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.

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.

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.

Oral and maxillo-facial injuries in victims of political repression during the Chilean dictatorship.

INTRODUCTION: Chile was under a civil-military dictatorship from 1973 to 1990. During that time, systematic violations to human rights were perpetrated. Oral and maxillo-facial trauma was not an exception, and such trauma was carried out through different methods of torture or ill treatment by agents of the State. Currently, Chile has laws and programs in the public healthcare system to carry out the re-habilitation and reparation process in victims, and the registration of the suffered injuries is considered an important part of these med-ico-legal procedures. The aim of this study is to describe and classify the type of torture or ill-treatment in the orofacial area of victims of political repression during the Chilean military dictatorship and relate them to the injuries registered in written reports. METHODS: 14 reports of oral and maxillo-fa-cial injuries of tortured victims from 2016 to 2020 were analyzed, considering the alleged history of the patient, the visible effects on the oral examination, and the type of torture that was inflicted. Historical clinical records and X ray exams were analyzed when available. RESULTS: 6 variations of torture and ill-treat-ment that involve the maxillo-facial area were caused by agents of the State during the dic-tatorship period. DISCUSSION: According to the patient ́s account and the clinical examination, all of the torture techniques applied caused, directly or indirectly, the loss of teeth. This resulted in not only physical problems, but psychological problems for the victims.

Exploratory study on the quality of forensic assessments using the Istanbul Protocol in a virtual versus face-to-face environment.

INTRODUCTION: With the advent of the Covid-19 pandemic, most torture victim care centres had to adapt their forensic assessment methods and move to online methodologies. Therefore, it is essential to assess the advan-tages and disadvantages of this type of inter-vention, which seems to be here to stay. METHOD: Structured administered surveys were conducted with professionals (n=21) and with torture survivors (SoT) (n=21) from a sample of 21 Istanbul Protocols (IP). Compar-ing face-to-face (n=10) and remote (n=11) in-terviews in relation to the evaluation process, satisfaction, difficulties encountered, and compliance with therapeutic aspects. All as-sessments were primarily psychological. Three remote and four face-to-face interviews in-cluded a medical assessment. RESULTS: No significant problems were found in relation to the ethical requirements of the IP. Satisfaction with the process was pos-itive in both modalities. Regarding the online method, there were frequent connection prob-lems and a lack of adequate material resources in the remote assessments, requiring a signifi-cantly higher number of interviews in most cases. Survivors were more satisfied than eval-uators. Overall, the forensic experts described problems in complex cases with an under-standing of the person's emotional response, they established a bond, and they undertook psychotherapeutic interventions in the event of an emotional crisis during the assessment. In the face-to-face protocols, logistical and travel problems were frequent, which meant that fo-rensic work times had to be adapted. DISCUSSION: The two methodologies are not directly comparable but have specific issues to be studied and addressed. More invest-ment and adaptation in remote methodology is needed, especially given the poor economic situation of many SoT. Remote assessment is a valid alternative to face-to-face interviews in specific cases. However, there are very relevant human and therapeutic aspects that indicate that, whenever possible, face-to-face assess-ment should be preferred.

Protocol on medico-legal documentation of solitary confinement.

INTRODUCTION: This Protocol originates from a joint project regarding documentation of psychological torture initiated by the Public Committee against Torture in Israel (PCATI), REDRESS and DIGNITY - Danish Institute Against Torture (DIGNITY) in 2015 after the Copenhagen Conference on Psychologi-cal Torture. The project is a vehicle to estab-lish a common understanding between health and legal professions as to how to best ensure the most accurate documentation of torture.The aim of the Protocol is to improve docu-mentation of solitary confinement and therefore to clarify the facts of the case so that stron-ger legal claims can subsequently be submitted to local and international complaints mecha-nisms. The Protocol has been developed based on a methodology involving a compilation and review of legal and health knowledge on soli-tary confinement and discussions among the authors and in a group of international experts. METHODS AND RESULTS: This Protocol is cognisant of the significance of the specific social, cultural and political contexts in which solitary confinement is used. We hope that this Protocol will assist in the discussions between the various stakeholders and provide guidance on what can be documented and how to doc-ument torture.

