What is rehabilitation as a form of reparation and why is it important?

C4JR spoke to Professor Nimisha Patel on rehabilitation as a form of reparation, why it is important, and what needs to be done so that survivors can realise their right to rehabilitation guaranteed under the Yazidi Survivors Law. Professor Nimisha Patel is the Executive Director of the International Centre for Health and Human Rights (a UK-based NGO) and Professor of Clinical Psychology at the University of East London. She has extensive experience in clinical work, research and policy development in relation to torture survivors, developing a global framework of human rights indicators for the right to rehabilitation as reparations for torture survivors to support the implementation, monitoring, and state accountability under international obligations. Her expertise is in clinical work and interdisciplinary (psychology and law) research and policy development to support survivors of torture and gender-based violence, including in armed conflict.

Interview summary:

• What is rehabilitation as a form of reparation and why is it important? (00:35)
  • Rehabilitation is one form of reparations, and it’s based on the principle that every person who has been subjected to harm and gross human rights violations is entitled to a form of reparation.
  • Rehabilitation is not just providing one service: it’s about providing holistic care.
  • Because gross human rights violations can lead to harm at the individual level, at the family level, and at the community level, it’s important that rehabilitation seeks as far as possible to help survivors and their family members to recover. 
  • Rehabilitation must be comprehensive and holistic. It needs to see each survivor as having multiple needs and provide for those multiple needs.
  • The right to reparation needs to be holistic, specialised, and interdisciplinary. 

• Is rehabilitation a human right? (03:45)
  • Rehabilitation is a form of a right to reparation and a fundamental human right.
  • All forms of rehabilitation work together to facilitate rehabilitation, so recovery cannot fully happen without all forms of reparation being pursued.
  • Survivors can feel that if they are not safe, and if there is no justice and no public acknowledgement of the harms that were done to them, that perhaps no one really believes what happened to them, or no one really believes or understands the gravity and deep impact on them and their families.
  • Rehabilitation as reparation recognises that these harms were made because of human rights violations and therefore, there need to be rights in order to try and correct the impact of those harms.

• Why is it important to incorporate holistic understanding of rehabilitation into the administrative reparation programs? (06:28)
  • It is important for states to ensure that rehabilitation is built into all administrative reparation programmes, because rehabilitation is an integral component of reparation.
  • Reparation is not just one component. It includes many things, including restitution, satisfaction measures, compensation measures, rehabilitation, and guarantees of non-repetition. These measures must be seen together, as well as individually.
  • Rehabilitation has to be integrated and can’t be just left to NGOs to pick up the pieces and to try and reach out to survivors; it has to be a state responsibility.
  • If administrative reparation programmes integrate rehabilitation, there is more chance that survivors can be helped, wherever they are, whether they are displaced, whether they are in refugee camps, whether they are living in different cities or different areas, or in their places of origin.

• What are indicators on rehabilitation and why are they important? (08:13)
  • Human rights indicators are an essential tool to help us address how to move from standards in law to implementation.
  • Indicators are a tool for accountability, and provide some sense of direction, as in what do we still need to do to make sure that survivors and their families get what they are entitled to, and what they deserve. 
  • There are three separate categories of human rights indicators, beginning with structural indicators, which help us assess the state’s commitment to its international human rights obligations. In other words, has the state enacted laws that ensure reparation for survivors? Are there any gaps in the law?
  • The second category is process indicators, which measure the extent to which the state is making efforts to realise the right to rehabilitation rights.
  • The third category is outcome indicators, which help us to address the question,”Well, if we have a law, if we are making these efforts to implement the law, how do we know whether it’s really effective?” Outcome indicators for the right to rehabilitation ask questions about the standards of support and whether they are equally fair, accessible, and applied by the state.
  • Taken together, these indicators help actors to continue making progress.

