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Medical and psychological examination of women seeking asylum: documentation of human rights abuses.

Human rights abuses of women are ubiquitous throughout the world. Those perpetrated by governments entitle women to seek political asylum, and many women refugees do so in the United States. The asylum process often requires medical or psychological evaluations to corroborate women's reports of torture or other abuses. This article provides an overview of how to conduct such examinations and how to document findings for the asylum process.

Expert Testimony↗

Human rights abuses and concerns about women's health and human rights in southern Iraq.

CONTEXT: Although human rights abuses have been reported in Iraq, the full scope of these abuses has not been well documented. OBJECTIVE: To assess the prevalence of human rights abuses since 1991 in southern Iraq, along with attitudes about women's health and human rights and women's rights and roles in society, to inform reconstruction and humanitarian assistance efforts in Iraq. DESIGN: Cross-sectional, randomized survey of Iraqi men and women conducted in July 2003 using structured questionnaires. SETTING: Three major cities in 3 of the 9 governorates in southern Iraq. PARTICIPANTS: A total of 1991 respondents representing 16 520 household members. MAIN OUTCOME MEASURES: Respondent demographics, information on human rights abuses that occurred among household members since 1991, women's health and human rights, opinions regarding women's rights and roles in society, and conditions for community health and development. RESULTS: Respondents were a mean age of 38 years and were mostly of Arab ethnicity (99.7% [1976/1982]) and Muslim Shi'a (96.7% [1906/1971]). Overall, 47% of those interviewed reported 1 or more of the following abuses among themselves and household members since 1991: torture, killings, disappearance, forced conscription, beating, gunshot wounds, kidnappings, being held hostage, and ear amputation, among others. Seventy percent of abuses (408/586) were reputed to have occurred in homes. Baath party regime-affiliated groups were identified most often (95% [449/475]) as the perpetrators of the abuses; 53% of the abuses occurred between 1991 and 1993, following the Shi'a uprising, and another 30% between 2000 and the first 6 months of 2003. While the majority of men and women expressed support for women's equal opportunities for education, freedom of expression, access to health care, equality in deciding marriage and the number and spacing of children, and participation in community development decisions, there was less support among both men and women for women's freedom of movement, association with people of their choosing, and rights to refuse sex. Half of women and men (54% and 50%, respectively) reported agreeing that a man has the right to beat his wife if she disobeys. Fifty-three percent of respondents reported that there were reasons to restrict educational opportunities for women at the present time and 50% reported that there were reasons to restrict work opportunities for women at the present time. CONCLUSIONS: Nearly half of participating households in 3 southern cities in Iraq reported human rights abuses among household members between 1991 and 2003. The households surveyed supported a government that will protect and promote human rights, including the rights of women. However, currently, neither men nor women appear to support a full range of women's human rights.

Aged↗

Physician participation in human rights abuses in southern Iraq.

CONTEXT: Physicians are known to have participated in human rights abuses in Iraq during Saddam Hussein's Baathist regime, but the nature and extent of that participation are not well documented. OBJECTIVES: To characterize the nature of physician participation in human rights abuses, identify structural factors that facilitated physician participation, and assess approaches for accountability and for prevention of future physician participation in abuses. DESIGN, SETTING, AND PARTICIPANTS: A self-administered survey in June and July, 2003, of a convenience sample of 98 physicians and semistructured interviews of hospital directors and physicians in 3 major hospitals with general surgical units in 2 cities in southern Iraq. MAIN OUTCOME MEASURE: Respondent reports of peer and self-participation in human rights abuses in Iraq since 1988. RESULTS: The majority of participants were male (88% [86/98]) and Shi'a Muslims (97% [95/98]). Respondents reported a mean of 6.8 years in practice. A total of 71% of respondents (65/91) reported that torture was a problem to an extreme extent in Iraq since 1988. The proportion of respondents indicating that, since 1988, their physician peers as a group were extremely or quite a bit involved in human rights abuses included 50% (42/83) for nontherapeutic amputation of ears as a form of punishment, 49% (39/79) for falsification of medical-legal reports of torture, and 32% (25/78) for falsification of death certificates. Fewer numbers of respondents (range, n = 2 to 6) reported participation in abuses themselves. More than half (52% [48/92]) indicated that physicians did not willingly participate in these abuses; 93% (52/71) reported that the Iraqi paramilitary force Fedayeen Saddam was responsible for initiating physician complicity. Fear of harm to oneself or family members was a common explanation for complicity. Respondents reported that physicians who refused to participate in abuses faced consequences including loss of job, imprisonment, torture, and disappearance. Respondents reported on preventive measures that should be undertaken to prevent physician involvement in future abuses, including increasing human rights and ethics education of physicians (99% [79/80]), legal provisions to ensure effective monitoring (97% [73/75]), punitive sanctions for physicians who commit abuses (96% [77/80]), and ensuring the independence of physicians from state authorities (95% [76/80]). CONCLUSIONS: Although not generalizable beyond the study participants, the findings of this study suggest that among those surveyed, physician participation in human rights abuses included falsification of medical-legal reports of alleged torture, physical mutilation as a form of punishment, and falsification of death certificates. As Iraq rebuilds, it is essential that the country address these violations and enact measures to prevent physicians from future complicity in human rights abuses.

