A clinical perspective on General Comment No.3 Dr Nimisha Patel, International Centre for Health and Human Rights and the University of East London, UK Dr Nimisha Patel reflected on what constitutes rehabilitation from a clinical perspective. She referred to the definition given in the General Comment but also emphasised that, from a practitioner’s view, the definition goes further. For example, in practice the outcomes of rehabilitation are far wider than defined by the General Comment. From a clinical perspective, the outcomes include the individual, family and community; rehabilitation may rebuild the physical, psychological, interpersonal and social functioning, as well as address an existential meaning, i.e. the victim making sense of their suffering and wanting a sense of justice. One important question she underlined is to consider what changes are needed in the torture victim’s environment to facilitate a full rehabilitation. Again, while the General Comment defines rehabilitation as services, in practice the services will vary greatly in terms of the components, activities, availability of professionals and the local needs in each context. Dr Patel reflected that in its functioning as a form of reparation, rehabilitation may include any range of measures (e.g. clinical, social, legal, educational, vocational, prevention activities, community development, etc.). There is no single intervention that is guaranteed to work for everyone in any given context. With this in mind, the relationship between rehabilitation services and other measures, including compensation, need to be looked at together. Rehabilitation is not merely an end point, she said, but a process of recovery that could draw on different approaches to rehabilitation: medical, psychological, empowerment and justice. She proposed defining rehabilitation as a combination of these various approaches, involving a range of services, activities and measures to enable victims to survive the harm endured. Regarding the reference to “victim-centred rehabilitation” in the General Comment, she stressed that victims (survivors) should be able to speak out and should not be seen as passive in the rehabilitation process. As such, victims’ views are important, not only when tailoring the rehabilitation programme, but also when evaluating services, planning and designing programmes and conducting advocacy and research. She highlighted the importance of seeing victims as experts in their own right, many of whom are willing to be involved in a more active way in raising awareness of torture rehabilitation. A key question asked by Dr Patel in her presentation was, how do we implement “as full rehabilitation as possible”, and how do we know when services provided meet the obligations laid out in the General Comment? Her view was that there is a need to inte- 4 International Rehabilitation Council for Torture Victims grate survivors’ views with clinical experience and align these to the legal standards. The importance of building core standards and benchmarks, not just aspirations, is evident. But what should those standards be? Dr Patel introduced her on-going research on Victim-Centred Standards for Rehabilitation, in which she seeks to establish a framework to analyse the existing rehabilitation provision in a state in order to facilitate planning, designing and delivery and evaluation of rehabilitation service provision. Her framework adopts six independent and inter-related standards, including appropriateness and safety, both of which are mentioned in the General Comment framework. Finally, it is important to locate the victim’s experience in their particular context. Rehabilitation has to make sense to victims and be meaningful to them. The General Comment as a legal definition should be seen not as constraining but as an open-ended, on-going process. It should pave the way for greater collaboration between legal and health professionals. Where does the right to rehabilitation fit in to the global perspective on health systems? Public health systems: Holding governments accountable — establishing standards, measuring implementation Dr Paul Bolton (Johns Hopkins Bloomberg School of Public Health, USA) Dr Paul Bolton spoke about the methods and challenges of establishing standards and measuring implementation in public health systems, with particular reference to cases where he has worked with torture victims. Reflecting on the challenges to implementing standard measures linked to the General Comment framework, he underlined the importance of allowing survivors to participate in the process and taking into account the personality, background and history of the survivor. Thus, although the basic symptoms of torture victims may be similar at the global level, the problems faced by victims will vary from region to region. The diversity of reactions to torture creates “” The theme of the conference was so relevant to everybody working in the field of rehabilitation of torture victims, especially for the people who are willing to open new rehabilitation centres. Every presenter had her/his unique experience that we should all know about. Raghda Sleit, El Nadeem, Egypt