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Notifying people of their rights

Everyone deprived of liberty has the right to be given a reason for the arrest and detention. Article 9(1) of the ICCPR states that: ‘Everyone has the right to liberty and security of person. No one shall be subjected to arbitrary arrest or detention. No one shall be deprived of his liberty except on such grounds and in accordance with such procedures as are established by law.’

Everyone deprived of liberty has the right to be given a reason for the arrest and detention. Article 9(1) of the ICCPR states that: ‘Everyone has the right to liberty and security of person. No one shall be subjected to … Continue reading →

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Physical Evidence of Torture

Indispensable to compliance with the guidelines prescribed in the Istanbul Protocol is an understanding that “the absence of…physical evidence should not be construed to suggest that torture did not occur, since such acts of violence against persons frequently leave no marks or permanent scars.” As a matter of fact, survivors of torture and/or ill-treatment often to not have physical evidence of torture as most lesions heal in approximately 6 weeks. As stated in the Istanbul Protocol, “a detailed account of the patient’s observations of acute lesions and the subsequent healing process often represent an important source of evidence in corroborating specific allegations of torture or ill-treatment.” (IP, §171) Physical manifestations of torture may involve all organ systems. Some effects are typically acute while other may be chronic. Symptoms and physical findings will vary in a given organ system over time, though psychosomatic and neurologic symptoms are typically chronic findings. Musculoskeletal symptoms are commonly present in both acute and chronic phases. A particular method of torture, its severity, and the anatomical location of injury often indicate the likelihood of specific physical findings. For example:

  • Beating the soles of the feet (falanga) may result in subcutaneous fibrosis and a compartment syndrome of the feet.
  • The use of electricity and various methods of burning may also leave highly characteristic skin changes.
  • Whipping may also produce a highly characteristic pattern of scars.
  • Different forms of body suspension and stretching of limbs may result in characteristic musculoskeletal and nerve injuries.
  • Other forms of torture may not produce physical findings, but are strongly associated with other conditions. For example, beatings to the head that result in loss of consciousness are particularly important to the clinical diagnosis of organic brain dysfunction. Also, trauma to the genitals is often associated with subsequent sexual dysfunction.

Before conducting the physical examination, the Istanbul Protocol states that health professionals should interview individuals in an effort to compile background information, asking individuals to describe both acute and chronic symptoms and/disabilities. Health professionals should ask examinees about any injuries resulting from the alleged abuse, documenting instances where the examinees’ ability to describe injuries may be compromised by any after-effects of the torture. Typical acute symptoms include bleeding, bruising, burns from cigarettes, heated instruments or electricity, musculoskeletal pain, numbness, weakness, and loss of consciousness. Some common chronic systems are headache, back pain, gastrointestinal symptoms, sexual dysfunction, and muscle pain. In addition, many alleged victims suffer from chronic psychological effects, which can include depression, anxiety, insomnia, nightmares, flashbacks, and memory difficulties. Physicians should inquire about the intensity, frequency, as well as duration of each reported symptom.

After gathering background information, forensic experts should conduct a physical examination looking for findings or the lack of them that correlate with the allegations of torture and/or ill-treatment.In general, these examinations include an assessment of the following organs or systems: a) skin, b) face, c) chest and abdomen, d) musculoskeletal system, e) genitourinary system, and f) central and peripheral nervous system. The examiner should note all pertinent positive and negative findings, using body diagrams and photographs to record the location and nature of all injuries. Although genital exams can provide crucial corroborating evidence, these are to be performed only with the alleged victim’s consent. In the case that the physician differs in gender from the alleged victim, a chaperone must be present in the examination room. While diagnostic tests are not an essential part of the clinical assessment, there are some circumstances in which such tests may provide valuable supporting evidence.

Indispensable to compliance with the guidelines prescribed in the Istanbul Protocol is an understanding that “the absence of…physical evidence should not be construed to suggest that torture did not occur, since such acts of violence against persons frequently leave no … Continue reading →

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Psychological Consequences of Torture

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Components of the Psychological/Psychiatric Evaluation

The psychological evaluation starts at the beginning of the interview, with the very first contact. The individual’s overall appearance and manner of dress, posture, the manner of recalling and recounting the trauma, signs of anxiety or emotional distress, numbness or over-excitement, moments of emotional intensity, startled responses, posture and bodily expression while relating the events of torture, avoidance of eye contact, and emotional fluctuations in his/her voice can give important clues about the personal history and psychological functioning of an individual. Not only the verbal content of the examinee (what he/she says), but also his/her manner of speaking (how he/she says it) are important for the psychological evaluation. The individual may have difficulties in recollecting and recounting what s/he experienced or in talking about his/her complaints. Therefore, non-verbal communication may provide important information about his/her symptoms, as well as some clues for establishing and maintaining an effective relationship that allows the interviewer to elicit relevant information.

