1 State-led vs NGO-led rehabilitation – Uruguay, Netherlands, Burundi Miguel Scapusio (Servicio Paz y Justicia, Uruguay) gave an overview of the context of rehabilitation in Uruguay, where torture survivors from the military dictatorship (1973-1985) have faced a long history of impunity, stigmatisation and absence of reparation from the state. Only in 2006 did the government pass legislation granting reparations to people imprisoned during the dictatorship; and in 2008 a presidential decree assured health assistance — provided by the state — to victims and their families. Uruguay’s rehabilitation policies, he said, have serious shortcomings given that there is no concrete rehabilitation programme taking into account the victims’ individual needs. There is an absence of real public policies to deal with the historical context in which torture occurred. He reflected that rehabilitation cannot, in the context of Uruguay, be separated from the reparation process. There is a need to move forward in terms of truth, justice and memory, and he does not believe that rehabilitation should be separated from these other elements of reparation. Boris Drozdek (Psychotrauma Centrum Zuid, Netherlands) outlined the challenges faced in the Netherlands, which has a semi state-led system for the rehabilitation of torture victims. Asylum-seekers and refugees make up the main category of torture victims and many challenges in providing full rehabilitation are caused by the shortfalls in the asylum procedure. For example, the delays in processing applications, the prohibition of work and the limited access to the community all lead to social marginalisation of victims and restricted access to medical services. He mentioned the Committee against Torture recently highlighted that the eight-day asylum procedure for some applicants means that initial health checks are insufficient for determining torture sequelae. In addition the Committee found that there is a lack of proper implementation of the standards in the Istanbul Protocol, in particular, a denial of the causality between torture and mental health problems, and no transfer of medical data upon release from immigration detention, which impedes continuity of appropriate care. One positive step taken recently to improve the system is that the three specialised centres were given a carte blanche to reorganise the system by which mental health services are provided to asylumseekers. The new system envisages that the most specialised centres will provide treatment for acute cases and will also provide consultations and training 8 International Rehabilitation Council for Torture Victims “” The discussion was very relevant and timely. The Right to rehabilitation is not well explored in the country. [...] There is this closed discussion on who has the better rehabilitation program. Rosal Revaldo, Medical Action Group, Philippines on how to screen torture victims to the regional mental health institutions and reception centres. The system seeks to improve knowledge sharing between the different types of health services and encourage a greater focus on community care in the reception centres so that torture victims are more empowered during the recovery process. Mathieu Shalif (Solidarité d’Action pour la Paix/ Grand Lacs, Burundi) reflected on the challenges faced in providing and funding rehabilitation services in a country that has suffered years of conflict and in which the army and security forces have used torture as a tool of repression. He explained that SAP-GL was established in 1999 with the help of the Jesuit Refugee Services (JRS) to advocate against torture and help and support torture victims. It now has around 20 volunteer lawyers, social workers, nurses, psychologists and one physician and supports over 100 torture victims, mainly women and children. The centre works in a very challenging environment: Burundi sees very high numbers of refugees — many from the Democratic Republic of the Congo — transiting the country. Many of these refugees have suffered torture, trauma or sexual violence. It has also undergone periods of transition, from civil war to a democratically elected president, which led to political violence and on-going fighting. The centre has been attacked in the past by pro-government militia, and so staff and clients are in a highly stressful and insecure environment. SAP-GL works to identify victims of torture, to gather information on their behalf and assess their needs. It provides counselling, psychosocial assistance and medical treatment in its clinic. It also provides support in vocational or technical training, basic micro-business skill training (in income-generating activities) to aid the empowerment of victims. Its main centre is in Bujumbura, with “antennae” centres in the more rural areas of Burundi. Its recent accomplishments include establishing a medical centre,