Module 4: Torture Methods and their Medical Consequences

Electrical injuries

Electric shocks have been used commonly by torturers for many years because they cause exquisite pain but rarely leave identifiable physical signs. The equipment can be as basic as the magneto of an old military field telephone or a couple of bare wires in an electrical socket to complex stun guns.

Magnetos (generators) are generally hand-cranked devices that provide a direct current (DC) related to the speed at which a rotor is turned – giving an opportunity to threaten the victim further. Main electrical currents can be delivered through bare wires touched against the skin, which might have been previously covered in water. Clips are sometimes used, and these can cause small lacerations when they pull off as the victim jolts with the force of the current. Some torturers have used fixed systems using switches or levers which again can be used to increase the threat of the torture.

Battery operated devices are portable but can still deliver a high voltage which may be alternating current (AC) or DC. Electric shock batons are being superseded by a range of devices including stun shields, remote control stun belts, and tasers, many of which were originally designed for law-enforcement purposes.

Electrical torture uses the property of the electrical current to cause pain: in the body the current travels along nerves and blood vessels as they are the paths of lower resistance. As the current travels, it causes contractions to the muscles involved and severe pain. These contractions can cause dislocation of joints and, if the chest muscles are involved, difficulties in breathing. If the current passes through the heart, arrhythmias (irregular heartbeat) can develop, leading to sudden death. Torturers apply electricity to the most vulnerable and intimate parts of the body. Genitals and breasts are often targeted and the victim is threatened on his or her reproductive capacity. When the current involves the muscles controlling urination and defecation those can occur without the victim being able to exercise control. The mouth also is very sensitive and often targeted.

Areas of reddening may persist for weeks. Occasionally the electrodes can leave small burns, probably from sparking. Both tend to be circular and less than 0.5 cm in diameter. These lesions may create hyperpigmentation. However, as these lesions are small, they may be difficult to find. Although non-specific, they can corroborate allegations of electric shock torture, especially if they are in certain parts of the body. Studies have shown distinctive changes to cells beneath the site of the shock on microscopy, but such investigations should only be performed if they are essential to the legal case.

Electric shocks have been used commonly by torturers for many years because they cause exquisite pain but rarely leave identifiable physical signs. The equipment can be as basic as the magneto of an old military field telephone or a couple … Continue reading

Asphyxiation

The most common way of inducing asphyxia to near-death is submarino as it is nicknamed in Latin American countries. The head is immersed in water for minutes at a time to the point of drowning, then brought out and immersed again. In some countries the victim is suspended by the ankles and lowered repeatedly into a tank. A variant of submarino is for a plastic bag or similar impervious material filled with liquid to be tied over the head. In all these techniques the water is often contaminated with sewage or chemicals, adding to the immediate distress and increasing the likelihood of permanent ill-effects.

“Waterboarding” is another form of asphyxiation torture that dates back to the Middle Ages and recently practised by the United States. Victims are strapped to a board or made to lie in a supine position with their heads lower than the rest of their bodies, their faces covered with cloth, and water is poured over their mouths to create the sensation of drowning.

Dry submarino is practised with a plastic bag or similar impervious material placed over the head and tied tightly around the neck. Again, there is often contaminated material or an irritant such as chilli powder inside the bag. In Sri Lanka a small amount of petrol is often put in the bag so that there is chemical poisoning as well as asphyxiation.

The immediate effects of these techniques vary according to whether there has been any contamination. If so, there is likely to be severe upper respiratory and perhaps broncho-pulmonary inflammation. Conjunctivitis or otitis media may follow, particularly after submarino. Irritants such as petrol or chilli may cause a dermatitis which is indistinguishable from acne. Any long-term effects of these techniques are not easy to assess but many victims attribute their asthma or bronchitis to having been asphyxiated many years previously. If there was no history of pre-existing disability, it may be reasonable to consider this as a possibility.

