The Center for Victims of Torture

Consistent exposure to refugee narratives of trauma and torture can profoundly impact trauma therapists. This secondary analysis reanalyzed data from a narrative inquiry investigating the lived experiences of refugee trauma therapists. We aimed to explore emergent concerns through an existential lens to enrich understanding and provide additional insights into the lived experiences of these individuals. Participants in this purposive sample (N = 19) were therapists who had provided interventions to refugees for 2-34 years. Narrative construction, theory-guided data analysis, and memo writing were used to reanalyze data generated by semistructured interviews augmented by photo elicitation. The findings indicate that being forced to reevaluate familiar beliefs consequent to one's professional roles induced intense existential moments, described as "a dark night of the soul," "the paradox of life and death," "uncanny feelings of not being at home," and "a falling." Acknowledging the complexities of the field, an existential framework to assist refugee trauma therapists in metabolizing and living with the professional challenges they encounter instead of focusing on alleviating decontextualized symptoms of distress is recommended. Research to inform requirements of the space to enable refugee trauma therapists to share their concerns and facilitate transitions toward more authentic, nonevasive sense of "being-in-the-world" is suggested.

As an IRCT member organization supporting survivors of torture, the Torture Abolition and Survivor Support Coalition (TASSC) International places survivor engagement at the core of their work, aiming to provide safe and inclusive spaces for survivors to speak out and take meaningful action to prevent torture. This article describes TASSC's model for engaging survivors in advocacy and presents evidence on the personal impacts such engagement can have. Each year from 2016-2019, TASSC administered a simple survey with questions for survivors to complete after their annual "Advocacy Day" in Washington D.C. Quantitative and qualitative data was collected to inform internal service provision and the design of future events. Across the four years a total of 140 survivors and compatriot human rights advocates participated in the annual Advocacy Day, and a majority completed the surveys. In their survey responses, survivors agreed they had many positive thoughts and feelings after advocacy. Their reported positive experiences included a sense of being listened to and heard by an understanding and responsive audience, the power of feeling part of a group that was speaking out on behalf of themselves and others, and a sense of motivation and hopefulness for the future. Although undertaken primarily to inform internal processes, TASSC's surveys with survivors who engaged in advocacy shed light on the potential value of well-designed advocacy experiences. Consistent with past research, survivors reported strong motivations around and compelling benefits from participating, despite the challenges that the deeply personal nature of their engagement could present. This feedback suggests TASSC has a strong model that could be replicated elsewhere, but it would be beneficial to further investigate the experiences of survivors engaging in advocacy in other country settings.

The author brings an account of his life trajec-tory as a psychiatrist born and working in Pal-estine. The author dives in his early memories, including those of his brother's death, that shaped his character and the way he lives his rejection of occupation and violence. Besides the early institutional beginnings of the TRC Center in West Bank, the author describes the subtle forms of the daily abuse that a doctor working in Palestine must endure.

Maternal stress during pregnancy is associated with differential DNA methylation in offspring and disrupted cortisol secretion. This study aimed to determine methylation signatures of cortisol levels in children, and whether associations differ based on maternal post‐traumatic stress disorder (PTSD). Blood epigenome‐wide methylation and fasting cortisol levels were measured in 118 offspring of mothers recruited from the Kosovo Rehabilitation Centre for Torture Victims. Mothers underwent clinically administered assessment for PTSD using Diagnostic and Statistical Manual of Mental Disorders. Correlations between offspring methylation and cortisol levels were examined using epigenome‐wide analysis, adjusting for covariates. Subsequent analysis focussed on a priori selected genes involved in the hypothalamic–pituitary–adrenal (HPA) axis stress signalling. Methylation at four sites were correlated with cortisol levels (cg15321696, r = −0.33, cg18105800, r = +0.33, cg00986889, r = −0.25, and cg15920527, r = −0.27). In adjusted multivariable regression, when stratifying based on prenatal PTSD status, significant associations were only found for children born to mothers with prenatal PTSD (p < 0.001). Several sites within HPA axis genes were also associated with cortisol levels in the maternal PTSD group specifically. There is evidence that methylation is associated with cortisol levels, particularly in offspring born to mothers with prenatal PTSD. However, larger studies need to be carried out to independently validate these findings.

The refugee narrative spans time, geography, and generations, enfolding the complexity of constructing identities through displacement and migration. Through adapted narrative analysis, we examined the physical narratives of war trauma which a sample of Karen refugee women constructed, as they claimed their experiences of war trauma and torture in interview discussions. We employed an adapted narrative method relevant to the analysis of field texts to interpret the remembering and retelling of trauma narratives. This method helped to elicit positional identities and physical/sensory memories that were prominent in women's experiences and to contextualized concurrently collected quantitative data. Accounts revealed key constructs relevant to the narrative function and orientation of the narratives: remembering childhood, being a mother, embodiment of trauma.

Thank you for this opportunity to share perspectives from our work within the Physiotherapy and Refugees Education Project, PREP, an Erasmus+ funded project within the KA2 strategic partnership program. Researchers, educators, students, and clinicians within institutions of higher education, health services and humanitarian organisations, have worked together in this project to define competencies that physiotherapists need in working with refugees. Based on this, we have made a course openly available for physiotherapists worldwide. A central aim of the work in PREP has been the creation of a network in which educators, students and clinicians can meet, discuss, and learn from each other. We welcome everyone who shares our interest to join us in this network. In this perspective paper, we want to share our thoughts and opinions on how such a collaboration can be used for building competence. We will discuss topics that are central for physiotherapists working with victims of torture, and finally, we will discuss what we believe are the important next steps within physiotherapy to be able to support this group.

Editorial

This paper describes how various community partners collaborated to design and implement a student-centred, trauma-informed educational program that addresses the personal and systemic barriers identified by refugees who are survivors of trauma as obstacles to accessing higher education, and consequently social inclusion, in Canada. This 14-week program created a safe space where participants could rebuild identities, agency, and confidence and develop healthy relationships of trust and mutual respect. Measures of well-being and qualitative interviews conducted at entry, mid, and exit points showed statistically significant improvements on measures of self-esteem, resilience, and life satisfaction and overall satisfaction with the program.