In 1994 was initiated the activity of the Centre (Ambulatory) for Victims of Political Persecutions at the Department of Social Pathology at the Chair of Psychiatry of the Jagiellonian University Collegium Medicum, which was in 1996 ratified by prof. I. Gościński (Head of the Public Clinical Hospital) and prof. A. Szymusik (Head of the Chair of Psychiatry of the Jagiellonian University Collegium Medicum). The Centre for Victims of Political Persecution is housed within the Out-patient Unit of Adult Psychiatry Clinic of the University Hospital at the Jagiellonian University Collegium Medicum. The realization of the research projects takes place in the Centre, at the Chair of Psychiatry and also at the Chair of Psychotherapy of the Jagiellonian University Collegium Medicum.

History and activity

The Centre for Victims of Political Persecution came into being in 1996. The Centre is a unit which is attached to the Department of Social Pathology, the Chair of Psychiatry at the Jagellonian University, Collegium Medicum. The approval for activity was granted by the head of the Chair of Psychiatry CM UJ, Prof. A. Szymusik, and the then director of the University Hospital (former State Clinical Hospital), Prof. I. Goscinski. The CVPP continues the tradition of research and help provided in Kraków for the survivors from concentration camps since 1959, fully described in the “Przegląd Lekarski – Oświęcim” medical magazine between the years 1962 – 1981.

The CVPP offers specifically psychiatric and psychological help for victims of torture. However, legal help and consultations in internal medicine and neurology can also be obtained, as well as some specialised examinations and physical rehabilitation. The work of the centre has been known among veterans of the independence of Poland and former political prisoners for years. Patients are mostly post middle-aged people with numerous somatic disorders, usually resulting from the endurance of torture and other forms of persecution such as deportation. Almost every person who has reported to the centre has been treated internally or has been hospitalised. Some of them have been, and still are being treated for numerous neurological disorders, which were the consequences of strokes, Parkinson’s disease and dementia. Cases which occurred in this age group were aggravated to a higher extent than the age of the patient would suggest. People from all over the country are able to get help at the Centre. For most of them, it is the only chance to undergo treatment within an academic medical unit. Depending on the distance from the Centre, the patients remain in permanent health care or they use the diagnosis from a single consultation whose results are presented to their district physician. All physicians working at the Centre are specialists in a given branch of medicine and are employed in different University clinics. Every person who reports to the Centre has the following examinations done: psychiatric and psychological examinations (including tests), internal examination with electrocardiography, spirometria and neurological examinations and densimetry. Most patients first undergo psychiatric treatment which is frequently carried out in their home town. All patients obtain medical certification which shows their health condition. The CVPP is still developing its therapeutic treatments. At the end of 2001, all patients were given a chance to undergo, free-of-charge, densimetrical examinations for osteoporosis. It is connected with the demand to state the consequences of extreme undernutrition, as well as the effects of stress, and the destruction of the organism. Also physical rehabilitation (massages etc.) has been offered to all patients, but participation is easier for patients from the Kraków region.

Apart from medical help, all people who report at the Centre can obtain legal help; they are instructed about the possibilities and ways of getting compensation and pensions. In Poland, people who were persecuted for political reasons are granted pensions which are the same as those of war veterans. However, they must justify the fact that their health condition deteriorated because of the persecution. Almost everybody uses these certifications in further legal proceedings. Judging by the information provided by the patients, we are able to estimate that at least 90% of them receive pensions thanks to a diagnosis made in the Centre. Specialists from the CVPP also take part as witnesses in court cases as experts in posttraumatic cases.

The CVPP, as a unit of the Department of Social Pathology at the Chair of Psychiatry at the Jagellonian University, Collegium Medicum has been granted approval to conduct specialist training comprising clinical psychiatry and psychology. Resident Doctors and psychologists train at the CVPP and they become familiar with the problems of the consequences of torture, the specific character of victims and methods of treatment. As a result of this, education is another activity of the CVPP. Furthermore, weekend sessions (workshops) for medical doctors, psychologists, nurses and lawyers are organised. They comprise exploration of the problems of post-traumatic disorders. The following aspects are worked on: clinical aspects, diagnosing, symptoms, treatment, legal regulations and international co-operation in torture prevention. These courses have been approved by the Polish Psychiatric Association (Polskie Towarzystwo Psychiatryczne) and attendants obtain educational points/credits. It is worth noting that the activities taking place in the centre make other physicians and lawyers more sensitive to the problems of torture. The patients return to their home towns with certification and by showing this to others they draw their attention to the consequences of torture.

Summing up, the CVPP takes part in the following activities:

1. diagnosis and psychiatric treatment of victims of torture
2. diagnosis and psychological treatment
3. diagnosis and internal treatment
4. diagnosis and neurological treatment
5. specialised examinations (densimetry, ECG)
6. help and assistance in receiving pensions and compensation
7. compiling statistical data, which enables to plan further help for
   victims of torture
8. registering for further study
9. compiling and publishing educational material about help available for the victims of torture
10. training of professionals

The activity of the CVPP is co-financed by the Jagellonian University, the University Hospital, the European Union and the United Nations Voluntary Fund for Victims of Torture. The European Union, awarded project: Medical Rehabilitation Centres for Torture Survivors in Central Europe (7040/2000/T-1999/412). The United Nations Voluntary Fund for Victims of Torture, awarded project: Diagnostics and the treatment of posttraumatic disorders in survivors of political persecution in Poland (P.333). Awarded projects are realised through international cooperation with centres from other countries: the ICAR Foundation from Romania (main applicant for the EU grant), The CORDELIA Foundation for the Rehabilitation of Torture Victims, the Victims of Organized Violence from Hungary and The Medical Rehabilitation Centre for Torture Victims MEMORIA from Moldova. The CVPP also co-operates with the other countries in the Central, East and North-European Network called CENENET. This network consists of the following centres: the Estonian Centre of Medical rehabilitation for Victims of Torture, MRT in Estonia, The Centre for Torture Survivors in Finland, CTSF in Finland, the CORDELIA Foundation for the Rehabilitation of Torture Victims and the Victims of Organized Violence in Hungary and the Medical Rehabilitation Centre for torture Victims SMRC in Latvia. The CVPP is in continuous contact with the International Rehabilitation Council for Torture Victims (IRCT) in Denmark from where they have received substantial help and organisational support.