The most common way of inducing asphyxia to near-death is submarino as it is nicknamed in Latin American countries. The head is immersed in water for minutes at a time to the point of drowning, then brought out and immersed … Continue reading

Violent Shaking

Violent shaking may be haphazard or, as in the case of Israel, systematic and planned. In such cases, bruising may be found on the chest or shoulders where the victim was seized but otherwise there are few outward signs. In the acute phase there is usually headache, disorientation and often a changed mental state. The most severe cases demonstrate all the features, potentially fatal, that have been well documented in shaken infant syndrome – cerebral oedema, subdural haematoma and retinal haemorrhage, the last being the major sign that makes possible a diagnosis before death. It has been named the shaken adult syndrome.

Non-fatal brain trauma from violent shaking can potentially result in more subtle but clinically significant cognitive impairment possibly due to diffuse axonal injury, injury to the brain cells themselves. Non-fatal consequences of shaking may also include recurrent headaches, disorientation and mental status changes, all of which can become chronic. Violent shaking can also produce neck trauma, producing a whiplash mechanism of cervical strain. Cervical spine fracture with spinal cord compression may also occur, resulting in quadriplegia.

Violent shaking may be haphazard or, as in the case of Israel, systematic and planned. In such cases, bruising may be found on the chest or shoulders where the victim was seized but otherwise there are few outward signs. In … Continue reading

Sexual Assault

Sexual torture begins with forced nudity, which in many countries is a constant factor in torture situations. An individual is never as vulnerable as when naked and helpless. Nudity enhances the psychological terror of every aspect of torture, as there is always the potential of abuse, rape or sodomy. Furthermore, verbal sexual threats, abuse and mocking are also part of sexual torture, as they enhance the humiliation and its degrading aspects. The groping of women is traumatic in all cases and is considered to be torture.

Sexual assault is clearly not simply a physical assault on the individual, but in many instances it is the psychological insult that is most injurious. Often, sexual assaults will be accompanied by direct or implied threats. In the case of women, the threat may be one of becoming pregnant. For men, those inflicting the torture may also threaten (incorrectly but usually deliberately) that the victim will become impotent or sterile. For men or women there may be the threat of contracting HIV or other sexually transmitted infections (STIs) and often the threat or fear that sexual humiliation, assault or rape will lead to ostracism from the community and being prevented from ever marrying or starting a family. Sexual assaults can be categorised as:

  • Assaults to the genitals
  • Electric shocks to the genitals and anus
  • Forced sexual acts on themselves or on/with others
  • Object inserted into the vagina (in women)
  • Object inserted in the urethral meatus (in men)
  • Object inserted through the anus
  • Penis forced into the mouth
  • Penis forced through the anus
  • Penis forced into the vagina (in women).

The term ‘rape’ refers to the last of these, but in many jurisdictions it can mean one or more of the others. Thus if the term is used, the act should also be specified.

There are some differences between sexual torture of men and sexual torture of women, but several issues apply to both. Rape is always associated with the risk of developing sexually transmitted diseases, particularly human immunodeficiency virus (HIV).[1] Currently, the only effective prophylaxis against HIV must be taken within hours of the incident, and may not be available in countries where torture occurs routinely. In most cases, there will be a lewd sexual component, and in other cases torture is targeted at the genitals. Electricity and blows are generally targeted on the genitals in men, with or without additional anal torture. The resulting physical trauma is enhanced by verbal abuse. There are often threats of loss of masculinity to men and consequent loss of respect in society. Prisoners may be placed naked in cells with family members, friends or total strangers, breaking cultural taboos. This can be made worse by the absence of privacy when using toilet facilities. Additionally, prisoners may be forced to abuse each other sexually, which can be particularly difficult to cope with emotionally. The fear of potential rape among women, given profound cultural stigma associated with rape, can add to the trauma. Not to be neglected are the trauma of potential pregnancy, which males, obviously, do not experience, the fear of losing virginity and the fear of not being able to have children (even if the rape can be hidden from a potential husband and the rest of society).

Children may also be victims of rape and sexual assault. Even older children may be unaware of what happened to them, and may not be able to give a coherent account of their experience. Using drawings and, if available, dolls may help them explain where they do not have the necessary language or understanding. It is even more important that the examination is performed by someone who is experienced in this field.

