The idea of having an organization designed to offer appropriate and comprehensive assistance to victims of torture in the Palestinian territories is crucially necessary in the context of the ongoing violations committed by Israel under the Occupation. This is particularly true where torture, organized violence, and other human rights abuses are perpetrated amid a widespread culture of impunity throughout Palestine.

The Treatment and Rehabilitation Center for Victims of Torture (TRC) strives to alleviate the traumatic physical and psychological effects of torture and politically motivated violence while giving victims a place to go and discuss their problems. The Center delivers its unique work by reaching out to the Palestinian community at all levels and applying its treatment and rehabilitation services to the individual, family and community.

Through its Treatment and Rehabilitation Program, the TRC provides comprehensive medical, psychiatric, and psychosocial care to torture survivors and their families. Its treatment activities target ex-detainees and their families, victims of organised violence as well as survivors of house demolitions, sieges, raids, curfews, and bombing.

Suad Mitwalli Badran, Director of the Treatment and Rehabilitation Department, introduced the TRC’s approach to the target group of ex-detainees and outlined the main types of psychological consequences of torture and violence commonly encountered among them. She explained that the TRC’s team initially intervene to assess the psychological effects on their clients once they are discharged from prison, since it is very difficult to reach them during their detention. The only circumstance in which the TRC can gain access to the detainees, in coordination with human rights organizations, Israeli medical associations or other groups, is when they need psychological or medical support. After their release, the prisoners clearly manifest various psychological consequences and this is when the TRC’s specialized staff can look into these negative effects left by torture and other violence.

Badran said the psychological effects typically shown by former prisoners can be categorized into short and long-term effects. In the immediate to short run, lack of appetite, sleeplessness or sleep disrupted by nightmares (bringing back images from time spent in prison), anger, nervousness, anxiety, stress and increased heavy smoking are the most common symptoms manifested. In general, ex-detainees display bad behaviour against their wives, children and other family members as these are the most directly exposed subjects in the daily life.

Feeling worried, depressed and needing time in dealing with their own problems, they also prove to be unable to live their marital life often experiencing sexual difficulties with their wives. The general lack of opportunities in Palestine, coupled with the poor work prospects for former prisoners, means these subjects have missed out work and vocational/training opportunities, during long periods spent in jail, and they now face great problems in reintegrating into work life. Overall, ex-detainees live through a deep sense of isolation and uselessness, find it very hard to be part of society again, to have any social interactions, endure significant problems with their families as well as outside home, and are in need of long-term rehabilitation.

On a physical level, some of the major problems found after serving time in prison are asthma and breathing difficulties, skin disease or fungi due to lack of hygiene, stomach related problems because of poor food hygiene.

One issue of serious concern is the increasing number of cases that develop a form of cancer while in jail, stay imprisoned for many years, and are sometimes released at the final stage of their cancer or just few months before they die.

The Director of the Treatment and Rehabilitation Department also looked at the long term psychological consequences noting that the former prisoner’s personality is affected on many levels. From being a happy, rational, good person before going to jail, he turns into someone else becoming depressed, showing low motivation, and neglecting his appearance.

Post-traumatic stress disorder is the most typical long term effect encountered: flashbacks, memories associated with life in prison including incidents of torture, interrogation, and confinement in small individual cells. For a very long period, the ex-detainee had nobody to talk to; he was left isolated, had a lot of time on his hands to focus on his situation while in jail, and often found himself thinking in an irrational way. Being psychologically disordered means he will be a ‘stigma’ in the society, and he will be looked at as someone who needs mental help, which usually makes it preferable to stay at home and keep alone.

In the most serious cases, ex-detainees even refuse to go out and this is where the TRC’s staff step in to arrange home visits along with doctors and encourage the clients to leave the house. The other common issue after release is the return to the household and the father’s desire to re-gain his role. Because he was away from home and didn’t spend time with his wife and children, the father had no role there while the mother was taking the lead in the family.

Coming back from a long period in prison, he is now considered a ‘stranger’ in his same family, the wife now has to give back her role to him and this is when the struggle starts in restoring their roles in the household. It becomes hard for the wife and children to fill the gap towards their father after his long absence, and this causes many confrontations in the family life. The ex-detainee feels, at the same time, small and helpless in his new position.

Raya Farsakh, Psychologist at the Treatment and Rehabilitation Center, presented the case of a family in order to better understand how the TRC intervenes and treats its clients in a comprehensive way. A lot of the times, based on what the TRC’s staff tend to experience; it is not uncommon to see that behind an individual client there are deep implications for the family members, which makes it necessary to tackle the case with a multi-level approach.
The family examined is made up of eight members consisting of the father, Majed Arar, his wife, three girls and three boys –aged between 2 and 19- from Qurawa Ban Izet, a village near Ramallah.

In 2005, their house was demolished by Israeli bulldozers. The family had invested all their money into this brand new property and suddenly they watched the destruction of their home taking place. At that time, the family was giving refuge to a group of people who were ‘wanted’ by the Israeli forces. The troops ordered the large family out and proceeded to then demolish the house; two of the people hiding away remained inside and died during the demolition.

