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At least 19 recordsLinked to original sources
PubMed2000

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?

OBJECTIVES: To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. DESIGN: Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. SETTING: The internal medicine clinic of a large, urban medical center. PARTICIPANTS: A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. INTERVENTIONS: All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. MAIN OUTCOME MEASURES: Self-reported history of torture. The awareness of primary care physicians of this history. RESULTS: Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. CONCLUSIONS: Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients.

Adult↗
PubMed1992

Medical appraisal of allegations of torture and the involvement of doctors in torture.

Today, torture is used in more than 90 countries. In most of these countries, the authorities try to conceal the use of torture. Therefore torture methods which do not leave marks are more often selected. Consequently, appraisal of statements of torture is mostly based on interviews with ex-prisoners. The statement of torture is compared with the description of symptoms in the period following imprisonment and with the result of the clinical examination, which is often normal. In the evaluation of the validity of a statement reservations often have to be made for minor disagreements between the single elements of the examination, for example because of impaired concentration during the examination and loss of consciousness during the torture. Furthermore, the statement may be incomplete because of psychological inhibitions and imperfect interpretation. Assessment of allegations of medical involvement in torture is also based on information given by the ex-detainee. The presumed doctor's examination technique and the treatment carried out and prescribed by him, are compared with the context in which he acted. Only very rarely do torture victims have marks from e.g. injections or suturing which can be related to medical treatment in torture centres. The critical evaluation of data collected during in-depth interviews with torture victims is the core of documentation of torture and medical involvement in torture. The national medical associations share the responsibility of ensuring that their country's doctors comply with the ethical rules and do not in any way participate in or omit to report torture.

Burns↗
PubMed1994

Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey.

OBJECTIVE: The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners. METHOD: The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features. RESULTS: The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology. CONCLUSIONS: The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.

Adult↗
PubMed1988

Sequelae to torture. A controlled study of torture victims living in exile.

Twenty-eight Turkish refugees living in Denmark were examined by the authors in the period 1984-85. Fourteen of the persons alleged having been tortured in Turkey during the period 1980-83. The remaining 14 persons reported that they had not been tortured and thus acted as controls. All the testimonies were found valid according to a method previously used by us. The most common forms of violence reported were blows and electrical torture. Blindfolding, solitary confinement and threats were also frequent. At the time of examination the main mental complaints were sleep disturbances with nightmares and impaired memory. Emotional lability and concentration disturbances were also frequent. Physically the torture victims suffered from headache, various cardio-pulmonary and muscular pains, dyspepsia and reading disturbances. All reported that they had been healthy before torture. The clinical examination revealed only a few signs related to torture, although examples of minimal scars, fractured or missing teeth, discrete neurological disorders and mental depression were found. The 14 controls had significantly fewer complaints, and almost no abnormalities were found during the clinical examination. The present study clearly demonstrates the traumatic effects of torture.

Adult↗
PubMed1999

[Bodily evidence can reveal torture. 5-year experience of torture documentation].

At the Centre for Torture and Trauma Survivors in Stockholm, 201 subjects from 34 countries were documented during a period of five years. Torture reports differed little between individuals from the same countries or regions, regarding methods and circumstances. Africans from Uganda (n = 22) reported brutal torture and manifested extensive scarring (mean number of scars, 20; range 4-65), whereas subjects from Syria (n = 28) reported falaka (i.e., bastinade), whipping and suspension, but manifested few or no scars (mean number 5, range 0-17). Of the subjects examined, 17% were women, of whom 79% reported having been raped during torture. Chronic back pain was the most common complaint at the time of examination. Correlation was found to exist between sexual torture and genito-urinary symptoms, bastinade and neural symptoms, and electrical torture and symptoms from the joints and gastro-intestinal tract. Severity of physical torture was a correlate of post-traumatic stress disorder. However, the forensic report had no effect on the verdict of immigration authorities regarding individual asylum applications.

Adolescent↗
PubMed1985

Psychological and physical long-term effects of torture. A follow-up examination of 22 Greek persons exposed to torture 1967-1974.

