Activities within the Project
Training and awareness raising
The local training that took place in El Nadim trained a total of 6 persons and consisted of lectures, group discussions and self-study organized by the centre staff at a rate of one activity per week, during the two years of the project. The training most often took the shape of weekly sessions of two hours at the center. The main topics covered by this training were: types and consequences of torture; guidelines for PTSD and other diagnoses; management of PTSD; torture and the relation to PTSD; interview skills; group supervision and re-traumatised children.
The training of trainers took place in February 2009 and lasted for 5 days. 9 persons were trained, including staff working at the torture rehab program and the women's program. The training was provided by Dr. Alaa Shukrallah from the Center for Development Services in Egypt. The output of the training involved two training schemes on counselling survivors of both torture and gender violence.
A Public symposium was organized in the first week of September 2009 which addressed the increasing prevalence of torture in the country, the challenges that face its victims and the role of the different stakeholders. Participants in the seminar included human rights activists, lawyers, media people and bloggers.
For awareness raising purposes, leaflets/articles in the local media were produced. In the case of survivors who wish to go public with their stories, an element of the rehabilitation process is to publicize their testimony and distribute it widely to the different media channels. Several of those testimonies are published in local newspapers. Several of our clients have also been invited to speak in talk shows on satellite channels. Two cases were included in a documentary by El Jazeera on torture in Egypt.
During the project period, two regional training seminars took place in the MENA region, both of them in Istanbul, Turkey. The first took place in late June 2008 and the second in late January 2009. The reason Istanbul was chose as a venue was to facilitate the access particularly of partners from the Gaza Strip who at the time had no access to Egypt. The first regional training covered the topic of clinical supervision and care for caregivers and was conducted by Dr. Johan Lansen and Dr. Ton Haans from the Netherlands. 20 professionals from 8 different countries in the Middle East and North Africa region participated in the 5-day training, which included case presentations, presentations on aspects of the partner centers’ work, poster displays, group work, supervision and observed practice of new skills learnt. During the second regional training participants were trained on psychotherapy questionnaires and research skills and how to examine and treat child survivors of torture. The training was conducted by Amber Elizabeth Gray on the topic of child survivors of torture and Craig Higson-Smith on the topic of research skills. 21 professionals from 9 different countries in the MENA region participated. For both trainings the participants’ level of energy and involvement throughout the trainings was high and the training topics were found to be useful and relevant. There was positive feedback on the trainers by the participants in their evaluations, as well as on the interactive format of the training and the subject matter.
The training materials used in the different trainings in Egypt as well as during the regional trainings in the MENA region are gathered in the "Training Materials" section.
Treatment of torture survivors
Torture in Egypt is a state policy and not merely the responsibility of individual officers. There are several indicators of this among them the use of identical methods of torture in all places of detention ranging from flogging to burning with cigarettes, to rape threats or actual rape, to blindfolding and stripping throughout the days of torture, in addition to beating, slapping, kicking in all parts of the body, using electricity either in the "Stakosa" position where electric wires are connected to the tips of toes and the head or the Abu Ghreib position where wires are connected to the genitals and the nipples and tying the victim to a long iron bar from both hands and feet in a position called the "Grill". Egyptian legislation carries an additional evidence of the state's systematic use of torture, where the national legislation restricts the definition of torture only to cases who are accused of a crime and only when torture targets confessions. The emergency state continues to be enforced since 1967, with a short emergency-free interval between May 1980 and October 1981. If we add the situation of the prosecution in Egypt, the relation of the public prosecutor to he executive authorities and the problems surrounding the independence of the judiciary we can visualize the siege surrounding the victims of torture and the impunity enjoyed by the torturers.
Under the Global Project a total of 310 torture survivors were treated by El Nadim. Treatment in the centre is provided on an outpatient basis. Our team of psychiatrists (and trainee psychiatrists) provide diagnosis, management and referral of patients to other specialties or psychosocial service providers. Pharmacological and long term psychotherapeutic treatments are provided by default. These include supportive psychotherapy, cognitive behavioral therapy (CBT) and family therapy. Occasionally, a victim or a group of victims in distress are identified via contacts, media or other means and an outreach visit is planned. Assessment and short, individual or group, therapy session is held during the visit.
A key element of the treatment program within the project was the clinical supervision provided by both internal and external supervisors. In El Nadim immediate supervision by senior staff is always available for the junior staff during the working week. In addition, a standard group supervision meeting was held every month by Prof. Dr. Shawky el-Akaboui (external supervisor). The supervision took the form of case presentation and discussion. Women and children cases were of higher priority in those discussions. Furthermore, group supervision based on the method introduced to the centre in the first regional training in the MENA region in June 2008 was held, although less often than the external supervision.
Among the achievements of the project in terms of patient treatment it is worth mentioning that the centre increased the number and heterogeneity of the therapeutic team. In 2008, the centre also registered 189 new cases, which is an increase of about 23.5% to the average of the previous 5 years. 32 outreach visits were carried out compared to an average of 8 per year in the previous 5 years.
A research project aiming at assessing the outcome of the patient treatment was designed and implemented by the five project partners. Data on the service users (torture survivors), intervention use and effectiveness were generated by the use of the following clinical questionnaires:
- A baseline medical and social questionnaire
- The Harvard Trauma Questionnaire (HTQ)
- Beck Test of Depression (BDI)
Data was gathered during the clinicians' first encounter with a patient as well as after three and six months. The quantitative data was entered into a database in the five centers and subsequently analyzed by an international research consultant. The quantitative results, coupled with qualitative data and case studies from the five partner centers, were used to produce five individual and one combined paper. The Egyptian article will be published in English in the Journal of the Institute of Psychiatry at Ain Shams University in Cairo as well as in a separate Arabic language publication for distribution among health professionals in Egypt. Findings from the research will also be presented at different national, regional and international conferences during the fall of 2009.
Despite the many challenges of the research, foremost the continued persecution of clients which makes their compliance difficult regarding follow, as well as the situation where the first assessment frequently takes place, i.e. in local communities, at the client's home etc., the research also contributed to the development of the documentation component of our work, through the inclusion of standardized instruments of assessments in addition to the clinical interview, providing a reference for follow up as well as a quantitative tool for assessment of our work.