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PubMed2004

Sexual torture of men in Croatia and other conflict situations: an open secret.

Sexual torture constitutes any act of sexual violence which qualifies as torture. Public awareness of the widespread use of sexual torture as a weapon of war greatly increased after the war in the former Yugoslavia in the early 1990s. Sexual torture has serious mental, physical and sexual health consequences. Attention to date has focused more on the sexual torture of women than of men, partly due to gender stereotypes. This paper describes the circumstances in which sexual torture occurs, its causes and consequences, and the development of international law addressing it. It presents data from a study in 2000 in Croatia, where the number of men who were sexually tortured appears to have been substantial. Based on in-depth interviews with 16 health professionals and data from the medical records of three centres providing care to refugees and victims of torture, the study found evidence of rape and other forced sexual acts, full or partial castration, genital beatings and electroshock. Few men admit being sexually tortured or seek help, and professionals may fail to recognise cases. Few perpetrators have been prosecuted, mainly due to lack of political will. The silence that envelopes sexual torture of men in the aftermath of the war in Croatia stands in strange contrast to the public nature of the crimes themselves.

Croatia↗
PubMed2006

Prevalent musculoskeletal pain as a correlate of previous exposure to torture.

AIM: To research possible associations between previous exposure to specific torture techniques and prevalent pain in the head and face, back, and feet. METHODS: 221 refugees, 193 males and 28 females, previously exposed to torture in their home country, were subject to a clinical interview at a rehabilitation clinic for torture victims. The interview focused on exposure to torture and somatic symptoms prevalent at examination. RESULTS: The mean number of times imprisoned was 2.3; the mean number of months imprisoned was 19.7; the mean duration from initial imprisonment to final release was 3.7 years; and the mean duration from final release to preliminary interview was 8.4 years. The most frequent physical torture method reported was beating (92.3%) and the main mental torture method was deprivation (84.6%). Pain in the head and face was found to be strongly associated with torture against head and face (OR 3.89, 95% CI 1.49-10.20) and with the cumulative number of physical torture methods exposed to. Pain in the back was associated with sexual torture (OR 2.75, 95% CI 1.07-7.12). Besides beating of the lower extremities (OR 5.98, 95% CI 2.47-14.48), the strongest predictor for pain in the feet was general abuse of the whole body (OR 5.64, 95% CI 1.93-16.45). CONCLUSION: In spite of many factors being potentially co-responsible for prevalent pain, years after the torture took place it presents itself as strongly associated with specific loci of pain, with generalized effects, and with somatizing.

Adolescent↗
PubMed2000

Study of knowledge, attitude and practice concerning aspects of torture.

The report presents the first attempt of the IMA-AKN Sinha Institute of continuing medical and health education and research to study the knowledge, attitude and practice of doctors regarding torture. Although, majority of the doctors in India are aware of various national and international human rights institutions, but they seem not to be aware of the human rights of the detainees. It is interesting to note that the doctors are aware of the long term physical and psychological effects of torture and also agreed that physical examination is not sufficient to detect torture sequelae. A large number of doctors have seen cases of torture, and were willing to treat them and felt reasonably competent. A significant number of doctors justified use of coercive technique and manhandling in dealing with detainees by law enforcement agencies. A small number of doctors expressed their unwillingness to get involved in the treatment of the victims of torture due to medicolegal consequence. The dissemination of information on human rights and medical ethics and incorporating them into the medical curriculum at undergraduate and postgraduate training was emphasised by majority of the respondents. Almost unanimous view was expressed by respondents on the importance of the role of medical ethics and the profession's responsibility to its members. An important finding of the study is the need for IMA to help establishing counselling and rehabilitation centres for treatment of torture victims and educate its members. A large number of doctors mentioned the need of initiating community action in case of rape, child abuse, dowry victims and sexual harassment. Further, a majority of respondents expressed the view that the medical association should take the responsibilities of protecting the doctors who fearlessly testify cases of torture besides disciplining doctors who facilitate torture. Respondents felt that the reasons for doctors' participation in torture need further study. It is encouraging that most of the responding physicians are willing to take up training and become counsellor for victims of torture to be able to provide treatment, counselling and rehabilitation.

