Psychiatry in Kyrgyzstan: What is It For and Why?
Nuraiym
Her hair is nut-brown, she is wearing a grey baggy jacket with high collar and a black long skirt that almost touches the ground and covers her boots… She approached the table fast, said hi and sat in front me with her legs crossed. She pulled her sleeves down over their hands, put her arms above her knees and with her hands clasped together.
She smiled a bit, took off her dark sunglasses and unveiled her hazel eyes. Her lost look is not focused and her eyes are shifty as they move back and forth. She feels vulnerable and tries to hide from the world around her. Sometimes she squeezes into the chair, pulls up the collar to cover her bitten lips. She holds the sleeves of her jacket hard and covers her healing wounds on her arms. She stutters a bit when speaking, and she is speaking in a whisper.
Nuraiym has a posttraumatic disorder that developed into a psychosis state. In other words, she stopped controlling herself and was in limbo. Her father was dealing with construction business in Bishkek. Her mother was a housewife. She recalls her father and tells about him with a smile, but suddenly her face changes and becomes sad. She shuts her lips and tears blur her eyes. Nuraiym starts to scratch her arms:
- I loved my father very much. He was the man I wanted to be with. He was tall and handsome. He was always self-collected. My father used to give me gifts – dresses, shoes, sweets. He said I was his diamond and he would always be next to me. He was always concerned about me being sad. He used to approach me and ask about what happened and if he could help me. I was more attached to my father than mother. Maybe because I saw her more than my father as he was always working. But I still love my mother because she has supported me all the time. If they had a quarrel with my mother, I used to take my father's side. Now I understand that he was wrong in many quarrels.
At school, I liked a boy who was studying in a parallel class. But he did not pay attention to me. Later on, he said that he always looked at me. He wanted to ask me on a date but was afraid of my reaction. The following year, our classes were combined. I was a 10th grade student then. We communicated more often and over time he asked me to be his girlfriend. He came to my place and we walked to school together, and then he saw me to my house. In the evenings, we used to walk together and meet with our friends in common. We used to go to a park and downtown. He always made me smile. I felt myself comfortable with him.
I started getting bad grades. I was wrapped up in this relationship and didn't think about school, especially when we had quarrels with him. My mother scolded me for that but I ignored her words. After a month of our relations, I realised that my feelings got stronger and I could not spend an hour without him. I missed him very much and looked for every opportunity to be with him. That's when we confessed love to each other.
We did not communicate with him for a week. He got angry at me because I told him that his friends were bad because I thought that they were a bad influence on him and he spent less time with me. It was the first time when he shouted at me like a beast and flourished his arms wildly. He said that I didn't have a right to meddle in his friendship and suggested that his friends were more important than me. One week later, we made peace with him, but he became cold towards me. Although he used to come to my place at night and stand in front of my house before that quarrel.
She smiled a bit, took off her dark sunglasses and unveiled her hazel eyes. Her lost look is not focused and her eyes are shifty as they move back and forth. She feels vulnerable and tries to hide from the world around her. Sometimes she squeezes into the chair, pulls up the collar to cover her bitten lips. She holds the sleeves of her jacket hard and covers her healing wounds on her arms. She stutters a bit when speaking, and she is speaking in a whisper.
Nuraiym has a posttraumatic disorder that developed into a psychosis state. In other words, she stopped controlling herself and was in limbo. Her father was dealing with construction business in Bishkek. Her mother was a housewife. She recalls her father and tells about him with a smile, but suddenly her face changes and becomes sad. She shuts her lips and tears blur her eyes. Nuraiym starts to scratch her arms:
- I loved my father very much. He was the man I wanted to be with. He was tall and handsome. He was always self-collected. My father used to give me gifts – dresses, shoes, sweets. He said I was his diamond and he would always be next to me. He was always concerned about me being sad. He used to approach me and ask about what happened and if he could help me. I was more attached to my father than mother. Maybe because I saw her more than my father as he was always working. But I still love my mother because she has supported me all the time. If they had a quarrel with my mother, I used to take my father's side. Now I understand that he was wrong in many quarrels.