If in cases of sexual abuse the alleged victim does not wish the event to be known due to sociocultural pressures or personal reasons, the physician who carries out the medical examination, investigative agencies and the courts have an obligation to cooperate in maintaining the victim’s privacy. Establishing a rapport with torture survivors who have recently been sexually assaulted requires special psychological education and appropriate psychological support. Any treatment that would increase the psychological trauma of a torture survivor should be avoided. Before starting the examination, permission must be obtained from the individual for any kind of examination, and this should be confirmed by the alleged victim before the more intimate parts of the examination. The individual should be informed about the importance of the examination and its possible findings in a clear and comprehensible manner.

Review of symptoms

A thorough history of the alleged assault should be recorded. There are, however, some specific questions that are relevant only to an allegation of sexual abuse. These seek to elicit current symptoms resulting from a recent assault, for example bleeding, vaginal or anal discharge and location of pain, bruises or sores. In cases of sexual assault in the past, questions should be directed to ongoing symptoms that resulted from the assault, such as urinary frequency, incontinence or dysuria, irregularity of menstruation, subsequent history of pregnancy, abortion or vaginal haemorrhage, problems with sexual activity, including intercourse and anal pain, bleeding, constipation or incontinence.

Ideally, there should be adequate physical and technical facilities for appropriate examination of survivors of sexual violation by a team of experienced psychiatrists, psychologists, gynaecologists and nurses, who are trained in the treatment of survivors of sexual torture. An additional purpose of the consultation after sexual assault is to offer support, advice and, if appropriate, reassurance. This should cover issues such as sexually transmitted diseases, HIV, pregnancy, if the alleged victim is a woman, and permanent physical damage, because torturers often tell victims that they will never normally function sexually again, which can become a self-fulfilling prophecy.


[1]I. Lunde and J. Ortmann, “Sexual torture and the treatment of its consequences”, Torture and Its Consequences, Current Treatment Approaches, M. Başoglu, ed. (Cambridge, Cambridge University Press, 1992), pp. 310-331.

Sexual torture begins with forced nudity, which in many countries is a constant factor in torture situations. An individual is never as vulnerable as when naked and helpless. Nudity enhances the psychological terror of every aspect of torture, as there … Continue reading

Sexual Humiliation

Sexual humiliation usually involves forcing individuals to perform humiliating acts, often in an attempt to exploit cultural and religious stereotypes regarding sexual behavior and induce feelings of shame, guilt and worthlessness.

Sexual humiliation can result in lasting psychological symptoms in the form of posttraumatic stress disorder and major depression, and that individuals often relive the humiliation long after their release through flashbacks and nightmares. Sexually humiliating treatment can also affect an individual’s sense of identity and autonomy. Individuals often experience feelings of intense shame, guilt, grief, fear, and social isolation. Victims who have been forced into humiliating acts can feel “responsible for participating in their own degradation” resulting in intense and long lasting shame.

The UN Special Rapporteur on Torture has found that both depriving detainees of clothing and stripping them naked are psychologically harmful methods used by the United States that constitute torture and ill-treatment.[1] The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has found that even mere threats of sexual humiliation “could be considered to amount to psychological torture.”[2]


[1] Hashemian F, Crosby S, Iacopino V, Keller A, Nguyen L, Ozkalipici O, et, al. Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and It’s Impact. Physicians for Human Rights. June, 2008. pp. 108. (Hereafter: Broken Laws, Broken Lives).

[2] Broken Laws, Broken Lives pp. 108.

Sexual humiliation usually involves forcing individuals to perform humiliating acts, often in an attempt to exploit cultural and religious stereotypes regarding sexual behavior and induce feelings of shame, guilt and worthlessness. Sexual humiliation can result in lasting psychological symptoms in … Continue reading

Prolonged Isolation and Sensory Deprivation

Prolonged isolation is the denial of contact with other human beings, including through segregation from other prisoners, for prolonged periods of time, i.e. solitary confinement. Sensory deprivation refers to the reduction or removal of stimuli from one or more of the senses for prolonged periods.

