INTRODUCTION
The Human Rights Foundation of Turkey (HRFT) has, since its establishment, been carrying out the Project for the Treatment and Rehabilitation of Torture Survivors as one of its main projects.
The project started in 1990 and by the beginning of 1998, 3304 people had applied to the treatment and rehabilitation centers of the HRFT. With 706 people applying to the centers in 1998, the number of applicants reached 4010. Multidisciplinary teams of hundreds of health professionals work, either on a professional or voluntary basis, for the solution of the physical, psychological and social problems of the applicants to the centers.
In 1998, we have caught up, to a great extent, with the program that we have developed in previous years and set for ourselves for the year with regards to the treatment and rehabilitation project. Our teams have attempted to turn the treatment and rehabilitation centers into more effective institutions.
The project was carried out by the treatment and rehabilitation centers of the HRFT in Adana, Ankara, İstanbul and İzmir until June 1998. The opening of the Diyarbakır Treatment and Rehabilitation Center in June was a very important step regarding the project. The Human Rights Foundation of Turkey took the decision to establish a center in Diyarbakır as early as 1992 but for several reasons, it was not possible until 1998. With the efforts of the relevant people and organizations in Diyarbakır, the preparations for opening a center, which started in 1997, were concluded in June 1998 and the HRFT’s fifth center started functioning. In addition to the daily work, the Diyarbakır Treatment and Rehabilitation Center has organized a series of activities. Despite the opening of the Diyarbakır Center and despite the fact that the Adana Center started to work in cooperation with İçel, the 5 Cities project continued in 1998 in the provinces of Malatya, Gaziantep, Hatay, Adıyaman and Şanlıurfa as human rights violations were persistent in this region.
Another important field of activity in 1998 within the context of the Treatment and Rehabilitation Centers Project was the preparations regarding the “Second International Meeting for the Development of a Manual on the Effective Documentation of Torture – Istanbul Protocol.” It is a great honor for the HRFT to have had an important function in the realization of this study. After a 3-year preparatory period, the İstanbul Protocol meeting was held on 11-13 March 1999 in İstanbul with the participation of the relevant people and organizations from all over the world and from Turkey. Attempts are underway to turn the İstanbul Protocol into a UN Protocol in this field.
The Treatment and Rehabilitation Centers Project, besides providing medical treatment and rehabilitation for torture survivors, also supports training, scientific research and scientific activities for increasing the quality of services.
Both Turkish and English versions of this report, including the results derived from the Treatment and Rehabilitation Centers Project carried out in 1998, have been published as in previous years.
Concerning the effectiveness of annual reports, the date of publication is important. Therefore, the publication of the 1998 report in May 1999 might have achieved this effectiveness. In the coming years, the HRFT will pay more attention to this point.
The 1998 Treatment and Rehabilitation Centers Report includes an introduction by President Yavuz Önen on behalf of the Governing Board, followed by two sections.
The first section includes an outline of the health services provided by the HRFT in 1998. The outline includes information and evaluations regarding the applicants to the HRFT Treatment and Rehabilitation Centers in Adana, Ankara, İstanbul, İzmir and Diyarbakır for torture related problems.
The second section consists of articles on certain issues that the treatment centers of the HRFT have worked on in 1998.
This part starts with an article by Dr. Cem Kaptanoğlu, which is entitled “Complex Posttraumatic Stress Disorder (C PTSD).” Dr. Kaptanoğlu indicates in his article that the discussions on the clinic of PTSD will concentrate on a complex versus simple PTSD conception in the future and argues that complex PTSD appears to be very different from simple PTSD. He stresses that we need a diagnostic category to facilitate our understanding of torture survivors who face prolonged, repetitive trauma. He ends his article with the following sentence: “This is a country where for more than 20 years instead of fairy tales there have been stories of warfare, people being killed in the streets and in their homes, torture, kidnapping and disappearances as well as gangs. Perhaps the diagnosis of complex PTSD would help us to understand the present and future behavior, the responses, thoughts and emotions of children growing up in Turkey, many of whom have reached 20 years of age.”
The second article in this section is Dr. Ümit Şahin’s article on complaints and disorders related with the musculoskeletal system, which are widespread among torture survivors. Dr. Şahin points out that a distinguishing characteristic of musculoskeletal disorders related to torture is that the pain can become chronic in time and it can appear in the late period, in the years following the infliction of torture. He argues for the necessity of interdisciplinary cooperation among the physical, psychological and social disciplines. Dr. Şahin makes an assessment of the physical disorders, especially chronic or late-term disorders of the applicants to the HRFT İstanbul Representation Treatment and Rehabilitation Center who had musculoskeletal system complaints and who had received physical treatment and rehabilitation consultations. He makes an analysis of the complaints of these applicants, the diagnosis they received and the treatment applied.
Prof. Dr. Gül Şener and Asst. Prof. Dr. Mintaze Kerem from the Hacettepe University Physical Treatment and Rehabilitation Faculty in their article shows the importance of the rehabilitation approach in eliminating or minimizing the problems following torture. The authors present a study on musculoskeletal and neurological problems related to torture and on the physical treatment methods selected in line with the needs of the patient. They stress the need for a good rehabilitation team, a reasonable treatment method and social approaches for minimizing the physical and psychological problems.
The next article is entitled “Forensic and Psychiatric Aspects of Trauma and Some Suggestions,” and is by four authors: Dr. Ü. Biçer and Dr. B. Çolak from the Kocaeli University Medical Faculty Forensic Medicine Department, Dr. M. Bilgili from the Ministry of Justice Forensic Medicine Institute, and Dr. Y. Ergezer. The authors emphasize that while the physical consequences of trauma have been analyzed in-depth with regard to forensic medicine, the psychiatric consequences of trauma had not been dealt with until recently. They draw attention to the forensic, medical and legal regulations that are required concerning the psychological aspect of trauma. The article is an important contribution to the debate on the recognition of forensic and psychiatric aspects of psychological trauma and its evaluation from forensic, medical and legal points of view with regard to some objective criteria.
The last article in this part is about a sample case in which N. Betül Vangölü and Selçuk Kozanoğlu were the attorneys. The case involves the discussion of various aspects of the practice of forensic medicine.
The activities of the HRFT are realized through the efforts of hundreds of health professionals and human rights defenders from many cities in Turkey. We would like to thank all our friends who contribute to our work and who have stood by us, and to thank the Human Rights Association and Turkish Medical Association who have been lending their support from the very beginning.