At school, I liked a boy who was studying in a parallel class. But he did not pay attention to me. Later on, he said that he always looked at me. He wanted to ask me on a date but was afraid of my reaction. The following year, our classes were combined. I was a 10th grade student then. We communicated more often and over time he asked me to be his girlfriend. He came to my place and we walked to school together, and then he saw me to my house. In the evenings, we used to walk together and meet with our friends in common. We used to go to a park and downtown. He always made me smile. I felt myself comfortable with him.
I started getting bad grades. I was wrapped up in this relationship and didn't think about school, especially when we had quarrels with him. My mother scolded me for that but I ignored her words. After a month of our relations, I realised that my feelings got stronger and I could not spend an hour without him. I missed him very much and looked for every opportunity to be with him. That's when we confessed love to each other.
We did not communicate with him for a week. He got angry at me because I told him that his friends were bad because I thought that they were a bad influence on him and he spent less time with me. It was the first time when he shouted at me like a beast and flourished his arms wildly. He said that I didn't have a right to meddle in his friendship and suggested that his friends were more important than me. One week later, we made peace with him, but he became cold towards me. Although he used to come to my place at night and stand in front of my house before that quarrel.
What can cause a mental disorder?
According to the National Statistical Committee, in 2019 Kyrgyzstan registered 10,096 persons with mental and behavioural disorders.
Mental health is an essential component in human's life – physical condition depends on the mental health. For example, immune system problems can be caused by apathy or depression. A person can be short of breath sometimes not to mention serious mental disorders.
Speaking about medical facilities, hospitals complain about small budgets and wages. And those, in turn, affect the quality of treatment.
According to the director of 'Mental Health and Society' Public Fund, Zhakshylyk Zhyrgalbekov, there is no single cause and progress of the disorder. But there are common symptoms that develop during schizophrenia and severe mental disorders. These can be hallucinations, communication disorders, lost communication with the world.
"No one can name a single cause. The disorder may be either endogenous, i.e. may be caused by some intrinsic agents, or caused by different reasons. For example, the reasons can be related to the childhood, upbringing, having some stressful situations," Zhyrgalbekov said.
According to him, the disorders may develop after a certain age, often after the age of adolescence. The people who are vulnerable to them have associated problems – poverty, problems with upbringing. Women often develop postpartum blues. The causes may be either mental, or medical related to bodily injuries. For example, brain contusion.
According to the director of 'Mental Health and Society' Public Fund, Zhakshylyk Zhyrgalbekov, there is no single cause and progress of the disorder. But there are common symptoms that develop during schizophrenia and severe mental disorders. These can be hallucinations, communication disorders, lost communication with the world.
"No one can name a single cause. The disorder may be either endogenous, i.e. may be caused by some intrinsic agents, or caused by different reasons. For example, the reasons can be related to the childhood, upbringing, having some stressful situations," Zhyrgalbekov said.
According to him, the disorders may develop after a certain age, often after the age of adolescence. The people who are vulnerable to them have associated problems – poverty, problems with upbringing. Women often develop postpartum blues. The causes may be either mental, or medical related to bodily injuries. For example, brain contusion.
"It felt like a thousand tiny pinpricks, and I could do nothing about it"
The text contains the scenes of violence. If you find the story inappropriate, please do not read the text below.
- We were dating for almost four months. We had yet another quarrel that day. We used to quarrel often lately. However, we went home together after classes. He was angry and silent, and his movements were precipitous. He walked fast and hurried me up. He said that it was cold and he wanted to come home faster. Then he stopped suddenly and said that we would go to his place.
I used to be at his place often and I agreed to go there without a hidden agenda. I wanted to make peace with him. We entered his house, he went to his room, and I sat down on the sofa in the living room. When he came back, he sat next to me, hugged me and started to kiss me. Everything was fine then. I rejoiced and thought that he was angry no more.
Suddenly he stopped and said that we were dating for a long time and maybe we could have sex? I said I could not do it then and I did not want to do it before wedding. It was very important for me. He knew about it because we talked about it before. He stood in front of me, took me by the hands and squeezed them until they hurt. He said that if I wanted to be with him, we must have sex or else we would break up.
He started to take my clothes off, I tried to kick him, but he knocked me instead and said that he would hit me stronger if I did it again or continued to shout. He kept on taking my clothes off and took off his pants. Then he took my neck with one hand and started to strangle me. I was crying and begging him to stop but he was getting even angrier. He became very mad, wasn't listening to me and shouted that I should shut up. I was feeling disgusting as if something foreign substance was inside me, and it felt like a thousand tiny pinpricks and I could do nothing about it.
