RCT Annual Report 2008

Årsberetning 2008Rehabiliterings- og Forskningscentret for Torturofre Annual Report 2008Rehabilitation and Research Centre For Torture Victims

Tema RehabiliTeRing foR fRemTidenTheme RehabiliTaTing foR The fuTuRe

RCT08

annual report 2008

Rehabilitation and Research Centre for Torture Victims, RCT

Borgergade 13P.O. Box 2107DK-1014 København KPhone: +45 33 76 06 00Fax: +45 33 76 05 10e-mail: [email protected]

SE-nr. 69 73 51 18Giro BG Bank nr. 1199-0007383940Danske Bank nr. 3001 4310821209

editorsSimon AnkjærgaardHeidi Koch TokleTue MagnussenAnette KlahrEdith MontgomeryJan Ole HaagensenBengt H. Sjölund (Editor-in-chief)

graphic designEckardt ApS

ProductionSangill Grafisk

ISBN: 978-87-90878-29-0ISSN: 1396-2418

Printed in Denmark 2009

CONTENTS

Editorial 1

Theme: Rehabilitating for the futureCutting waiting lists: RCT enhances rehabilitation 2

Rehabilitation is a team effort 4

Pain is not objective 5

Crumbling souls 6

RCT wants more time for patients 9

Best-practice conference 10

Conference snapshots 12

How to assess torture survivors 14

Highlights of the year 2008 16

Freedom from torture in the age of globalisation 18

Substantial enhancement of research at RCT 20

Research Projects 2008 22

Publications 2008 23

Donations and pledges of support 2008 24

Annual accounts 25

Printed on Cyklus Offset

” Since the beginning, the

approach in RCT’s rehabilitation of

torture survivors has been multi-

professional, acknowledging the

physical, the mental and the social

sequela of torture.

1WWW.RCT.DK

The rehabilitation of torture survivors was the main reason for founding the Rehabilitation and Research Council for Torture Victims in 1982. It is still one of our most important activities, and we now receive around 200 referrals each year from physi-cians in Denmark. Since the beginning, the approach in RCT's rehabilitation of torture survivors has been multi-professional, acknowledging the physical, the mental and the social sequela of torture. Over the years, this approach has developed into an interdisciplinary approach where the teams at RCT make compre-hensive, joint assessments and rehabilitation plans in dialogue with the patients. The different rehabilitation teams, whether in individual, group or family programs, apply a blend of the expe-rience collected during the years and the most recent evidence-based rehabilitation methods, as evidenced in the present annual report.

To consider the problems of the torture survivor not only as mental is mandatory - for example realizing that the chronic pain experience may have a background in disturbed function of the nervous system or in less adequate tension and use of muscle groups. Likewise, it is important to understand that some of the mental experiences these persons may have sustained do indeed cause permanent changes of the brain, which makes the therapy of symptoms difficult and sometimes impossible. On top of this, there is usually a huge social problem, both as regards coherence of a family structure and the build-up of an economical support mechanism in a new, sometimes hostile and culturally ignorant, environment. This means that it is necessary to perform assess-ment and rehabilitation with teams containing professional com-petences within medicine, physiotherapy, psychology as well as social work, and to focus on the individual and his/her life situa-tion rather than on the organ, which is the core hallmark of RCT rehabilitation programs.

During the last few years, RCT has invested heavily in its rehabil-itation activities, both internally in updating the evidence-base of our programs and externally by writing the first existing Field Manual of Rehabilitation, to be used in places where resources and competences are few to rehabilitate victims of torture but where torture is abundant. Experienced present and past RCT therapists have cooperated with scientists from our rehabilita-tion research cluster and with experienced international program managers to produce a manual of about 400 pages organized according to the International Classification of Functioning, Disa-bility and Health of the WHO. The advice is given in three levels, for the layman, for the non-specialist physician/nurse and for the rehabilitation specialist. References to relevant key studies

are included as well as a chapter on the most commonly occur-ring treatment methods.

The manual has been distributed during 2008 in 1.400 copies all over the world. Feedback was collected in the autumn of last year and discussed in an international conference on Rehabilitat-ing Torture Survivors that RCT arranged with the Trans-Cultural Center for Psychiatry in Copenhagen in December 2008. More than 180 participants discussed interdisciplinary rehabilitation from all angles in a three-day program allowing plenary lectures as well as workshops for open discussion (se more on pages 10-15). The presentations can be downloaded from the RCT web-page, www.rct.dk, forming a virtual library of current knowledge in the field. The input collected regarding the manual will be used to revise the text and the second edition will be translated from the current English version to other world languages.

We do not know how many of the refugees finding a haven in Denmark that have been subjected to torture or organized vio-lence. A recent study by Amnesty International physicians in Denmark indicate that almost half of those applying for asylum have actually been so. Thus, the queue situation has at times been unbearable for torture survivors waiting in line to receive rehabilitation in our country. However, the Danish Government recently allotted more resources to rehabilitation of traumatized refugees and, hence, we are very happy to tell that another re-habilitation team was employed at the end of 2008 to contribute fully to our programs from early 2009. A problem in Denmark is still, though, that those who have not been granted a residency permit are not allowed to benefit from our services.

In summary, the future looks a bit brighter as regards rehabilita-tion of torture survivors: We have more useful knowledge, tools have been developed to be used in the South and our own pro-grams have more resources. Still, it is most unfortunate that our clinical programs are needed! There should be no torture at all, and the RCT vision is a world free of torture. Therefore, the work within our other departments, the Research and International Departments are extremely worth while to improve the human rights situation in countries where torture is used and to find mechanisms and interventions that constitute effective preven-tion. So, this is what RCT is all about, to combine the efforts from the various activities to create an impact larger than any single activity would have been able to elicit. Let us hope that we can approach this goal more and more, year by year.

Professor Bengt H. Sjölund, Director General, RCT

1WWW.RCT.DK

Editorial

THEME: REHABIlITATING FOR THE FuTuRE

RCT ANNuAl REPORT 20082

At the end of 2008, RCT widened the scope of its rehabilitation work with a brand new team consisting of a doctor, a physi-otherapist, a psychologist and a social worker, a move facilitated by DKK 75 million earmarked in the 2009–11 by the Danish government for the extension and enhancement of services for traumatised refugees. Part of the sum has been allocated to RCT, OASIS and RCT Jutland. The expansion of the Rehabilitation Department enables RCT to seriously address the problem of excessively long waiting lists for torture victims. After their initial assessment, patients who require individual treatment (as opposed to group or family treatment) have faced a wait of one to two years. - It is frustrating for patients and therapists alike, explains Anette Klahr, physiotherapist in the Rehabilitation Department at RCT. - Excessively long waiting lists make patients feel they are in some kind of deadlocked situation. It’s incredibly stressful for them. We work with family doctors to help as much as we can during the wait.

Individual treatment enhanced The vast majority of patients referred for rehabilitation at RCT are treated individually, so the waiting list for individual treat-ment is by far the longest and the new team will concentrate on individual therapy. - The only way to tackle the lengthy waiting list was to take on more staff, Klahr adds. - The money from the government has now facilitated that. The waiting list for individual treatment was the longest one, so that is where we have deployed the new team. The team started work at the beginning of the year, and have already made an impression. The waiting list for individual treatment is now shorter – and that sends positive signals to both patients and therapists.

- It is obviously good for patients, as their preliminary ex-aminations are brought forward, and so is the start of the actual rehabilitation process, Klahr points out. - It also means a great deal to us as therapists to see our patients making faster progress. Bengt H. Sjölund, Director General of RCT, is also satisfied with the extra rate-adjustment pool funds and the new team. - It is highly gratifying that we were able to recruit new employees from 1 January and cut waiting times, he comments. - And it is even more gratifying when you look at the issue from a European perspective. Studies have shown that most Eu-ropean countries – even the other Nordic countries – don’t fully fund specialist rehabilitation for refugees who have been the victims of torture in their homelands. - Once again, Denmark has taken the lead in helping this group of seriously afflicted victims. Those of us who work with tortured refugees will do our best to spend the additional fund-ing in a responsible and effective manner.

Cutting waiting lists: RCT enhances rehabilitation

Simon Ankjærgaard, communication officer

RCT has expanded its rehabilitation efforts thanks to funding from the rate-adjustment pool. The new multidisciplinary team, comprising a doctor, a physiotherapist, a psychologist and a social worker, has already had a positive impact on waiting lists.

Funding From the rate-adjustment poolThe rate-adjustment pool is used to fund social, health and labour-market programmes designed to improve conditions for the weakest social groups. In the period 2009-11, DKK 75 million has been ear-marked for the expansion of processing capacity in specialist services for traumatised refugees. RCT, OASIS and RCT Jutland, will receive funding for three years commencing in 2009 to enhance their capacity to an extent corresponding to adding a second treatment team. The amount corresponds to DKK 2.6 million p.a. at each centre.