The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System.

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (ß = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (ß = -0.345) and physical health problems of parents (ß = -0.305), and youth gender (ß = 0.126) and trauma exposure of youth (ß = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (ß = 0.449). Family type had an indirect effect on youth adjustment through youth gender (ß = 0.142), youth trauma exposure (ß = -0.165), parent physical health problems (ß = -0.202), and parent mental health (ß = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.

Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.

RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.

A Comparison of Psychosocial Services for Enhancing Cultural Adaptation and Global Functioning for Immigrant Survivors of Torture.

Forced migrants suffer from significant psychological distress. However, they often prioritize urgent practical resettlement needs over mental health needs. The present study used a quasi-experimental design to compare pathways of treatment for survivors of torture (N = 369) from 42 different counties receiving care from a refugee health clinic. Random intercept ANOVAs were used to compare combined case management services and psychological treatment (CM-PT) to case management services only (CM) on changes in cultural adaptation and global functioning over time. Results showed that both groups improved on each outcome. Importantly, the CM-PT group endorsed greater improvements in cultural adaptation (b = 0.28, 95% CI 0.14, 0.41, p ≤ 0.001) and global functioning (b = 3.29, 95% CI 1.33, 5.25, p = 0.001) compared to the CM group. These findings suggest that treatment for survivors of torture should be multifaceted and include case management and psychological treatment. Case management services alone may be beneficial when socio-cultural and resource barriers exist for mental health treatment.

Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives.

Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination, which can provide strong evidence of torture. Female genital mutilation and cutting, a basis for asylum, is classified according to the World Health Organization. Many resettled refugees and foreign-born immigrants at urban health care facilities have been tortured, but few report it to physicians due to factors affecting both survivors and physicians. Specific torture methods can cause characteristic long-term sequelae. Painful somatic disorders of mind-body interaction and psychological disorders are common. Practices derived from cultural factors and traumatized individuals' feedback enhance management of survivors. Individual and group psychotherapy provide modest proven benefit, but assessment is limited. Physicians and psychotherapists should coordinate care.

Identifying resilience-promoting factors for refugee survivors of torture.

INTRODUCTION: There are 1.3 million refugee survivors of torture living in the United States today. An existing body of research with refugees has largely examined mental health, but few of these studies focused on resilience. OBJECTIVE: Using a clinical sample of refugee survivors of torture, we tested the resiliencepromoting factors of community engagement, employment, English fluency, and psychological flexibility. We conducted moderation and mediation analyses to investigate how these resilience-promoting factors impact the torture-mental health relationship. RESULTS: Torture severity had significant positive associations with all mental health symptoms including PTSD (post-traumatic stress disorder), depression, and anxiety. Conversely, psychological flexibility had significant negative associations with all mental health symptoms. Additionally, psychological flexibility was a significant mediator of the torture-mental health relationship, highlighting its potential as a causal mechanism between torture and mental health. This evidence suggested that experiencing greater torture severity led to greater mental health problems in part via difficulties in psychological flexibility. Separately, English fluency and employment status were negatively correlated with mental health symptoms. CONCLUSION: The findings from this study identified potentially resilience-promoting factors for refugee survivors of torture and contributed to both research and clinical insights in better serving this vulnerable population.

The manipulation of minds:reckoning with the legacy of the american post 9/11 torture program.