Female↗

The Truth and Reconciliation Commission in South Africa: relation to psychiatric status and forgiveness among survivors of human rights abuses.

BACKGROUND: The impact on individual survivors of human rights abuses of testifying before South Africa's Truth and Reconciliation Commission (TRC) has not been established. AIMS: To examine the degree to which participation in the TRC is related to current psychiatric status and forgiveness among survivors. METHOD: Survivors (n=134) who gave public, closed or no testimony to the TRC completed instruments measuring exposure to human rights abuses, exposure to other traumatic events, current psychiatric status and forgiveness attitudes towards the perpetrator(s). RESULTS: There was no significant association between TRC participation and current psychiatric status or current forgiveness attitudes, and low forgiveness was associated with poorer psychiatric health. CONCLUSIONS: Truth commissions should form part of, rather than be a substitute for, comprehensive therapeutic interventions for survivors of human rights abuses. Lack of forgiveness may be an important predictor of psychiatric risk in this population.

Adult↗

A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo.

OBJECTIVES: This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania. METHODS: Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed. RESULTS: The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault. CONCLUSIONS: The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.

Adolescent↗

Prevalence of war-related sexual violence and other human rights abuses among internally displaced persons in Sierra Leone.

CONTEXT: Sierra Leone's decade-long conflict has cost tens of thousands of lives and all parties to the conflict have committed abuses. OBJECTIVE: To assess the prevalence and impact of war-related sexual violence and other human rights abuses among internally displaced persons (IDPs) in Sierra Leone. DESIGN AND SETTING: A cross-sectional, randomized survey, using structured interviews and questionnaires, of internally displaced Sierra Leone women who were living in 3 IDP camps and 1 town, which were conducted over a 4-week period in 2001. PARTICIPANTS: A total of 991 women provided information on 9166 household members. The mean (SE) age of the respondents was 34 (0.48) years (range, 14-80 years). The majority of the women sampled were poorly educated (mean [SE], 1.9 [0.11] years of formal education); 814 were Muslim (82%), and 622 were married (63%). MAIN OUTCOME MEASURES: Accounts of war-related sexual assault and other human rights abuses. RESULTS: Overall, 13% (1157) of household members reported incidents of war-related human rights abuses in the last 10 years, including abductions, beatings, killings, sexual assaults and other abuses. Ninety-four (9%) of 991 respondents and 396 (8%) of 5001 female household members reported war-related sexual assaults. The lifetime prevalence of non-war-related sexual assault committed by family members, friends, or civilians among these respondents was also 9%, which increased to 17% with the addition of war-related sexual assaults (excluding 1% of participants who reported both war-related and non-war-related sexual assault). Eighty-seven percent of women believed that there should be legal protection for women's human rights. More than 60% of respondents believed a man has a right to beat his wife if she disobeys, and that it is a wife's duty/obligation to have sex with her husband even if she does not want to. CONCLUSIONS: Sexual violence committed by combatants in Sierra Leone was widespread and was perpetrated in the context of a high level of human rights abuses against the civilian population.

Adolescent↗

The role of the pathologist in human rights abuses.

The objective and unbiased statement is much valued in international work against human rights abuses. Pathologists play an increasingly important role. In this article, this role is illustrated by examples and the international set of rules is described. It is emphasised that under no circumstances should physicians assist in procedures, such as torture, which can weaken a human being. There is ongoing research into the sequelae of torture, both by gross and microscopic examination and in the living and dead victims.

Autopsy↗

Sadistic personality disorder in perpetrators of human rights abuses: a South African case study.