Patients in individual treatment are now dealt with sooner. Money from the extra rate-adjustment pool funds has enabled RCT to recruit a second rehabilitation team, which has helped to cut excessively long waiting lists. Photo: RCT

p

3WWW.RCT.DK



When victims are first referred to the Rehabilitation and Research Centre for Torture, they are assessed by a doctor, a psychologist, a physiotherapist and a social worker. The rehabilitation team then collectively draws up a rehabilita-tion programme that takes into account the patient’s mental, physical and social condition. This interdisciplinary approach is the very foundation of RCT’s rehabilitation method. Years of experience have shown that the trauma suffered by torture vic-tims is extremely complex, and rooted in a mixture of physical, psychological and social factors. The psychological problems may manifest themselves as depression, anxi-ety attacks, problems with concentra-tion, learning difficulties and irascibility. Physically, patients may suffer from chronic pain, either as a direct conse-quence of the torture, or as a reaction to the severe psychological pressures to which they have been subjected. In addi-tion, their mental and physical problems mean that patients may encounter social difficulties that are compounded by the fact that they are often refugees who have lost everything, may be incapable of working, and who have had to adapt to a new culture and come to terms with a new social context. Social problems may include keeping the family together, settling in a new home or finding and keeping a job. This is why treatment by a single therapist, focusing on a single aspect of the problem is not enough. Interdiscipli-

nary rehabilitation is necessary if victims are to be helped to resume full and nor-mal lives.

The team delivers the treatment At RCT, it is not individual therapists who take care of the patient, but the whole team. - Take for example, patients’ sleep problems, explains Anette Klahr, a physi-otherapist in the Rehabilitation Depart-ment. - These are not just the responsibil-ity of the psychologist. The physiothera-pist can help the patient to relax, and the doctor can prescribe medicine that makes it easier to fall asleep. - As therapists, our skills are all closely interrelated, and it is a privilege to work so closely with other types of practitioners. It is the only effective way of making a real difference to trauma-tised torture victims.

Not just in the consultation room RCT’s interdisciplinary approach is not just limited to its work in the centre on Borgergade in Copenhagen. For an inter-disciplinary approach to remain effective,

it is crucial that it reaches beyond the consultation room. Patients have to be able to cope with the world beyond RCT – a world of social services, employers, family GPs, nursery staff, school teach-ers, etc. - In some parts of the system, they may come up against a critical lack of knowledge of torture victims as a patient group. So we have to make sustained efforts to understand the complexity of our patients’ lives and communicate that knowledge to the outside world. Why do our clients react the way they do? And what are the potential consequences?, Klahr says. - The family team networks with the people and bodies that come into contact with the patient. As well as explaining about the patient’s complex situation, network meetings also provide a unique opportunity to share knowl-edge, which makes it easier for all con-cerned, including the individual client or the family, to make the right decisions. We very much hope that the network-meeting model will spread to the teams working with individual treatment and group therapy.

Rehabilitation is a team effort


A multidisciplinary approach is the key to the rehabilitation of torture victims. Doctors, psychologists, physiotherapists and social workers at RCT work closely together to help patients resume full and normal lives.

ViSiTaTion

aSSeSSmenT

PhYSiCian PhYSioTheRaPiST

Team meeTing

feedbaCK meeTing

WiTh ClienT

SoCial WoRKeR PSYChologiST

RCT’s social workers, doctors, physiotherapists and psy-chologists work closely together right from the initial in-depth examination of the victim, whose experiences are discussed collectively by the various therapists. Model: RCT

WWW.RCT.DK

Pain is not objective


At their first interdisciplinary assessment at RCT, the vast majority of patients re-port problems with chronic pain and dis-ability. However, there is more than one way to deal with pain. Pain is not some-thing objective, but an experience that is unique to the individual, and which therefore has varying degrees of signifi-cance and different consequences for different clients. Many factors – physical, mental and social – also affect the way in which pain is experienced. The solution is interdisciplinary rehabilitation, which does not focus exclusively on the medical treatment of pain, but instead looks at the clients’ circumstances as a whole. - Social and psychological stress factors, e.g. fear, may intensify the feel-ing of pain, says Anette Klahr of the RCT Rehabilitation Department. - So not only doctors and physi-otherapists, but psychologists and social workers are involved in treating it. The physiotherapist works with the pa-tient’s motor apparatus, looking at how they might walk, sit or sleep differently. The psychologist works with the patient’s psychological perception of pain, which may, for example, be causing nightmares

and related patterns of thought, which may be causing inactivity. In collaboration with the patient, the social worker can look at how social pro-vision and other public-sector services might help increase the activity of the patient despite the pain. To supplement its group therapy, RCT set up a pain school, which spends ten weeks focusing on what it is like to live with chronic pain, and how it can be treated. The pain school is multidiscipli-nary, involving doctors, psychologists, social workers and physiotherapists. Different practitioners work on dif-ferent themes, conducting discussions and attending seminars in subjects such as pain and stress, pain mechanisms, pharmaceutical painkillers, pain and movement, pain and sleep, pain and depression, and the social consequences of long-term pain. A great deal of time is devoted to discussion between thera-pists and patients.

When starting a rehabilitation programme at the RCT, the client draws a diagram illustrating where exactly they feel the pain. Drawing: RCT

p

Pain cannot be understood as just a physical phenom-enon. Psychological and social stress factors may help to intensify the individual’s experience of pain. For this reason, the treatment of pain requires co-operation between doctors, physiotherapists, psychologists and social workers. Model: RCT

f

PSYCho-logiCal SoCial

SomaTiC

MC

MC

MC

RCT’s treatment of pain illustrates the importance of an interdisciplinary approach.

Not a day passes without Mohammed thinking of the cold cell with no windows, the incessant humiliation, the daily pounding to his face and body, and – in particular – the screams of the other prisoners. Mohammed was incarcerated in one of Iran’s most notorious prisons, purely because his political beliefs did not conform to those of the theocracy. Mohammed lives in Denmark now and has been reunited with his family, but he still bears the physical and psychological scars from his time in jail in Iran. When he was granted a residence permit in Denmark, Mo-hammed’s life was, for the first time in years, characterised by peace and joie de vivre. The family had a place to live, and Mo-hammed had a job. However, the time spent at the mercy of his tormentors could not stay suppressed. The nightmares returned – and with them, the anxiety attacks and despondency. Mo-hammed found it difficult to concentrate on even the simplest of tasks and would fly off the handle at work and at home. The

pains he had suffered in his head, back and neck since his tor-ture also returned, worse than ever.

A family falling apart It is normal for torture victims to experience a feeling of rela-tive well-being after they have obtained a residence permit. Unfortunately, it is also common, once normality sets in, for them to feel worse, physically and mentally, and this has seri-ous consequences for their lives. That is what happened to Mohammed, who found it more and more difficult to face work, partly because of the pain, partly because of anxiety attacks and fatigue. At home, ar-guments with his wife and children became more and more heated. Sleep was regularly interrupted as Mohammed woke up screaming. Finally, he visited his GP, who had no hesitation in referring him to RCT for rehabilitation. After what felt like a frustrating long waiting list, he was called in for an initial examination at the centre in Copenhagen. On the other side of the glass doors were a doctor, a psychologist, a physiotherapist and a social worker, who were to work with Mohammed to identify his problems and plan a programme of rehabilitation. The floodgates opened during his examination, Mohammed told all – about his time in prison, about the pain, about the nightmares, about the daily fear of being unable to cope, both at home and at work.

A family in treatmentMohammed’s trials and tribulations in his Iranian cell have cast a long, dark shadow over the whole family – particularly the children. First there was the fear: Where’s dad? What’s hap-pened? Will he ever come home again? Later came the flight, and the disruption of moving to a new country. It has been a life marred by their father’s sense of impotence and slow deterioration. The therapists at RCT see all of this right away.

6 RCT ANNuAl REPORT 2008


Crumbling souls


What happens when a torture victim arrives in Denmark and starts rehabilitation at RCT? We present the story from a fictional perspective.

Modelphoto

7WWW.RCT.DK

The children’s needs have not been met, and they have had to assume enormous responsibility just to maintain some kind of stable family life. It has worn them down, and the danger of sleep problems and a decline into aggressive or introverted behaviour is imminent. As a result, Mohammed, his wife and children are offered treatment by RCT’s family team, which consists of a doctor, a physiotherapist, a social worker, a psychologist and a family therapist. The family attends counselling in Borgergade a couple of times a week. The psychologist and family therapist work with the whole family, while the parents receive individual treat-ment from the doctor and physiotherapist. The social worker steps in with advice, and works with Mo-hammed and his wife to put together a plan for how the family will get back on their feet and establish themselves in Denmark. The plan includes looking for better housing, applying for extra benefits to cover the costs of medicine, finding leisure activities for the children, and education and training for Mohammed’s wife. Through network meetings organisations and actors who have regular contact with Mohammed and his family – e.g. em-ployers, school teachers and GP – are informed of the family’s situation and of the plans for the future. The family makes very good progress, and after a year of rehabilitation at RCT they are ready to stand on their own feet. Memories of torture can never be erased, but the interdiscipli-nary input by RCT’s therapists has provided Mohammed and family with enough ballast to re-enter society.

Mohammed is fictional, but his story is typical of those encountered

at RCT. His case has been described in generic terms, but it must be

stressed that every patient is unique and so is every treatment pro-

gramme.

Who comes to rct? RCT receives patients who have been traumatised by torture, organised violence, war, conflict and/or political persecution, and who have been granted residence per-mits in Denmark. 80% of the patients are men and they come from a range of social backgrounds.

” The floodgates opened during

his examination, Mohammed told

all – about his time in prison, about

the pain, about the nightmares, about

the daily fear of being unable to cope,

both at home and at work.