The psychological evaluation should provide a detailed description of the individual’s history, a mental status examination, an assessment of social functioning, and a formulation of clinical impressions/opinions. The impact of the symptoms on daily life can be highly relevant for forensic procedures or questions of compensation in torture cases. If appropriate, a psychiatric diagnosis should be given.

The components of psychological/psychiatric evaluation are as follows:

Identifying Data

  • Individual’s name, age, ethnicity, country of origin, marital status, number of children
  • Referral source
  • Summary of collateral sources (such as medical, legal, psychiatric records)
  • Methods of assessment utilized (interviews, symptom inventories and checklists, neuropsychological testing, etc.)

History of Torture and Ill-treatment

Every effort should be made to document the full history of torture, persecution and other relevant traumatic experiences (see Module 3 [3] [2] [1]). This part of the evaluation is often exhausting for the person being evaluated. Therefore, it may be necessary to proceed in several sessions (if it is possible). The interview should start with a general summary of events before eliciting the details of the torture experiences and include:

  • Summary of detention and abuse: Before obtaining a detailed account of events, elicit summary information, including dates, places, duration of detention, frequency and duration of torture sessions
  • Circumstances of apprehension: What time, from where, by whom (with details, if possible); other persons around, witnesses/bystanders; interaction with family members; violence/threats used during the apprehension; use of restraints or blindfold
  • Place and conditions of detention: What happened first, where, any identification process, transportation, distinctive features; other procedures; condition of the cell/room; size/dimensions, ventilation, lighting, temperature, toilet facilities, food; contact with third persons (family members, lawyer, health professionals); conditions of overcrowding or solitary confinement, etc.
  • Methods of torture and ill-treatment:
    • Assessment of background: Where, when, how long, by whom; special features of the environment, perpetrators, devices/instruments; usual “routine”, sequences and other information
    • For each for of abuse: body position, restraint, nature of contact, duration, frequency, anatomical location, the area of the body affected and how and other information
    • Sexual assaults
    • Deprivations (sleep, food, toilet facilities, sensory stimulation, human contact, motor activities); threats, humiliations, violations of taboos, behavioural coercions and other methods
    • Previous medico-legal reporting process (if any)

As mentioned in Module 3 [3] [2] [1], a method-listing approach may be counter-productive, as the entire clinical picture produced by torture is much more than the simple sum of lesions produced by methods on a list.

Current Psychological Complaints

Assessment of current psychological functioning constitutes the core of the evaluation:

  • All affective, cognitive, and behavioural symptoms that appeared since the torture should be described. For each symptom: first emergence, duration, intensity, frequency, content, fluctuation of each symptom should be asked and recorded with examples and all details.
  • Adaptative and maladaptive strategies and triggers such as anniversary reactions, specific stimuli or places, situations and topics causing avoidance should be noted.
  • Specific questions about the most common symptoms and diagnostic criteria for most common diagnosis need to be asked.

Post-torture History

The clinician should inquire about current life circumstances including:

  • Sources of additional stress, traumas, losses, difficulties (i.e. other traumatic experiences or ongoing persecution to the individual or his/her family, refugee displacement, etc.)
  • Formal and/or informal social support resources.
  • Marital and family situation.
  • Employment status, livelihood.
  • Vocational, social status and conditions.
  • Life conditions and quality of life of the interviewee and his/her family.

Pre-torture History

This component of the psychological evaluation obtains information about current life circumstances and stresses. The summary of pre-trauma history is important to assess mental health status and level of psychosocial functioning of the alleged torture victim prior to the traumatic events. In this way, the interviewer can compare the current mental health status with that of the individual before he or she was tortured. In evaluating background information the interviewer should keep in mind that the duration and severity of responses to trauma is affected by the severity and duration of the trauma events, the meaning assigned to the individual’s experiences, genetic and biological predisposition, developmental phase, age, prior trauma, pre-existing personality, and social support system. A Pre-torture History should include:

  • Developmental history
  • Family history: family background, family illnesses, family composition
  • Educational history
  • Occupational history
  • Social history: activities, including political activities, interests, group interactions
  • History of past trauma: childhood abuse, war trauma, domestic violence, etc
  • Cultural and religious background

Medical History

The medical history summarises pre-trauma and current health conditions and should include:

  • Pre-trauma health conditions.
  • Current health conditions.
  • Body pain, somatic complaints.
  • Physical injuries and findings: physical findings that might be related to trauma should be noted. It is important that the health professional that is making the psychological evaluation should also look for and document the physical findings of trauma. In some instances, the clinician who conducts the psychological evaluation may be the first or the only health professional with whom the alleged victim comes in contact with.
  • Use of medications, including possible side effects and obstacles in using medications.
  • Relevant sexual history.
  • Past surgical procedures and other medical data.

