The rehabilitation service provider needs to respond to a complex set of outcomes of the torture of women in addition to the social and cultural context that they are in. Among the range of outcomes are depression, sleeplessness, nightmares, flashbacks, fistula and other types of damage to their reproductive organs as found in cases where women are raped, and raped with implements. Many women will have also contracted HIV and other sexually transmitted diseases and the clinical responses to this may mean the development of effective outreach programs to providers specializing in meeting the health and psycho-social needs of those with HIV. One of the key findings of the Justice Denied report that will inform many rehabilitation service providers is: “ (r)esort to healthcare in the immediate aftermath of torture was surprisingly low given the brutality of the violence inflicted. Treatment was often sought informally or in secret to avoid public or community knowledge of sexual violation. Where women formally sought professional care from medical staff, it was often for the treatment of physical injuries … many women seeking medical assistance failed to report rape…”. (page 3) It is clear that there are powerful barriers to women in seeking effective rehabilitation due to the nature of the torture and of their marginalized role in so many societies. A major challenge for service providers in this context is to find ways to make rehabilitation services accessible in the fullest sense of the word. That is, services must be attuned to the needs and circumstances of women and respond to their needs with extensive account of their individual community and family contexts. Against this backdrop are the persistent gender inequalities in many communities that mean there are other systemic biases. The challenge for rehabilitation service providers is to provide appropriate services that specifically address women survivors particular needs, knowing that disclosure will not be possible without the right conditions and that some of these conditions are externally imposed and not within the control of the service provider. Rehabilitation services need to develop care pathways that are suited to this situation. Finally, women should be active participants in determining the context and content of any rehabilitation services. Included in this section are examples of programs that are in place in some of the rehabilitation service providers that are part of this project. For further information on appropriate rehabilitation responses and establishing rehabilitation services that are suited to women victims of torture, contact Leanne MacMillan at lm@irct.org. Suggested reading Amnesty International and REDRESS (2011) Gender and Torture: Conference report http://www.redress.org/downloads/publications/GenderandTortureConferenceReport191011.pdf MacMillan, Leanne Ed., Smith, Ellie and Boyles, Jude. Justice Denied: the experiences of 100 torture surviving women of seeking justice and rehabilitation. Medical Foundation for the Care of Victims of Torture (2009) http://www.torturecare.org.uk TPO Nepal, CARE Nepal and CARE, Austria. Psychosocial issues of Women Affected by 31

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