RCTs interdisciplinary work reaches beyond the con-sultation room. The therapists make great efforts to ensure that the outside world – e.g. social services, the health service and the school system – understands the complex situation in which patients find themselves. Model: RCT

RCT offers individual rehabilitation, family rehabilitation and group rehabilitation.

individual rehabilitation Individual rehabilitation is offered to particu-larly vulnerable torture victims, who require a personalised approach. The rehabilitation involves physiotherapy, social counselling, medical rehabilitation and psychotherapy. The vast majority of patients are offered individual rehabilitation, which means that the waiting list for it is by far the longest. For this reason, RCT deployed a second individual rehabilitation team at the start of the year.

Family rehabilitation RCT’s family team helps refugee families, multiple members of which have encountered

physical, psychological and social difficulties as a result of torture, organised violence, abuse, war and exile. The team offers a customised programme of rehabilitation for the whole family, based on an assessment of their prob-lems and resources as well as the parents’ indi-vidual rehabilitation needs. The programme lasts 8–16 months, during which time either the entire family or the adults may expect to attend RCT once or twice a week. The Family Team consists of a doctor, a physiotherapist, a social worker, a psychologist and a family therapist.

group rehabilitation Many torture victims suffer the same symp-toms, such as poor sleep patterns, stress, depression, pain and inactivity. They have a

tendency to isolate themselves, to find them-selves in conflict with rest of the world and to fail to integrate into Danish society. Bring-ing victims together in groups allows them to share their problems with others in a safe environment. They are encouraged to reflect upon their situation and learn more about their symptoms. Collective strategies are developed that will make their everyday lives easier and enhance their quality of life. Group therapy involves a psychologist, a doctor, a social worker and a physiotherapist. The whole process takes approximately one year. Patients are assigned to a particular group and attend RCT two or three times a week.

Further details are available on www.rct.dk.

three types oF rehabilitation

RCT’S RehabiliTaTion Team

mohammed and hiS familY

SChool

fam

ilY

doCT

oR

Job CenTRe

daY CaRe SYSTem

SoCial WoRKeR

9WWW.RCT.DK

The LEAN philosophy has made inroads all over in the world in the decades since it was developed by Toyota, and is now used in the service and healthcare sectors as well as industry. LEAN is all about trimming fat all the way down to the smallest oper-ational detail, and optimising every aspect of the organisation. Positive outcomes in the hospital sector include shorter waiting lists and greater patient satisfaction. The decision to implement a LEAN programme in the Reha-bilitation Department followed a particularly demanding period of repeated structural changes. In 2006, the department was brought under the Hospital Act. The resultant growth in waiting lists and increasing demands on therapists made life stressful and confusing for the staff. The organisational structure of the department also changed, as family and group treatment were introduced to complement individual treatment. The teams faced considerable challenges during the settling-in period, and sick leave and staff turnover levels rose.

A stress-free working day – More services by fewer people was never the purpose of the LEAN project. In fact, the aim was to provide the services budgeted for without stress and overtime. Could we make our procedures less cumbersome? Could the department free up ‘idle time’, establish a clearer overall perspective and fo-

cus more closely on the patients?, Director General Bengt H. Sjölund explains. One of the first decisions was to reduce the number of meet-ings and afford therapists more time to work with their patients. The number of meetings was halved almost overnight. Next, the post of team secretary was abolished. Secretaries were no longer linked to particular teams, so they could spend less time in meetings and more on their administrative duties. Previously, each team operated with different procedures and ways of keep-ing patient journals. A joint secretariat was set up, with uniform standards for all three teams, and this has improved co-operation on holidays and sick leave between the teams. The booking func-tion has also been devolved to the secretaries, again allowing more time for therapists to concentrate on patients. – An electronic journal and booking system will be the next initiative, Sjölund continues. – It allows us, for example, to send patients text-message reminders. The hope is that this will further reduce the number of missed appointments and shorten waiting times for future patients. Implementation of the LEAN programme has not been without its difficulties. As the Rehabilitation Department has yet to evaluate the project, it would also be premature to com-ment on the degree to which it has live up to expectations.

RCT wants more time for patients

Heidi K. Tokle, web editor/science writer

What does the Japanese lEAN way of thinking have to do with rehabilitation?, RCT staff asked themselves in spring 2008, when the Rehabilitation Department initiated major changes.



A major international conference hosted by RCT in December utilised evidence-based experience and research findings to help identify the best and most effective methods of rehabilitation.

Best-practice conference


One of the milestones for RCT in 2008 was the hosting of its biggest international conference to date – Rehabilitating Torture Survivors – from 3-5 December. Over 180 top researchers and practitioners from around the world converged on Copenhagen to discuss the latest research and to swap information about the rehabilitation of torture victims. The conference was organised in collaboration with the Centre for Trans-Cultural Psychiatry at Co-penhagen University Hospital, and with funding from the Danish Research Council for Health and Disease. The aim was to collate and disseminate evidence-based knowledge about the rehabilitation of victims of torture and organised violence. RCT’s international work has identified a significant lack of definitive knowledge in this area, something which only serves to underline the importance of focusing even more clearly on evidence – i.e. on what we know works, rather than what we think works. The international conference and the unique RCT Field Manual have helped to map out the current situation. The conference revolved around key note lectures and work-shops that focused on various aspects of work with torture vic-tims and research into rehabilitation methods. The panel chairs and speakers were all leading experts in their fields, and all the input and discussions shared the same aim – i.e. identifying the best and most effective methods of rehabilitation.

Field manual and the interdisciplinary approachNaturally, one of the core themes of the conference was the interdisciplinary approach practised by RCT in the rehabilitation centre in Borgergade, as well as in its collaboration with overseas partners. This approach focuses on the physical, psychological and social problems faced by torture victims.

The interdisciplinary perspective was a common denominator of the many different themes discussed at the conference, e.g. the context of the torture, victims’ mental problems, neurobiology, chronic pain, and the victims’ social and family situation. All of these themes, as well as the interdisciplinary perspec-tive, are addressed in depth in The RCT Field Manual on Reha-bilitation, which was discussed in a workshop involving all seven authors of the manual. The discussion was fruitful and forward-looking, with plenty of praise for the pioneering publication, and good, constructive suggestions for how it could be made even better and more useful to rehabilitation professionals working in some of the poorest parts of the world. The manual, which is cur-rently in English, will be updated and translated into other major languages in 2009.

Important dialogue initiated In addition to insightful and constructive debates about rehabili-tation methods, the conference also enabled participants to forge key international and interdisciplinary contacts that will provide a solid foundation for collective efforts to fight torture and or-ganised violence in the future.

RCT would like to thank all the conference participants and speak-ers for their attendance and the strength of their commitment.

The conference-planning committee consisted of Bengt H. Sjölund, Director General of RCT, Marianne Kastrup, consultant at the Centre for Trans-Cultural Psychiatry, Edith Montgomery, head of research at RCT, and Ann Persson, senior scientist at RCT.

11WWW.RCT.DK

Theme: Assessment of Torture SurvivorsPresentation and Mental Symptoms – Allen Keller, New YorkChronic Pain – Andrew O. Frank, londonAn ICF Approach – Bengt H. Sjölund, Copenhagen

Workshops:Controversies in Assessment – Marianne Kastrup and uwe Harlacher, CopenhagenOutcome Studies in TOV* Survivors – Jessica Carlsson, Birgit lie, Inger Agger and Peter Polatin, Copenhagen

Theme: Rehabilitation of Torture SurvivorsEvidence for Psychotherapy in PTSD – Stuart Turner, londonEvidence for Pharmacotherapy – Jonathan Ipser, StellenboschPain Rehabilitation: What is the Current Evidence? – Amanda C. de C. Williams, london

Workshops:Team Work in TOV* Survivor Rehabilitation: The RCT Model Example – uwe Harlacher, Bente Midtgaard, lise Worm and Anette Klahr, Copenhagen

Internet-Based, Self-Management Treatment for PTSD – Brett T. litz, Boston, and Christine Knaevelsrud, BerlinChildren and the family of Torture Survivors – Solvig Ekblad, Stockholm, and Edith Montgomery, Copenhagen

Theme: Critical issuesImaging Studies in Torture Survivors – J. D. Bremner, AtlantaEye Movement Desensitization and Reprocessing (EMDR): Mechanism, Procedure and Evidence – udi Oren, JerusalemSocial Integration of Torture Survivors – Cécile Rosseau, Montreal

Workshops:The RCT Field Manual on Rehabilitation: An Update – uwe Harlacher, Gunilla Brodda Jansen, Marianne Kastrup, Ane-Grethe Madsen, Edith Montgomery, Karen Prip and Bengt H. Sjölund, CopenhagenThe Danish National Centre Network Annual Meeting on Effect Studies – ulrik Jørgensen and Marianne Engberg, Copenhagen

* TOV: Torture and Organised Violence.

Many of the conference presentations are available online at www.rct.dk.

programme and speakers

The many delegates filled Forsikringens Hus, the venue hired by RCT for the conference.


conFerence snapshots Plenty of time was found for debate about evidence-based re-habilitation when more than 180 researchers and practitioners from 30 countries gathered for RCT’s biggest-ever international conference. Here are some snap-shots from the event.

Coffee and food are the lifeblood of every conference. Delegates continued their discussions when they nipped out for refreshments.

RCT’s international partners posed a large number of questions during the discussion of RCT’s Field Manual.

13WWW.RCT.DK

Cécile Rosseau from Canada talked about the social integration of torture victims.

uwe Harlacher, a psychologist at RCT, talked about the treatment of chronic pain.

