Defining and documenting threats in the context of ill-treatment and torture

Threats are a common feature of detention and interrogation settings and have long been regarded as a routine procedure. Despite their prevalence and propensity to amount to ill-treatment and torture, threats have not been systematically and thoroughly analysed in case documentation processes. Given a lack of understanding, threats have unduly been considered a form of “torture-lite” at best by some juridical actors. However, its effect as an instrument of coercion can be devastating – engendering states of fear and anxiety and forcing its subject to act against their will. There is an important lack of theoretical reflection on what threats are, what types exist and how they impact the survivor. In this editorial, we aim to partly fill this gap from a medical and psychological perspective, providing a framework of understanding that will hopefully improve conceptual and practical assessment, documentation and qualification.

Patterns of torture among forcibly displaced Eritreans in California: A cross-sectional study

Introduction: Unprecedented global increases in involuntary migration have created large populations of forcibly displaced people, who are disproportionately likely to have experienced abuse and torture. We undertook this study to better understand the frequency and consequences of specific types of torture and abuse within an immigrant population in our community, San Francisco, East Bay. Methods and Results: We conducted a cross-sectional study of 59 Eritreans seeking asylum in the United States presenting to a human rights clinic for forensic medical and psychological evaluations. Demographic features of individuals, reported history and specific types of torture, and physical and psychological sequelae were analyzed. Over 300 instances of torture were reported, an average of about 6 per person. The primary forms of torture reported were beating and forced positioning, and many others were reported sporadically. 90% of asylum seekers examined had clinical findings which were consistent with the torture they reported, and some physical findings had clinical as well as forensic significance. 86% met diagnostic criteria for post-traumatic stress disorder. Discussion: Forcibly displaced people are likely to have witnessed and experience violence, deprivation, and abuse, and for this reason bear a disproportionate burden of physical, psychological, and social morbidity. Our study describes the epidemiology of torture and its consequences in a specific population, and demonstrates why understanding local and general epidemiology of torture and other forms of abuse is necessary to provide excellent biopsychosocial care to forcibly displaced people.

Trauma Psycho Social Support Plus® and EMDR therapy for children and adolescents in a post-conflict setting

Being confronted with the alarming situation in countries like Iraq and Syria – areas shaped by war, of people having lost their homes and suffering from horrible experiences - TraumaAid has designed and conducted a training program, especially for health workers in refugee camps. Clearly the intervention would have to adjust to specific circumstances; it would need a method adapted to another language and culture, an approach that could be used in a not-yet-secure situation with an undetermined number of sessions with every client. Resilience is an important aspect enabling people who suffered from different traumata to resume an everyday life again. Resource installation is a basic technique in EMDR (Eye Movement Desensitization and Reprocessing) which intensifies an integral awareness of individual resources for the client. As easy as this method may seem, a careful priming for its actual use is required. A profound understanding of how a traumatic experience affects body, thoughts and emotions is needed as background knowledge. Moreover qualified skills concerning the interaction with children are needed to be able to establish a trustful relationship in the first place. The following article describes a pilot project in Kurdistan / Northern Iraq - a training for psychologists, social workers and other mental health professionals working in different refugee camps. The aim was to provide the staff members with background knowledge of the dynamics of traumatization and teach them how to use resource installation in a responsible way to work with children, adolescents and their parents.

Obituary

In recent months, during a year when organizations that provide services for survivors of torture faced new challenges during the global COVID-19 pandemic, some of the people who have been leading the anti-torture movement for years have passed. We would like to remember and pay tribute here to some of these figures. This list is by no means exhaustive. It is intended, through the names it contains, to serve as a tribute also to the many workers, survivors and friends who have left us.

Engaging torture survivors in the global fight against torture

Lived experience can be emancipating and also paralysing, but foremost, it is immensely valuable to combat what has been suffered in first person (Henry, 2021). How to recognise that contribution and engage torture survivors in the global fight against torture? What role do survivors play in society? How to involve survivors in advocacy and policy-making processes? What are the existing power (in)balances at play? Who gets to decide whether a survivor should speak up or not? Acknowledging that it can prompt some organisational, therapeutic, and professional considerations, what are the limits? How do we ensure that the survivor’s well-being is protected along the process? To what extend should survivors be engaged in our organisation’s decision-making? In front of the current on-going debate on the need of actively engaging torture survivors in the global fight against torture, IRCT held a webinar to explore this topic. The webinar examined torture survivor engagement in the rehabilitation process of rebuilding lives, seeking justice and torture prevention. This article summarises the discussion held during the webinar with the presentations from Léonce Byimana[1], Feride Rushiti[2], Kolbassia Haoussou[3] and Vasfije Karsniqi-Goodman[4] and further inputs from other IRCT-members. [1] Executive Director of Torture Abolition and Survivors Support Coalition (TASSC) [2] Executive Director of the Kosova Rehabilitation Center for Torture Victims (KRCTV) [3] Director of Survivor Empowerment at Freedom From Torture [4] Survivor and member of the Kosovan parliament

Perception, practice and proximity. Qualifying threats as psychological torture in international law.