• Final reflections on rehabilitation as a form of reparation under the Yazidi [Female] Survivors Law and what needs to be done so that survivors truly realise their right to rehabilitation guaranteed under the YSL and in Iraq. (13:55)
  • Iraq has this very progressive Yazidi Survivors Law, which is a wonderful start, and a very good and strong commitment to survivors. Many of the components in the law are relevant and essential to survivors.
  • It is essential to ensure that the law is implemented to ensure that survivors feel that the harms done to them are recognised and that they can access the means for support so that they can continue their lives.
  • Survivors see the value in rehabilitation, and recognise and ask that all of the other aspects of the YSL are implemented, not just rehabilitation.
  • Rehabilitation is essential, and it’s essential to see rehabilitation as part of a package of all the other forms of reparation that the Yazidi Survivors Law has. 
  • Iraq has made a very good start, there is clearly commitment, and there is clearly a will, to support survivors as best we can, and to support their family members. However, the work has just begun.
  • Having the law on its own is not sufficient. It’s important to translate this commitment into reality so that survivors can have rehabilitation, they can have their compensation, they can have all the things that they are entitled to including a right to life in dignity, and to feel that they can live together in peace and harmony within their own communities. 
  • The Yazidi Survivors Law means little to survivors unless it is realised and comes to fruition, and there is real action in terms of delivering rehabilitation to survivors.
  • Collaboration and a commitment to work together is key. No one person or organisation or the state or one department in the state can do this alone. The willingness is there, so the main thing is to keep the momentum going and to work together towards the same goal, which is ultimately: “How do we repair the harms done to survivors, their families and their communities?”

Full transcript:

What is rehabilitation as a form of reparation and why is it important?

Rehabilitation is one form of reparations, and it’s based on the idea, or the principle, that every person who has been subjected to harm and gross human rights violations is entitled to a form of reparation.

Rehabilitation is a very complex, comprehensive concept. It is not just providing one service, it’s about providing holistic care, because many of these gross human rights violations lead to many, many, many harms: at the individual level, at the family level, at the community level. At the individual level, they lead to many harms and needs in terms of psychological, medical, social, vocational, illegal, education is often disrupted,  Because many of these harms have multiple impacts on individuals – the emotional, the psychological, the physical, the spiritual, existential, basic welfare needs, educational needs, even vocational needs – it’s important that rehabilitation seeks as far as possible to help survivors and their family members to recover.

That doesn’t necessarily mean that they are restored to how they were before this happened. What it means, is that rehabilitation has to be comprehensive, and it has to be holistic. Holistic in the sense that it should see each survivor as having multiple needs, and services to provide for those multiple needs. To provide a one component, for example, educational support or psychological support, on its own does not constitute rehabilitation.

As a right to reparation, rehabilitation needs to be not just holistic, but it needs to be specialised. In other words, it is not general healthcare. This is about providing care in all those different domains, which directly addresses the gravity and the seriousness and the long-term impacts of harm, like torture, like rape, like genocide, like murder. All those things have impacts in the longer term as well for individuals and families.

Rehabilitation must be both holistic, it has to be specialised, and it has to be interdisciplinary so that all different specialities can work together to provide the best possible support and care for survivors and their families, to enable them to have some form of life going forward and to have their sense of dignity and some sense of recovery and sense of feeling more human again.

Is rehabilitation a human right?

Yes, rehabilitation is a right, a form of a right, to reparation. It is one component of the right to reparation; the other components work together with the right to rehabilitation. In other words, it’s not okay just to provide rehabilitation. If, for example, a person feels that they don’t have the financial means to rebuild their lives, or for the harms that have been done to them or that they can’t pay for services or for a home or things that they need in order to rebuild their lives.

All forms of reparation work together to facilitate rehabilitation, so recovery cannot happen fully and certainly not without all forms of reparation being pursued, as well as justice. For many survivors, it is impossible to feel as if rehabilitation can be really effective or helpful when they don’t have justice, or when they have a sense that there is no even commitment or pursuit of justice; no hunting or searching of perpetrators, no investigation, no punishment, and when there is ongoing impunity. For survivors that can feel like an open wound, like there can never be true safety or recovery, because they are constantly under a threat and fear that these harms may be perpetrated against them again.