J. Douglas Bremner gave an insightful presentation on neurobiological studies of post-traumatic stress syndrome.

Solvig Ekblad talked about the children of torture victims.

All of the authors were present for the discussion about The RCT Field Manual on Rehabilitation. From the left: uwe Harlacher, Gunilla Brodda Jansen, Marianne Kastrup, Edith Montgomery, Karen Prip, Ane-Grethe Madsen and Bengt H. Sjölund.



Up to the Second World War it was a common belief that trau-matic life events did not by themselves result in lasting mental health consequences in those involved. It was believed that per-sons, who developed chronic conditions, were likely to be of a particular vulnerability. Historically there have been several descriptions of condi-tions among persons who under different circumstances have experienced different kinds of traumatic events. Railway Spine Disorder, Soldier’s Heart, Irritable Heart, Shell Shock, Combat Fatigue and Anxiety Neurosis to name a few. Investigations of holocaust survivors, however, showed a population that had long lasting psychological sequelae follow-ing extremely traumatic events. These populations apparently had no previous high presence of psychopathology. The findings indicated that chronic extreme stress may lead to mental health consequences in previously normal individuals. Later we have seen similar findings in persons exposed to e.g. other extreme stress conditions. So today we have ample evidence that exposure to extreme stress may have mental health consequences with aspects w common irrespective of geography and setting, and there is good reason to believe that we are dealing with similar mechanisms.

Post Traumatic Stress DisorderSince the Vietnam War the long-lasting symptoms after ex-periencing traumatic events have been conceptualised as Post Traumatic Stress Disorder (PTSD), introduced in the DSM-III clas-sification of 1980. Later editions of the DSM classification have made certain modifications of the original diagnostic criteria, but the assump-tion is that different types of traumatic events have similarities in psychopathological profiles. In the WHO ICD classification system a similar entity ap-peared in the 10th edition as well as a diagnostic category “enduring personality change after exposure to catastrophical events”. In this classification we thus have two diagnostic catego-ries covering consequences of traumatic stress.

It has been pointed out by torture survivors that neither of the categories are useful in describing the individual experience and how it is felt to be a torture survivor. In fact it has been stressed that it is inconceivable that mental health professionals may diagnose an individual without a comprehensive understanding and respect for the experiences behind the suffering. From a clinical perspective, however, the diagnostic category PTSD is meaningful. Many findings on the biological aspects of PTSD indicate that the hyper arousal seen as the startle response is one of the findings that very strongly support a universal post traumatic stress syndrome. But not all who are exposed to trauma develop PTSD and we have insufficient knowledge on factors of resilience that may reduce the development of PTSD despite experienced traumatic event.

The inadequacy of PTSDA question is, however, if the diagnosis sufficiently reflects the symptom complex observed among torture survivors. The existence of a specific torture syndrome was proposed in the late 1970’ies, but it was emphasized that more research is needed in order to identify whether there is a valid specific nosological entities reflecting the consequences of torture But till now the attempts to describe an independent torture syndrome has not been found very convincing, and it has not till now been possible to delineate a torture syndrome, but symp-toms among severely traumatised refugees were closely associ-ated with the PTSD diagnosis. Today the focus of interest has shifted and little interest is placed in demonstrating a unique torture syndrome.Investigations in recent years have not been able to support a specific torture syndrome that is different from PTSD and a sur-vey of recent publications seem to suggest that we presently do not see a great research interest in this field.

DESNOS – an alternative diagnosis?It is generally agreed that PTSD is a useful instrument to describe the symptomatology of traumatised individuals. A key question

How to assess torture survivors

Marianne Kastrup, Senior Consultant at the Transcultural Psychiatry Centre, Rigshospitalet

Torture survivors are often diagnosed with Post Traumatic Stress Disorder, but is this an adequate description covering all the symptoms? Or is it time to formulate a specific torture syndrome? Marianne Kastrup elaborates over the issue in this article which is building on her lecture at the international conference in December.

15WWW.RCT.DK

is whether PTSD as a diagnosis covers the comprehensiveness of the aftereffects experienced by torture survivors or whether it is time to develop a better and more incisive conceptualisation and diagnosis of the phenomenon. In short, the PTSD diagnosis has been criticized for being too narrowly focusing on psychological symptoms and thereby not being an adequate or suitable diagnostic category for people suffering also from intense physical symptoms after extreme traumas. That has lead to the conclusion that survivors of torture and organized violence in some ways do not fit into the category of PTSD, since they – in addition to the psychological symptoms – also experience a broad range of physical symptoms such as head-ache, pain in legs, feet, neck, back, shoulders, stomach and chest. To grasp the complexity of these symptoms it has been sug-gested to develop an alternative diagnostic category such as a “torture syndrome” or to use the definition of symptoms known as DESNOS – Disorder after Extreme Stress not otherwise speci-fied. The diagnosis of DESNOS requires alterations in six areas of functioning; 1) regulation of affect and impulse, 2) attention or consciousness, 3) self-perception, 4) relations with others, 5) somatisation, and 6) systems of meaning. It has been proposed that the diagnosis should be included in the next version of the influential and widely used American classification system, DSM.But the tendency to include a biomedical paradigm such as DESNOS has been criticised from several sources claiming that it is a Western trend that does not sufficiently takes the socio-political context into consideration

Dynamic diagnosisDiagnostic concepts are dynamic entities that continuously un-dergo changes based upon experiences encountered. Thus, it is necessary to continue systematic collection of data on detailed descriptions of the symptomatology of torture survivors in dif-ferent cultural settings, the relationship to other traumata and to the pre-morbid personality of those traumatised in order to fur-ther develop the diagnostic universe and its ability to reflect the consequences of traumatisation.

” It has been pointed out by torture

survivores that neither of the categories are

useful in describing the individual experience

and how it is felt to be a torture survivor. In

fact it has been stressed that it is inconceivable

that mental health professionals may diagnose

an individual without a comprehensive

understanding and respect for the experiences

behind the suffering.

Image: Shamal Adel Salim

dsm and icdThe Diagnostic and Statistical Manual of Mental Disorder (DSM) provides diagnostic criteria for mental disorders. It is used in the united States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. Interna-tional Classification of Diseases (ICD) is the international standard diagnostic classification for all general epidemi-ological, many health management purposes and clinical use. It is used to classify diseases and other health prob-lems recorded on many types of health and vital records including death certificates and health records.

marianne kastrupMarianne Kastrup, MD, PhD and psychiatrist, is working as Senior Consultant at the Transcultural Psychiatry Centre at the Copen-hagen university Hospital/Rigs-hospitalet. From 1997 until 2001 she worked as Medical Director at the Rehabilitation and Research Centre for Torture Victims.

RCT ÅRSBERETNING 2008RCT ÅRSBERETNING 2008


January: RCT is granted a consultative sta-tus by the uN Economic and Social Council (ECOSOC), which entails attendance and speaking rights in forums such as the uN Human Rights Council. The granting of consultative status represents an important recognition of RCT’s work to prevent torture and to rehabili-tate victims.

march: In a letter to Prime Minister Anders Fogh Rasmussen, RCT calls for a Danish protest against President Bush’s veto on restricting the CIA’s use of torture, including water-boarding. In the letter, Director General Bengt H. Sjölund empha-sises that Denmark’s role as a pio-neer in torture prevention and the country’s close relationship with the

united States makes it particularly important to take a clear stand on the Bush veto.

april: A new bill proposes that criminal law will include a provision to impose heavier punishments for torture. As it only suggests the imposition of stricter penalties, the bill does not live up to the longstanding call from RCT, the uN Committee against Torture, etc. for an explicit ban on torture.

may:uN special rapporteur on torture, Manfred Nowak, visits Denmark and Greenland. September:RCT researchers conducting a long-term study of 131 young Danes coming from refugee backgrounds

demonstrate that the time they spend as refugees in Denmark has a greater impact upon the youngsters than the traumas suffered in their native countries. Although many refugee children are traumatised by war and organised violence, those are not the experiences that deter-mine their long-term development, it is the conditions they encounter in their new homeland.

RCT warns against the new pact on immigration policy agreed on September 22 by the government and the Danish People’s Party. The new regulations will make life even harder for torture victims and traumatised refugee couples liv-ing on benefits. RCT is particularly concerned about further restrictions on benefits and on granting Danish citizenship.

october:The government’s long-awaited report on the CIA’s secret rendition flights in Danish airspace is pub-lished on Thursday October 23. RCT feels that the report fails to address fundamental issues. The govern-ment neither denies nor confirms CIA incursions into Danish airspace. RCT urges the government to launch an independent inquiry.

RCT and the uN both express con-cern about the consequences of the statement by the Secretary of Justice on October 22 about using diplomatic guarantees to deport al-iens to countries suspected of using torture. She insists that Denmark study the option of deportation with diplomatic assurances. The idea arose from the case against a Tu-nisian who the Danish Security and

In December 2007, one lawyer, Thorkild Høyer, took over from another, Steen Bech, as chair of the Board of RCT. The handover was marked with a reception at RCT on March 3, 2008. In April, Høyer visited RCT’s local partner organi-sation Balay in the Philippines. He is seen here in the middle at the back, flanked on the left by Bengt H. Sjölund (RCT Director General) and Jan Ole Haagensen (Director, International Department), and on the right by Erik Wendt (programme manager for Asia).