I fainted at some point. I don't know if it was because of fear or because I didn't have enough air to breathe. I woke up because he was punching me in the face and was saying he was sorry. He thought I was dead. I don't remember how I got home. My mother met me on the threshold. I told her everything. My mother started to cry and told me to wash my face. I was scared to look at myself in the mirror. My face turned out to be battered. It was all in blood and swollen. My neck was purple. My clothes – a shirt and trousers – were all in blood and torn.
I wanted to wash it all away, burn my clothes and myself. I took a scouring pad and began to wash myself with it. I was rubbing my body continuously. Only my mother who came in and saw that I was all in blood could stop me. She was looking at me, crying and shaking. I was sleeping when I heard how my father came. I was very scared; my body, face and neck were aching. I was feeling nauseous. I was waiting for his words. I heard how they started arguing and he started to shout at her. Father said that he didn't believe that and that it was all my fault.
Then I heard steps approaching me. They were loud and weighty. My father knocked out the closed door, ran into my room, he was all blushing, his forehead veins were protruding, and his eyes were as red as my boyfriend's. He took me tightly by the hands and began to shout. He said that it was my fault and slapped me in my face so that my vision darkened. I fell on the floor. I heard how he was saying that I was not his daughter, that he could not look in the eyes of his relatives, that I could not get married. He said that no one needed me like that. My mother ran into the room and started to shout at my father and hit him. I felt nothing afterwards.
The next thing I remember was in the hospital.
- We were dating for almost four months. We had yet another quarrel that day. We used to quarrel often lately. However, we went home together after classes. He was angry and silent, and his movements were precipitous. He walked fast and hurried me up. He said that it was cold and he wanted to come home faster. Then he stopped suddenly and said that we would go to his place.
I used to be at his place often and I agreed to go there without a hidden agenda. I wanted to make peace with him. We entered his house, he went to his room, and I sat down on the sofa in the living room. When he came back, he sat next to me, hugged me and started to kiss me. Everything was fine then. I rejoiced and thought that he was angry no more.
Suddenly he stopped and said that we were dating for a long time and maybe we could have sex? I said I could not do it then and I did not want to do it before wedding. It was very important for me. He knew about it because we talked about it before. He stood in front of me, took me by the hands and squeezed them until they hurt. He said that if I wanted to be with him, we must have sex or else we would break up.
He started to take my clothes off, I tried to kick him, but he knocked me instead and said that he would hit me stronger if I did it again or continued to shout. He kept on taking my clothes off and took off his pants. Then he took my neck with one hand and started to strangle me. I was crying and begging him to stop but he was getting even angrier. He became very mad, wasn't listening to me and shouted that I should shut up. I was feeling disgusting as if something foreign substance was inside me, and it felt like a thousand tiny pinpricks and I could do nothing about it.
I fainted at some point. I don't know if it was because of fear or because I didn't have enough air to breathe. I woke up because he was punching me in the face and was saying he was sorry. He thought I was dead. I don't remember how I got home. My mother met me on the threshold. I told her everything. My mother started to cry and told me to wash my face. I was scared to look at myself in the mirror. My face turned out to be battered. It was all in blood and swollen. My neck was purple. My clothes – a shirt and trousers – were all in blood and torn.
I wanted to wash it all away, burn my clothes and myself. I took a scouring pad and began to wash myself with it. I was rubbing my body continuously. Only my mother who came in and saw that I was all in blood could stop me. She was looking at me, crying and shaking. I was sleeping when I heard how my father came. I was very scared; my body, face and neck were aching. I was feeling nauseous. I was waiting for his words. I heard how they started arguing and he started to shout at her. Father said that he didn't believe that and that it was all my fault.
Then I heard steps approaching me. They were loud and weighty. My father knocked out the closed door, ran into my room, he was all blushing, his forehead veins were protruding, and his eyes were as red as my boyfriend's. He took me tightly by the hands and began to shout. He said that it was my fault and slapped me in my face so that my vision darkened. I fell on the floor. I heard how he was saying that I was not his daughter, that he could not look in the eyes of his relatives, that I could not get married. He said that no one needed me like that. My mother ran into the room and started to shout at my father and hit him. I felt nothing afterwards.
The next thing I remember was in the hospital.
