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PubMedDate not supplied

Assessment of torture and ill treatment of detainees in Mexico: attitudes and experiences of forensic physicians.

CONTEXT: International and Mexican human rights organizations have documented torture of detainees (ie, those held and indicted but not sentenced) in all 31 states and the Federal District of Mexico, but little is known about the attitudes and experiences of forensic physicians examining detainees. OBJECTIVE: To assess forensic physicians' experiences with and attitudes toward the nature and extent of torture and ill treatment among detainees examined in the previous year. DESIGN, SETTING, AND PARTICIPANTS: With the support of the Mexican Office of the Federal Attorney General, as part of a larger initiative to implement governmental reforms to eradicate torture in Mexico, an anonymous, self-administered, written, 80-item survey designed to assess correspondence of physician practices and attitudes with international standards on forensic investigation and documentation of torture was distributed to all federal forensic physicians (n = 115) and a convenience sample of state forensic physicians (n = 99) in Mexico in 2002. MAIN OUTCOME MEASURES: Estimates of the numbers of federal detainees medically evaluated and numbers of cases of suspected, alleged, and documented torture or ill treatment among federal detainees; factors interfering with documentation of forensic evidence; physicians' attitudes toward torture; measures that would help them document torture; and recommendations for reform. RESULTS: Survey responses were received from 93 (81%) federal and 91 (92%) state forensic physicians. Forty-nine percent of federal physicians and 58% of state physicians reported that torture is a severe problem for detainees in Mexico. Federal physicians estimated that they had conducted 26 445 to 30 650 or more medical evaluations of the 13 000 federal detainees in the past year and that between 1658 and 4850 of these detainees had alleged torture; these physicians also estimated that they had documented evidence of torture in a range of 285 to 1090 cases. Forty percent of respondents had suspected torture and/or ill treatment of detainees examined during the previous year, 64% had examined detainees who alleged these practices had occurred, and 49% had documented forensic evidence of torture among these detainees. Respondents reported that lack of photographic equipment and services (58%), inadequate monitoring and accuracy of medical examinations (36%), inadequate documentation of torture (29%), limitations in their training (28%), fear of reprisals for documenting torture (23%), and fear of coercion by police officials (18%) are factors that interfere with documentation of torture and ill treatment of detainees. Respondents further reported the need for additional training (98%), standardized protocols and documentation procedures for use in cases of alleged or suspected torture and/or ill treatment (81%), and monitoring to ensure the quality and accuracy of medical evaluations (95%). CONCLUSIONS: Torture and ill treatment of detainees is a major problem in Mexico facilitated by multiple medical and legal factors. Mexican forensic physicians support measures to improve forensic documentation of torture and ill treatment of detainees.

Attitude of Health Personnel↗
PubMed2002

[Torture as a part of war strategy in Bosnia and Herzegovina].

PURPOSE: To make an identification methods of torture in Bosnia and Herzegovina and their frequency during aggression of war period employed on survivors of torture victims. METHODS: The research study included 108 patients with experiences of war torture. Of 108 patients, 74 or 68.5% were males and 34 or 31.5% females. Most of them were Bosniacs--102 patients, three Croats and three belonging to other nationality. In registration of employed methods of torture, we used Scale for exposition to torture. RESULTS: Majority of patients--75% was frequently tortured during a long period of time, 18% were not tortured that frequently, and 7% were rarely tortured. The most frequently present methods of torture employed were psychological torture, physical torture, and the last sexual methods of torture. CONCLUSIONS: The psychological methods of torture were very hard overcoming by torture survivors who developed chronic psychological consequences of torture.

Adolescent↗
PubMed2003

Torture and its sequel--a comparison between victims from six countries.

The aim of the study was to compare torture victims from six different nations and analyse differences and similarities. From the files of the Centre for Trauma Victims in Stockholm (KTC), 160 patients were selected: 53 patients from Bangladesh, 21 from Iran, 16 from Peru, 24 from Syria, 25 from Turkey, and 21 from Uganda. The data was classified into: (i) information about social conditions and circumstances pertaining to alleged torture, (ii) type of trauma and torture methods, and (iii) acute and late sequel to torture. Descriptive and non-parametric statistics were used in the analyses. There was a strong male dominance in all but the Ugandan group where 43% were women. The majority in all but the Turkish group had college exams and/or university studies. Over 84% were members of a political organisation except in the Iranian and Syrian groups, where more than 40% had no political affiliation. The majority in all groups had travelled to Sweden alone to apply for asylum, but most refugees from Turkey, Iran, and Syria had close relatives already living in Sweden. The stories of circumstances and torture methods were similar within each group but differed a great deal between groups. Typically, in Bangladesh, Peru, and Turkey, the periods under arrest were short: from a few hours to 3 days. In Iran, Uganda, and Syria, the time in custody varied from several months to several years. A prison sentence preceded by trial was common only in Iran. Many patients, especially from Bangladesh and Turkey, had been arrested several times. Sensory deprivation by isolation and blindfolding was common in all countries except Uganda and Peru. Beating with fists, sticks, truncheons, etc. were reported in 100% in every group. In Bangladesh, police batons (lathi) were used more commonly than in any other group. Whipping with electric cords occurred frequently only in Iran and Syria. Rape was most often reported among the Ugandans. Genital torture was frequently alleged by patients from Bangladesh and Turkey. Suspension was common in all countries except for Uganda. Falaka, i.e. beating of the soles, and electric torture were common (>60%) in Bangladesh, Iran, Syria, and Turkey. Sharp injuries inflicted with knives and bayonets were often seen among the Bangladeshi and Ugandans. Burning injuries due to cigarettes were commonly seen only in patients from Bangladesh. Some methods were found to be almost exclusive for each country: "water treatment" (Bangladesh), the "tyre" (Syria), "telephono" and "submarino" (Peru). The sequel of torture differed in some respects between groups. Fractures were more common among Iranians. Patients from Uganda and Bangladesh had numerous scars. Subjectively reported symptoms were most frequent among Bangladeshi, especially joint pain and ear, nose, and throat symptoms and least frequent among Ugandans. PTSD diagnosed on the basis of a psychiatric interview and psychological tests was found in 69-92% of patients in all groups. The study shows significant differences between countries regarding circumstances, torture methods, and sequel to torture. This knowledge is of value to forensic specialists documenting alleged torture and essential for fair and valid forensic statements.