In this article, we argue that the government's post 9-11 torture program was a big lie, in that the designers, executors and enablers knew all along that torture does not elicit reliable information. We review the government's own research on the matter, and we discuss the ways in which methods known to be unreliable were implemented, most saliently at the detention facility at Guantánamo Bay. We review the secrecy and propaganda surrounding the scope and horror of the torture program at Guantánamo and black sites around the world, and the painful truth of how the government knowingly adopted the terror policies of the torture program, against their own knowledge, against international human rights, and against the law. On January 20, 2021, Joseph R. Biden, Jr. became the 46th President of the United States, following what might very well have been the most chaotic election in the recent history of the United States. The turmoil reached a peak on Jan 6, 2021, when Trump supporters stormed the Capitol in Washington, DC. At the center of this extended and ongoing political upheaval is what has been labeled "The Big Lie" - the completely disproven notion that Biden's win was based on fraudulent grounds, and that the election was stolen from Trump because of a corrupted voting process. President Biden has consistently rejected reality warping and presents himself on the national stage as a man of reason, and a strong supporter of science. He has proclaimed "Science is discovery. It's not fiction", as he announced that his team of scientific advisors would summon "science and truth" to combat climate change, the COVID-19 pandemic and other challenges facing his new administration, adding "The same laws apply, the same evidence holds true regardless of whether you accept them." President Biden can show his self-proclaimed commitment to truth by following through on his words with action. In particular, he can fulfil the task which his two predecessors, Trump and Obama, both failed to do: Closing the detention facility at Guantánamo Bay. The same United States law and international law apply; the same evidence, or lack thereof holds true for those remaining 38 prisoners being held within the confines of a US-run concentration camp in the Caribbean. The laws of science apply, the rules of evidence apply, and the rule of law applies. Science and truth cannot be situationally applied to suit political agendas, especially not within the confines of a facility once called a "Battle Lab" (Leopold, 2015), where the military touts phrases like "honor bound" and "defend freedom" at the entrance, yet the truths of what goes on inside are withheld from the public record, via the government's complex layers of secrecy, including classification, redactions, and obfuscations. There can be no justice without truth. The system has derailed every effort to bring the suspected 9/11 terrorists to justice before tribunals that have failed and have been derailed by torture. While President Biden can't remove the stain of the national torture policies, he can show that the Constitution endures; that the rule of law prevails, by illuminating the shadowland of the torture regime. Joe Biden needs to demonstrate that truth matters - even painful truths. In this article, we will describe that through a painstaking and laborious process of discovery, we now know that behind the gates of Guantánamo Bay and its related archipelago of black sites there were prisoners, often held on dubious grounds or no reasonable grounds at all. We know that these prisoners were submitted to treatments aimed squarely at generating complete psychological disintegration. As we will lay out in the article, prisoners captured during Operation Enduring Freedom and Operation Iraqi Freedom were subjected to physical violence, sexual violence, and an astonishing array of psychologically abusive tactics under the misnomer 'interrogation'. We also know that the torture program metastasized into a monster, as if lifted from the pages of the most absurd of postmodern fictions, and that the United States has never held anyone accountable, nor faced any reckoning for this disaster of human rights (Senate Select Committee Study of the Central Intelligence Agency Detention and Interrogation Program, 2014). And we know that the disaster that was the torture program was all based on lies, one big lie in particular - that torture worked to break through to truth. The chief argument, which we will defend below, is that the schemers behind the system of torture knew all along that this was bogus; that torture does nothing to produce truth, that what it breaks is a person's autonomy and very selfhood, rendering them compliant in the extreme. Indeed, the CIA and United States military, who both committed war crimes, knew all along that they propagated falsehoods - our main argument is that the historical record shows that the CIA itself has a long history of studying precisely the effect of techniques like those employed post 9/11. As we shall see, the so called architects had no interrogation experience, but were well-versed in communist-based methodologies known to produce false information.

Launch of the revised version on the Istanbul Protocol.