There is a particularly great need for rehabilita-tion services for torture victims in countries where professional health resources are scarce or limited. To help cover that need, RCT launched the English-language RCT Field Manual on Rehabilitation in April, the first such reference work of its kind. Intended as a guide for laymen and health workers with a range of skill levels, the manual is problem-oriented and designed to serve as a practical tool – an A-to-Z of the rehabilitation of victims of torture and violence.

RCT held an open-house event to mark Science Day, April 25. RCT’s health and social research-ers talked about the consequences of the falanga method of inflicting torture (beating the soles of the feet), about measuring pain, and about the changing nature of the concept of torture. Visitors were also introduced to the RCT library, the world’s largest and most au-thoritative collection of documentation about torture.

HIGHlIGHTS OF THE YEAR 2008

17WWW.RCT.DK

Intelligence Service suspect of plot-ting to kill the cartoonist Kurt West-ergaard. The Tunisian is granted “exceptional leave to stay” in Den-mark because the Danish Refugee Appeals Board cannot guarantee his safety in his home country.

RCT is informed that DKK 75 million from the Danish government has been earmarked for the expansion of processing capacity in specialist services for traumatised refugees. RCT, OASIS and RCT Jutland will re-ceive funding for three years com-mencing in 2009 to enhance their capacity to an extent correspond-ing to adding a second treatment team. The amount corresponds to DKK 2.6 million p.a. at each centre.

november:The uN Human Rights Committee

issues a warning to Denmark about diplomatic assurances and CIA rendition flights.

december:RCT meets with the government working group set up in response to the ‘Tunisian’ case and the de-bate about “exceptional leave to stay”. The purpose of the meeting includes assessing whether or not Denmark is entitled to make use of diplomatic guarantees. RCT argues against the proposal in a 12-page memo (available at www.rct.dk).

By the end of 2008, the protracted conflict in Sri lanka, where RCT is involved in anti-torture work, has developed into a genocide. Clear evidence of large-scale attacks is uncovered, supported by a recent statement from the Genocide Pre-

vention Project, an international organisation that monitors conflict zones around the world. On De-cember 9, Sri lanka is added to a list of eight countries where geno-cide is imminent. Conditions for human-rights workers have dete-riorated badly – e.g. RCT’s partner organisation is prevented from carrying out much-needed work to prevent police torture and restore the rule of law.

Following its torture-prevention project in Jordan, RCT launches a project in Amman that offers reha-bilitation to victims.

On the night of December 29, the building that houses RCT’s partner organisation Gaza Community Mental Health Program (GCMHP) is badly damaged during an Israeli air

strike on a nearby police station. GCMHP is a politically independent organisation that does not collabo-rate with neither Hamas nor Fatah. Fortunately, at the time there is only one guard in the four-storey high building, which often contains up to 50 people during the day, and he survives.

RCT and five other Danish hu-manitarian organisations call upon foreign minister Per Stig Møller, on behalf of Denmark and via the European union, to demand Israeli withdrawal, a sustainable ceasefire and full, unrestricted access for all humanitarian aid to Gaza, as well as for the suspension of negotia-tions on an upgrade agreement between the Eu and Israel until the Israeli government agrees to those demands.

June 26 – the international uN Day for Victims of Torture – was marked by the screening of the documentary Taxi to the Dark Side in the Gloria cinema in Copenhagen. The film focuses on the uSA’s use of torture and its violations of human rights in Afghanistan, Iraq and Guan-tanamo, and won an Oscar in the category Best Feature Documentary. The film was introduced by programme editor Mette Hoffmann Meyer from the Danish Broadcasting Corporation and the chair of RCT, Thorkild Høyer.

The Kennedy Society awarded its annual Pro-files in Courage prize to RCT for its sustained, objective and courageous fight against tor-ture and for its efforts in the rehabilitation of victims. Explaining the decision, the Society referred to RCT’s protest against Guantanamo and Abu Ghraib as well as to its invitation to the Danish Prime Minister to protest against Presi-dent Bush’s veto on the restriction of the CIA’s use of torture-like interrogation techniques. The award ceremony took place on December 3. In the picture, the Director General of RCT Bengt H. Sjölund (right) accepts the prize from the President of the Kennedy Society, Svend Aage Nielsen.

On December 10, RCT and the publisher Tiderne Skifter marked the 60th anniversary of the uN universal Declaration of Human Rights with the publication in Danish of Den Blå Skygge, by the Argentinean journalist Mariano Saravia. The book tells the true story of the Danish-Argentinean luis urquiza, who fled to Denmark in 1980 after suf-fering torture at the hands of Argentina’s brutal military regime. Following the restoration of de-mocracy in Argentina, he returned home with his family only to discover that several of his torturers now occupied senior government positions. He became a central figure in the fight for justice in Argentina, but also received death threats, which eventually sent him into exile in Denmark for a second time. urquiza’s story is a grim tale of tor-ture, pain and fear, of uncertainty and privation, of flight and exile, persecution, death threats and a fragmented family, of impunity and the search for justice in a democracy with many skeletons in its closet. The picture shows luis urquiza (far left) with RCT founder Inge Genefke and journalist and latin America expert Jens lohmann.


The campaign against torture is as international as the phenome-non itself. RCT’s international work is conducted via local organi-sations that engage with their respective states in an attempt to improve conditions and ensure freedom from torture. However, no country is isolated when it comes to restricting the use of tor-ture, so RCT’s work also transcends borders in an attempt to push states to respect the Convention against Torture. In this context, co-operation with international organisations and networks is vital, particularly when local work shows no effect and the state lacks the will to implement the requisite changes.

Outside pressure is important in the Israel–Palestine conflict In the conflict between Israel and Palestine, RCT and our part-ners try, as far as possible, to exert influence on the main parties, all of whom violate fundamental international conventions by committing murder and torture. Both the Palestinian Author-ity and Hamas torture political opponents and criminals. Israel is behind extra-judicial killings, and the invasion of Gaza at the end of 2008 brought war to densely populated areas, resulting in unacceptably high civilian casualties and an even larger number of civilians traumatised by war. RCT works with the Gaza Com-munity Mental Health Program (GCMHP), which rehabilitates traumatised children and their families. The pressure on the or-ganisation is immense and was exacerbated by the destruction of its headquarters in an Israeli air strike at the end of December. Torture is legally never permitted – it goes for war situa-tions as well as in peace time. Over the years, the situation in the region has only worsened, and it has become apparent that the

parties involved in the Israel-Palestine conflict are incapable of solving the problem themselves. External pressure is required. RCT lobbies the international community urging donors to exert their influence on the Palestinian Authority and Hamas to put an end to the use of torture. It also lobbies Danish and European organisations to encourage the EU to impose the same human-rights requirements upon Israel as they do for other countries seeking trade benefits.

Consequences of conflicts in neighbouring countries In South Africa, where problems with torture and organised violence persist, RCT’s partners have been affected by a massive influx of refugees, particularly from Zimbabwe. This stream of refugees has reduced tolerance towards refugees in general, and led to violence against them in many impoverished neighbour-hoods. RCT’s partner, the Centre for the Study of Violence and Reconciliation, has had to adapt to the new situation and deal with the immediate needs of deeply traumatised refugees. The root of these problems is to be found in the severe political, economic and social problems suffered by Zimbabwe because of Robert Mugabe’s misrule. In Sierra Leone, the fragile peace following the brutal civil war may be undermined by the increased use of the region by South American drug barons as a staging post for shipments to Europe.

The Obama effect Political developments in the rich Western countries also have an impact on anti-torture work. The election of Barack Obama as US

THE INTERNATIONAl WORK

Freedom from torture in the age of globalisation

Jan Ole Haagensen, Director, International Department

Torture knows no boundaries, and neither does the fight against it. RCT’s international work transcends borders and is conducted on multiple levels.

At the end of 2008 Gaza was repeatedly bombed by the Israeli forces. The buildings of RCT-partner GCMHP was hit during the attacks.

19WWW.RCT.DK

President, and his clear distancing of his administration from tor-ture, is a marked change from the policy of his predecessor. Since many dictators and others responsible for torture hid behind American practice during the previous administration, the new signals emanating from the USA may well provide a major boost to anti-torture campaigns all over the world. It would also be a boost for prevention work if those responsible for torture carried out by, or with the consent of, the Americans were brought to justice. A domino effect might spread to other countries.

Important link between grassroots and states Through our partners in other countries, RCT seeks to support and advise both local grassroots and senior decision-makers. This places great demands upon our local partners, who have to be able to exert their influence at local, national and international levels. One day, they may be working in poverty-stricken areas or with prisoners, the next day with NGOs in the city, on the third day they might be conducting a dialogue with the nation’s President, and on the fourth day they may find themselves in Geneva, presenting a report to the UN. The ability to work effectively on all these levels is not something learned overnight. It requires patience and long-term co-operation.

Heavy demands on RCT Supporting our partners in the work against torture places heavy demands on RCT – especially as it is vital that we function as a rel-evant and useful partner, not just as a donor. We must act in a pro-

fessional manner at all levels. To make the greatest impact, we need to be able to discuss issues related to our work with local stakehold-ers, government ministers, prison governors and UN agencies. No single level of this work is more important than the oth-ers. How deeply RCT engages in the various levels, and in what way, is determined by the situation and problems faced. If it is to play a key role in a globalised world, RCT must re-main at the forefront of developments in the torture field. We are well positioned to achieve this thanks to our talented researchers and the wealth of experience of our employees.