Adult↗
PubMed1997

Psychological preparedness for trauma as a protective factor in survivors of torture.

BACKGROUND: Although much research has focused on mechanisms of traumatization and factors related to post-trauma psychological functioning in survivors of trauma, there have been few studies of survivors of torture despite the widespread practice of torture in the world. The aim of this study was to examine the role of 'psychological preparedness' for trauma in post-traumatic stress responses in survivors of torture. METHOD: Thirty-four torture survivors who had no history of political activity, commitment to a political cause or group, or expectations of arrest and torture were compared with 55 tortured political activists, using structured interviews and measures of anxiety, depression, and post-traumatic stress disorder. RESULTS: Compared with tortured political activists, tortured non-activists were subject to relatively less severe torture but showed higher levels of psychopathology. Less psychological preparedness related to greater perceived distress during torture and more severe psychological problems, explaining 4% of the variance in general psychopathology and 9% of the variance in post-traumatic stress disorder symptoms. CONCLUSIONS: The study findings lend support to the role of prior immunization to traumatic stress and to unpredictability and uncontrollability of stressors in the effects of traumatization. Further research aimed at identifying the behavioural and cognitive components of psychological preparedness that play a role in traumatization may provide useful insights into effective treatment strategies for survivors of torture.

Adaptation, Psychological↗
PubMed2006

Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice.

BACKGROUND: The prevalence of torture among foreign-born patients presenting to urban medical clinics is not well documented. OBJECTIVE: To determine the prevalence of torture among foreign-born patients presenting to an urban primary care practice. DESIGN: A survey of foreign-born patients. PATIENTS: Foreign-born patients, age > or = 18, presenting to the Primary Care Clinic at Boston Medical Center. MEASUREMENTS: Self-reported history of torture as defined by the UN, and history of prior disclosure of torture. RESULTS: Of the 308 eligible patients, 88 (29%) declined participation, and 78 (25%) were not included owing to lack of a translator. Participants had a mean age of 47 years (range 19 to 76), were mostly female (82/142, 58%), had been in the United States for an average of 14 years (range 1 month to 53 years), and came from 35 countries. Fully, 11% (16/142, 95 percent confidence interval 7% to 18%) of participants reported a history of torture that was consistent with the UN definition of torture. Thirty-nine percent (9/23) of patients reported that their health care provider asked them about torture. While most patients (15/23, 67%) reported discussing their experience of torture with someone in the United States, 8 of 23 (33%) reported that this survey was their first disclosure to anyone in the United States. CONCLUSION: Among foreign-born patients presenting to an urban primary care center, approximately 1 in 9 met the definition established by the UN Convention Against Torture. As survivors of torture may have significant psychological and physical sequelae, these data underscore the necessity for primary care physicians to screen for a torture history among foreign-born patients.

Adult↗
PubMed2001

Psychiatric disorders among tortured Bhutanese refugees in Nepal.

BACKGROUND: The impact of torture on the distribution of psychiatric disorders among refugees is unknown. METHODS: We surveyed a population-based sample of 418 tortured and 392 nontortured Bhutanese refugees living in camps in Nepal. Trained interviewers assessed International Classification of Diseases, 10th Revision (ICD-10) disorders through structured diagnostic psychiatric interviews. RESULTS: Except for male sex, history of torture was not associated with demographics. Tortured refugees, compared with nontortured refugees, were more likely to report 12-month ICD-10 posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders. In addition, tortured refugees were more likely to report lifetime posttraumatic stress disorder, persistent somatoform pain disorder, affective disorder, generalized anxiety disorder, and dissociative (amnesia and conversion) disorders. Tortured women, compared with tortured men, were more likely to report lifetime generalized anxiety disorder, persistent somatoform pain disorder, affective disorder, and dissociative (amnesia and conversion) disorders. CONCLUSIONS: Among Bhutanese refugees, the survivors had higher lifetime and 12-month rates of ICD-10 psychiatric disorder. Men were more likely to report torture, but tortured women were more likely to report certain disorders. The results indicate the increased need for attention to the mental health of refugees, specifically posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders among those reporting torture.

Adult↗