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Context – The collapse of the Eastern Bloc / the collapse of Yugoslavia :

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

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Context – The collapse of the Eastern Bloc / the collapse of Yugoslavia :

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  1. Scientific symposium: Delivering on the Promise of the Right to RehabilitationMexico 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 ZeljakBožović Rehabilitation Center for Stress and Trauma, Zagreb

  2. Context – ThecollapseoftheEasternBloc/ thecollapseofYugoslavia: War/s 1991-95-99 informerYugoslavia Unexpected? Ethniccleansing Massivetraumatization War crimes/lack of justice Displacement Migrations INTERNATIONAL COMMUNITY?

  3. Endof1992. croatian population: 4,5 mil 663 493 IDP andrefugeesfrom BiH (Esterajher, J., 2015.)

  4. RCT Zagreb 1993-2016 StartedwithrefugeesfromBosniaandHerzegovinain1993. • (IRCT – EC)  • Identification • Rehabilitation: Medical, Psychological, Social, Legal • Research • Education • Torture prevention

  5. Lessons learned: Impact of expectations on psychological well-being

  6. 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).

  7. 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 • Thepsychosocial(changing) contextinwhichtherapyisbeingconductedisofimmensevalue • 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)

  8. Lessonslearned: ImportanceofSocialAcknowledgmentinTreatmentofClientswithWar Trauma Experience • Socialacknowledgmentisdefined as a victim'sexperienceofpositivereactionsfromsocietythat show appreciation for thevictim'suniquestateandacknowledgethevictim'scurrentdifficultsituation. • Differencesinsocialacknowledgmentmayhaveanimpact on how trauma survivorsemotionallyandcognitivelyprocesstheirtraumaticexperiences: warveteransandrefugees • Ljubotina D & all. Treatment Outcomes and Perception of Social Acknowledgment in War Veterans: Follow up Study. Croatian Medical Journal, 2007; 48:157-166.

  9. Project: The Path to Reconciliation-paving the way to becoming contributing members of the community* • Higlytraumatizedsample, N=30 (15 TV war-relatedin Croatia,15 asylees) • 15 clients (war-related torture victimin Croatia involvedinlegalprocessesseekingjusticeorcompensation): • Untreated trauma, lackofjusticeandsocialacknowledgment, socialisolation: Long lasting consequences on general and mental health, family relations, social functioning, aging... (*5 partners - EU fundedprojectto develop a holistic, client-centered, culture and gender sensitive, community based rehabilitation program, 2015-17)

  10. 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 ofnonmaterialdamage- loosing process &having to pay administrative costs) Long time seeking justice (crimes comitted in Croatia, trials in Serbia) (Vukovar/Ovčara case): hope and dissapointment

  11. Kerestinectrial: • „I wasraped, beated, • torturedbyelectricitydevices.. • orderedbythe „doctor” (1991). • „Afterprison I had a nervousbreakdown.. • But I never told my doctor about torture.” • Itwasdifficult to decideaboutwitnessinginthecourt (2012). • Judgeshowedrespect • 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 annulledthe first instance decision and return the case for re-trial on April 16, 2014…

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

  13. 21 years after conflict • Rehabilitation priority so far: National programs to protect war veterans and their families (electoral base) actually failed • Cilvilvictimsofwar? 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.

  14. … • Thereis no interest for warrelatedcivil victimsof torture - lackofunderstandingofthecostsofnon-action - ignorance - unwillingness to assumeresponsibility • Fieldexperience: Health andSocialcare institutions: - do not recognize torture (qualityofservices?) • Judicary system - Often incompetent and inefficient processing of war crime cases; (retraumatizationandTV indifferenceto the work of the judiciary institutions)

  15. The challenges in implementing the right to rehabilitation/ lack of political will to adress problems, to implement laws... Whatcanwe 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.  Importanceofcommunitybasedwork Creating professional network in local communities (sensibilization of general practitioners, local activities) Networkingwith human rightorganisations (Documenta – Center for dealingwiththe past, Center for civil rights..) Advocacy, research...

  16. „I couldnotendureallchallengeswithoutyoursupport!”Importanceoflongtermservices Documentary on You Tube „20 years with the most vulnerable” (available under the Croatian title „20 godina s najranjivijima”)

  17. New development: • Croatia's Parliamentadopted a law on May 2015 granting compensation to rape victims in the 1991-95 waras well asother 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” (NilsMuižnieks, Councilof Europe - Commissioner for Human Rights, 2015.)

  18. Conclusion • In a post warcountry, thoseresponsible for warcreateanatmosphereofnotallowingreconciliationwithinthesociety (as well as intheregion). • Avoidance to confrontthe past andtheerosionofsocialstatedebilitatemeasures for socialrecovery. • Right to rehabilitation – discrepance between rights and implementation. • Victims should not rely on their own resources...

  19. FormerYugoslavianandrecentrefugeecrisis (How to use acquiredknowledge?)

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