Adult↗
PubMed2006

Prevalent pain and pain level among torture survivors: a follow-up study.

AIM: To estimate change over nine months and over two years, as concerns the prevalence and level of pain in the head, back and feet, among previously tortured refugees settled in Denmark, and to compare associations between torture methods and the prevalence of pain at baseline and at follow-up. METHODS: Sixty-nine refugees previously exposed to torture in their home country were interviewed at a Danish rehabilitation clinic. Fifty-four accepted to be re-interviewed after nine months, and 47 were interviewed again 14 months later. Interviews focussed on the history of exposure to physical and mental torture and on pain in the head, back and feet at baseline and at follow-up. RESULTS: The mean cumulative duration of imprisonment was 1.7 years, and on the average more than 10 years elapsed between torture and examination. The most frequent physical torture method reported was beating (97%), whereas the main mental torture method was threats of death (97%). The prevalence of pain reported at the follow-up interviews did not differ significantly from that reported at baseline (pain in the head, 81% at baseline and 77% at 23-month follow-up; back, 78% and 81%; feet, 59% and 70%). The same pattern was found when examining the level of pain as indicated by Visual Analogue Scales. Pain in the feet at follow-up was associated with previous exposure to beating against the feet. Pain in the back at baseline and pain in the head at follow-up were associated with suffocation. CONCLUSION: More than ten years after the torture took place, survivors of torture continue to suffer from pain associated with the type of torture they had been subjected to. This presents a considerable challenge to future evidence-based development of effective treatment programmes.

Adult↗
PubMed1998

Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal.

CONTEXT: Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown. OBJECTIVE: To examine the impact of torture on Bhutanese refugees in Nepal. DESIGN: Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression. SETTING: Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal. PARTICIPANTS: A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex. MAIN OUTCOME MEASURES: The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety. RESULTS: The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2.6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system- and respiratory system-related complaints (P<.001 for both). CONCLUSION: Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.

Adult↗
PubMed2004

[Medical aspects of objectifying torture sequels].

Migration, civil wars and other conflicts in various regions of the world have led to a drastic increase in the number of displaced persons and refugees. Associated with this development is an increase in the number of torture victims seeking asylum. This means that the medical personnel is increasingly confronted with the evaluation and therapy of torture victims. The methods of verification of sequels of torture are of utmost importance in the work-up of treatment centres for survivors of torture. Since each organ can be affected by torture, a multidisciplinary cooperation is mandatory for the examination of torture victims. In this paper we shall discuss some aspects concerning the diagnosis of injuries caused by torture which are essential for interviewing and examining torture victims in order to objectify sequels of torture.

Crime Victims↗
PubMed1990

Prevalence and sequelae of sexual torture.

283 torture victims (135 examined by the Amnesty International [AI] Danish Medical Group, and 148 by the International Rehabilitation and Research Center for Torture Victims [RCT]) were questioned about methods of torture and subsequent sexual difficulties. Overall, the prevalence of sexual torture was 61% (women 80%, men 56%), but this was higher in the RCT than in the AI group. More Latin Americans than Europeans had been sexually tortured in the AI group. Prevalence of sexual difficulties was 32%, the RCT recording a significantly higher prevalence than the AI (43% vs 20%). Sexually tortured victims were more likely to have sexual difficulties (40%) than were non-sexually tortured victims (19%). Overall, there were more cases of sexual difficulties in victims from Africa and from Turkey/Middle East/Far East than in victims from Latin America and from Europe. In the RCT subsample, prevalence of sexual difficulties and anxiety was significantly higher in sexually tortured victims than in non-sexually tortured victims; the two groups were broadly similar with respect to depression and low self-esteem. Depressed victims and victims with low self-esteem were more likely to have sexual difficulties. In the RCT group, but not overall, prevalence of sexual difficulties was significantly associated with age but was independent of low self-esteem and of depression.

Adolescent↗
PubMed2002

Torture and its neurological sequelae.