Types of treatment in psychiatric hospitals
Voluntary treatment
In case of voluntary treatment, the patient or their relatives must sign an informed consent for treatment. The patient undergoes a primary examination to find out the level of required treatment.
"In hospitals, a psychiatrist, medical staff, nurses deliver medical care. Their tool is medicinal treatment only. Hospitals treat citizens only upon their visit," Zhakshylyk Zhyrgalbekov said.
By law, in case of voluntary treatment, the patient may not stay in a hospital for more than 45 days. If the patient does not want to be discharged from the hospital, they will undergo repeated examination to see if further treatment is required.
"In hospitals, a psychiatrist, medical staff, nurses deliver medical care. Their tool is medicinal treatment only. Hospitals treat citizens only upon their visit," Zhakshylyk Zhyrgalbekov said.
By law, in case of voluntary treatment, the patient may not stay in a hospital for more than 45 days. If the patient does not want to be discharged from the hospital, they will undergo repeated examination to see if further treatment is required.
Compulsory treatment
Compulsory treatment is carried out only when a person breaks the law or is not able to assess their actions and the surrounding environment adequately.
In such cases, a special service is called to take the patient to a psychiatric hospital to evaluate their condition.
In addition, people who commit grave crimes, for example, insane homicide, are sent for compulsory treatment. If a forensic psychologist finds a person insane during the crime, the court prescribes treatment in a psychiatric hospital. The patient will be released after recovery.
In such cases, a special service is called to take the patient to a psychiatric hospital to evaluate their condition.
In addition, people who commit grave crimes, for example, insane homicide, are sent for compulsory treatment. If a forensic psychologist finds a person insane during the crime, the court prescribes treatment in a psychiatric hospital. The patient will be released after recovery.
Now there are four republican mental health centres (PCPZ) in Kyrgyzstan in the form of hospitals. Every region has a psychiatric unit. According to Uraimzhan Ismailov, the director of the Bishkek RCPZ, the outpatient level contains 74 psychiatrist's rooms in the system of family medicine centres across the country.
Unfortunately, the wages in this sphere of medicine leave much to be desired. The base pay in psychiatry is 5 thousand som (58.96 dollars). The doctor's wage is 10 thousand som (117.93 dollars). Because of difficult conditions, young doctors earn 7,500 som (88.45 dollars) plus percent of each cured case. Such wages contribute to the level of assistance provided, and, what's most important, high staff turnover.
"Young specialists are not willing to work for such money provided that professional burnout is rather frequent among them. Also, the treatment of one patient may take years with no visible progress. Therefore, those who stay have worked here for a long time," Ismailov said.
In 2018, Kyrgyzstan adopted the state programme for mental health protection until 2030. Among goals specified in the document there are attraction of new staff to the regions by means of cash bonuses and construction of new psychiatric units in compliance with international standards.
The programme is intended to ensure effective outpatient treatment and treatment in psychiatric hospitals. The main task is to reduce the number of beds in hospitals and to increase the number of multidisciplinary teams in the regions. The plan is to reduce unnecessary expenses.
Even now, 1,600 beds were reduced to 400 beds in the hospital located in Chym Korgon village, according to Uraimzhan Ismailov, and 1,125 beds were reduced to 325 beds in the village of Kyzyl Dzhar.
Unfortunately, the wages in this sphere of medicine leave much to be desired. The base pay in psychiatry is 5 thousand som (58.96 dollars). The doctor's wage is 10 thousand som (117.93 dollars). Because of difficult conditions, young doctors earn 7,500 som (88.45 dollars) plus percent of each cured case. Such wages contribute to the level of assistance provided, and, what's most important, high staff turnover.
"Young specialists are not willing to work for such money provided that professional burnout is rather frequent among them. Also, the treatment of one patient may take years with no visible progress. Therefore, those who stay have worked here for a long time," Ismailov said.
In 2018, Kyrgyzstan adopted the state programme for mental health protection until 2030. Among goals specified in the document there are attraction of new staff to the regions by means of cash bonuses and construction of new psychiatric units in compliance with international standards.
The programme is intended to ensure effective outpatient treatment and treatment in psychiatric hospitals. The main task is to reduce the number of beds in hospitals and to increase the number of multidisciplinary teams in the regions. The plan is to reduce unnecessary expenses.
