support and counselling, including:

• medical attention
• psychotherapeutic treatment
• psychosocial support 
• legal services and redress
• social reintegration

However, there is great unmet need and while some survivors benefit from services provided as part of public and mental health services, most rely on those funded through non-governmental sources. States that continue to torture their citizens seldom acknowledge this, let alone establish funding streams for rehabilitation.   

On 26 June, those who feel safe enough, tell their story of torture, the devastation it wreaked on them and on their families and communities. For many survivors, the legacy of torture persists across generations. These stories tell of survivors that have been tortured in different but equally harrowing contexts -  in times of conflict and post-conflict, in repressive regimes or in so called democratic countries where torture is used as a daily practice in policing, in prisons and by the military.  

The common thread between all survivors is their need for rehabilitation services, which centres around the world are struggling to provide due to continued funding cuts and a lack of resources.

The IRCT advocates that rehabilitation should be:

• holistic
• available, appropriate, accessible and provided in a way that guarantees the safety and personal integrity of the victims, their family and their caretakers
• provided at the earliest possible point in time after the torture event, without a requirement for the victim to pursue judicial remedies, but solely based on recommendations by a qualified health professional
• provided in close consultation with the victim and tailored to meet the specific needs of each individual victim
• adequately funded by national governments

In Europe, IRCT member centre Association for Rehabilitation of Torture Victims - Centre for Torture Victims (CTV) in Sarajevo, still receives many torture victims in great need of rehabilitation, a legacy of the war in the former Yugoslavia. 

These survivors are living evidence that 20 years on, victims of war still struggle with their trauma. Through provision of health care, social support and advocacy work, CTV has helped thousands of survivors of war cope with the trauma of their experiences. Yet, despite the fact that the centre is still receiving new clients, it is now cutting vital services in order to survive.

The situation at Survivors of Torture, International (SURVIVORS), is similar to that in centres in many countries of asylum. Little things matter – something as small as a bus ticket can mean the difference between treatment and no treatment for torture victims. As the centre explains, “ These clients rely on money for public transport to get to the actual center, but with the latest cuts, SURVIVOR won’t be able to pay their bus ticket.” 

For decades, torture rehabilitation centres have struggled to fund the vital work they do. Some have been forced to close their doors and others to operate with skeleton staff. In many communities, there are no other sources of rehabilitation assistance so survivors are left to cope alone and their suffering continues. 

In many contexts the public health system does not specifically allocate resources to address the physical and mental health needs of survivors. In some contexts services are only available to a survivor if they are able to prove through legal proceedings they have been tortured. However, these processes can often retraumatise survivors, as they are forced to relive their experiences and participate in a judicial system that may be ineffective and corrupt.  

Health providers are often the first to interact with survivors at a time when they feel secure enough to disclose their torture experience and need for help. Reaching out to those providing mental health care is a key challenge for the torture rehabilitation sector, to ensure that the early identification of survivors is possible and that referral systems are developed to respond to their needs.

Mental health service providers play a vital role in ensuring there are services tailored to the needs of survivors of torture and state funding can help to bridge this gap between the sectors. 

States must act now and allocate the resources needed to provide services to survivors. On 26 June and every other day of the year we will continue to call for action to make the right to rehabilitation a reality. 

Main Image: © Moran Barak