After an observation period of about 10 years a follow-up examination was made of 22 Greeks earlier exposed to torture. All had physical symptoms and about 90% of the examinees had chronic psychological symptoms which had appeared after the torture experience, the most notable of which were emotional instability, depression, passivity, fatigue and disturbed sleep. Eight of the victims had a chronic organic psychosyndrome as defined by us. The clinical picture of the torture victims is very similar to other stress-conditioned syndromes, which underlines the significance of the psychological trauma for the pathogenesis. Certain physical symptoms can be related to specific forms of torture; in this series particularly, symptoms of the feet and lower extremities can be related to 'falanga' (repeated blows to the soles of the feet). The most noticeable objective finding was unilateral atrophy of testis in 2 of the examinees caused in all probability by genital torture. Treatment of the sequelae to torture should be initiated as early as possible in the course of the illness, and studies on the effect of this treatment should be carried out.

Adult↗
PubMedDate not supplied

[Torture survivor asylum seekers in Italy: the experience of the humanitarian association "Doctors Against Torture"].

In recent years, the arrival in Italy of people who suffered torture in their countries led a group of volunteer doctors to set up a humanitarian association, "Doctors Against Torture", to provide care and treatment for torture survivors present in Rome. The paper describes the characteristics of 354 persons having at least one access from 1-1-1999 to 31-12-2001. About 51% of the victims came from the Middle East, 43% from Africa. Mean age was 29.6 (SD 7.0). The victims have suffered beatings and other forms of blunt trauma (64%), suspension and other positional torture (14%), psychological violence (28%), inhuman conditions of detention (10%), burns/electric shock (21%), wet asphyxiation and water jets (11%), sexual violence (15%), amputation/penetrating injuries (22%), dental torture and traumatic removal of nails (6%) and 58% suffered more than one type of torture. The types of violence observed require a thorough analysis of our knowledge in the field, in order to help victims on their way to rehabilitation, which is long and uncertain; at the same time, it is fundamental that public health begins to make itself responsible for these persons.

Adult↗
PubMedDate not supplied

Recent medical evidence for torture and human rights abuse in Sierra Leone: a report for the Medical Foundation for the Care of Victims of Torture.

A study was carried out using the case notes of all Sierra Leoneans referred to the Medical Foundation for the Care of Victims of Torture between 1996 and 1998 for medical reports. Data were abstracted on the type and extent of torture reported, and the cases were followed up to the present day to ascertain how long the United Kingdom asylum and immigration process had taken to process their claims. In the sample of 36 cases there were 68 reported incidents of torture or human rights abuse. Sixty-nine per cent (18/26) of the women in the sample had been raped at least once, and 72% (26/36) of the sample had been beaten at least once. The average time for the minimum due process of the asylum claim to be processed was 44 months (3.7 years). On 31 January 1999, 61% of the sample (22 people) were still involved in the asylum process. Waiting times must be reduced and safeguards imposed so that those who have suffered torture can be rapidly identified and referred for medical treatment, care and documentation.

Adult↗
PubMed1995

Working with survivors of torture and trauma: the Victorian Foundation for Survivors of Torture in perspective.

The health and welfare needs of refugee survivors of torture and trauma have in recent years belatedly found a prominent place on the policy agendas of Federal and State Governments. The development of a statewide service to meet these needs provides an opportunity to illustrate some of the general issues in developing a model specialist community health service, as well as the specific and complex elements involved in the care and resettlement of refugee survivors of torture and trauma. The early experience of the Victorian Foundation for Survivors of Torture is described and some descriptive data presented. Unresolved issues are highlighted, particularly the difficulty in providing skilled psychotherapeutic assistance to relatively large numbers of traumatised refugees.

Acculturation↗
PubMed1989

Torture of a Norwegian ship's crew. The torture, stress reactions and psychiatric after-effects.

During the summer of 1984, 14 seamen, the entire crew of a Norwegian ship, were seized upon arrival in Libya. They were kept under arrest for 67 days and subjected to psychological and physical torture because they were suspected of being enemies of the Libyan state. Within the first few days of imprisonment one seaman had been murdered, another had been abducted and was believed to be dead, and a third had been severely physically maltreated. The immediate reactions to the extreme stress were fear, depression and rage. Not a single seaman gave in to the torture. Shortly after their release, all the seamen underwent thorough medical examinations. Six of them suffered from clear-cut post-traumatic stress disorder (PTSD) and one more seaman developed the disorder two months later. In spite of comprehensive treatment, the same seven sailors, or 54% of the crew, still suffered from post-traumatic stress disorder six months after their release. Used in conjunction with clinical interview, general mental status rating scales (GHQ 20, STAI, State Anxiety Inventory), and specific post-traumatic rating scales (Amnesty Score, IES intrusion subscale, PTSS-10) had a high sensitivity and specificity in discriminating between cases and non-cases.

Adaptation, Psychological↗