as a priority, justice or development issue. Moreover, victims may prefer non-state services because they do not trust the state as it may be the perpetrator of their torture. Therefore, it is mostly non-governmental or private institutions and rehabilitation centres that play a key role in providing support to victims of torture. living in extreme poverty, people struggle to meet their basic needs, such as food, sanitation or proper housing and cannot afford to seek care. In all three countries, many victims of torture do not have health insurance, just as they cannot afford to pay for transportation to care providers, hospital bills or the medication prescribed. By providing psychosocial support and redress to victims of torture and trauma, rehabilitation centres can help individuals rehabilitate, reconstruct broken societies and empower communities. Without this kind of support, torture victims are often unable to participate in local decision-making processes, which are at the heart of democratic development. Poverty also negatively affects the rehabilitation process. Torture leads to high levels of stress, a lack of confidence and low self-esteem. These feelings of vulnerability, failure and a sense of ‘uselessness’ are exacerbated by the daily struggle to buy basic goods and the low social status associated with extreme poverty. In order for rehabilitation services to be truly effective, poverty needs to be addressed. In the Great Lakes region, the availability of services is extremely limited. In Rwanda for example, the Ministry of Health stated in 2010 that almost 30 percent of Rwandans suffer from severe trauma; yet it is estimated that only two percent can access mental health services.6 The project sought to fill gaps of this kind. Over four years it focused on increasing access to more effective torture rehabilitation services for victims and their families living in rural areas of Burundi, the DRC and Rwanda. It also focused on rural areas where there is little access to rehabilitation services. According to the 2011 Mental Health Atlas of the World Health Organization, Rwanda only has one psychiatrist per 2,000,000 inhabitants, or six psychiatrists in the entire country.7 In Burundi these figures are even lower, with just one psychiatrist per 10,000,000 people.8 In the DRC, there are 6.6 psychiatrists per 10,000,000 inhabitants.9 Even when victims can access existing services, those with rehabilitation needs may not be diagnosed correctly, as those required to provide holistic services, such as hospitals, police, lawyers, psychologists, local authorities, community workers and others are either not trained to do this work or do not work in collaboration. The expertise required to diagnose psychosomatic diseases for example is very rare. Moreover, the existing health centres in more rural areas of Burundi, Rwanda and the DRC are often staffed with nurses instead of doctors or psychologists. The main cause of the lack of availability and access to services is poverty. The 2014 UN Human Development Index lists Rwanda as 151, Burundi as 180 and DRC as 186 out of a total of 187 countries.10 For gross domestic product per capita from 2011 to 2014, Rwanda is listed as 171, DRC as 182 and Burundi as 184 out of 186 countries.11 This acute lack of resources results in very limited infrastructure for rehabilitation services. More importantly, when 8 IRCT Great Lakes Project medical referrals, the centres provided information and psychological support to family and communitymembers when conducting hospital visits. The project also supported the co-ordination of awareness raising activities at community level, particularly in rural areas. The events brought victims, the local police, local authorities, the army and centre staff together with members of the community and created opportunities for victims to speak out and call for the care they need and deserve. The events also allowed the centres to explain what torture and violence are and how they can be prevented, and to make community members aware of their services and activities. In addition to the victims, rehabilitation centres also play an important role in caring for secondary victims of torture and sexual violence, who are often forgotten by traditional care-providers. Having developed close relationships with the community, rehabilitation centres see first-hand and identify the impact of violence on those close to the victim. Children who witnessed their mother being raped, wives who saw their husbands being beaten, fathers whose daughters have been tortured in prison; all endured extreme levels of stress and mental suffering and also need care. The project specifically addressed secondary victims in the rehabilitation process, and provided them with psychological, psychosocial and sometimes socioeconomic support. Secondary victims were included in all community-based rehabilitation services, such as income generating activities and social counselling. Aside from providing psychological, legal or socio-economic support, the rehabilitation centres included family members of the victims in all phases of the rehabilitation process and provided moral support. In legal cases, this can take the form of providing transportation and accommodation for family and/or community-members to enable them to attend court cases. With strengthen the links between services. At the centres, there were typically three key rehabilitation services available: medical, psychological and legal counselling. The medical care was mostly limited to first-aid responses and the provision of basic medication. The psychological assistance consisted of different types of psychotherapy, such as ergo therapy, movement therapy, dance therapy, group therapy and relation therapy. The legal support generally included providing information and advice, liaising with judicial bodies on behalf of the victim and in some cases mediating directly between two clients. Many centres also have programmes on HIV-Aids, education, shelter and conduct research on the different types of approaches they use and their effectiveness. The project supported the rehabilitation centres to strengthen and expand these services by allowing them to directly deliver or to refer victims to other service providers in four key areas: • Medical care through referrals to specialised medical institutions • Legal assistance through the hiring of law firms to bring cases to court • Psychosocial support through community-based social counselling • Livelihood development and income generating activities A holistic and community-based approach was implemented across the three countries. Genocide survivors singing at the opening of the new rehabilitation centre in the Ngoma district, Rwanda in December 2014. The importance of holistic rehabilitation and the role of civil society was discussed by the representatives of local communities, survivor groups, the Mayor of Ngoma, the EU ambassador, the IRCT and the representatives of the police in attendance. Between 2011 and 2015, 11 awareness-raising events were organised in the three countries on the importance of the fight against impunity for torture and the right to rehabilitation for torture victims. In total, more than 750 people participated in these events, which brought together key stakeholders and allowed them the time and space needed to forge stronger networks and improve their co-ordination and co-operation. Overall, the project aimed to improve the quality and quantity of existing services, as well as 1. Holistic rehabilitation Torture victims have different reactions to their experiences, just as the consequences of torture are likely to be influenced by many internal and external factors. While torture is used to fragment, break and destroy people, the aim of rehabilitation is to help put them back together. Torture has such a devastating impact that survivors may need help on a number of levels to effectively rebuild their life. Holistic rehabilitation means that centres take an approach that encompasses co-ordinated and integrated cross-disciplinary services. These services extend beyond medical and psychological treatment to include social, vocational, and legal support, delivered to primary and secondary torture victims in a way that is as responsive as possible to their needs, expectations and aspirations. Rehabilitation centres should be informed about the IRCT Great Lakes Project 9