Scientific symposium: Delivering on the Promise of the Right to Rehabilitation Mexico City, Mexico, 5 - 7 December 2016 Right to rehabilitation: Lessons Learned and Lessons to be Learned in Post-Conflict Environment in Croatia Zdenka Pantić, Valentina Zeljak Božović Rehabilitation Center for Stress and Trauma, Zagreb

Context – The collapse of the Eastern Bloc/ the collapse of Yugoslavia: War/s 1991-95-99 in former Yugoslavia Unexpected? Ethnic cleansing Massive traumatization War crimes/lack of justice Displacement Migrations INTERNATIONAL COMMUNITY?

End of 1992. croatian population: 4,5 mil 663 493 IDP and refugees from BiH (Esterajher, J., 2015.)

RCT Zagreb 1993-2016 Started with refugees from Bosnia and Herzegovina in 1993. (IRCT – EC)  Identification Rehabilitation: Medical, Psychological, Social, Legal Research Education Torture prevention

Lessons learned: Impact of expectations on psychological well-being

Lessons learned: Long-term effects of trauma Intensity of symptoms (Mean values) measured by Brief Symptom Inventory administered to a group of torture victims (N=53) and to a control sample (N=500) 10 years after trauma Evaluation of therapy and contextual influence: 10 years after inflicted trauma (EU funded project The STOP, Study on Treatment Behaviour and Outcomes of Treatment in People with PTSD following conflicts in Ex –Yugoslavia, polycentric study on 520 persons, 2003-2006). 

Lessons learned: Psychotherapy and context (research and clinical experience) Current stressors in war-traumatized people (marital problems, problems with children, political changes during/after therapy, legal changes concerning their status or rights, exhumation of close relatives...) affect the course of psychotherapy The psychosocial (changing) context in which therapy is being conducted is of immense value Ljubotina & all. Quality of life as a measure of outcome in treatment of clients with PTSD following war related trauma (10th European Conference on Traumatic Stress)

Lessons learned: Importance of Social Acknowledgment in Treatment of Clients with War Trauma Experience Social acknowledgment is defined as a victim's experience of positive reactions from society that show appreciation for the victim's unique state and acknowledge the victim's current difficult situation. Differences in social acknowledgment may have an impact on how trauma survivors emotionally and cognitively process their traumatic experiences: war veterans and refugees Ljubotina D & all. Treatment Outcomes and Perception of Social Acknowledgment in War Veterans: Follow up Study. Croatian Medical Journal, 2007; 48:157-166.

Project: The Path to Reconciliation-paving the way to becoming contributing members of the community* Higly traumatized sample, N=30 (15 TV war-related in Croatia,15 asylees) 15 clients (war-related torture victim in Croatia involved in legal processes seeking justice or compensation): Untreated trauma, lack of justice and social acknowledgment, social isolation: Long lasting consequences on general and mental health, family relations, social functioning, aging... (*5 partners - EU funded project to develop a holistic, client-centered, culture and gender sensitive, community based rehabilitation program, 2015-17)

Seeking justice: (re)traumatization, waiting for solutions, lack of social acknowledgment, unsupportive context „Person that murdered my mother was accussed. My neighbour, his father apologised. I accepted.” “Who murdered my daughter in 1991.?” “Testifying in court (2006) gave me back my dignity. Those who were hiding perpetrators would not say anymore I was crazy.” (result of the request for compensation of nonmaterial damage - loosing process & having to pay administrative costs) Long time seeking justice (crimes comitted in Croatia, trials in Serbia) (Vukovar/Ovčara case): hope and dissapointment

Kerestinec trial: „I was raped, beated, tortured by electricity devices.. ordered by the „doctor” (1991). „After prison I had a nervous breakdown.. But I never told my doctor about torture.” It was difficult to decide about witnessing in the court (2012). Judge showed respect On October 31st 2012, the Zagreb County Court's War Crimes Council pronounced the non-final verdict in which the defendants were found guilty and sentenced. The Supreme Court annulled the first instance decision and return the case for re-trial on April 16, 2014…

Trauma, development phase, aging... Affected as young people – torture interferes with the capacity to form mature relationships in life; identity problems... Affected as mature people – Trauma/torture and aging = similar developmental tasks

21 years after conflict Rehabilitation priority so far: National programs to protect war veterans and their families (electoral base) actually failed Cilvil victims of war? Neglected. The exact number of war torture victims in Croatia cannot be precisely established Torture victims are becoming more and more “publicly invisible“, which harms the possibility of their rehabilitation.

… There is no interest for war related civil victims of torture - lack of understanding of the costs of non-action - ignorance - unwillingness to assume responsibility Field experience: Health and Social care institutions: - do not recognize torture (quality of services?) Judicary system - Often incompetent and inefficient processing of war crime cases; (retraumatization and TV indifference to the work of the judiciary institutions)

The challenges in implementing the right to rehabilitation/ lack of political will to adress problems, to implement laws... What can we do? BOTTOM UP approach Education of medical and other healthcare personnel needs to address issues concerning treatment of torture survivors, who will be seen in all possible settings but not necessarily recognised or treated adequately.  Importance of community based work Creating professional network in local communities (sensibilization of general practitioners, local activities) Networking with human right organisations (Documenta – Center for dealing with the past, Center for civil rights..)   Advocacy, research...

„I could not endure all challenges without your support „I could not endure all challenges without your support!” Importance of long term services Documentary on You Tube „20 years with the most vulnerable” (available under the Croatian title „20 godina s najranjivijima”)

New development: Croatia's Parliament adopted a law on May 2015 granting compensation to rape victims in the 1991-95 war as well as other forms of reparation, including medical rehabilitation and psychosocial services Ministry for War Veterans responsible?! Again, is it an honest attempt?: „Certain shortcomings in the law and its implementation were reported to me during my recent visit to Croatia” (Nils Muižnieks, Council of Europe - Commissioner for Human Rights, 2015.)

Conclusion In a post war country, those responsible for war create an atmosphere of not allowing reconciliation within the society (as well as in the region). Avoidance to confront the past and the erosion of social state debilitate measures for social recovery. Right to rehabilitation – discrepance between rights and implementation. Victims should not rely on their own resources...

Former Yugoslavian and recent refugee crisis (How to use acquired knowledge?) Yugoslavian refugee crisis Recent refugee crisis Traumatization Retraumatization on the way to safe haven „Small” numbers, restricted area Big numbers, diversity of countries of origin and situations, prolongation of suffering Expectations – return Expectations – NO return Main problem: anxiety feelings, uncertainty, isolation Public attitude: solidarity, ambivalence Public attitude: ambivalence, fear, cynicism, ignorance Integration: sucessful (if there is a positive context), but trauma remains ... Lack of justice… Social reconstruction? Integration in new environment: uncertain, prolonged