Past Psychiatric History

One should inquire whether the individual has a past history of mental or psychological disturbances, the nature of the problems, and whether they received treatment or required psychiatric hospitalisation. Inquire which, if any, psychotropic medications were used in treatment.

Substance Use and Abuse History

The clinician should inquire about substance use before and after the torture, changes in the pattern of use and abuse, and whether substances are being used to cope with insomnia or psychological/psychiatric problems.

Neuro-psychological Assessment

Torture can involve physical trauma that leads to various levels of brain impairment. Blows to the head, suffocation and prolonged malnutrition may have long-term neurological and neuro-psychological consequences that may not be readily assessed during the course of a medical examination. Frequently, the symptoms for such assessments have significant overlap with the symptomatology arising from PTSD and major depressive disorders. Fluctuations or deficits in level of consciousness, orientation, attention, concentration, memory and executive functioning may result from functional disturbances as well as organic causes.

Clinical neuropsychology is an applied science concerned with the behavioural expression of brain dysfunction. Neuropsychological assessment, in particular, is concerned with the measurement and classification of behavioural disturbances associated with organic brain impairment. The discipline has long been recognised as useful in discriminating between neurological and psychological conditions and in guiding treatment and rehabilitation of patients suffering from the consequences of various levels of brain damage. Neuropsychological evaluations of torture survivors are performed infrequently and to date neuropsychological studies of torture survivors is limited in the literature.[1]

Despite significant limitations, neuropsychological assessment may be useful in evaluating individuals suspected of having brain injury and in distinguishing brain injury from PTSD. Neuropsychological assessment may also be used to evaluate specific symptoms, such as problems with memory that occur in PTSD and related disorders.

Mental Status Examination

The mental status exam begins the moment the clinician meets the subject. The interviewer should make note of the person’s appearance (such as signs of malnutrition, lack of cleanliness, etc.), changes in motor activity during the interview, use of language, presence of eye contact, and the ability to relate to the interviewer. The following list summarises the components of the exam: general appearance, motor activity, speech, mood and affect, thought content, thought process, suicidal and homicidal ideation, cognitive status (alertness, orientation, concentration and calculation, long term memory, intermediate recall, and immediate recall), and insight.

The individual’s responses to specific mental status items are affected by their culture of origin, educational level, literacy, language proficiency, and level of acculturation. The mental status examination of torture survivors requires flexibility on the part of the examiner, who must have a good understanding of the individual’s cultural, linguistic, and educational background before attempting any formal assessment. The level of education is an important factor in determining the appropriate questions and tasks.

Assessment of Social Function

Trauma and torture can affect a person’s ability to function. The psychological consequences of the experience may impair the individual’s ability to care for him/herself, earn a living, support a family, or pursue education. The clinician should assess the individual’s current level of functioning by inquiring about daily activities, social role function (as housewife, student, worker, etc), social and recreational activities, and perceptions of health status. For obvious reasons, one cannot accurately assess the social functioning of an individual held in detention.

Psychological Testing and the Use of Checklists and Questionnaires

If an individual has trouble expressing in words his or her experiences and symptoms, it may be useful to use a trauma event questionnaire or symptom checklist. These tools may facilitate disclosure of severely traumatic memories and reduce the anxiety often experienced in an unstructured interview. There are numerous questionnaires available; however, none is specific to torture victims. Caution must be exercised in the interpretation of responses and scores because established norms do not exist for most refugee populations. Similarly, there is little published information about the use of standard psychological and neuropsychological tests among torture survivors. Due to the fact that there is such wide cultural and linguistic diversity among survivors, one should exercise extreme caution when requesting or employing psychological and psychometric tests of any kind, most of which have not been cross-culturally validated.

In some countries and/or situations, courts and/or other authorities tend to give more weight to the results of psychometric tests and consider them more “objective” than the clinical impressions that clinicians obtain as a result of several interviews. However, for the psychological evaluation of trauma, the clinical interview, evaluation and the subsequent clinical formulation the clinician reaches are fundamental, whereas psychological tests have only complementary value. It is the clinician himself/herself who decides whether there is any need to use psychological testing in the evaluation process. Furthermore, the clinician must make his/her own decision without any interference in his/her clinical independence.

Clinical Impression

An essential aspect of the psychiatric evaluation is the formulation of a concise statement of the interviewer’s analysis of the case. Interpretation of the findings and formulation of a clinical impression are the last stages where the entire interview is discussed and evaluated; therefore care must be taken while formulating a clinical decision.

