Child torture victimization: Review of criminal statutes and medico-legal issues.

A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.

Assisting refugee survivors of torture and trauma: An existential perspective.

Consistent exposure to refugee narratives of trauma and torture can profoundly impact trauma therapists. This secondary analysis reanalyzed data from a narrative inquiry investigating the lived experiences of refugee trauma therapists. We aimed to explore emergent concerns through an existential lens to enrich understanding and provide additional insights into the lived experiences of these individuals. Participants in this purposive sample (N = 19) were therapists who had provided interventions to refugees for 2-34 years. Narrative construction, theory-guided data analysis, and memo writing were used to reanalyze data generated by semistructured interviews augmented by photo elicitation. The findings indicate that being forced to reevaluate familiar beliefs consequent to one's professional roles induced intense existential moments, described as "a dark night of the soul," "the paradox of life and death," "uncanny feelings of not being at home," and "a falling." Acknowledging the complexities of the field, an existential framework to assist refugee trauma therapists in metabolizing and living with the professional challenges they encounter instead of focusing on alleviating decontextualized symptoms of distress is recommended. Research to inform requirements of the space to enable refugee trauma therapists to share their concerns and facilitate transitions toward more authentic, nonevasive sense of "being-in-the-world" is suggested.

Manifestations of cruel, inhuman types of behavior and torture of Ukrainian military who died in captivity.

The given information and forensic medical characteristics of injuries found on the bodies of Ukrainian soldiers who were in Russian captivity and died as a result of cruel, inhuman treatment and torture in 2022-2023. According to their nature and morphological features, the damage could be the result of high temperature action using hot metal objects, but more likely, the result of the use of electric current conductors (bare end of the wire). In other cases, after the exhumation of the occupied territory of the Kharkiv region, the manifestations of torture were brain injuries and fractures of the bones of the body caused by blunt hard objects with a limited surface. All the injuries described by us correspond both to the list of physical evidence of torture of the "Istanbul Protocol" and to the list of war crimes of the "Rome Statute".

"Rectal Feeding"-Unethical Medical Officer Participation at CIA Secret Interrogation Facilities.

This Viewpoint discusses recently released information regarding the practice of "rectal feeding" among detainees at Guantanamo Bay and Central Intelligence Agency (CIA) secret prisons.

Torture survivors' experiences of receiving surgical treatment indicating re- traumatization.

Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.

Reported Methods, Distributions, and Frequencies of Torture Globally: A Systematic Review and Meta-Analysis.

Importance: Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals worldwide, and health care practitioners globally are increasingly encountering refugee torture survivors in their clinical practices. The methods, geographic distribution, and frequency of torture globally are not well described, which limits health care practitioners' ability to adequately diagnose and treat the sequelae of torture. Objective: To rank the commonness of torture methods and identify the regions of the world with which they are associated. Data Sources: For this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Web of Science, and The Cochrane Library were searched from inception to July 2021. Study Selection: Included studies were peer-reviewed articles in English, contained an independent sample population of individuals who experienced torture, and outlined the type(s) of torture experienced. Excluded studies were not peer reviewed, lacked an independent sample population, or did not specify torture methods. Articles were chosen for inclusion by 2 independent and blinded reviewers, and a third, independent reviewer resolved discrepancies. Overall, 266 articles-15.3% of the 1739 studies initially identified for full review-met the inclusion criteria. Data Extraction and Synthesis: Data abstraction and quality assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 2 independent and blinded reviewers into predefined templates, and a third, independent reviewer resolved discrepancies. The risk of bias was evaluated using the Downs and Black Checklist. Main Outcomes and Measures: Torture methods were ranked by their average frequencies, numbers of reporting studies, and numbers of countries wherein the methods occurred. Results: A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor. Conclusions and Relevance: The findings of this study suggest that torture remains widespread. Although innumerable torture methods exist, a limited number account for the vast majority of reported tortures. So that targeted therapies may be developed, additional investigation is needed to better elucidate the sequelae associated with the most common torture methods, described here.

What is 'agency' in torture and trauma recovery? An inquiry into the properties and explanations of the concept of agency and it's impacts.

This paper presents learnings from trauma recovery mechanisms and social movements from around the world relating to a survivor's role and as such- their agency. It unpacks various conceptual frameworks as possible alternative, effective and strategic pathways in torture rehabilitation. Ongoing and new challenges such as resourcing, cultural adaptability limitations, lack of access to services and inhumane foreign policies pose barriers to established systems that render some practices inadequate in terms of meaningful service delivery or social impact for torture survivors (Wheildon et al., 2022, p. 1689). It is well documented that "Torture aims to dehumanise survivors through calculated acts of cruelty to remove the survivors' dignity and make them powerless." (Luci and Di Rado, 2020, p. 3). As such this paper deliberately straddles multiple thematic fields, all grappling with relatable notions of restoring power or agency to survivors. At the risk of discursiveness into fields beyond torture rehabilitation then, this paper aims to showcase and learn from other successful movements. It also invites you as the reader into this discourse of inquiry and self-reflection, in order to counter the ten- dency of assuming a prescriptive, blanket (or blank) meaning of survivor engagement activities. Its findings suggest the manifestation of bespoke programming according to context and survivors' needs. It does not suggest a systematic overhaul, but rather a shift of incremental and cumulative changes that are recognised as advantageous. This paper deep dives into theories on agency, looking firstly at the broader archetypes that provide commonality and structure before then exploring particularities from different contexts. Implications for practice are then discussed, with nuances drawn out from the findings.