The link to Denmark Denmark is a part of a globalised world. We draw upon our in-ternational experience in Denmark, and apply our Danish experi-ences abroad. For example, the advice RCT offers to partners and governments on the new national visiting mechanisms estab-lished under the Additional Protocol to the UN Torture Conven-tion is linked to the Centre’s involvement in the Danish visiting mechanism with the parliamentary ombudsman. For instance, we consult with the police, the prison service and the State Prosecu-tor in Denmark in conjunction with our work with corresponding bodies in Jordan. Conversely, our acclaimed work on the prevention of ju-venile delinquency and gang crime in Karlebo was inspired by RCT’s partner in Honduras. In other words, RCT’s international work influenced crime-prevention efforts in Denmark. The campaign against torture and organised violence is very much international.

under the cover of the war against the Tamil Tigers, the Sri lankan rulers are suppressing human-rights workers, including critical journal-ists. In close co-operation with the Asian Human Rights Commission (AHRC) and local human-rights organisations, RCT has spent years docu-menting the many cases of police violence, tor-ture and other gross violations of human rights in the country. The research paints a picture of an everyday life peppered with serious violations of human rights – kidnappings, torture, murder, forced recruitment into violence, and a desperate war with high civilian casualty rates. The Sri lankan leaders reject international criticism and insist that the Government re-spects democracy, freedom of speech and human rights. However, the fact is that 2008 saw a marked deterioration in the conditions faced by RCT’s partner organisations. The fight against torture goes on, but it has become even more dangerous. Staff now receive death threats from anonymous callers. One specific example is the defence lawyer Amitha Ariya-ratne, one of the brave few who still dare to bring torture cases to the Sri lankan courts.

Now, he fears for his life and for his wife and two small children. Ariyaratne has been repeat-edly threatened, even attacked in the police station in Negombo, and his house and law office have been subjected to arson attacks. It is symptomatic of the situation in Sri lanka that the police have failed to conduct any detailed investigation into the case, let alone provided protection for the Ariyaratne family. RCT and AHRC treat these threats with the utmost seriousness. Efforts to increase interna-tional pressure on the Sri lankan government are an important part of our work. At the same time, we are doing everything possible to sup-port and protect our partners. RCT has protest-ed to the Sri lankan government and the chief of police. We are demanding an investigation into the death threats against our partners, and that the necessary steps be taken to protect employees and their families. We have asked the Danish government and the Eu to take the matter up with the Sri lankan government. Finally, RCT has, in one specific case, supported a summons issued against the Sri lankan gov-ernment at the uN Human Rights Commission.

Amitha Ariyaratne is one of the few brave Sri lankan lawyers who still dare to speak out against the re-gime. However, he fears for his life and his family’s safety, especially after the arson attack on his office. Photo: AHRC

torture and murder under the cover oF the sri lankan civil War Erik Wendt, RCT programme manager for Asia


Research at RCT was further enhanced in 2008, partly as a re-sult of significant external funding from both private and public sources. Andrew M. Jefferson was appointed senior researcher, and a research nurse, a project manager and three new PhD stu-dents were added to the staff. One senior researcher left to take up a post as an associate professor at the University of Copen-hagen, but will continue to work with the RCT on the research programme Young People and Violent Organisations. A post for a new senior researcher into rehabilitation was advertised and filled in 2008. The successful applicant took up the post in 2009.

PreventionPrevention research describes and analyses the complex rela-tionships that form the basis for torture and organised violence (TOV). It focuses on the perpetrators, institutions and networks that inflict TOV, as well as the victims and the organisations that attempt to deal with the consequences. The research programme The Violent Organization of Politi-cal Youth was launched in 2008 with funds from the Research Council for Culture and Communication. The programme seeks to develop knowledge about how violence is generated within social networks and to reach a better understanding of how young men become radicalised by and committed to violent organisations. The programme involves three PhD students and two senior re-searchers – Steffen Jensen from RCT and Henrik Vigh from the Department of Anthropology at the University of Copenhagen. The PhD projects’ empirical focus is on networks of illegal im-migrants in Kenya, religious student networks in Bangladesh and political youth movements in Nepal. Andrew M. Jefferson’s project about institutions that per-petrate violence in Sierra Leone focuses on themes such as social life, the relationship between ghettos and prisons, and the con-ceptualisation of suffering among tortured refugees. The work enhances RCT’s expertise and knowledge of people in detention, and presents options for the reform of state security apparatuses. Close collaboration with a number of Danish and interna-tional research institutions enhances RCT’s own research. Two of RCT’s partners in the South, working in collaboration with the

International Department, have developed interventions based on the research into prevention.

Steffen Jensen’s analyses of governmental and non-governmental networks that perpetrate violence completes the research project Vigilante and popular forms of justice in South Africa. He identified the need to rethink the correlation between human-rights inter-ventions and the reform of practices in violent nations in a way that focuses upon those who actually enforce the violence.

Rehabilitation The RCT Field Manual on Rehabilitation, a guide to rehabilitation work in areas with few resources, was published in book format in 2008. It is also available for download free of charge from the RCT website. A total of 1,400 copies have been distributed around the world. Based on the feedback RCT has received, it will be revised in 2009. Research into long-term pain and chronic stress continued in 2008, led by RCT’s Director General, Professor Bengt H. Sjölund and senior researcher Ann Persson. In collaboration with other research institutions, RCT published a series of articles review-ing the literature that forms the basis for planning future clinical impact studies, stemming from the doctoral project describing the physical and behavioural consequences of falanga was also published in 2008. During 2008 seven presentations of new research data from the rehabilitation research at RCT have been presented at the 16th Euro-pean Congress of Rehabilitation Medicine in Brugge and at the 12th World Congress on Pain in Glasgow. The research concerns tech-niques for measuring pain and the capacity of different indicators in regard to monitoring rehabilitation processes in big populations. The first work in the PhD project aiming at describing the physical and behavioural consequences of falanga torture has been published in 2008. The study shows that the chronic pains felt by falanga victims for years are nerve damages from the original beating. This means that special attention must be given to neurological examination of the victim’s feet with regard to prescribing the right medicine.

STATuS FRA FORSKNING

Substantial enhancement of research at RCT

Edith Montgomery, Research Director

Research at RCT received a significant boost – both in financial and in human terms – in 2008.

21WWW.RCT.DK

Populations and communities Almost all of the necessary external funding was procured for the method-development project Crime prevention among trau-matised refugee families in 2008, and it has now been launched (see box). A project manager has been appointed and collabora-tion with six local authorities is being built up. The research programme Histories of Victimhood is approach-ing its culmination. Led by senior researchers Henrik Rønsbo and Steffen Jensen, it examines how victim categories are created within the international health and development system. A series of network meetings was held with various NGOs in Denmark in 2008, and two praxis papers written. Three of the programme’s four PhD projects, including two involving local researchers in Guatemala and South Africa, are scheduled for completion in 2009. Data collation for an epidemiological study of torture and political violence in areas racked with conflict was conducted in Bangladesh and Kosovo in 2008. The aim is to study the scale of torture, and to develop simple methods of mobilising the local community to get involved in rehabilitation and prevention. As well as conducting research, the project helps develop the or-ganisations and students taking part. Senior researcher Sven Arvid Birkeland continues his re-search into the long term consequences of extreme stress and is currently working with the stories of Danish soldiers returning from war zones on Balkan and in Iraq and Afghanistan. He is also researching the mental health on Danish war sailors who sailed under Allied flag during World War II.

DocumentationThe documentation centre continually improves access to its col-lections via the web, and its database features an ever-increasing number of documents. The number of registered users outside of Denmark is also growing. New services for registered users include e-mail notifications whenever new materials are available on subjects specified by the user. A new and improved version of the website was launched at the end of the year. It includes a media section that will enable users to search the documentation centre’s collection of image, video and audio files.

neW rct project to prevent crime Nanna Kold, project manager

RCT has launched a project designed to introduce network meetings into the procedures operated by Danish local au-thorities in order to minimise the risk of vulnerable children and young people getting involved in crime. Network meetings are a tool for preventing crime by vulner-able children in traumatised refugee families. The idea is to involve all relevant parties in multidisciplinary forms of pre-ventative collaboration. RCT is working with six local municipalities on the project: Brøndby, Fredensborg, Fredericia, Hillerød, Skive and Århus. The intention is that networking meetings will become an integral part of the local authorities’ work on social inclusion and crime prevention. The aim is to improve dialogue between traumatised refu-gee parents and public-sector networks, as well as between participating institutions and professionals. This will help the various parties understand each other better, and facilitate a broad-based preventative approach to vulnerable children and young people. The methodology is based on RCT’s family team, which uses network meetings as an integral part of the rehabilita-tion process. The team’s work inspired a pilot project in Karle-bo in 2005–06: Towards a Concerted Action – Networking for the prevention of juvenile delinquency in traumatised refugee families. The project led to quantifiable improvements in the behaviour of several youngsters. The project includes a course in running meetings for selected employees of the participating local authorities. A parallel PhD project provides insight into the families’ feel-ings about the meetings. The research project is designed to develop and ensure a scientific basis for crime prevention among youngsters from ethnic minority backgrounds. RCT expects network meetings to become an essential part of national prevention work on juvenile delinquency and violence in areas with a high concentration of refugees. The project will run for four years and is being funded by Egmont Fonden, Tryg Fonden, the Ministry of Integration and a number of other donors.