Interpretation of the clinical findings is a complex task. The following questions from the Istanbul Protocol will help guide the formulation of the clinical impression and diagnostic conclusions.

  1. Are the psychological findings consistent with the alleged report of torture?
  2. Are the psychological findings expected or typical reactions to extreme stress within the cultural and social context of the individual?
  3. Given the fluctuating course of trauma-related mental disorders over time, what is the timeframe in relation to the torture events? Where in the course of recovery is the individual?
  4. What are the coexisting stresses impinging on the individual (e.g. ongoing persecution, forced migration, exile, loss of family and social role, etc)? What impact do these issues have on the victim?
  5. What physical conditions contribute to the clinical picture? Pay special attention to head injury sustained during torture and/or detention.
  6. Does the clinical picture suggest a false allegation of torture?

When writing reports, clinicians should comment on the emotional state of the person during the interview, symptoms, history of detention and torture, and personal history prior to torture. Factors such as the onset of specific symptoms in relation to the trauma, the specificity of any particular psychological findings, as well as patterns of psychological functioning should be noted. If the survivor has symptom levels consistent with one or more DSM IV or ICD 10 psychiatric diagnosis, the diagnosis should be stated. If not, the consistency between the psychological findings and the history of the individual should be evaluated as a whole and stated in the report. Additional factors such as forced migration, resettlement, difficulties of acculturation, language problems, loss of home, family, social status, as well as unemployment should be discussed. The relationship and consistency between events and symptoms should be evaluated and described. Physical conditions such as head trauma or brain injury may require further evaluation. Behavioural, cognitive and emotional aspects of the individual observed during verbal and non-verbal communication should be noted as well.

It is common in medico-legal contexts for the clinician to be asked whether psychological symptoms were caused by that alleged torture and ill-treatment or other traumatic experiences that may have occurred before or after the alleged events. Clinician should note temporal relationships between the onset of symptoms and the alleged torture and ill-treatment. They should also consider content-specific symptoms that may relate to the alleged torture and ill-treatment such as: the content of nightmares, triggers for intrusive recollection, reliving experiences, avoidance reactions, etc.

It is important for clinicians to make clear to any court or judicial authority that not everyone who has been tortured develops a diagnosable mental illness. It must be stressed that even though a diagnosis of trauma-related mental disorder supports the claim of torture, not meeting criteria for a psychiatric diagnosis does not mean the person was not tortured. The absence of conclusive physical and/or psychological signs and symptoms does not invalidate an allegation of torture. The clinician should also take into consideration the possibility that an absence of psychological symptoms can be due to the episodic or often delayed nature of PTSD or to denial of symptoms because of shame or other difficulties.

It is possible that some people may falsely allege torture or exaggerate a relatively minor experience or symptoms for personal or political reasons. The clinician should keep in mind, however, that such fabrication requires a detailed knowledge about trauma related symptoms that individuals rarely possess. Also, inconsistencies can occur for a number of valid reasons such as memory impairment due to brain injury, confusion, dissociation, cultural differences in perception of time, or fragmentation and repression of traumatic memories (see Module 3 [3] [2] [1]). Additional sessions should be scheduled to help clarify inconsistencies and when possible, family or friends may be able to corroborate detail. Inconsistencies that are attributable to the psychological effects of an individual’s torture experiences may, in fact, support his or her allegations of abuse.

Recommendations

The recommendations following the psychological evaluation depend on the questions posed at the time the evaluation was requested. The issues under consideration may concern legal and judicial matters, asylum, resettlement, and a need for treatment. Recommendations can be for further assessments, such as neuro-psychological testing, medical or psychiatric treatment or a need for security or asylum. The clinician should not hesitate to insist on any consultation and examination that s/he considers necessary.

In the course of documenting psychological evaluation of torture allegations the clinicians are not absolved of their ethical obligations. Evaluation for documentation of torture for medico-legal reasons should be combined with an assessment for other needs of the individual. Those who appear to be in need of further medical or psychological care should be referred to the appropriate services. Clinicians should be aware of the local rehabilitation and support services.

Treatment Considerations

A full discussion of treatment is beyond the scope of this Module. To briefly summarise, intervention necessarily begins with establishing safety, protection, and basic human necessities for survival (food, shelter, income, etc.). Without these basic elements, no meaningful “treatment” can be effective. Any meaningful clinical treatment and rehabilitation program should include social services and if possible, legal services. Treatment can begin once basic necessities are secured, or perhaps even while they are being secured. Because torture affects an individual on so many levels, an integrated, coordinated multidisciplinary approach to treatment is essential. Mental health treatment modalities include individual, group, and family psychotherapy, psychopharmacology, psychoeducation, and somatic therapies. Traditional medicine practices should be respected and included in the treatment if the individual wishes, provided they are safe and that one avoids deleterious interactions between medications and herbal preparations.