On the 29th of June 2022, an updated version of the Istanbul Protocol was launched in Geneva, Switzerland; twenty three years after its first official endorsement by the OHCHR (Office of the Human Rights Commisioner, UN) in 1999. The Istanbul Protocol, or the Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; guides human rights activists, experts, and organizations around the world. The launch of this revised version was enabled by the contributions from more than 180 experts of the anti-torture field. It was hosted by the Geneva Academy of International Humanitarian Law and led by the Istanbul Protocol Editorial Committee. The Istanbul Protocol lays out the international legal norms and standards for dealing with torture and ill-treatment. It sets the relevant ethical codes, and provides guidelines for the legal investigation of torture. The Protocol also details general considerations for interviews and the guidelines for documenting physical and psychological evidence. The revision adds in two sections which respectively underlines the role of health professionals in documenting torture through various contexts and provides recommendations on the implementation of the Protocol. Informed by six years of preparation and consultation, this revised version was spearheaded by four civil society organizations (the Human Rights Foundation of Turkey, REDRESS Trust, Physicians for Human Rights, and the International Rehabilitation Council for Torture Victims) and four UN bodies, (Committee against Torture, the Subcomittee on the Prevention of Torture, Special Rapperteur on Torture; as well as the UN Voluntary Fund for Victims of Torture). This is the second update to the Protocol, the first being 18 years earlier in 2004. The revision of the Istanbul Protocol is not a replacement but rather an expansion. The document attempts to fill in the gaps created by almost two decades of global change. In the foreword of the updated document, Michelle Bachalet, UN High Commissioner for Human Rights, calls for states to make the Istanbul Protocol an 'essential part of training for all relevant public officials and medical professionals engaged in the custody, interrogation and treatment of persons subjected to any form of arrest, detention or imprisonment' (OHCHR, 2022).

The Syrian regime's apparatus for systemic torture: A qualitative narrative study of testimonies from survivors.

BACKGROUND: Despite broad interest of the Syrian refugee plight in the academic and media circles, there are still limited studies analyzing the lived experiences of torture survivors under the Syrian regime. This qualitative study interviewed torture survivors to examine the form and function of the Syrian regime's security apparatus, and the personal aftermath of survivors. METHODS: Thirteen in-depth interviews were conducted in Arabic with Syrian refugees who endured torture. Study participants were at least 19 years of age, resided as refugees in Jordan, and voluntarily agreed to participate in the study. Participation was anonymous and no incentives were provided. Only oral consent was required. Audio-recorded interviews were transcribed and translated to English, and then analyzed for repetitive themes utilizing the narrative approach. RESULTS: Major themes were observed across three experience-phases: pre-captivity, during captivity, and post-captivity. The pre-captivity phase included two sub-themes: the Syrian regime's initial detection and arrest system, and the intelligence system. The captivity phase was also divided into two sub-themes: environmental conditions in detention facilities, and torture methods including physical and psychological torture. Some of the environmental conditions in detention facilities included lack of sanitation, crowding, starvation, and withholding of medical care. Torture methods encompassed beatings, electric shocks, nail-pulling, hanging, drowning, suffocation, rape, and the witnessing of killing, sexual assault, or torture of others. The post-captivity phase included their release from captivity, escaping Syria, and post-displacement conditions and activism. CONCLUSIONS: The Syrian regime employs a vast security apparatus to track, detain, interrogate, torture, and subjugate its civilian population. A systematic mechanism commences even before captivity and continues for years after release, with negative implications on the well-being of survivors, their families, and the Syrian people as a collective community. The Syrian war saw a shift toward mass detention, torture as a form of social punishment, subjugation, and indeterminate imprisonment. Intervention agencies, host countries, and policymakers must be informed of survivors' experiences to better address their needs. Moreover, the international community must advocate for a firm stance against torture, demand justice, and prosecute all parties engaged in perpetuating such extreme forms of suffering and trauma.

Reflections on healing and recovery from the legacies of trauma and violence.

