fundaments of holistic care, but also be trained in methods and techniques that allow them to adopt attitudes and practices key to this approach. The IRCT and its partner rehabilitation centres recognised the complexity and inter-connectivity of social, economic, medical and psychological sequelae of torture, where one aspect can negatively or positively affect the other. Without a holistic approach, the rehabilitation process has little chance of success. Holistic rehabilitation services are centered on the victims, and the individuality of each victim is taken as the starting point of the process. By treating the physical and psychological effects of torture, and offering social, economic and legal support, centres empowered victims to pursue redress and enabled them to re-integrate into society. Providing professional, specialised treatment to torture victims was an essential element in improving the public health system and helping to rebuild the region’s broken societies. 2. Community-based rehabilitation physical space of a rehabilitation centre is important for medical treatment, psychological and legal counselling, as a safe space and for various other services available on an individual basis. acceptance and belonging by its most vulnerable members. This in turn allows them to gain the confidence to participate in communal life and become a valued member of their society. However, the community in which one lives is an equally important space for the victim’s rehabilitation process. For example, if victims live in extreme poverty and/or are excluded socially within the community, this can heighten their vulnerability and have a profoundly negative impact on their rehabilitation process. At a practical level, a community-based approach to rehabilitation can reduce the cost of services, increase accessibility for victims living in remote communities and be seen as an intimate space for victims to discuss their experiences. Through the project, existing community intervention approaches were strengthened and communitybased rehabilitation structures were created. Victims not only had access to quality medical care and psychological assistance, but participated in community counselling groups and initiated income generation activities. The result was a rehabilitation process that not only empowered individuals, but also families and communities. The community-based approach to rehabilitation facilitated by the Great Lakes Project complemented centre-based rehabilitation services with community-based services. Holistic services that adapt to this context and promote social reintegration play an essential role in trauma healing. In the Great Lakes Project this community-based approach was affirmed. For torture victims, this means reinstating their identity as a member of a family and a community. It means caring and being cared for by those close to you, participating in social life, cultural events and community meetings. It also means having the tools and the skills to provide for yourself and your family. For victims to reclaim their identity, it is vital for them to regain the ability to do the very things the perpetrators tried to take away from them. “I have to sit down and consider where I have been in order to prepare for my future. Our history has changed and we have started to live again. I am strong, I have to work to achieve my goals and live a bright future.” T.A., Rwanda Social counselling groups facilitated the discussion of issues old and new within communities across the region. The project was founded on the belief that services do not start and end in a rehabilitation centre. The 10 IRCT Great Lakes Project In a region where the identity of a person is closely linked to social status, but where traditional communal bonds have been broken through decades of inter-communal violence, a community-based approach to rehabilitation with a strong ‘collective healing’ component is key to ensuring a feeling of 3. Gender-based rehabilitation responses Approximately 70 percent of the beneficiaries of the Great Lakes Project were women. This is often the case in post-conflict societies, as large numbers of men have been killed, leaving behind women survivors who have had incredibly traumatic experiences. It is also often the case that women victims of torture are doubly disadvantaged. They endure serious physical and mental sequelae, but they also face additional stigma and shame because of the form of harm they endured, in particular sexual torture. Rape is often used as a weapon of war. During the Genocide in Rwanda, approximately 250,000 women were victims of rape.12 In the DRC, a comprehensive report on sexual torture by Freedom from Torture, published in 2014, found that rape and other forms of sexual violence are rampant in the country. The report stated that “aside from acts committed by soldiers of the Congolese army and members of armed groups in the context of the conflict, rape committed by civilians has become a problem in its own right, not helped by the widespread impunity for such crimes.”13 In Burundi, many human rights groups reported alarming levels of sexual violence committed both during and after the civil war. In a comprehensive report on rape in Burundi, Amnesty International reported the following: “poverty, a patriarchal society, and a culture in which rape and sexual violence are not taken seriously, contribute to a situation where many women are too afraid to report the crimes. Many women victims of rape fail to seek redress and are not supported by the state, the community and their family. Women often do not report rape because they fear reprisal attacks from the perpetrator. Furthermore, women in Burundi are subjected to various forms of gender discrimination, including the social stigma to which rape victims are subjected by their community.” 14 Due to this stigma, women in communities and families where there is no support or understanding try to hide what has happened to them. For this reason, rehabilitation needs to be structured, either through individual, marital or group approaches, to support the disclosure needed for appropriate responses. In order to reach these victims, service providers need to take this specific aspect into account. “Many women are afraid of the stigma resulting from getting specialised care by medical professionals working in the field of Sexual and Gender Based Violence (SGBV). At Panzi, we treat different kind of patients with a variety of gynaecological problems. We don’t only treat victims of SGBV but offer general gynaecological services. In this manner, women who are afraid of the stigmatisation can come for ‘ordinary’ treatment. It is not a stigma coming here.” Dr. Denis Mukwege, Director, Panzi Hospital, the DRC One of the many consequences of numerous wars in the region was the partial destruction of the region’s health systems. As a result of the Rwandan genocide for example, many of the estimated 250,000 women victims of rape only received emergency treatment and had little or no access to gynaecologists or any form of mental healthcare.15 A key element of the project’s response to this was to break the silence and make women aware of IRCT Great Lakes Project 11