Torture and its sequel—a comparison between victims from six countries

doi:10.1016/j.forsciint.2003.07.008

Forensic Science International

Volume 137, Issues 2–3, 26 November 2003, Pages 133-140

https://doi.org/10.1016/j.forsciint.2003.07.008 Get rights and content

Abstract

The aim of the study was to compare torture victims from six different nations and analyse differences and similarities.

From the files of the Centre for Trauma Victims in Stockholm (KTC), 160 patients were selected: 53 patients from Bangladesh, 21 from Iran, 16 from Peru, 24 from Syria, 25 from Turkey, and 21 from Uganda.

The data was classified into: (i) information about social conditions and circumstances pertaining to alleged torture, (ii) type of trauma and torture methods, and (iii) acute and late sequel to torture. Descriptive and non-parametric statistics were used in the analyses.

There was a strong male dominance in all but the Ugandan group where 43% were women. The majority in all but the Turkish group had college exams and/or university studies. Over 84% were members of a political organisation except in the Iranian and Syrian groups, where more than 40% had no political affiliation. The majority in all groups had travelled to Sweden alone to apply for asylum, but most refugees from Turkey, Iran, and Syria had close relatives already living in Sweden.

The stories of circumstances and torture methods were similar within each group but differed a great deal between groups. Typically, in Bangladesh, Peru, and Turkey, the periods under arrest were short: from a few hours to 3 days. In Iran, Uganda, and Syria, the time in custody varied from several months to several years. A prison sentence preceded by trial was common only in Iran. Many patients, especially from Bangladesh and Turkey, had been arrested several times. Sensory deprivation by isolation and blindfolding was common in all countries except Uganda and Peru. Beating with fists, sticks, truncheons, etc. were reported in 100% in every group. In Bangladesh, police batons (lathi) were used more commonly than in any other group. Whipping with electric cords occurred frequently only in Iran and Syria. Rape was most often reported among the Ugandans. Genital torture was frequently alleged by patients from Bangladesh and Turkey. Suspension was common in all countries except for Uganda. Falaka, i.e. beating of the soles, and electric torture were common (>60%) in Bangladesh, Iran, Syria, and Turkey. Sharp injuries inflicted with knives and bayonets were often seen among the Bangladeshi and Ugandans. Burning injuries due to cigarettes were commonly seen only in patients from Bangladesh. Some methods were found to be almost exclusive for each country: “water treatment” (Bangladesh), the “tyre” (Syria), “telephono” and “submarino” (Peru).

The sequel of torture differed in some respects between groups. Fractures were more common among Iranians. Patients from Uganda and Bangladesh had numerous scars. Subjectively reported symptoms were most frequent among Bangladeshi, especially joint pain and ear, nose, and throat symptoms and least frequent among Ugandans.

PTSD diagnosed on the basis of a psychiatric interview and psychological tests was found in 69–92% of patients in all groups.

The study shows significant differences between countries regarding circumstances, torture methods, and sequel to torture. This knowledge is of value to forensic specialists documenting alleged torture and essential for fair and valid forensic statements.

Introduction

According to Amnesty International, human rights were violated in 149 countries during 2000, frequently in the form of torture [1]. Reports of torture from the countries included in this study and many others have been published by Amnesty International since 1975 (http://www.amnesty.org). Refugees who apply for asylum, often report torture. The exact incidence is not known, but about 0.15% of all asylum applicants are each year subjected to examination and documentation at the Centre for Trauma and Torture Survivors (CTD), in Stockholm, Sweden (since 2001, the CTD is known as the Centre for Trauma Victims (KTC), Unit for Torture Survivors). The documentation, which includes forensic medical and psychiatric statements issued by specialists, is primarily intended to provide the immigration authorities with relevant information for decisions in each individual case.

The many aspects of torture have been detailed in the Tokyo Declaration of 1975. In short, torture is used not only as a method of interrogation, but also to punish and terrorise political dissidents as well as religious and ethnical minorities.

Modern torture involves physical and psychological methods. Experiences of more than 350 patients examined at the CTD indicate that the methods may vary a great deal between countries and regions, and that this knowledge facilitates the evaluation of the individual patient’s allegations of torture and increases the validity of the forensic expert opinion. This has been stressed by Forrest et al. [2] among others, but systematic data on national and regional variations in torture practices are scarce. In the present study, we have attempted to collect relevant data on social background, circumstances, and means of torture and its consequences as reported by alleged victims from six different countries.

Section snippets

Patients and methods

The study included 160 refugees: 16 Peruvian and 21 Ugandan subjects admitted for examination in 1993–1999, 25 Turkish subjects in 1993–2003, and 53 Bangladeshi, 24 Syrians, and 21 Iranians in 1998–2001. The selection of patients was based on the fact that these were the six largest national groups in the files and that all patients had been seen by the same forensic medical specialist. Forensic medical records, photographs, and records from the Swedish Immigration Board (Statens Invandrarverk

Social data

The mean age at examination varied between 29.4 years (Bangladesh) and 37.3 years (Syria). The majority of patients were male, with the percentage of females ranging from 0% (Syria) to 43% (Uganda) (Table 1).

The level of education was generally high, but the groups from Syria and Turkey included substantial proportions of individuals with none or merely elementary education.

Between 85 and 100% of the Bangladeshi, Turks, Peruvians, and Ugandans had been politically active in their home

Discussion

Since the patients involved in the study were refugees who had survived alleged torture they might not be representative of torture victims in general. A selection bias is also inherent in the handling of the cases by the Swedish authorities. For example, large refugee groups in Sweden, such as the Iraqis and ex-Yugoslavs, are less likely to have their asylum applications turned down, whereas the nationalities included in the present study have more difficulties regardless of allegations of

Acknowledgements

This study was supported by grants from the Board of Social Welfare in Sweden, no. 51-12659/98.

References (13)

D Forrest et al.
A guide to writing medical reports on survivors of torture
Forensic Sci. Int.
(1995)
D Forrest
Patterns of abuse in Sikh asylum-seekers
Lancet
(1995)
I Lunde et al.
Prevalence and sequel of sexual torture
Lancet
(1990)
D Forrest
The physical after effects of torture
Forensic Sci. Int.
(1995)
P Garbolino et al.
Evaluation of scientific evidence using Bayesian networks
Forensic Sci. Int.
(2002)
Amnesty International Report 2001, Amnesty International Publications, Oxford,...

There are more references available in the full text version of this article.

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Torture and its sequel—a comparison between victims from six countries

Abstract

Introduction

Section snippets

Patients and methods

Social data

Discussion

Acknowledgements

Forensic Sci. Int.

Lancet

Lancet

Forensic Sci. Int.

Forensic Sci. Int.