The interviewer should then take a detailed description of specific methods of ill-treatment employed during periods ofquestioning, interrogation or indeed at any time while they are in the control of the authority. It cannot be over-emphasised that it is not sufficient to document only physical ill-treatment and any resulting injuries or scars. Psychological methods must also be accurately noted since these will often produce both psychological reactions and physical symptoms.
In obtaining historical information on torture and ill-treatment, one should be cautious about suggesting forms of abuse that a person may have been subjected to. This may help to separate potential embellishment from valid experiences. However, eliciting negative responses to questions about various forms of torture also may help to establish the credibility of the interviewee.
Questions should be designed to elicit a coherent narrative account. Consider the following questions: Where did the abuse take place, when and for how long? Could you see? Why not? Before discussing forms of abuse, note who was present (give names, positions). Describe the room/place. What objects did you observe? If possible, describe each instrument of torture in detail; for electrical torture, the current, device, and number and shape of electrodes. Ask about clothing/disrobing/change of clothing. Record quotations of what was said during interrogation, insults to one’s identity, etc. What was said among the perpetrators?
For each form of abuse note: body position/restraint, nature of contact, including duration, frequency, anatomical location, and the area of the body affected. Was there any bleeding, head trauma, or loss of consciousness? Was the loss of consciousness due to head trauma, asphyxiation, or pain? One should also ask about how was the person’s condition at the end of the “session.” Could he or she walk? Did s/he have to be helped back or carried back to the cell? Could s/he get up the next day, eat, use the toilet, or walk up or down stairs? How long did the feet stay swollen? All this gives a certain completeness to the description, which a “check list” of methods does not.
Asking detailed questions about specific torture allegations will aid physicians in their efforts to assess correlations between allegations of abuse and presence or absence of medical findings. For example, questions related to allegations of suspension may include: the duration and frequency of the alleged torture (Note: time estimates are subjective, and may not be accurate since disorientation of time and place are common effects of torture), a description of the form of suspension (“crucifixion,” Palestinian,” etc.), the use of cloth restraints vs. rope, wire or other material, whether weights or pulling was used to increase the pain of the suspension, and whether there was any loss of consciousness, or any other acute or chronic symptoms or disabilities. Such details may be critical in corroborating physical evidence and allegations. For example, a history of brief or partial suspension (some of the individual’s weight supported by his/her feet) with the use of non-abrasive cloth restraints may help to explain the absence of any acute or chronic physical findings on examination. Alternatively, allegations of prolonged and repeated “Palestinian” using ropes would be highly consistent with evidence of a brachial plexus injury and circumferential wrist abrasions on examination.
In order to assess psychological evidence of torture, it is important for the clinician to assess thought content, affect, and psychological symptoms during and after the period of detention (see Module 6).
As previously mentioned, an individual’s narrative account should be open-ended. In the course of eliciting a detailed history of torture and ill-treatment it may be helpful for the clinician to consider possible categories of abuse. A survivor may have forgotten, for instance, that he or she was subjected to a mock execution. The following list of torture methods is not meant to be used by clinicians as a “check list”, nor as a model for listing torture methods in a report. A method-listing approach may be counterproductive, as the entire clinical picture produced by torture is much more than the simple sum of lesions produced by methods on a list. Furthermore, it is important to recognise that the distinction between physical and psychological methods is artificial.
Torture methods to consider include, but are not limited to:
- Blunt trauma, such as a punch, kick, slap, whipping, a beating with wires or truncheons or falling down;
- Positional torture, using suspension, stretching limbs apart, prolonged constraint of movement, forced positioning;
- Burns with cigarettes, heated instruments, scalding liquid or a caustic substance;
- Electric shocks;
- Asphyxiation, such as wet and dry methods, drowning, smothering, choking or use of chemicals;
- Crush injuries, such as smashing fingers or using a heavy roller to injure the thighs or back;
- Penetrating injuries, such as stab and gunshot wounds, wires under nails;
- Chemical exposure to salt, chili pepper, gasoline, etc. (in wounds or body cavities);
- Sexual violence to genitals, molestation, instrumentation, rape;
- Crush injury or traumatic removal of digits and limbs;
- Medical amputation of digits or limbs, surgical removal of organs;
- Pharmacological torture using toxic doses of sedatives, neuroleptics, paralytics, etc.;
- Conditions of detention:
- Such as a small or overcrowded cell
- Solitary confinement
- Unhygienic conditions
- No access to toilet facilities
- Irregular or contaminated food and water
- Exposure to extremes of temperature
- Denial of privacy
- Forced nakedness
- Deprivation of:
- Normal sensory stimulation, such as sound, light, sense of time, isolation, manipulation of brightness of the cell,
- Physiological needs, restriction of sleep, food, water, toilet facilities, bathing, motor activities, medical care,
- Social contacts, isolation within prison, loss of contact with the outside world (victims are often kept in isolation in order to prevent bonding and mutual identification and to encourage traumatic bonding with the torturer);
- Humiliation, such as verbal abuse, performance of humiliating acts;
- Threats of death, harm to family, further torture, imprisonment, mock executions;
- Threats of attack by animals, such as dogs, cats, rats or scorpions;
- Psychological techniques to break down the individual, including forced “betrayals,” learned helplessness, exposure to ambiguous situations or contradictory messages;
- Violation of taboos;
- Behavioural coercion, such as:
- Forced engagement in practises against the religion of the victim (e.g. forcing Muslims to eat pork)
- Forced harm to others through torture or other abuses
- Forced destruction of property
- Forced betrayal of someone placing them at risk of harm;
- Forcing the victim to witness torture or atrocities being inflicted on others.
The above examples do not by any means constitute a definitive list. There are many other forms of abuse that have been witnessed in the past, and there will probably be new forms in the future. International definitions of torture deliberately avoid providing a list of methods that are seen as torture. One of the reasons for this is that such a list may imply that it is exhaustive, and those engaged in such practises would simply devise methods that do not appear on the list, in an attempt to circumvent the definition. Torture is a complex phenomenon; it cannot be simply reduced to a list of acts.
A review of common torture methods and their physical and psychological sequelae is included in Module 4.