Sensory deprivation is a technique that is “calculated to disrupt profoundly the senses” and “the personality.” It tends not only to result in situations of complete dependency on the interrogator but also leads to severe anxiety and often causes hallucinations. Studies have demonstrated that even short-term isolation can result in: an inability to think or concentrate; anxiety; somatic complaints; temporal and spatial disorientation; deficiencies in task performance; hallucinations; and loss of motor coordination.

Solitary confinement can result in include depression, anxiety, difficulties with concentration and memory, hypersensitivity to external stimuli, hallucinations and perceptual distortions, paranoia, suicidal thoughts and behaviour, and problems with impulse control. The UN Committee against Torture has encouraged states to abolish the practise, noting that, outside the interrogation context, solitary confinement “should be applied only in exceptional cases and not for prolonged periods of time” [1] and has determined that prolonged solitary confinement could constitute cruel, inhuman or degrading treatment or punishment.[2] Furthermore, according to the UN Special Rapporteur on Torture, solitary confinement may impact the psychological “integrity of the prisoner.”[3]


[1] Broken Laws, Broken Lives pp. 101.

[2] Broken Laws, Broken Lives pp. 101.

[3] Broken Laws, Broken Lives pp. 101.

Prolonged isolation is the denial of contact with other human beings, including through segregation from other prisoners, for prolonged periods of time, i.e. solitary confinement. Sensory deprivation refers to the reduction or removal of stimuli from one or more of … Continue reading

Sleep Deprivation

Sleep deprivation of normal sleep for extended periods through the use of stress positions, sensory overload, or other techniques may have profound psychological consequences. It causes significant cognitive impairments including deficits in memory, learning, logical reasoning, complex verbal processing, and decision-making; sleep appears to play an important role in processes such as memory and insight formation. Sleep deprivation may also result in decreases in psychomotor performance as well as alterations in mood. In recent years, a growing body of research has emerged that point to the complex and bidirectional relationships between sleep disturbance and psychiatric disorders. For example, evidence suggests that sleep disturbance is not only a symptom of major depression, but it also independently affects the clinical outcome and the course of the disorder. Moreover, sleep disturbance seems to be associated with an independent increase in the risk of suicidal ideation and actions.

Even sleep restriction of four hours per night for less than a week can result in physical harm, including hypertension, cardiovascular disease, altered glucose tolerance and insulin resistance. Sleep deprivation can impair immune function and result in increased risk of infectious diseases. Further, chronic pain syndromes are associated with alterations in sleep continuity and sleep patterns.

The UN Committee against Torture has noted that sleep deprivation used to extract confessions from suspects is impermissible,[1] and that “sleep deprivation for prolonged periods” constitutes torture.[2]

The UN Committee against Torture has determined that “hooding under special conditions” constitutes both torture and cruel, inhuman or degrading treatment or punishment.[3] It noted that this finding would be “particularly evident” when hooding is used in combination with other coercive interrogation methods.[4]


[1] Broken Laws, Broken Lives pp. 104.

[2] Broken Laws, Broken Lives pp. 104.

[3] Broken Laws, Broken Lives pp. 102.

[4] Broken Laws, Broken Lives pp. 102.

Sleep deprivation of normal sleep for extended periods through the use of stress positions, sensory overload, or other techniques may have profound psychological consequences. It causes significant cognitive impairments including deficits in memory, learning, logical reasoning, complex verbal processing, and … Continue reading

Temperature Manipulation

Temperature manipulation typically involves prolonged periods of exposure to extreme heat or to extreme cold, for example, holding detainees in cells that are deliberately too hot or too cold, forcing detainees to strip down to their underwear in a frigid cell or to stand in cold water, and dousing victims with freezing water.

Exposing a detainee to the cold can have serious health consequences even if the environmental temperature is well above freezing. The body is highly regulated to maintain core body temperature within a narrow range. Maintenance of this core temperature is essential to human survival. Hypothermia can have a number of adverse physical effects. Even moderate cold exposure can lead to significant shifts from the peripheral circulation to the body core, slowing heart function (including arrhythmias, ventricular fibrillation and cardiac arrest). If the body temperature drops below 90˚F, there may be cognitive effects including amnesia. If the body temperature drops below 86˚F, major organs can fail and death can occur.

