Uruguay Netherlands Burundi Inadequate identification and referrals Availability Medical screening conducted within asylum reception centres Health assistance restricted to state services Limited services — initially only one staterun rehabilitation centre in Montevideo Serious challenges regarding location, bureaucracy and financial resources Asylum-seekers have access to basic medical services, but limited opportunities for psychosocial rehabilitation in reception centres Staff in reception centres lack knowledge of torture sequelae and tend to distrust “trauma narratives” — can compromise the screening and recognition Lack of availability of services in the more rural and isolated regions Funding shortages — SAP-GL cannot establish centres in all regions Rehabilitation entirely NGO-led No government policy or funding for rehabilitation Few referrals are made by reception centres to one of the three specialised centres, which generally handle more acute cases No opportunities for empowerment Lack of training and knowledge of torture sequelae Appropriateness Lack of sensitivity amongst professionals working with survivors Victims have no control over their referral for treatment to specialised services — this is organised by the state Lack of trust of state services — victims often consult NGOs to check the reliability of state services Lack of good quality psychiatric, psychological and psychosocial assistance. A Mental Health Programme never materialised, due largely to a lack of political will, budgetary and regulatory issues Holistic rehabilitation only present at the top level of services, i.e. the three specialised centres Compartmentalising services can paralyse the holistic rehabilitation process at other levels Medical professionals often not independent (e.g. medical staff at reception centres or detention centres are state employees) The victim’s individual needs are often not properly evaluated SAP-GL provides a holistic approach Care providers consider victims’ individual needs SAP-GL raises awareness to encourage communities to change their attitudes towards torture victims, to avoid stigmatisation, marginalisation and to encourage cooperation within communities to ensure a support network is available Mental health services are not prioritised Family and community networks important as a basis for educating communities on the effects of torture Accessibility No discrimination accessing state services Victims can access a Citizen Service Office that provides information on medical care provided by the state, part of the Integrated National Health System However, system faces a high level of bureaucracy, a dependency on decisions made based on political incentive, delays from a lack of staff and space Environment is open and safe, but often inaccessible State agents disable the recovery environment and the legal system works against full access to specialised rehabilitation centres Knowledge spread through existing community structures, e.g. churches and hospitals Counselling empowers victims and communities Orientation activities and judicial assistance also encourage community involvement Widespread poverty impedes access to all services, e.g. legal Security and safety concerns for victims and human rights defenders; high level of impunity 10 International Rehabilitation Council for Torture Victims