Best practices in survivor engagement in IRCT member centres.

INTRODUCTION: While the literature encourages engaging torture survivors in the direction and provision of services, little is known about how best to do this. METHOD: We surveyed 82 member centres of the International Rehabilitation Council for TortureVictims (IRCT), a worldwide network of anti-torture organisations, and interviewed fourteen staff members and executive directors about current practices, best practices, and the advantages and disadvantages of engaging survivors. RESULTS: While few agencies involve survivors extensively, those that did found survivor engagement helped agencies engage in better planning, service provision, and advocacy, while at the same time being healing and empowering for survivors. Agency staff described strategies to minimize retraumatization, particularly in not encouraging survivors to share the story of their trauma, but to engage in other ways. Agency staff suggested a number of ways to engage survivors in program direction, service provision, and advocacy, which included having survivors serve on the board of directors, hiring survivors as staff, involving survivors in advocacy, advising staff and volunteers on how better to provide services, and working as community outreach workers and mediators. CONCLUSION: IRCT member centres can engage survivors in programming without retraumatizing them, and there are many advantages to doing so.

Self-organisation and empowerment in the struggle against silence. Network of Tortured People of Navarre.

In 2021, a group of tortured people and their relatives in Navarre started a process of selforganisation that culminated in 2022 with the birth of the organisation Network of Tortured People of Navarre. The process of self-organisation of tortured people in Navarra is an uncommon phenomenon, which can offer interesting lessons especially for torture victims in other countries and contexts. The aim of this article is to describe a survivor-lead experience and to analyse the keys to this process of collective empowerment.

Torture survivors who engage in advocacy in the U.S.: Review, characteristics and policy implications.

INTRODUCTION: Despite facing many challenges, some survivors of torture seeking asylum in the U.S. have courageously engaged in advocacy efforts to bring attention to human rights issues relevant to their own personal experiences. This study sought to add to our understanding of the characteristics of survivors who engage in advocacy in comparison with those who do not. METHOD: We analyzed demographic, social, and psychological quantitative data collected from survivors (n=730) connected to a support agency that regularly facilitates advocacy events using between-groups t-tests and regression analyses. Based on theory, clinical insights, and past research around survivor advocacy we predicted that participation in advocacy would be associated with and predicted by factors indicating lower levels of trauma-related symptoms and higher social power and stability. RESULTS: We found no significant difference in clinical symptoms or most demographic or social characteristics between advocacy participants (n=75) and non-participants. However, advocacy participants had spent significantly more time in the U.S. and were less likely to have had employment authorization at time of service intake, and were more likely to be male, compared to non-participants. Without controlling for other demographic factors, higher spirituality and not having been detained at entry to the U.S. also predicted advocacy participation. DISCUSSION: Our findings suggest that, despite some patterns of difference indicating greater stability and access to power (e.g., being male, having more time in the U.S., more daytime availability, a strong sense of spirituality, and less experience of detention in the U.S.), survivor-advocates are diverse and not consistently differentiated from non-advocates by specific characteristics. Thus, we find no evidence to support using psychological or demographic indicators as a "screening" criterion for selecting advocacy candidates. We contend that it is important to adopt a gender-inclusive approach in providing wider opportunities that help more survivors overcome potential (racial, socio-economic, mental health, etc.) barriers to engagement, and to pay close attention to who is being left out of advocacy opportunities.

'I was lost in my life and they helped me find my way again': Befriendee and befriender experiences of the Spirasi Befriending Programme for survivors of torture in Ireland.

INTRODUCTION: Befriending is one of the rehabilitative services embedded in the holistic approach adopted by Spirasi, the Irish National Centre for the Rehabilitation of Survivors of Torture. Their befriending programme offers survivors one-to-one companionship from trained volunteer befrienders. The literature suggests that befriending programmes can improve quality of life, provide emotional support and combat loneliness. However, there is little empirical research of the effectiveness of befriending programmes for torture survivors. OBJECTIVE: The main objective was to explore, in complementary ways, the impact of the Spirasi befriending programme on befrienders and befriendees and to incorporate their voices into recommendations for optimising the service. METHODS: The methodology consisted of five focus groups (two with befriendees, two with befrienders and one with both) and a portrait workshop facilitated by two community artists, where each befriending pair member created a portrait of their partner to express and visually explore the befriending relationship. Data comprised the focus group transcripts and written feedback on the portrait-creation process. RESULTS: The themes identified in both data sets firmly ground the befriending programme in Spirasi's holistic approach to recovery. For the focus group participants, befriending promotes integration; models trusting, kind and reciprocal relationships; combats loneliness and protects against suicide. They also highlighted the importance of regular befriender training, increasing the programme's reach and developing a befriender community of practice. The portrait workshop was found to strengthen relationships and provide a context of normality, acceptance and shared humanity through compassionate and creative exchanges. CONCLUSIONS: This paper highlights the benefits of the befriending programme within Spirasi's holistic approach and the importance of collaborative expressive arts activities in building befriending relationships. It provides recommendations for good befriending practice which are relevant to all organisations working with survivors of torture as well as those working with people seeking international protection more broadly.