Background: Fear is a central dimension of torture and cruel, inhuman and degrading treatment (hereafter ‘other ill-treatment’), particularly as a part of verbal or non-verbal threats. Adjudicators and policy-makers have grappled, arguably at a greater depth than with other methods of psychological torture, with the circumstances in which fear-based methods amount to torture or other ill-treatment. The pursuit of non-coercive standards of police interrogation has further underscored the need to better distinguish the prohibited from the permitted. Upon this background, this article reviews the existing jurisprudential and social scientific literature in formulating a lens through which fear-inducing methods could be better functionally conceptualised. Method: This article has identified, through systematic full-text search of databases, texts with keywords ‘threat’, ‘fear’, ‘coercion’, ‘intimidation’, ‘distress’, ‘anguish’ and ‘psychological pressure’. The identified texts, limited to English-language journal articles, NGO reports, court-cases and UN documents from 1950 to date, were then selected for relevance pertaining to conceptual, evidentiary and legal critique provided therein. Discussion: Whilst it is broadly recognized that the deployment of fear to inflict violence can amount to torture, methods of threats or coercion are not adequately conceptualized particularly at the lower end, i.e. routine interrogational torture. Here, principles pertaining to the legitimate use of force and minimum level of severity are used as functional guidelines to distinguish the prohibited from the permitted. The power, practice and proximity of state authorities to harm necessarily qualify threats as real, immediate and credible and therefore torturous.

Experiences of surviviors of commercial sexual explotation availing rehabilitation at R&P homes in India

Background: Sex trafficking constitute as the primary form of human trafficking involving predominantly young girls and women. Rehabilitation of rescued victims of commercial sexual exploitation is critical in efficient reintegration into society. Aims: The main aim of the study is to explore the narratives of the victims of commercial sexual exploitation in understanding various factors towards eventual Rehabilitation within Rehabilitation & Protection (R&P) homes in India. Method: The study involves participatory action research at R&P homes in India. In total, 30 victims of commercial sexual exploitation, aged 29-50 years, participated in the study. Results: The result through thematic analysis reflected the initiators and detrimental factors towards Rehabilitation in R&P homes. The analysis also reflected various internal and external factors contributing to effective Rehabilitation. Conclusion: The results provide insight into various factors for critical action by practitioners on the field through intervention, policies, and other mechanisms. The research also emphasizes the employment of participatory action research for research with the critical and marginalized population.

Remote medico-legal assessment by telephone during COVID-19: Monitoring safety and quality when documenting evidence of torture for UK asylum applicants

Due to the Covid-19 pandemic, we developed remote assessment to provide interim medicolegal reports, ensuring people could obtain medical evidence to support their asylum claim. The Freedom from Torture research ethics committee approved the project. To audit this new way of working we collected feedback from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. Individuals reported that the doctors developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good as when face-to-face. In a majority of assessments the doctor was unable to gain a full account of the torture or its impact. Doctors reported feeling cautious about pressing for more information on the telephone, mindful of individuals’ vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture that was given with the psychological findings, in accordance with the Istanbul Protocol. The surveys indicated factors that hindered the assessment: inability to observe body language, the person’s ill health, and confidentiality concerns. The limitations of these assessments underline the need for a follow-up face-to-face assessment to expand the psychological assessment and undertake a physical assessment. This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment.

Acceptability of a physiotherapeutic pain school treatment in trauma-affected populations in the Middle Eastern & Northern African region

Introduction: The aim of this study was to evaluate the acceptability of a physiotherapeutic pain treatment (Pain School), focusing on patient education, physical exercises and self-reliance, and a capacity building program developed for MENA based physiotherapists working with pain and trauma-affected populations.Method: The perceived benefits and challenges of the physiotherapy Pain School treatment were evaluated through qualitative interviews with seven physiotherapists participating in the Pain School training program. The acceptability and feasibility of the treatment manual and training program of the physiotherapists was evaluated. The preliminary results of the Pain School treatment were also analyzed with a paired-sample t-test pre- and post-treatment in 38 patients suffering from persistent pain and trauma-related stress in the MENA region. Results: The qualitative analysis showed good feasibility and high acceptance among the participating physiotherapists of this physiotherapeutic treatment and training program. The pre- to post-treatment evaluation of Pain School, also gave an indication of positive treatment effects. Monitoring and evaluation of treatment was found useful, but indications of mental health status were evaluated to be missing. Due to other limitations, such as author biases (authors carrying out training, interviews and analyzing qualitative results) and no control group, the results from this study do not provide a final conclusion on the training program nor treatment effects. Nevertheless, this study is an important first step to offer evidence-based standardized treatment for pain and trauma-affected populations in the MENA region.