challenges to drawing up an agreed list of standard measures and instruments, but underlines the need to carry out basic qualitative research beforehand. Such research would consist of listing all commonly mentioned problems from sample interviews with torture victims and then prioritising these based on frequency and severity. For example, if torture victims identify economic problems as a primary complaint, perhaps mental health rehabilitation should not be given priority. In this way, he viewed holistic treatment as being a particular package of programmes that are put together in a region to meet the specific priorities of the local people. In terms of monitoring and evaluation of programmes, Dr Bolton reflected that the purpose of monitoring is to identify problems as they occur so that they can be addressed immediately. Evaluation is determining if there is a change in the indicator between the beginning and end of the programme. Indicators that can be used to establish effective implementation may include: • Fidelity monitoring: evaluating whether the intervention provided is of good quality; • Availability and access: indicators could include distance, time taken to travel to a centre, travel and opportunity costs (e.g. attending treatment during working hours impacts on the costs to the individual in loss of working hours); • Uptake: the appropriateness of services can be defined by how many people who know about the services actually access them; • Survivor compliance or cooperation: how many of those who start treatment complete it; • Feasibility and cost: who (e.g. the state?) will pay for the services and is the funder able and willing to pay for the duration necessary; • And effectiveness: what would happen to the survivor in the absence of services, i.e. the services are effective if the survivor would be worse off without them. Alternatively, if the intervention does harm or causes the survivor’s condition to worsen, it should be avoided. For example, the outcome of effectiveness in relation to the framework of the General Comment would be the restoration of dignity to the survivor, in terms of the survivor’s individual role and roles in relation to his/her family and society. As this will vary according to the society, there is no single instrument to measure the individual’s restoration. However, by conducting basic qualitative research through openended questions, researchers can determine which indicators could be used to monitor the effectiveness of the services offered. Dr Bolton noted it is hard to hold states accountable but suggested that treating the state as a partner whose priorities also need to be met could be one way of overcoming this obstacle. In this way, services would address the priority problems of the survivors, instead of just on problems due to torture. Where possible, survivors should access the services alongside other beneficiaries. He gave the example of Iraq, where most torture victims receive mental health and counselling services integrated into the physical health system, which is accessed by all. The advantages of this approach are several-fold: • The government is often more supportive; • There is more anonymity, which appeals to clients; • Reach and access are enhanced through integration; and • Torture survivors who need specialist care can still access it through a referral system to torture and trauma centres. He also cited the apprenticeship model of training and supervision — a process of continuous learning with on-going supervision and on-the-job training — as a method for expanding access to quality treatment in low-resource countries. This model allows non-professionals to learn to provide treatment while assuring survivors get quality care. In the open discussion following Dr Bolton’s presentation, it was noted that assessment of torture treatment services in asylum-receiving countries may be based on different needs of the victims than in countries where torture takes place. Torture victims not present in their home country will have different priorities and concerns, e.g. accessing the asylum system, finding their family and finding work. Therefore, interventions and instruments to measure outcomes need to be adapted to reflect this population. It was noted that there is a need to carry out more research, including by the service providers themselves, on the quality and effectiveness of the services provided. Governments and donors are also requesting this information. Public health systems: accessing health systems and health financing Prof. Martin McKee (London School of Hygiene and Tropical Medicine, UK) Prof. Martin McKee spoke about access to health systems and health financing in the context of the right to health. Prof McKee pointed out that a key difference from the right to rehabilitation is that the right to health does not include a right to redress and therefore does not provide an automatic legal entitlement; it is subject to progressive realisation and to resource availability. He outlined the challenges of achieving universal Right to Rehabilitation for Torture Victims, Beirut, Lebanon – 27/28 June 2013 5