NOTE: An online course, “Caring for Torture Survivors [4],” offered by the Boston Center for Refugee Health and Human Rights, is available at: http://www.bcrhhr.com/education/caring-for-survivors.html [5]

[1] Jacobs U, Iacopino V. Torture and its consequences: a challenge to neuropsychology. Professional Psychology: Research and Practice. 2001;32(5): 458–464.

Quelle

  • [1] https://phrtoolkits.org/toolkits/istanbul-protocol-model-medical-curriculum/module-3-interview-considerations/
  • [2] https://phrtoolkits.org/toolkits/istanbul-protocol-model-medical-curriculum/module-3-interview-considerations/
  • [3] https://phrtoolkits.org/toolkits/istanbul-protocol-model-medical-curriculum/module-3-interview-considerations/
  • [4] http://www.bcrhhr.com/education/caring-for-survivors.html
  • [5] http://www.bcrhhr.com/education/caring-for-survivors.html

The psychological evaluation starts at the beginning of the interview, with the very first contact. The individual’s overall appearance and manner of dress, posture, the manner of recalling and recounting the trauma, signs of anxiety or emotional distress, numbness or … Continue reading →

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Past Medical History

Obtain a complete medical history, including prior medical, surgical and/or psychiatric problems. Be sure to document any history of injuries before the period of detention and any possible after-effects. Knowledge of prior injuries may help to differentiate physical findings related to torture from those that are not.

Obtain a complete medical history, including prior medical, surgical and/or psychiatric problems. Be sure to document any history of injuries before the period of detention and any possible after-effects. Knowledge of prior injuries may help to differentiate physical findings related … Continue reading →

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Eye Trauma

Direct trauma to the eye is very common, either incidental to general beating about the head or else intentionally aimed. There may be conjunctival or retinal haemorrhage, dislocation of the lens or detachment of the retina. Torturers may force their victims to look at the sun or bright lights for long periods. Conversely, detainees may be kept for months or years in total darkness. Survivors often complain long afterwards of lacrimation (tearing) and photophobia (light sensitivity). However, such cases do not show any detectable physical abnormality and treatment is purely symptomatic.

Direct trauma to the eye is very common, either incidental to general beating about the head or else intentionally aimed. There may be conjunctival or retinal haemorrhage, dislocation of the lens or detachment of the retina. Torturers may force their … Continue reading →

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Materials

Case Summary/Referral #02

(distribute to students who conduct the interviews)

(Strong physical, moderate psychological and strong historical evidence; medical evaluation 7 days after alleged torture)

Note: This case example #02 is written for male role-player. All names included in the narrative are fictitious.

  • Name: Mr. Hassan Bashir Adam
  • Date Reporting to the Center: dd/mm/yyyy (today’s date)
  • Date of Birth: dd/mm/yyyy (age 25)
  • Age: 25 yrs
  • Marital Status/Children: Single, no children
  • Religion: Muslim
  • Ethnic Group: Darfurian, Zagawa tribe
  • Profession: Student, Khartoum University
  • Political/Social Affiliation: Member of Student Democratic Front (SDF)
  • Date of Detention: dd/mm/yyyy (7 months prior to the exam date)
  • Place of Detention: XXX police station
  • Period of Detention: 3 days
  • Trauma History: On dd/mm/yyyy (7 months prior to the exam date), Mr. Adam as arrested by four officers from the NSA. He was placed in a truck with blackened windows, blindfolded and taken to a police station. His mobile phone and ID card were confiscated. His hands were restrained and he was punched, kicked and beaten with black water hoses and electric wires. They suspended him by his wrists and applied electric shocks to his genitals.
  • Alleged Perpetrators: Security personnel from the NSA, including Abdel Salih, and Kaleel Rahim, also 2 perpetrators referred to as Rasoul and Mujahid.
  • Reasons for Visit: Treatment for problems related to torture and to take legal action against the perpetrators. The client has already met with SOAT legal advisors, and they have requested a medical evaluation of the client’s allegations of torture.
  • Effects of Torture: Musculoskeletal pain, multiple bruises and burns.

Case Narrative #02

(distribute to role-players only)

Note: Case example #02 is written for male role-players. All names included in the narrative are fictitious.

