Overseas work

The Medical Foundation has undertaken a number of overseas projects in recent years, for we recognise that while the bulk of our work is directed at helping survivors of torture in the UK, many more are unable to leave the country where they have been persecuted and may have little or no access to specialist clinical and counselling services.

Kosovo: The first generation of psychology students at Pristina University were trained by MF therapists to help victims of torture and organised violence. The training was aimed at strengthening the provision of mainstream mental health services for those still damaged by war in Kosovo.

Key to the MF's involvement was the pledge by three government ministries (Health, Education, and Social Welfare) to provide work placements during the course and jobs upon graduation in mainstream services.

The MF and other non-governmental organisations, the UN High Commissioner for Refugees and the UN Administration all expressed strong concern about the lack of availability and unsuitability of treatment for returning refugees - and for the resident population - who are in need of mental health services, and about the lack of appropriate provisions for women and children among them.

Israel & the Occupied Territories: An MF co-ordinator worked with clinical teams to develop and improve services to survivors of torture through the use of clinical supervision, workshops, individual consultations and strategy development. Partner organisations included the Gaza Community Mental Health Programme, Treatment and Rehabilitation Centre for Victims of Torture (Ramallah), Prisoners' Club (Bethlehem), Public Committee Against Torture in Israel, Physicians for Human Rights and the Palestinian Rights Group (Nazareth).

Guatemala: More than 200,000 were killed or "disappeared", and torture was rife during a 36-year civil war which left 100,000 war widows and 250,000 orphans. In an MF project spanning several years, clinical psychologist Dr Judith Zur and her anthropologist husband Dr Sergio Navarrete attempted to break the legacy of fear and distrust in communities that had been torn apart. Human rights abuses, said Judith, were used as a strategy for social control during the war.

Their activities centred on a highland region called Rabinal which was one of the areas hardest hit by the violence. Some 40 community mental health workers were trained to help those who suffered torture, or were forced to witness the torture or killing of others.

MF staff also engaged in writing social dramas for community radio about issues such as trauma, impunity, violence, poverty and gender inequality, with the programmes proving extremely popular. The plays have been performed at community meetings, giving those attending a unique opportunity to discuss their experiences of violence and survival.

Mexico: The success of the Guatemala initiative led to Dr Zur and her husband replicating it in Chiapas, Mexico, where the inhabitants shared many similar experiences, having been subjected to long periods of military occupation and violence. A series of workshops to train community mental health workers were held.

Somaliland: For more than three years we supported a project helping local people with mental health problems receive proper care and treatment. In the face of a widespread lack of health resources, jailing had become the most common response to mental illness. Project worker Anwar Awad explained: "More than 65 percent of those now affected by personal crisis are those who lost education and employment opportunities due to the civil war. In order to minimise the explosion of personal crises into insanity, and prevent these vulnerable people being locked up in jails, we are working to provide basic mental health services for all."

Sri Lanka: In November 2004, a month before the tsunami struck, a team of MF therapists visited Sri Lanka at the invitation of torture rehabilitation groups Shanthiham ( the Association for Health and Counselling) in the north, and the Family Rehabilitation Centre, which operates all over the island.

The MF team, its trip sponsored by the British Council, had been invited to impart its knowledge of a relatively new treatment method, systemic family therapy, which focuses on the relationship between individual family members, extended family members and others of significance to the core family.

It encourages family members, and those closely involved with them, either verbally, or in the case of children, through play and art therapy, to express their perceptions and anxieties in front of each other in order to identify underlying patterns, rules, beliefs and issues that may be unhelpful, as well as overt problems. In building up the family unit's understanding of the difficulties facing its individual members, and the family as a whole, it seeks to bring about change.

Expertise such as that offered by the MF is a vital healing component in a country where few have escaped the ravages of war, but where there is no government funding for counselling and therapy, which are left to non governmental organisations to provide. The challenge for the MF team was to reach out across cultures so that Western family therapy principles and practices could be translated into a 'language' that fitted the social, cultural and religious contexts of the communities visited.

The MF team first visited Colombo, the island's capital, which lies in the south where Sri Lanka's Sinhalese population forms the island's majority. From there the Family Rehabilitation Centre operates four regional centres providing medical attention, counselling, physiotherapy and other support services throughout most of the island, including Jaffna and the Vanni - 2,000 square miles of swamp and jungle in the north held by the Liberation Tigers of Tamil Eelam (LTTE).

From Colombo, the MF team then travelled through the Vanni to the Jaffna Peninsular where Shanthiham provides training in psychosocial skills and counselling to help community workers identify and treat those traumatised by torture or war, or both. Volunteer groups in outlying villages help identify cases for referral to trained counsellors.