In addition to immediate effects, hypothermia can result in prolonged adverse health consequences. The neurologic effects of hypothermia include mental slowing, diminished reflexes and eventually flaccid muscle tone. With exposure to temperatures below 32˚C (89.6˚F) patients develop amnesia and below 31˚C (87.8˚F) there may be loss of consciousness. Exposure to heat can result in elevations of core body temperature, particularly when access to water is limited. Heat stroke is a life-threatening condition that can occur when the core temperature rises above 40˚ C (104˚ F). Heat stroke is characterized as predominant central nervous system dysfunction resulting in delirium, convulsions and coma. Even with aggressive and appropriate treatment, heat stroke is often fatal.

The UN Committee against Torture has found that exposure to extreme temperatures, even in the absence of other forms of abusive interrogation or detention techniques, constitutes both torture and cruel, inhuman and degrading treatment.[1] The UN Special Rapporteur on Torture has similarly determined that depriving detainees of clothing and exposing them to extremes of heat or cold constitute torture and ill-treatment. [2]


[1]Broken Laws, Broken Lives pp. 103.

[2] Broken Laws, Broken Lives pp. 103.

Temperature manipulation typically involves prolonged periods of exposure to extreme heat or to extreme cold, for example, holding detainees in cells that are deliberately too hot or too cold, forcing detainees to strip down to their underwear in a frigid … Continue reading

Sensory Bombardment

Sensor bombardment is usually practised with exposure to bright lights, flashing strobe lights and/or loud music for extended periods of time. The use of lights and loud music may cause physiologic distress and disorientation. The body can interpret certain noises as danger signals, inducing the release of stress hormones which may increase the risk of acute myocardial infarction (heart attack) among those with pre-existing cardiovascular disease. Loud music can also cause hearing loss or ringing in the ears; these consequences can be both short term and chronic, with chronic tinnitus, or ringing in the ears, being more common.

Sound and light bombardment is used to disorient, cause anxiety, and even contribute to personality disintegration, as well as to deprive the person of sleep. It is often combined with other tactics. The UN Committee against Torture has determined that “sounding of loud music for prolonged periods” constitutes torture and cruel, inhuman or degrading treatment or punishment both when it is used in combination with other methods of interrogation and when it is used by itself.[1] The UN Special Rapporteur on Torture has similarly determined that depriving a detainee of, or exposing him to, light for a prolonged period constitutes torture and ill-treatment.[2]


[1] Broken Laws, Broken Lives pp. 102.

[2] Broken Laws, Broken Lives pp. 102.

Sensor bombardment is usually practised with exposure to bright lights, flashing strobe lights and/or loud music for extended periods of time. The use of lights and loud music may cause physiologic distress and disorientation. The body can interpret certain noises … Continue reading

Threats of Harm

Threats to an individual’s life or physical well-being or to the well-being of his family or friends can have a long-lasting psychological impact. Such threats are known to induce extreme fear and are associated with PTSD and major depression among trauma survivors. Individuals who have been threatened with death often relive their near-death encounters in nightmares, flashbacks, and intrusive memories. These experiences can provoke feelings of intense anxiety that cause dysfunction at work and in family settings. Mock executions and other situations where death is threatened often cause victims to repeatedly experience their last moments before anticipated death and induce chronic fear and hopelessness. Those who experience mock executions and death threats often suffer from PTSD symptoms, anxiety and depressive symptoms and increased frequency of suicidal behaviour.

The UN Human Rights Committee has found that conducting a mock execution within a prison environment constitutes cruel and inhuman treatment and breaches a State’s obligation to respect human dignity.[1] The UN Committee against Torture determined that threats, including but not limited to death threats, constitute both torture and cruel, inhuman or degrading treatment.[2]


[1] Broken Laws, Broken Lives pp. 105.
[2] Broken Laws, Broken Lives pp. 105.

Threats to an individual’s life or physical well-being or to the well-being of his family or friends can have a long-lasting psychological impact. Such threats are known to induce extreme fear and are associated with PTSD and major depression among … Continue reading