Case Summary/Referral Information

  • Name: Mr. Hassan Bashir Adam
  • Date Reporting to the Center: dd/mm/yyyy (today’s date)
  • Date of Birth: dd/mm/yyyy (age 25)
  • Age: 25 yrs
  • Marital Status/Children: Single, no children
  • Religion: Muslim
  • Ethnic Group: Darfurian, Zagawa tribe
  • Profession: Student, Khartoum University
  • Political/Social Affiliation: Member of Student Democratic Front (SDF)
  • Date of Detention: dd/mm/yyyy (7 months prior to the exam date)
  • Place of Detention: XXX police station
  • Period of Detention: 3 days
  • Trauma History: On dd/mm/yyyy (7 months prior to the exam date), Mr. Adam as arrested by four officers from the NSA. He was placed in a truck with blackened windows, blindfolded and taken to a police station. His mobile phone and ID card were confiscated. His hands were restrained and he was punched, kicked and beaten with black water hoses and electric wires. They suspended him by his wrists and applied electric shocks to his genitals.
  • Alleged Perpetrators: Security personnel from the NSA, including Abdel Salih, and Kaleel Rahim, also 2 perpetrators referred to as Rasoul and Mujahid.
  • Reasons for Visit: Treatment for problems related to torture and to take legal action against the perpetrators. The client has already met with SOAT legal advisors, and they have requested a medical evaluation of the client’s allegations of torture.
  • Effects of Torture: Musculoskeletal pain, multiple bruises and burns.

Identification

My name is Hassan Bashir Adam. I live in Khartoum, and I am 25 years-old.

Additional Information:

  • Date of Birth: dd/mm/yyyy (age 25)
  • Citizenship: Sudanese
  • Marital Status/Children: I am single, and I do not have children.
  • Place of Birth: Nyala
  • Place of Residence: Khartoum
  • Highest Level of Education: Currently a student at Khartoum University.
  • Occupation: Student
  • Religion: Muslim
  • Identification: ID confiscated
  • Ethnic Group: Darfurian, Zagawa tribe
  • Physician Examiner Name and License #: Fill out
  • Individuals Present in the Examination Room and Reason for Presence: Fill out
  • Language Spoken: Zagawa
  • Name of Interpreter: None
  • Restrictions Noted: This depends on the response of the interviewer.
  • Detainee Status: Detained by police and released

Past Medical/Surgical History and Psychosocial History

Past Medical/Surgical History

Before I was arrested, I had no medical problems, no major illnesses or injury, no surgery, broken bones or head injury. I never had any mental problems, nor has anyone in my family. I am not on any medications. I do not use any illegal drugs or drink alcohol. I smoke about one pack of cigarettes per day.

NOTE: Provide information in parentheses only if specifically asked by the interviewer.

Psychosocial History Pre-Arrest

I was born in Nyala and have two younger brothers. My father owns a small grocery store in Nyala and my mother helps him out at the store. I was good in school and decided to go to Khartoum University for business studies. I have had various part-time jobs, but I have never worked for my parents. My plan was to have a good job with a large company in the future. I have been an active member of the SDA (Student Democratic Front) for the past two years. Many of my friends and I were detained after the student elections last year. I was beaten, but not as bad as the others. One of my brothers was killed by security forces in Darfur about 9 months ago. My parents worry about me, because they know I am an active member of the SDF and they do not approve.

Trauma History

NOTE: At the time of arrest, there was no arrest warrant or subpoena order, search warrant, or resistance by the accused.

On dd/mm/yyyy (7 months prior to the exam date), at about 10:00 pm, four officers from the NSA came to the flat that I share with two other students. They told me that they needed to ask me some questions. I asked them if I was being charged with a crime. One of them, Abdel Salih, told me “Keep your mouth shut if you know what’s good for you.” Another one of them was named Kaleel Rahim.

I was placed in a truck with blackened windows and taken to XXX police station.

They took my mobile phone and ID card. When we arrived, they locked me in a room, about one meter by one meter and a half in size. The room was filthy and smelled of urine. There were no light and the ventilation in the room was very poor. During the time that I was detained, I had difficulty sleeping and was given only a small amount of poor quality food.

Later that night, they took me to an interrogation room and started asking questions about members of the SDF, who I knew and worked with and the nature of our work. I had made a speech recently on the situation in Darfur and they told me, “You may think you are free to criticize us, but we are free to do anything we like. We could kill you tonight and no one would care.” They tied my hands with rope and started beating me with punches, kicks, black water hoses and electric wires. This went on for more than an hour. One of them, “Rasoul,” put a plastic bag over my head and I was gasping for air. He repeated this 3 or 4 more times and I passed out.