Also, survivors can feel that if they are not safe, and if there is no justice and no public acknowledgement of the harms that were done to them, that perhaps no one really believes what happened to them, or no one really believes or understands the gravity, the depth, the long-term and the breadth of the impact on them and their families.

So to summarise, yes. Rehabilitation is a fundamental human right as a form of reparation. Survivors are not ill, they don’t have diseases, they’re not sick in their mind. This isn’t something that is wrong with them. They have been harmed and they’re suffering as a direct response to the harm, and rehabilitation as reparation recognises that these harms were made because of these human rights violations and therefore, there need to be rights in order to try and correct the impact of those harms.

Why is it important to incorporate holistic understanding of rehabilitation into the administrative reparation programs?

It is very important for states to ensure that rehabilitation is built into all administrative reparation programmes. Why is that important? Because reparation is not just one component. It’s a whole concept. It includes many things: restitution, satisfaction measures, compensation measures, rehabilitation, and guarantees of non-repetition. They have to be seen together, as well as individually. Rehabilitation has to be integrated, it can’t be just left to NGOs to try and pick up the pieces and to try and reach out to survivors. It has to be a state responsibility, even if it is the state working with NGOs to collectively and collaboratively provide rehabilitation to survivors as their right.

It is also important that administrative reparation programmes consider rehabilitation as an integral component, because it’s important that states provide for rehabilitation nationally, all over the country wherever the needs are. If it is not included in reparation programmes, it is often left as a kind of ad-hoc response for NGOs or odd services here and there, trying to provide for the needs of survivors. So if administrative reparation programmes integrate rehabilitation, there is more chance that survivors can be helped, wherever they are, whether they are displaced, whether they are in refugee camps, whether they are living in different cities or different areas, or in the places of their origin.

What are indicators on rehabilitation and why are they important?

Human rights indicators are an essential tool to help us address the question, “How do we move from the standards in law to implementation in reality?” Indicators provide us with a roadmap. They’re a tool for accountability, but they also provide us with some sense of direction: what do we still need to do to make sure that survivors and their families get what they are entitled to, and what they deserve?

Human rights indicators can be categorised into three separate categories. They are categorised in this way to help us get as full a picture as possible. They never give us a complete picture, but they give us a full enough picture, or close enough to reality a picture, of where things are at. The first category is structural indicators and our structural indicators help us to assess the state’s commitment to its international human rights obligations. In other words, has the state enacted laws that ensure reparation for survivors? Are there any gaps in the law? These indicators help us to assess whether the state has made a commitment for reparation.

The second category of indicators are called process indicators, which measure the extent to which the state is making efforts to realise those rights. In other words, what mechanisms are in place, what programmes are in place, what training and awareness programmes have been made for decision-makers for the judiciary, for service providers, to ensure that everybody is aware of the right to rehabilitation as a form of reparation. Process indicators help us to answer the question, “What efforts is the state making to implement the law that it has enacted?” In other words, how do we know that this is not just a paper commitment, but that there are actual efforts being made by the state to implement the law? For example, process indicators can include those indicators that ask questions like, “What mechanisms do we have to assess whether that services are available?”; “What mechanisms do we have to assess whether we have adequately trained qualified professionals to offer specialised rehabilitation?”; “What mechanisms do we have to monitor these services?”; “What programmes for awareness raising do we have to train the judiciary, to train health professionals, to train service providers to make sure that they know what the right to rehabilitation as reparation is?”; “What mechanisms do we have to raise awareness in the public about what the right to rehabilitation is, to try and reduce the stigma within communities and negative discourses that may be around towards survivors?” These are efforts that states can be making, so the process indicators help us to assess what efforts the state is making.