BACKGROUND: Refugees and asylum seekers continue to enter the United States and the European Union in record numbers. Some have estimated that between 5-35% of all refugees have suffered torture in their countries of origin. Although general practitioners and specialized physicians are likely to encounter victims of torture as patients, few providers are familiar with the health problems that may affect this patient population. PURPOSE: :To provide neurologists, neurosurgeons, and rehabilitation medicine physicians with basic knowledge about survivors of torture that can help in the diagnosis, treatment, and referral of such patients. METHODS: A MEDLINE (1966-October 2001) search using keywords torture and sequelae (nervous system diseases and brain injuries) was conducted. Other data sources included books, reference lists, online resources and expert opinion. FINDINGS: :Forms of torture that may affect the nervous system include beatings, gunshot wounds, stab wounds, asphyxiation, prolonged suspension and electrocution. Victims of torture commonly experience neurological symptoms such as headaches, vertigo, loss of consciousness and dizziness during and after torture. A successful and meaningful clinical interaction with a survivor of torture includes avoiding retraumatization, building trust, spelling out any limits on confidentiality, and above anything else, establishing empathy with the patient. CONCLUSIONS: Neurological sequelae of torture can be devastating physically and psychologically. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique and must focus on avoiding retraumatization and helping the victim reintegrate into society as quickly as possible.

Comorbidity↗
PubMed1990

Medical education for the prevention of torture.

The United Nations Convention against Torture came into force on June 1987 and the European Convention for the Prevention of Torture on 1 February 1989. The two Conventions are complementary and do not overlap in any respect, including their relevance to training of health personnel. The United Nations Convention calls for education of all doctors and other health personnel. Education should therefore be at the undergraduate level and should provide an insight into torture methods, the goal and objectives of torture and the sequelae of torture so that doctors can identify victims of torture. Refugee victims of torture should not be sent back to countries where they are at risk of torture. The main principles of treatment must also be taught. The European Convention makes no demands for education of doctors in general and thereby no demands for undergraduate training. However, the activities of the Committee necessitate special postgraduate training of a limited number of persons: members of the committee, experts and interpreters.

Curriculum↗
PubMed1994

Factors related to long-term traumatic stress responses in survivors of torture in Turkey.

OBJECTIVE: To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture. DESIGN: The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors. SETTING: Istanbul, Turkey. MAIN OUTCOME MEASURES: Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory. RESULTS: Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms. CONCLUSIONS: These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.

Adult↗
PubMed1995

Evidence of physical torture in a series of children.

In a refugee camp for Kashmiris it was stated that children had been exposed to torture and ill-treatment; consequently, we decided to appraise the validity of such statements. Ten boys allegedly exposed to torture and 10 children who were said to have been ill-treated were interviewed and examined. The veracity of the individual statements about exposure was appraised through an assessment of the consistency between the history and the clinical findings. In all cases of alleged torture, the history was in agreement with clinical findings ascribed to torture. Torture methods included cuts with bayonets and burns with items easily available in any setting. In five of the 10 cases of torture, the scars were highly indicative of intentionally inflicted injuries, by their shapes, their presence in clusters and their localization in regions not normally exposed to traumatization. Nine of the 10 children allegedly exposed to ill-treatment had scars in accordance with their histories. In all cases, Indian security forces were said to have been responsible for the inflicted violence. The histories and the clinical findings were in accordance with results of examinations of adult victims of organized violence from the same region. On the basis of the physical evidence, in each case in agreement with the history, it is concluded that torture of children has occurred in Kashmir. Series of children with physical evidence of torture have not previously been described in the medical literature.

Adolescent↗
PubMed2006

Physical methods of torture and their sequelae: a Sri Lankan perspective.

Methods of torture vary from country to country and sometimes within regions in the same country. Knowing torture methods used in a country or region assists in evaluating injuries, scars and other chronic sequelae of torture. Medical records of 100 victims of torture examined between 1998 and 2001 in the Judicial Medical Officer's Office in Colombo, Sri Lanka, were perused to gather data on torture methods used in Sri Lanka during that period. Altogether 68 methods of torture had been used on these victims. They included assault with blunt and sharp weapons, burns with lighted cigarettes, 'dry submarino', kicking, 'wet submarino', 'hanging', electric torture, 'falaka' and many more. However, only 18% of victims had any physical residual effects, highlighting the typical objective of torture, which is inflicting maximum pain without causing serious injury or death.