When I woke up, they started beating me again (punches, kicks, and hoses). They forced me to take off all of my clothes. My hands were tied behind my back with a rope that was hanging from the ceiling. They lifted me off the ground; the pain was unbearable. They continued beating me while I was suspended. Then they sprayed cold water over me with a hose and forced it in my mouth and nose so I had trouble breathing. One of the agents attached a clip with some wires to my penis and my right foot. He said insulting things (Like “you won’t be needing this anymore.”). My whole body cramped violently when they shocked me. I lost consciousness after they shocked me about five or six times. When I woke up, I was on the floor. I felt several burning sensations on my right forearm. One of them had a lit cigarette in his hand. He burned my arm again and again. One of them told me, “You better stop making speeches or you will end up like your brother.” I was locked in a cell for two days before I was released. I am not guilty of anything, and no one should be treated this way. That is why I had the courage to take legal action against the people who tortured me.

Review of Torture Methods

The following history should be revealed only on further questioning, unless asked in the context of the trauma history:

  • The review of torture methods is negative for the all other torture methods, physical and psychological.

Symptoms (Acute and Chronic) and Disabilities

Acute Symptoms
  • Multiple bruises over my arms, legs and back, no injuries to the head. The bruises are red and swollen and still visible on my body. (No cuts or bleeding)
  • Pain in the shoulders, arms and wrists.
  • A number of burn marks on my right forearm, which took about 2-3 weeks to heal.
  • I did not observe any lesion on the penis where they shocked me.
  • Difficulty lifting objects due to pain in my arms and numbness in my right arm for a few months, but this resolved.
Chronic Symptoms
  • Scars noted on right forearm from cigarette burns.
  • Difficulty having erections, i.e. not able to perform sexually but has noted erections upon waking for sleep.
Disabilities
  • None noted

Psychological Evaluation and Mental Status

Mental Status

Mr. Adam was appropriately dressed and groomed and looked his stated age. He was alert, fully oriented, pleasant and cooperative throughout the evaluation. There were no gross abnormalities in movement or posture on observation. Sensory functions and motor functions appeared to be intact. He appeared to possess above average intellectual ability, with good insight and judgment. His speech was clear and fluent. There was no evidence of delusions, hallucinations or psychotic thought processes. Memory was intact. Attention and concentration appeared intact. His mood was apprehensive in the presence of the police officer who escorted him to my office, but then calm during the evaluation. There was no evidence of suicidal or homicidal ideation.

Psychological Findings

Mr. Adam did not admit to any symptoms of post-traumatic stress disorder or major depression. Though his affect was calm throughout most of the interview, he expressed considerable anger toward those who tortured him and the loss of his brother. Mr. Adam indicated that since being tortured, he is less sure of his future plans. He is now considering altering his career path to become more active politically. His parents have expressed strong disapproval, however; they consider his political activity to be “foolish and dangerous.” This has resulted in considerable discord between them. He and his father have not spoken to one another in the past several weeks.

Physical Examination

NOTE: Images of “virtual physical examination” findings will be presented in a separate room using PPT slides.

  • Slide #1 and #2 (day of exam): Hyperpigmented, circumferential scars above both wrists, highly consistent with wrist abrasions from alleged restraint with rope and suspension
  • Slide #3 and #4 (day of exam): Multiple hyperpigmented circular scars (about 1 cm in diameter) with indistinct margins and no central palor or atrophy. The characteristics of the lesions and location on one arm only are highly consistent with the alleged cigarette burns.
  • Slides #5 and #6 (6 days following alleged torture): Linear “tram-track” lesions with peripheral echymosis and central palor, consistent with acute signs of beating to the back with a water hose.

Interpretation and Conclusion

Per trainee’s assessment

Case Summary/Referral #02 (distribute to students who conduct the interviews) (Strong physical, moderate psychological and strong historical evidence; medical evaluation 7 days after alleged torture) Note: This case example #02 is written for male role-player. All names included in the … Continue reading →

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Avoiding incommunicado detention

International standards do not expressly prohibit incommunicado detention – where a detainee is denied all contact with the outside world – in all circumstances. However, international standards provide and expert bodies have maintained that restrictions and delays in granting detainees access to a doctor and lawyer and to having someone notified about their detention are permitted only in very exceptional circumstances for very short periods of time.

The Human Rights Committee has found that the practise of incommunicado detention is conducive to torture[1] and may itself violate Article 7 or Article 10 of the ICCPR.[2] It has stated that provision should also be made against incommunicado detention as a safeguard against torture and ill-treatment.[3]

The UN Commission on Human Rights has stated that “prolonged incommunicado detention may facilitate the perpetration of torture and can in itself constitute a form of cruel, inhuman or degrading treatment.”[4] The UN Special Rapporteur on Torture has stated that “torture is most frequently practised during incommunicado detention. Incommunicado detention should be made illegal, and persons held incommunicado should be released without delay.”[5]

[1] Preliminary Observations of the Human Rights Committee: Peru, UN Doc. CCPR/C/79/Add.67, paras 18 and 24, 25 July 1996.