The family was left outside the house, and managed to find -from one of their relatives- a temporary lodging in a small garage. On the same day, the Israeli military took the father and put him in jail. It needs to be mentioned that the father was not a militant, instead a simple man working in the building industry, only his two friends who had taken refuge in his house were politically involved. On the whole, the family went through a large-scale trauma: they were thrown out of their house and humiliated, their house was bombed, the father was taken away, they witnessed the death of two men under rubble.

Following his arrest, Majed Arar was subjected to different forms of torture: humiliation, verbal abuse, beatings, sleep and food deprivation, enduring painful positions, having hot and cold air thrown at him, being forced to stay naked, suffering inhumane treatment in general. As part of the interrogation methods used, he was put into an individual cell, where he spent 90 days, and was interrogated at two stations. In addition, he was moved into a room with spies -usually recruited among Palestinians and trained by Israeli agents- and stayed there for one month. This recurring method involves using collaborators to act as regular inmates (political prisoners) and inflict psychological torture on the detainee.

As a result of his time spent in detention, Majed developed, on a physical level, skin problems fungi, chronic pain all over his body, and dystrophy in his back, arms and legs. As for the psychological symptoms shown, he had little to no appetite, his sleep was disrupted by nightmares about the torture and interrogation suffered in jail, he faced up to sexual problems with his wife, he was often forgetful and poorly focussed, he felt like a stranger inside and outside his family, he lost interest in social interaction, he couldn’t trust people. Back in 2005, Majed had lived through three incidents in one: the house demolition, the killing of the two men he was helping to hide, and his imprisonment.

Next to the father, the rest of the family faced hard consequences from what had happened in 2005. Farsakh noted, according to her experience at the TRC, a case be sometimes emphasised on one family member more heavily than another, but then it takes little to find out –by working on the file- that everyone is suffering. In this case, one of the children –aged 7- was treated before the other family members.

The child was going through learning issues, scoring low at school, suffering frequent bedwetting, becoming very obsessive about keeping things for himself and never giving them away, beating his brothers, showing very aggressive behaviour in general. While the child was initially approached as the ‘victim’ in the family, through his particular case it was soon found that the whole family was affected, reflecting problems in their way to communicate with and relate to one another, and give each other roles as family members.

The TRC first worked, on an individual level, with the father and the 7 year-old child. At a later stage, the staff decided to work with the family, considering they had gone through a triple loss: the destruction of the house, the detention of the father and consequent loss of family income. So after the individual therapy, the TRC’s staff applied a family based therapy.

Then, the cognitive-behavioural therapy was used: a briefing was carried out over what the family had experienced, work was done on relationships within the family itself with a focus on: positive communication, mutual support, how to interact with each other, behave with the children, teach and learn together, and how to re-take and assign roles in the family.

The TRC’s staff later moved on to the marital therapy, then the family was referred back to the psychologist who had worked with Majed individually. This stage of the treatment was not easy for the father as in the Palestinian culture it is very difficult to talk with female psychologists in the presence of women and children, so he and his wife were advised to go on individual marital therapy again. After termination of the whole family therapy, the children were put on specialised (therapeutic) summer camps and they greatly benefited from interacting with other children who either were facing common problems or even had more serious problems than their own.

Majed had left prison in 2007, but it was not until 2009 when the staff at the TRC learned about his case. In the first instance, the family had brought the 7 year-old child to the Center two years after the father’s release. The child was effectively the first one to be treated in the family, and only later on the therapist discovered that the youth was son of an ex-detainee and -through consultation and awareness- the decision was made to work with the father.

While the staff were addressing the father’s case, it became clear that the family members were all affected so the family therapy was introduced along the individual one. The main work on the father’s case was accomplished over one year approximately. The individual therapy still continued after one year, the father attended follow-up sessions once every 2 weeks, and his treatment was completed two months later. The family based treatment was carried out within a 4-5 month period (14-15 sessions).

The therapist who worked with Majed had a very good feedback: he works now, he has managed to secure an income, has a good relationship with his wife, children and people outside his family, he plans to build a new house. Besides, it was observed -towards the late part of his therapy- the father joined group activities organized by the TRC regularly, and even became the first client to turn up at these social events.

On the family side, the 7 year-old child progressed in his academic performance, he stopped bedwetting, gained higher self-esteem and self-confidence through the summer camps, and became better behaved with other children. These days, he is quite interactive, no longer aggressive, supportive towards his brothers and family. Overall, a great improvement was found in the family relationships, the mother developed more insight into the family and awareness of her children’s needs, everyone is now supportive with each other as parents and children, and they know what are their roles and can live as one family.

The Treatment and Rehabilitation Centre for Victims of Torture is a leading non-profit organization in the promotion and dissemination of information regarding the plight of the victims of torture in Palestine. The TRC is often the only option left for those victims of torture and organized violence in the West Bank who cannot afford paying for treatment in private clinics.

The TRC counts on a multi-disciplinary clinical team that offers a range of holistic treatment plan to each individual client. A treatment plan is designed to best cover the client’s needs including psychological, social and medical.