” Close collaboration with a

number of Danish and international

research institutions enhances RCT’s

own research.


RESEARCH PROJECTS 2008

rehabilitation

Mechanisms and Symptom Therapy after Torture and Organised Violence

p Mechanisms for Muscular Painp Torture, Disability, Pain Mechanisms and

Behavioural Consequences (PhD-project)p Biological Alterations of the Brain after

Traumatic Experiencesp Analyses of Psychiatric Symptom Clusters

after Torture and Organised Violencep Stimulation Treatment for Chronic Painp Physiotherapy for Chronic Pain

Effects of Rehabilitation Programs on Activity and Participation after Torture and Organised Violence

p Instruments and Principles of Evaluating Rehabilitation in an ICF Perspective (PhD-project)

p Monitoring Instruments for Pain Rehabilitationp Field Manual on Rehabilitation (ongoing

revision)

populations & communities

Refugee Families

p Mental State and Integration of Adolescent Refugees from the Middle East

p Health and Wellbeing of Refugee Children in the Nordic Countries

p Crime Prevention among Traumatized Refugee Families: Implementation of network meetings in Danish Municipalities

p Prisons and Refugee Families: Youth Crime and Traumatized Refugee Families and their Meeting with the System of Justice and Social Authorities

Community Violence

p Influence of Violence on Social and Gender Identity in latin America

p An Epidemiological Study of Public Violence and Access to Justice in Guatemala

p Epidemiological Study of Torture and Political Violence in Conflict Settings

Histories of Victimhood

p The Political Economy of Victimhoodp Social Suffering, livelihood and Networks

among Internally Displaced People in Columbia (PhD-project)

p Post-conflict Reparation Politics and their Impact in the Ixil Area (PhD-project)

p Residual Suffering, Gender and Violence in Palestine (PhD-project)

p living in limbo? An Ethnographic Study of Institutions, Interventions and Poor Black Zimbabwean Migrants in South Africa (PhD-project)

Long-term Consequences from Extreme Emotional Strain

p In the Wake of World War IIp Danish War Sailors - The War Sailor Syndrome p The Face of the War - Stories of Danish

Soldiers after Returning from the Balkans, Iraq and Afghanistan

p Fates from WW2 - from the allied side and the German side

prevention

Institutions that Practise Torture and Human Rights Abuse

p Preventing Torture and Organised Violence: A Study of Detention and Violence in Sierra leone

p Reforming State Violence in Transitional Societies

p State and Non-State Police Practice in South Africa

p Democratization and State Violence: A Comparative Study of post-Soviet States (PhD-project)

p Security Patrols in Bolivia (PhD-project)

Networks that Practise Torture and Organised Violence

p The Violent Organisation of Political Youthp Mungiki: Between Violent Youth

Politics and Traditionalist Sect - An Anthropological Study of urban Politics and Violence in Nairobi, Kenya (PhD-project)

p Mobilisation and Social Navigation in Student Politics at Dhaka university, Bangladesh (PhD-project)

p Political Activism in the Context of Nepal’s Democratic Transition: Mobilisation, Hope and Survival Among Youth in Kathmandu (PhD-project)

The Scientific Advisory Board was set up by the RCT board to advise on research into strategic issues. It has undergone major changes in the last couple of years, with several members reaching the end of their terms (max. six years).

The new chair is Professor laurids lauridsen, of the Institute for International Development Studies (RuC), who also sits on RCT’s board. The Advisory Board’s other new members are Solvig Ekblad, psychologist, PhD, associate pro-fessor at the Stress Research Institute, Stock-holm university; Professor at Malmö Högskola, Dr. Asbjørn Hróbjartsson of the Nordic Cochrane

Centre at Copenhagen university Hospital; and Professor Ole Wæver of the Department of Political Science and Public Management at the university of Copenhagen.

Two members – Professor Rolf Ekman of the Neuro-chemical laboratory, Mölndal, Gothen-burg university, and Professor Susan Reynolds Whyte, anthropologist at the university of Copenhagen – will continue their work on the Advisory Board.

In 2008, the Scientific Panel was set up. Its role is to maintain contact with the outgoing

members of the Advisory Board and continue to derive benefit from their expertise. The panel consists of former members of the Sci-entific Advisory Board who help RCT in specific cases and participate in the annual mini-con-ference alongside the Scientific Advisory Board and RCT researchers.

In the Scientific Advisory Board’s internal evalu-ation, chair laurids lauridsen writes: “Overall, research in 2008 has to be considered entirely satisfactory”. The Advisory Board also found that RCT’s research in the various fields remains internationally competitive.

changes to the scientiFic advisory board

23WWW.RCT.DK

RCT PuBlICATIONS 2008

international peer-revieWed articles

agger i, Ansari F, Suresh S, Pulikuthiyil G: Justice as a healing factor : psycho-legal counseling for torture survivors in an Indian context. Peace and Conflict, 2008, 14(3): 315-333

Jansen GB, Edlund C, Grane P, Hildingsson C, Karlberg M, link H, Måwe u, Portala K, Rydevik B, Sterner Y: Whiplash injuries : diagnosis and early management. European Spine Journal, 2008, 17 (Suppl. 3): S355-S358

montgomery e: long term effects of organized violence on young Middle Eastern refugees’ men-tal health. Social Science & Medicine, 2008, 67 (10): 1596-1603

montgomery e: Self- and parent assessment of mental health : disagreement on externalizing and internalizing behaviour in young refugees from the Middle East. Clinical Child Psychology and Psychiatry, 2008, 13 (1): 49-63

Persson al, Sjölund bh, larsson BK: Three clus-ters of differerent properties characterize women with chronic trapezius myalgia. Journal of Muscu-loskeletal Pain, 2008, 16 (4): 289-299

Persson al, Veenhuizen H, Zachrison l, Gard G: Relaxation as treatment for chronic musculoskel-etal pain : a systematic review of randomised controlled studies. Physical Therapy Reviews, 2008, 13 (5): 355-365

Portala K, Waldenström E, von Knorring l, West-mark K: Psychopathology and personality traits in patients with treated Wilson disease grouped according to gene mutations. upsala Journal of Medical Sciences, 2008, 113 (1): 79-94.

Prip K, Persson al: Clinical findings in men with chronic pain after falanga torture. Clinical Journal of Pain, 2008, 24 (2): 135-41

Ronsbo h: Hybridity and change : Gamonales, Montoneros and young Politicos in South-Central Peru. Bulletin of latin American Research, 2008, 27 (1): 83-101

Silvemark AJ, Kallmen H, Portala K, Molander C: life satisfaction in patients with long-term malignant pain : relation to demographic factors and pain intensity. Disability and Rehabilitation, 2008, 30 (25): 1929-1937

Silvemark AJ, Källmén H, Portala K, Molander C: life satisfaction in patients with long-term ma-lignant pain : relating liSat-11 to the Multidimen-sional Pain Inventory (MPI). Health and Quality of life Outcomes, 2008, 6 (70): 1-10.

Vigh h: Crisis and chronicity : anthropological perspectives on continuous conflict and decline. Ethnos, 2008, 73 (1): 5-24

international books and book chaptersbuch l, Jakobsen Sf, Jensen S, Paniagua W, Ronsbo h, Sideris T: learning from the ECAP-MWCC-RCT network : methodology paper on

collaborative research. (Praxis Paper, no. 6). København: RCT, 2008

Fernando B, Perera C, andersen mK: Task Force against Torture : knowledge-generating activism. (Praxis Paper, no. 5). København: RCT, 2008

Jakobsen Sf, Jensen S, Rønsbo h: Diary studies : methods for understanding poor people’s cop-ing with crisis after conflict. (Praxis Paper, no. 7). København: RCT, 2008

Jefferson am: Imaginary reform : changing the post-colonial prison. In: Carlen P (ed.): Imaginary penalities. uffculme [uK]: Willan, 2008: 157-171

Jensen S: Gangs, politics & dignity in Cape Town. Oxford: James Currey, 2008

Jensen S: Policing Nkomazi : crime, masculin-ity and generational conflicts. In: Pratten D, Sen A (eds.): Global Vigilantes. New York: Columbia university Press, 2008: 47-68

Jensen S, Rodgers D: Revolutionaries, barbarians or war machines? : gangs in Nicaragua and South Af-rica. In: Panitch l, leys C (eds.): Violence Today : Ac-tually Existing Barbarism? (Socialist Register 2009). New York: Monthly Review Press, 2008: 220-238

conFerence papersagger i, Polatin P, Raghuvanshi l: Testimonial therapy: a brief intervention to improve wellbeing in victims of TOV (abstract). Rehabilitating Torture Survivors : an Evidence-Based International Confer-ence, December 3-5, 2008, Copenhagen, Denmark

Garametsos S, Pedersen J, Persson al: Computer aided surface estimation of pain drawings - Intra and interrater reliability. 16th European Congress of Rehabilitation medicine, June 3-6, 2008, Brugge

harlacher u: Controversies in assessment : chron-ic pain (abstract). Rehabilitating Torture Survivors : an Evidence-Based International Conference, December 3-5, 2008, Copenhagen, Denmark

harlacher u, midtgaard b, Worm l, Klahr a: Team work in TOV survivor rehabilitation : the RCT model example (abstract). Rehabilitating Torture Survi-vors : an Evidence-Based International Conference, December 3-5, 2008, Copenhagen, Denmark

Merrick D, Persson al, Sjölund bh, Westermark S: Visual analogue scale vs. electrical magnitude matching in chronic pain. 12th World Congress on Pain, August 17-22, 2008, Glasgow Merrick D, Novo M, Sjölund bh, Stålnacke B: Moni-toring pain rehabilitation through Swedish national quality register for pain rehabilitation. 12th World Congress on Pain, August 17-22, 2008, Glasgow

montgomery e: Trauma and resilience in young refugees : the long-term consequences of expo-sure to torture and organized violence (abstract). Rehabilitating Torture Survivors : an Evidence-Based International Conference, December 3-5, 2008, Copenhagen, Denmark

Novo M, Nyberg V, Sjölund bh: MPI profiles am-ing 15.000 persons disabled with chronic pain.