Even now, 1,600 beds were reduced to 400 beds in the hospital located in Chym Korgon village, according to Uraimzhan Ismailov, and 1,125 beds were reduced to 325 beds in the village of Kyzyl Dzhar.
Multidisciplinary teams (MDTs) provide psychological, social and medical care:
- Social services:Trainings in self-service of communications, organisation of trips to mountains, cinema and other events. They are meant to involve people with mental disorders into public life.
- Psychological services:Psychological consultations, therapy, trainings focused on psychoeducation, understanding and regulation of own state.
- Medical services:medicinal treatment , correction, medication intake, consultation to family and relatives and their involvement into rehabilitation.
It covers the main needs of patients with mental disorders.
"In MDTs, the patient has a supervisor who evaluates the needs of every patient and develops an individual programme of treatment and rehabilitation. They provide social services: recovery of documents, assistance in getting benefits, in finding a job, training in self-service, for example, creation of a daily routine. They teach how to clean the premises, cook, be socially active," Zhakshylyk Zhyrgalbekov said.
Patients get into MDTs after hospital treatment and without any treatment. Very often, these patients are people with severe mental disorders such as schizophrenia, or affective disorder.
"Multidisciplinary teams have proved to be promising. They are 11 now both in the capital and in the regions. They are planned to be 22," Uraimzhan Ismailov said.
"In MDTs, the patient has a supervisor who evaluates the needs of every patient and develops an individual programme of treatment and rehabilitation. They provide social services: recovery of documents, assistance in getting benefits, in finding a job, training in self-service, for example, creation of a daily routine. They teach how to clean the premises, cook, be socially active," Zhakshylyk Zhyrgalbekov said.
Patients get into MDTs after hospital treatment and without any treatment. Very often, these patients are people with severe mental disorders such as schizophrenia, or affective disorder.
"Multidisciplinary teams have proved to be promising. They are 11 now both in the capital and in the regions. They are planned to be 22," Uraimzhan Ismailov said.
"The environment I was in had a bad impact on me. Everything was dirty there"
- I opened my eyes, my mother was sitting in front of me. My body and the lower stomach were aching. I felt back then as if something was crawling on me. I told about it to my mother, doctors, but they said that they saw nothing. I felt like insects were eating me from the inside – under my skin. They were getting into me when I was sleeping, through my ears, nose, mouth. And then they lived inside my body.
I felt my body was burning a lot, everything was itching. I was trying to get them off me. I thought I had some insect eggs under my fingernails. I took small scissors and was poking under fingernails and was trying to take them off through my skin. Then my parents decided to transfer me to a psychiatric hospital.
The environment I was in had a bad impact on me. Everything was dirty there. They didn't care about their patients. Many patients smelled like toilet. Some hospital attendants were abusing us. They forced us to clean our wards. Sometimes, they battered us. We had to eat tasteless broth with no pulp in it.
Because of unsanitary conditions, I developed an oxyesthesia. The medications gave a temporary relief because I slept more afterwards. The medications did not treat me, they just made me less vigorous. I have stayed there for two months. I felt bad in the hospital and my mother decided to take me home. But my father did not want to see me at all.
When I came home, he did his best to avoid seeing me. He went to work early and came back late. When I wanted to talk to him, he was silent and turned his face away, left for another room, or just went outside. I was visiting the psychiatrist once a week for three months. But I was still thinking that something was wrong with my body and I felt dirty. I developed depression that led to the attempted suicide. Afterwards, I was placed into the psychiatric hospital for treatment again.
I was there for one month this time. Then we came to another psychiatrist, whom I visit until now. He has helped me to get back to my normal state. He does not force me to do anything and does not say that I am sick.
Now I am on antidepressants. They help me to be more active, to take myself and work with my shortcomings. After one year of therapy, I found a job. Moreover, I am studying at the university. I still have a feeling of anxiety sometimes, I feel uneasy in public places and face to face with other people. If something bad happens during the day, I have panic attacks at night. As if someone is strangling me and I wake up from the oxygen deficiency.
I felt my body was burning a lot, everything was itching. I was trying to get them off me. I thought I had some insect eggs under my fingernails. I took small scissors and was poking under fingernails and was trying to take them off through my skin. Then my parents decided to transfer me to a psychiatric hospital.