The third category of indicators is outcome indicators, which help us to address the question, “Well, if we have a law, if we are making these efforts to implement the law, how do we know whether it’s really effective?”; “What are the results of these efforts that we’re making?” Outcome indicators for the right to rehabilitation ask questions like, if there are rehabilitation services available, do they meet the standards in international law as well as best practice globally? Are they fair? Are they equally available to all survivors, regardless of age, gender, ethnicity, religion, or faith? Or language? They may ask questions like, “Are these services accessible?”; “Are they in a location that survivors can reach easily?”; “Do survivors have the means for transportation to be able to go to those services?”; “Do they have disability access?”

Outcome indicators also ask questions like, “Are services coherent?” In other words, if different organisations and the state are providing different types of different components of rehabilitation services, how well do they work together? How coordinated are they, so that survivors are able to get the best possible package of holistic rehabilitation and not be treated as if they are like footballs, being kicked from one service to another, to another?

There are many indicators of outcome indicators which help us to assess how well the law is being implemented. Together, these indicators give us a really good picture of where we are right now. Where are the gaps? What still needs to be done? And how do we know that we’re making progress? Using human rights indicators is not a one-off exercise, it’s a roadmap, it’s a tool; it is there to help us to keep making progress. It is there to help us keep assessing if we are making progress, where the gaps are, and where we still need to focus our attention.

Final reflections on rehabilitation as a form of reparation under the Yazidi [Female] Survivors Law and what needs to be done so that survivors truly realise their right to rehabilitation guaranteed under the YSL and in Iraq.

Iraq has this very progressive Yazidi Survivors Law which is a wonderful start, and a very strong commitment to survivors. Many of the components in the law are very relevant and essential to survivors. Yes, there may be gaps still, but why is it important to ensure that the law is implemented? To ensure that survivors feel that the harms done to them are recognised, and they are able to access support so that they can continue their lives.

I have spoken to many survivors and their family members, and one of the things that really strikes me is that all of them recognise the importance of rehabilitation, but they also recognise and ask that all of the other aspects of the Yazidi Survivors Law are also implemented, not just rehabilitation. Because if you have access to a rehabilitation service, for many it means nothing if they have no means for basic survival; if they are still living in tents, if they don’t have adequate housing, if they don’t have the financial means to rebuild their lives, if they don’t have space to come together as a community.

For many people, they were saying, yes, compensation is important. But on its own, it’s not enough. Rehabilitation is really essential, and it’s essential to see rehabilitation as part of a package of all the other forms of reparation that the Yazidi Survivors Law has. My own impression is, Iraq has made a very good start; there is clearly commitment, and there is clearly a will, to support survivors as best as we can, and to support their family members. 

However, the work, I imagine, has just begun. Because having the law on its own is not enough, it’s not sufficient. We have a commitment, but it’s important that you’re able to translate this commitment into reality so that survivors can have rehabilitation, they can have their compensation, they can have all the things that they are entitled to, and to recognise that these are people, survivors and their families are people, who have been harmed. They didn’t choose these things to happen to them. They have an entitlement and a right to life in dignity, and to feel that they can live together in peace and harmony within their own communities.

I see the Yazidi Survivors Law as a very good thing in Iraq, but it means little to survivors in reality, unless it is actually realised and comes to fruition. There is real action in terms of delivering rehabilitation to survivors. One reflection I would also like to share is, having spoken to and listened to many colleagues who are all wanting the same thing in terms of rehabilitation and reparations for survivors. What I see, and what I’ve seen today in our workshop for key stakeholders, is a real commitment to work together, to collaborate together, and to coordinate efforts between all of you. This is really essential because no one person, or organisation, or the state, or one department in the state, can do this alone. It needs all directorates to work together, to coordinate their efforts together. It needs NGOs to collaborate and coordinate together, and for the state and NGOs to work together to provide rehabilitation for survivors. The only way you can move this forward is if we come together and work towards a common purpose. This, I see, is already there. The willingness is there. The main thing is to keep the momentum going and to work together towards the same goal, which is ultimately: how do we repair the harm done to survivors, their families and their communities?