Although state-sponsored human rights abuses have long been commonplace, the psychological profiles of perpetrators are not well delineated. This article examines the utility of the diagnosis of sadistic personality disorder (SPD) in explaining the commission of atrocities. The history of, and controversies surrounding, SPD are briefly reviewed. Using a case study from the amnesty trials of the Truth and Reconciliation Commission (TRC) in South Africa, the relevance of the SPD diagnosis for an infamous perpetrator of political violence is debated. Sources of data include the perpetrator's autobiography, transcripts from the amnesty trial, and Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Spitzer, Gibbon, & Williams, 1994) ratings provided by four people who had contact with the perpetrator during his trial. The authors provide arguments for and against the use of the SPD diagnosis in this case and in similar contexts of perpetration. It is proposed that neither psychological reductionism nor social reductionism can adequately account for the motivations of political perpetrators, and an integrative approach to the understanding of perpetrators is advocated. Implications for diagnostic criteria are discussed.

Human Rights↗

Human rights abuse and other criminal violations in Port-au-Prince, Haiti: a random survey of households.

BACKGROUND: Reliable evidence of the frequency and severity of human rights abuses in Haiti after the departure of the elected president in 2004 was scarce. We assessed data from a random survey of households in the greater Port-au-Prince area. METHODS: Using random Global Positioning System (GPS) coordinate sampling, 1260 households (5720 individuals) were sampled. They were interviewed with a structured questionnaire by trained interviewers about their experiences after the departure of President Jean-Bertrand Aristide. The response rate was 90.7%. Information on demographic characteristics, crime, and human rights violations was obtained. FINDINGS: Our findings suggested that 8000 individuals were murdered in the greater Port-au-Prince area during the 22-month period assessed. Almost half of the identified perpetrators were government forces or outside political actors. Sexual assault of women and girls was common, with findings suggesting that 35,000 women were victimised in the area; more than half of all female victims were younger than 18 years. Criminals were the most identified perpetrators, but officers from the Haitian National Police accounted for 13.8% and armed anti-Lavalas groups accounted for 10.6% of identified perpetrators of sexual assault. Kidnappings and extrajudicial detentions, physical assaults, death threats, physical threats, and threats of sexual violence were also common. INTERPRETATION: Our results indicate that crime and systematic abuse of human rights were common in Port-au-Prince. Although criminals were the most identified perpetrators of violations, political actors and UN soldiers were also frequently identified. These findings suggest the need for a systematic response from the newly elected Haitian government, the UN, and social service organisations to address the legal, medical, psychological, and economic consequences of widespread human rights abuses and crime.

Adolescent↗

Investigation of clandestine graves resulting from human rights abuses.

The role of the forensic scientist in the investigation of clandestine graves resulting from human rights abuses is discussed. Individuals buried in such circumstances have perished following abuse by persons in authority or by other political factions. Such persons have been classed by the abusers as dissidents or political opponents, or have been killed simply for belonging to a particular racial or religious grouping. Guidelines for investigation and the general approach by the scientist are suggested and examples of exhumations are cited in which the author has had personal involvement. These include exhumations carried out in the former Yugoslavia, Rwanda and Chile.

Journal Article↗

The use of drugs in torture and human rights abuses.

The forced administration of drugs, usually by injection, may accompany physical torture. In the extrajudicial environment in which torture occurs, documentation of the types of drugs used is difficult. In violation of all codes of professional ethics, physician participation appears to be ubiquitous. In the Soviet Union, human rights abuses have become institutionalized within the mental health care system. Therapeutic drugs are used, often at toxic levels, to punish political and/or religious dissidents.

Dissent and Disputes↗

Discrimination and human rights abuse in Russia.

AIDS-related discrimination and human rights violations in Russia are widespread. The problems have been documented in a report prepared by the Russian NAMES Foundation, a national non-profit organization that provides services in HIV/AIDS awareness, offers social and psychological support to people affected by the AIDS epidemic, and advocates effective and non-discriminatory AIDS policies. The report is entitled AIDS-Related Violations of Human Rights and the Russian Legislation. The information presented in the report is based on testimonies by people with HIV/AIDS, their friends and families, medical professionals, state officials, workers at non-governmental organizations, and other citizens. The following is an edited version of the report.

AIDS Serodiagnosis↗

Survey reveals human rights abuses in Alberta.

A survey of people with HIV/AIDS in Alberta suggests that there are serious deficiencies in the provision of pre- and post-test counselling to people undergoing HIV-antibody testing. Survey respondents also identified human rights abuses in employment, housing, and other areas.

Alberta↗