The environment I was in had a bad impact on me. Everything was dirty there. They didn't care about their patients. Many patients smelled like toilet. Some hospital attendants were abusing us. They forced us to clean our wards. Sometimes, they battered us. We had to eat tasteless broth with no pulp in it.
Because of unsanitary conditions, I developed an oxyesthesia. The medications gave a temporary relief because I slept more afterwards. The medications did not treat me, they just made me less vigorous. I have stayed there for two months. I felt bad in the hospital and my mother decided to take me home. But my father did not want to see me at all.
When I came home, he did his best to avoid seeing me. He went to work early and came back late. When I wanted to talk to him, he was silent and turned his face away, left for another room, or just went outside. I was visiting the psychiatrist once a week for three months. But I was still thinking that something was wrong with my body and I felt dirty. I developed depression that led to the attempted suicide. Afterwards, I was placed into the psychiatric hospital for treatment again.
I was there for one month this time. Then we came to another psychiatrist, whom I visit until now. He has helped me to get back to my normal state. He does not force me to do anything and does not say that I am sick.
Now I am on antidepressants. They help me to be more active, to take myself and work with my shortcomings. After one year of therapy, I found a job. Moreover, I am studying at the university. I still have a feeling of anxiety sometimes, I feel uneasy in public places and face to face with other people. If something bad happens during the day, I have panic attacks at night. As if someone is strangling me and I wake up from the oxygen deficiency.
Assistance to doctors and medical staff
"Of course, our doctors have worked for many years and they exert emotional pressure. There are doctors who don't want to work, so young people do not come to [work] to us. It's difficult to supply city medical facilities with psychiatrists, not to speak of regional facilities," Uraimzhan Ismailov, the director of RCPZ, said.
Professional burnout, depression, apathy accompany the people who help others cope with these problems.
Professional burnout, depression, apathy accompany the people who help others cope with these problems.
In September 2020, Kyrgyzstan launched the Recovery Center Project. Everyone can get the required psychological aid there free of charge. Now they have experience of working with people who have serious disorders or parents who have children with Down's syndrome or autism. In addition, the centre renders aid to the people who have suffered from abuse.
But because of the coronavirus pandemic they have shifted to online work – they hold trainings in mental health, online consultations. The training for general practitioners was held recently to help them diagnose and treat minor mental disorders such as depression and anxiety disorder.
"In September, we gathered a focus group of doctors and we found out that they needed psychological groups to recover their mental health and treatment of professional burnout. This is generally related to the development of anxiety, annoyance, fatigue, and depression in them," said psychotherapist Lilia Panteleyeva.
They started with doctors who worked in the red zone. Among them were psychiatrists, psychologists and psychotherapists.
"We have divided doctors into groups. These were doctors who worked with coronavirus, volunteers who worked during the pandemic, and people who lost their relatives," said Panteleyeva.
But because of the coronavirus pandemic they have shifted to online work – they hold trainings in mental health, online consultations. The training for general practitioners was held recently to help them diagnose and treat minor mental disorders such as depression and anxiety disorder.
"In September, we gathered a focus group of doctors and we found out that they needed psychological groups to recover their mental health and treatment of professional burnout. This is generally related to the development of anxiety, annoyance, fatigue, and depression in them," said psychotherapist Lilia Panteleyeva.
They started with doctors who worked in the red zone. Among them were psychiatrists, psychologists and psychotherapists.
"We have divided doctors into groups. These were doctors who worked with coronavirus, volunteers who worked during the pandemic, and people who lost their relatives," said Panteleyeva.
I have difficulties and I am willing to cope with them
- Now I live and work in Bishkek. Some of my colleagues know that I have a mental disorder, but they support me. Due to the rehabilitation, I learned how to accept myself, how to build relationships. I have a boyfriend now. At first, I had difficulties in trusting him, but gradually I could do it. I know I have difficulties but I am willing to cope with them.
Authors:
- Zulfia Raissova,
- Daniil Lyapichev,
- Mazhab Jum'a
Editor:
Natalia Lee
Illustrations:
Nasiba Karimova
Layout:
- Zulfia Raissova
This publication was produced as part of the mentorship programme under the Development of New Media and Digital Journalism in Central Asia project delivered by the Institute for War and Peace Reporting (IWPR) with support from the UK Government. It does not necessarily reflect the official views of IWPR or the UK Government
