4 Working in challenging environments – Egypt, Russian Federation, Ecuador Raghda Sleit (El Nadeem Center, Egypt) introduced the work of El Nadeem, which is the only rehabilitation centre for torture victims in Egypt. The centre relies on funding from private donors and is supported by volunteer staff. Faridun Zavurbekov (Interregional Non-governmental Organization Committee Against Torture, Russian Federation) introduced the work of CAT, which has provided legal support and rehabilitation services to victims of torture since 2000. The centre has set up mobile groups in order to be able to react promptly to allegations of human rights violations in any region of the country. It then endeavours to organise an independent investigation into the incident and represents the victim at court and before investigation bodies, as well as providing access to medical and psychological treatment and counselling. Yadira Narvaez (Fundación para la Rehabilitatión Integral de Víctimas de Violencia, Ecuador) introduced the many challenges faced in providing rehabilitation services to torture victims in Ecuador. The country has a high number of refugees, torture occurs for more than half of persons in detention, and there are high numbers of enforced disappearances. Only 0.8% of torture victims have received care directly from the state. Many torture victims are reluctant to accept assistance from the state as the state is generally the perpetrator of acts of torture. There are many NGOs, around 12,000 working in the health field, but only two centres provide torture rehabilitation services. PRIVA has been advocating for a holistic penal code, which will recognise holistic rehabilitation as an element of full reparation. It has entered into dialogue with state institutions to encourage torture victims’ rehabilitation to be included as a part of public health policy. PRIVA seeks to influence university institutions to play a role in developing tools to evaluate victims’ needs in order to generate changes to public health policy. In this way knowledge is spread amongst legal and health professionals, and PRIVA is able to build on its limited capacity. General discussion Working in an environment in which the state authorities are not supportive of the work carried out by rehabilitation centres was the common theme in this workshop. Various countries, including Pakistan and Sri Lanka gave examples of similar ways of working to those illustrated in the three case studies. In some 16 International Rehabilitation Council for Torture Victims cases, trying to engage with the state authorities, particularly by offering training for police, judiciary, etc., can enable a more conducive working environment and build trust. It was also noted that breaking down the stigma attached to torture is important to encourage victims to rely on family support and seek help from available services. “” The most important aspect of the workshop was learning about different contextual problems which will allow us to develop strategies, especially to influence governmental institutions. Yadira Narvaez, PRIVA, Ecuador