12th World Congress on Pain, August 17-22, 2008, Glasgow

Persson al, Prip K, Sjölund bh: Sensory distur-bances and activity limitations in torture victims exposed to beating under the feet. 12th World Congress on Pain, August 17-22, 2008, Glasgow

Sjölund bh: Assessment of torture survivors : an ICF approach (abstract). Rehabilitating Torture Sur-vivors : an Evidence-Based International Confer-ence, December 3-5, 2008, Copenhagen, Denmark

Sjölund bh: From physical medicine to interdis-ciplinary rehabilitation - an ICF perspective in pain management. 16th European Congress of Physical and Rehabilitation Medicine, June 3-6, 2008, Brugge, Belgium. Journal of Rehabilitation Medicine, 2008, Suppl. 47: 33 Sjölund bh: Fundamental concepts about quality of care in PRM. 16th European Congress of Physi-cal and Rehabilitation Medicine, June 3-6, 2008, Brugge, Belgium. Journal of Rehabilitation Medi-cine, 2008, Suppl. 47: 45

Wang S-J: Collective exposure to organized and political violence (OPV) in the complex setting : epidemiology in the example of Bangladesh (abstract). Rehabilitating Torture Survivors : an Evidence-Based International Conference, Decem-ber 3-5, 2008, Copenhagen, Denmark

additional books and book chaptersPaludan ab: Hvad skal man gøre – straffe eller forsone? : synspunkt. In: Rønnow l (red.): Krigens regler – under pres : en undervisningsbog til his-torie og samfundsfag på de gymnasiale uddan-nelser. København: Dansk Røde Kors, 2008: 81

Raghuvanshi l, agger i: [Manual for community workers and human right defenders] [language: Hindi]. [uttar Pradesh]: People’s Vigilance Com-mittee on Human Rights (PVCHR); Copenhagen: RCT, 2008

articles in proFessional journals and specialist magazinesJefferson am: When you can’t tell warders from prisoners. The Wiser Review [supplement to The Mail & Guardian, South Africa], 2008, no. 3, June: 3

Jensen S: At leve med racefordomme og finde liv i Sydafrikanske ghettoer : dansk udviklingsforsker blandt farvede unge mænd og deres mødre i Cape Town. Social Kritik, 2008, 20 (116): 46-47

Jensen S: Farvede unge mænds strategier i Cape Town. Social Kritik, 2008, 20 (116): 48-55

Ronsbo h: Book review: The criminals of lima and their worlds : the prison experience, 1850-1935 / Carlos Aguirre. Bulletin of latin American Re-search, 2008, 27(2): 279-80

Feature articles etc. Jørgensen PS, montgomery e: Børnene i asylcen-trene skal hjælpes. Information, 2008, May 17-18 (section 2): 16



DONATIONS AND PlEDGES OF SuPPORT 2008

RCT has gratefully received the following dona-tions and funding from Danish foundations and endowments (where no purpose is specified, the amount has been donated to general work):

anonymous family fund DKK 200,000

grosserer andreas Collstrops og søn Rudolf Collstops mindelegat DKK 50,000 for the project Crime prevention among traumatised refugee families – Implemen-tation of network meetings in Danish local councils

aase og ejnar danielsens fondDKK 100,000 and DKK 50,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

danske banks fondDKK 25,000

W. demant og hustru ida e. fond, oTiCon a/S DKK 40,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

egmont fonden DKK 5,000,000 over three years for the project Crime prevention among traumatised refugee families – Implementation of network meetings in Danish local councils

flS industries gavefondDKK 15,000 and DKK 15,000 for the translation and publication of the book Den Blå Skygge

forsvarskommandoenDKK 40,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

minister erna hamiltons legat DKK 10,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

hotelejer andreas harboes fondDKK 10,000 for the translation and publication of the book Den Blå Skygge

franz hoffmanns mindelegatDKK 20.000

hærens Konstabel- og Korporalforening, Silkeborg DKK 20,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

generalkonsul høyvalds fond DKK 20,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

Jl-fondetDKK 40,000 for the project Crime prevention among traumatised refugee families – Imple-mentation of network meetings in Danish local councils

Kammeraternes hjælpefond DKK 5,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

Kong Christian den Tiendes fondDKK 20,000 for the project Crime prevention among traumatised refugee families – Imple-mentation of network meetings in Danish local councils

ministry of Refugee, immigration and integra-tion affairsDKK 1,000,000 (for three years) for the project Crime prevention among traumatised refugee families – Implementation of network meetings in Danish local councils

nordea-danmark fondenDKK 150,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

novo nordisk fondenDKK 750,000 for research purposes (donated in 2008 for use in 2009)

det obelske familiefondDKK 25,000 and DKK 25,000 for the research project The Face of War – Psychiatric conse-quences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

Skandinavisk Tobakskompagnis gavefond DKK 30,000

ekspeditionssekretær, cand.jur.Torkil Steenbecks legat DKK 50,000 for the PhD research project Falanga torture – disability, pain mechanisms and be-havioural consequences and DKK 50,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their fami-lies after returning from war zones in the Balkans, Iraq and Afghanistan

Chr. Sørensens mindefond (via Centralforeningen for Stampersonel)DKK 80,000 for the research project The Face of War – Psychiatric consequences for Danish soldiers and their families after returning from war zones in the Balkans, Iraq and Afghanistan

TrygfondenDKK 2,000,000 for the project Crime prevention among traumatised refugee families – Imple-mentation of network meetings in Danish local councils

Contributions from individuals DKK 157,777

Although much of RCT’s national and interna-tional activity in 2008 was funded by the Ministry of Health and the Ministry of Foreign Affairs, one of the criteria for the receipt of public fund-ing is that other RCT activities must be privately funded. The donations listed above have, there-fore, been invaluable to the work of the RCT. The Centre would like to express its gratitude for both the financial support and all the other support it has received in 2008.

It is of great importance to our clients, the torture victims, that the RCT enjoys the financial support of the Danish people.

RCT funded publication of the book Den Blå Skygge along with Hotelejer Andreas Harboes Fond and FlS Industries Gavefond.

annual accounts, RCT January 1 – december 31, 2008

income amounts in 1,000 dKK

The Danish Ministry of Foreign Affairs, Framework Agreement 45.000

Additional expenditures, Framework Agreement -1,797

Rehabilitation 15,250

Danida-financed projects in the South 3,227

Contributions, others 3,198

Pools revenue 286

Eu-OPCAT project 1,669

Other income 1,084

Total income 67,917

expenditures amounts in 1,000 dKK

RCT’s policy and organisational development 719

Rehabilitation 15,671

Prevention and advocacy 2,511

Information and communication 2,036

Research and documentation 16,471

TOV and development projects in the South 29,212

Planning and support 2,027

Audit 145

Total expenditures 68,792

Total income 67,917

Total expenditures 68,792

Result operations -875

Income financing 1,162

Expenditure financing 1

Result financing 1,161

net result of the year 286

RCT’s project expenditures in the South

amounts in 1,000 dKK

eu

Eu-OPCAT project, Asia 1,669

1,669

danida

legal assistance, Zimbabwean Human Rights, South Africa 711

ARCT, Albania 1,438

Rehabilitation, Jordan 119

KARAMA, Jordan 1,315

3,583

The danish ministry of foreign affairs, framework agreement

ARCT, Albania 141

CSVR, South Africa 1,816

Zimbabwean TOV survivors, South Africa 1,490

CEDSA, Sierra leone 65

CAPS, Sierra leone 1,072

CPTRT, Honduras 2,090

ODHAG, Guatemala 3,094

GCMHP, Gaza, Palestine 2,382

TRC, West Bank, Palestine 314

BRCT, Bangladesh 473

AHRC, Hong Kong/Sri lanka 1,707

BAlAY, Philippines 1,248

Promotion of OPCAT, Asia 281

PVCHR, India 454

16,627

Total expenditures for projects in the South 21,879

Total expenditures distributed among Focal Areas Project expenditures distributed among Geographical Areas

25WWW.RCT.DK

ANNuAl ACCOuNTS

22.8%

3.65%

2.96%

23.94%

42.46%

2.95% 0.21% 1.05%

latin America: 5,184

Middle East: 4,130Asia: 5,832

Eastern Europe:

1,579

Africa: 5,154

Rehabilitation and Research Centre for Torture Victims, RCT

Borgergade 13P.O. Box 2107DK-1014 Copenhagen KPhone: +45 33 76 06 00Fax: +45 33 76 05 10e-mail: [email protected]

RCT Annual Report 2008

Documents

Transcript of RCT Annual Report 2008