Adolescent↗
PubMed2000

Chronic pain in torture survivors.

According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the study. The patients were referred to a pain specialist for evaluation of unsolved pain problems. Eighteen male torture victims were examined. Twelve patients experienced pain at more than three locations. Nociceptive and neuropathic pain were demonstrated in all patients. Specific neuropathic pain conditions were related to the following four types of physical torture: Palestinian hanging, falanga, beating and kicking of the head, and positional torture. When treating torture victims, it is important to know about torture methods, to think differently than normal on etiological and pathogenetic factors and always consider the presence of neuropathic pain.

Adult↗
PubMed2000

Listening for the sounds of silence: a nursing consideration of caring for the politically tortured.

In 1997 Amnesty International reported that 115 out of 251 countries surveyed practised torture on their citizens. Many of these victims have been forced to flee their country of origin and become refugees in the West, in countries such as Australia, Canada, the UK and the United States. However, torture itself remains an unspoken and covert problem. In addition to the obvious traumatic effects, it may induce shame and dread on the part of the victim. It may be too terrifying and too painful to talk about, and yet may affect every aspect of a person's life (Forrest 1996). All too commonly a victim of torture may pass unnoticed or unrecognised because health care providers do not know how, or may be unwilling to engage with the issue. This paper will examine the implications for nurses of caring for the tortured. It will explore the nature of torture itself, who might be the perpetrators and who might be the victims (always acknowledging that nurses and other health care staff are often both), how victims of torture may present for health care, and the possible subjective perceptions of a torture victim when faced with a Western health care process and understanding. Finally, it will argue for an increase in awareness and sensitivity on the part of all nurses in all health care settings to the needs and sensibilities of victims of torture, and suggest that caring for them is the distillation of everything good nursing practice should be.

Empathy↗
PubMed1998

The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group.

The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.

Adult↗
PubMed2003

Psychiatric disability among tortured Bhutanese refugees in Nepal.

OBJECTIVE: Most refugees live in low-income countries. There is a lack of data on psychiatric disability among such refugees. The authors compared psychiatric disability in tortured and nontortured Bhutanese refugees living in Nepal and examined factors associated with psychiatric disability among the tortured refugees. METHOD: A cross-sectional survey was conducted among 418 tortured and 392 nontortured Bhutanese refugees, matched for age and gender. The Composite International Diagnostic Interview, version 2.1, and the World Health Organization Short Disability Assessment Schedule were used to measure ICD-10 psychiatric disorders and disability, respectively. RESULTS: Approximately one in five tortured and nontortured Bhutanese refugees were found to be disabled. Posttraumatic stress disorder, specific phobia, and present physical disease were identified as factors associated with disability among the tortured refugees. On the other hand, present physical disease, greater age, and generalized anxiety disorder were associated with disability among the nontortured group. CONCLUSIONS: These findings show that the tortured and nontortured refugees were equally likely to be disabled. Different sets of predictors were identified among tortured and nontortured refugees, indicating the need for comprehensive psychiatric assessment of both tortured and nontortured refugees in clinical practice.

Adult↗
PubMed2007

Classifying the torture experiences of refugees living in the United States.

Few research studies have systematically categorized the types of torture experienced around the world. The purpose of this study is to categorize the diverse traumatic events that are defined as torture, and determine how these torture types relate to demographics and symptom presentation. Data for 325 individuals were obtained through a retrospective review of records from the Bellevue/NYU for Survivors of Torture. A factor analysis generated a model with five factors corresponding to witnessing torture of others, torture of family members, physical beating, rape/sexual assault, and deprivation/passive torture. These factors were significantly correlated with a number of demographic variables (sex, education, and region of origin). Post Traumatic Stress Disorder, anxiety, and depression symptoms were significantly correlated with the rape factor but no other factors were uniquely associated with psychological distress. The results offer insight into the nature of torture and differences in responses.

Adolescent↗
PubMed2004

Somali and Oromo refugees: correlates of torture and trauma history.

OBJECTIVES: This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS: A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS: Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS: This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Adult↗