[2] Albert Womah Mukong v Cameroon, (458/1991), 21 July 1994, UN Doc. CCPR/C/51/D/458/1991; El-Megreisi v Libyan Arab Jamahiriya, (440/1990), 23 March 1994, UN Doc. CCPR/C/50/D/440/1990

[3] Human Rights Committee General Comment 20, para.11.

[4] Resolution 1997/38, para. 20.

[5] Report of the Special Rapporteur on Torture, UN Doc.A/56/156, July 2001, para. 39(f).

International standards do not expressly prohibit incommunicado detention – where a detainee is denied all contact with the outside world – in all circumstances. However, international standards provide and expert bodies have maintained that restrictions and delays in granting detainees … Continue reading →

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The Psychological Consequences of Torture

The potential effects of torture include cumulative traumatic experiences on individual, family and community levels.

On the individual level

Torture is a dynamic process that begins at the moment of losing liberty, and involves a sequence of traumatic events that may take place at different times and places, ending with the release or demise of the victim. Sometimes this cascade of events may start again within a short time-frame, without leaving any time for the individual to recover. The person experiences complete lack of control, inability to escape, and is also challenged by the unpredictability of the torturer.

Generally torture has an extremely threatening and painful character, and can induce immediate reactions of panic and fear, including significant fear of death, with a very high level of tension and, sometimes subsequently, of emotional numbness. These feelings may be accompanied by a sense of complete confusion, powerlessness, and loss of control which can bring about a shattered understanding of one’s self, of any meaningful existential system and of the predictability of the world. Torture can damage individuals on a number of levels:

  • physical and psychological integrity and entity,
  • cognitive, emotional, behavioural, social well-being,
  • personality,
  • identity,
  • autonomy,
  • self-actualisation,
  • self-respect or self-esteem ,
  • sense of safety and survival,
  • dreams, hopes, aspirations for the future,
  • belief system,
  • system of meaning about him/herself and the world,
  • attachment,
  • connectedness, and
  • trust.

The aim of torture is often not only the intentional destruction of the victim, but of his or her economic, social, and cultural worlds of the victims. Torture also may profoundly affect an individual’s sense of being grounded in a family and in society. It may also cause secondary problems which compromise social, educational and occupational functioning.

On the family level

Torture can profoundly damage intimate relationships between spouses, parents, children and other family members, and relationships between the victims and their communities. Such trauma can lead to various forms of family dysfunction and disruptions including:

  • Other members of the family may also be detained, tortured and ill treated.
  • Other members of the family may suffer from the secondary traumatisation.
  • The repercussions of the physical and psychological suffering of the tortured person within the family can cause an increased level of stress as well as fear, worry, feelings of being terrorised and threatened, and loss of sense of safety and security, affecting the family system and the other members of the family.
  • Torture may change the roles and relationship patterns in the family; it may result in deterioration in the ability to care for children and loved ones, and in parenting capacity.
  • Torture experiences may also cause substantial disruption of the quality of life in the family due to health problems, forced change of living place, loss of work and diminished social support.

The potential effects of torture include cumulative traumatic experiences on individual, family and community levels. On the individual level Torture is a dynamic process that begins at the moment of losing liberty, and involves a sequence of traumatic events that … Continue reading →

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Clinical Considerations

Symptoms of PTSD may appear in children. The symptoms can be similar to those observed in adults but the clinician must rely more heavily on observations of the child’s behaviour than on verbal expression. For example, the child may demonstrate symptoms of re-experiencing as manifested by monotonous, repetitive play representing aspects of the traumatic event, visual memories of the events in and out of play, repeated questions or declarations about the traumatic event and nightmares. The child may develop bedwetting, loss of control of bowel movements, social withdrawal, restricted affect, attitude changes toward self and others and feelings that there is no future. S/he may experience hyperarousal and have night terrors, problems going to bed, sleep disturbance, heightened startle response, irritability and significant disturbances in attention and concentration. Fears and aggressive behaviour that were non-existent before the traumatic event may appear, such as aggressiveness toward peers, adults or animals, fear of the dark, fear of going to the toilet alone and phobias. The child may demonstrate sexual behaviour that is inappropriate for his/her age and may experience somatic reactions. Anxiety symptoms may appear, such as exaggerated fear of strangers, separation anxiety, panic, agitation, temper tantrums and uncontrolled crying. The child also may develop eating problems.

Symptoms of PTSD may appear in children. The symptoms can be similar to those observed in adults but the clinician must rely more heavily on observations of the child’s behaviour than on verbal expression. For example, the child may demonstrate … Continue reading →

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