General description of the groups of patients admitted to the CVPP

Patients admitted to the CVPP can be divided into four groups:

1. Victims of political persecution in Poland during the communist regime in 1944-1956. This was the time of the most severe persecution for political reasons in Poland. People with non-tolerable political views were convicted and sentenced during fictitious trials, on the basis of falsified evidence, for many years of imprisonment and sometimes even faced the death sentence, which was then changed to imprisonment (though in history some death penalties were executed). During interrogations these people were tortured, many times with the approval of the authorities. Furthermore, they were forced to work in mines and quarries. Only some of them have lived to the present day. Some of them were deliberately murdered, some of them died in accidents in mines and others died of cachexy and diseases.
2. Victims of political and nationalistic persecution, which was performed by other countries on Polish territory. These are the prisoners of the Nazi concentration camps who were placed there because of fighting against invaders or for racial reasons, and for Holocaust survivors.
3. Another group of victims of political and nationalistic persecution, performed by other countries on Polish territory, comprises Polish citizens who were carried away by the soviet authorities. Deportations were carried out from the outbreak of WW II in 1939 to 1956. Between the years 1944-1956 some of the deportees returned and some of them, living in the countries of the former USSR, are still waiting to come back. During deportation they were exposed to numerous modes of torture.
4. Victims of other types of torture comprise the smallest group of patients.

All victims suffered from various psychical and physical tortures such as:

• beatings, hanging from the arms or legs,
  simulated executions, physical injuries (i.e. fractured fingers),
• sexual abuse,
• arrest, a loss of freedom,
• deportation to another country,
• a threat to life as a consequence of the applied torture – exposure to pain, cold, hunger and somatic illness (i.e. tuberculosis),
• anxiety for close relatives,
• the sense of injustice connected with convictions concerning the rightness of their guerrilla activity and patriotic attitude, which was a continuation of the fight for freedom in the years 1939-1945,
• deportation and deprivation of property and the ability to live in dignity,
• forced into slave work,
• deprivation of contact with relatives,
• constant death threats,
• humiliation inflicted by functionaries (of the militia, the Security Office, courts, prisons) of the same nationality as their victims,
• helplessness in the face of the deceitful propaganda campaigns (accusations of criminal offences, exposure to public contempt, e.g., marching the prisoners round the town whilst dressed in Nazi uniforms),
• making an honest court trial impossible, false accusations, the constant prospect of the death sentence,
• feelings of betrayal and a pressure to betray others,
• loneliness and limitation of contact with others,
• impression of never ending persecution (repeated investigations during prison service – the so-called ‘special investigations’, militia surveillance and supervision after the victim had served the sentence).

Tortures were applied not only to adults but also to very young children who were born in concentration camps or during deportation (or before).

All people who are diagnosed and treated at the Centre suffer from the consequences of psychological and physical trauma experienced during torture and persecution. These are most frequently disorders which have the following symptoms:

• • • PTSD
    • Personality disorders
    • Depression
    • Other mental disorders

• • Somatic disorders which directly result from the trauma:

   

  • • Deformations and scars
    • Efficiency limitation, hypoacusia
    • Consequences of frostbite

• • Somatic diseases developing in connection with the trauma:

   

  • • Contagious diseases (malaria, TB)
    • Premature ageing of the organism
    • Neurological disorders with some cases of dementia
    • Consequences of excessive hunger and undernutrition (rachitis, hypothyroidism)

• • Social consequences:

   

  • • Censure
    • Deprivation of the ability to work and no prospects of promotion.

Our Centre is the only institution of its kind in Poland. Diagnostic examinations consist of a wide-range of physical, psychical, psychological and social condition analyse of the survivors. It is necessary to analyse legal documentation (the survivor’s status confirmed by an appropriate annulling sentence verdict), medical documentation (previous treatment, hospitalisations etc.) and social documentation (confirmation of received welfare benefits, pension etc.). It is extremely important to assess the state of the social situation of former prisoners (environmental interviews, analysis of insurance conditions). In justified cases, it will be necessary to conduct legal proceedings including granting a disability pension, disability bonuses, social aid, verifying the level of disability resulting from distant exposure to mental and physical torture in the past. So far, examinations carried out in this group of survivors in a smaller population indicate a direct necessity for psychiatric treatment and the provision of appropriate psychological and social support. Persons of an advanced age, as the years go by become less efficient and the onset of chronic somatic illnesses resulting from physical injuries, past infectious illnesses (tuberculosis), undernutrition, circulatory failure, rheumatic illnesses, respiratory system illnesses, forced work in harmful conditions (work in a uranium mine or a methane coal mine) becomes dangerously more likely. Therefore, it is necessary to ensure specialist medical consultations for the survivors but also to specify individual therapeutic plans and to undertake highly qualified treatment.