Medico-legal evaluation of torture victims in the USA before the Istanbul Protocol.

Now that the updated version of the Istanbul Protocol has been published, there is an opportunity to reconstruct pieces of history on the long road to having forensic torture assessment tools. This article is an attempt to contribute to that journey through our firstperson personal memories of those experiences, especially in the early years, far before the drafting and approval of the Istanbul Protocol: Amnesty International (AI).

Torture beyond carceral settings against individuals from marginalized communities: the important role for clinical documentation.

Historically, torture often was understood as physical and/or psychological pain inflicted by governmental agents on an individual who is detained or imprisoned in governmental custody. As defined by the United Nations Convention Against Torture (UNCAT), however, torture is increasingly recognized as occurring in settings far beyond carceral settings.

Migration and torture in today's world.

The goal of the volume Migration and Torture in Today's World, curated by Fabio Perocco, is to show the existence of a link between torture and current migration policies.

Obstetric Violence: Sterilisation without Consent. The Case of Y.P. v. Russian Federation.

On 20 September 2022, the European Court of Human Rights (ECtHR) delivered its judgment in a remarkable case on sterilisation without the patient's consent, Y.P. v Russian Federation (ECtHR, application no. 43399/13, 20 September 2022). According to the Court, there is no inhuman and degrading treatment, but it was a justified medical procedure. However, the Court did conclude a violation of the right to private life, under Article 8 ECHR. This outcome is at odds with an earlier sterilisation case without consent, V.C. v Slovakia (V.C. v. Slovakia, ECtHR application no. 18968/07, 8 November 2011). The question is how both rulings can be understood, especially the legal consideration regarding the prohibition of torture. After all, both cases lacked the patient's consent.

Psychological torture: definitions, clinical sequelae and treatment principles.

Psychological torture, in its broadest sense, is the intentional infliction of suffering without resorting to direct physical violence, in what is known as 'no-touch' torture. While several other definitions of psychological torture have been suggested, there is no one precise definition. Given the rapidly evolving current global political climate and the intensification of conflict, war and asylum seeking, the need for better recognition of psychological torture among clinicians, followed by the provision of appropriate treatment support for victims, has become increasingly pertinent. This article raises awareness of the concept of psychological torture among clinicians, through an overview of its debated definitions, the modalities which constitute this form of torture, and its clinical sequelae and treatment approach.

Forensic description of impalement and associated torture lesions by Napoleon troops (Egypt, 1800).

Impalement bone traumas are very rarely described in the medical literature. We here present the first case of such a diagnosis carried out on a skeleton. The patient is Soleyman el-Halaby, executed in June 1800, who was the 24-year-old murderer of the Napoleonic general Kléber. The skeleton is now held in the National Museum of Natural History (Paris). This report describes the traumatic lesions diagnosed after a careful forensic anthropological examination. Such a case is important from a medical point of view, whether the origin of the pelvic or abdominal impalement is accidental or criminal. Forensic examination of skeletons conserved in anthropological collections may help reconstruct the modalities of death, and give data for an eventual repatriation process to the original community.

What Are the Characteristics of Torture Victims in Recently Arrived Refugees? A Cross-Sectional Study of Newly Arrived Refugees in Aarhus, Denmark.

Torture victims live with complex health conditions. It is essential for the rehabilitation of torture survivors that their traumas are recognized at an early stage. The aim of this study was to investigate (i) the prevalence of reported torture exposure, (ii) the association between demographic characteristics and exposure to torture, and (iii) the association between PTSD and exposure to torture among recently arrived refugees in Aarhus, Denmark. Data were extracted from health assessments of refugees arriving in Aarhus in the years 2017-2019, and 208 cases were included in the analysis. The prevalence of reported torture was 13.9% (29/208). Most torture victims were found among refugees arriving from Iran (17.0% (9/53)), Syria (9.3% (8/86)), and Afghanistan (25.0% (5/20)). Significant associations were found between reported torture exposure and male gender, Southeast Asian origin, and a diagnosis of PTSD. In the study, 24.5% (24/98) of males and 4.5% (5/110) of females had been subjected to torture. However, it is possible that the prevalence of female torture survivors is underestimated due to the taboos surrounding sexual assaults and fear of stigmatization. Nearly half of the torture victims in the study were diagnosed with PTSD (44.8% (13/29)). The results confirm that torture victims constitute a vulnerable group living with severe consequences, including mental illness such as PTSD. Furthermore, understanding the cultural perspectives of the distress among refugees is crucial in providing appropriate healthcare services. This study highlights the importance of addressing the mental health needs of torture survivors and tailoring interventions toward vulnerable refugee populations.