With the arrival in Denmark of torture sur-vivors from Latin America in the nineteen seventies and eighties, therapists faced the challenge of how best to accompany the sur-vivors in their healing processes. The New Left and Feminism were important political movements which influenced the therapeu-tic approaches discussed at that time. In the author's meeting with Latin American col-leagues a dialogue about therapeutic methods was further developed with emphasis on the connection between "Human Rights and Mental Health". The civil war in the Balkans in the nineties brought new challenges: the development of psychosocial community in-terventions as well as an intensification of the debate between the "medical" and psycho-social approaches to trauma healing. Coop-eration during the last decade with NGOs in e.g., India, Cambodia, and Honduras brought new and more holistic perspectives on therapy represented by a brief version of Testimonial Therapy that sought to integrate cultural and spiritual traditions as well as "third wave" cognitive methods.

Towards a systematic approach for the treatment and rehabilitation of torture and trauma survivors: The experience of STARTTS in Australia.

This paper recovers a text written in 1994 that explored and discussed the complex interac-tion between the psychological and psychoso-cial sequelae of exposure to highly traumatic situations in the context of organized violence, and the stresses and demands of the exile and re-settlement process of refugees. The effects on the individual, the family and refugee communities were explored, and a model to address these problems from a systemic per-spective, involving action at the individual, family, refugee community, mainstream com-munity and mainstream political structures was put forward. The role of approaches such as individual counselling, group work and community development in this framework, and various issues in the practical application of this model were discussed in the context of STARTTS experience. Looking back, almost 30 years later, the paper has renewed value as it shows the founding theoretical principles and the path to what today is one of the most im-portant anti-torture organizations in the world.

Healing and reintegration of former child soldiers: A relational resilience perspective.

The author advocates for a psychosocial and community perspective in the work with child soldiers, as torture survivors.

Rehabilitation for torture survivors: Six evidence myths and their implications for future research.

Whilst it is established that torture survivors suffer from complex, multiple and often severe and enduring physical, psychological, social, welfare and many other difficulties; and that rehabilitation as reparation should be holistic, interdisciplinary and specialist, majority of the research on rehabilitation focuses increasingly and almost exclusively on psychological interventions. Further, as-sumptions that this research provides evi-dence of which are effective psychological interventions may underpin and skew ser-vices funded and provided to torture sur-vivors. In this paper we challenge some of those assumptions, and discuss the concep-tual, theoretical, epistemological and meth-odological limitations of this research and implications for future research.

Control-Focused Behavioral Treatment: A brief intervention for survivors of war and torture.

This article briefly reviews the evolution and evidence-base of Control-Focused Behav-ioral Treatment (CFBT), largely self-help-based treatment that involves no cognitive interventions, focuses solely on reducing avoidance behaviors through self-exposure to anxiety-evoking trauma cues, and, unlike other interventions, aims to enhance sense of control over traumatic stressors, rather than anxiety reduction. As such, it is radi-cally different from other interventions in both theory and practice. Our studies have shown improvement rates of 80%-85% with a single treatment session in earthquake survivors. When administered in an average of 6 sessions in war and torture survivors, it achieved 82% reduction in posttraumatic stress symptoms (PTSD), leaving 97% of the cases nearly asymptomatic or with only mild PTSD symptoms. Meta-analytical compari-sons suggest that such improvement rates are substantially higher than those achieved by other evidence-based treatments.

30 years on: A brave new world or an unfolding disaster?

In this short essay, the focus is on social and political aspects of forced migration. It is argued that policies designed to restrict access to developed countries have, rather like the American "prohibition", produced a thriving criminal market for smugglers, in this case of people. Making travel more difficult increases both their profits and the sophistication of their methods. Provision of targeted, properly controlled, support for refugees in countries neighbouring conflict zones might help to reduce the pressure on travel to Europe and could be both more successful and more hu-manitarian. For those who do reach devel-oped countries, there is scope to improve the legal decision-making process. Psychological input should include scientific investigation of legal assumptions, and the provision of rel-evant expert literature reviews, for example concerning modern knowledge of memory. Trust is the first casualty of repressive vio-lence, and mistrust among opposition groups is probably one of the key mechanisms of its success. We need to make sure that we do not provide further grounds for this sort of reaction. Although there is no brave or new world ahead, we must continue to confront ignorance and prejudice, as we seek to avoid more humanitarian disasters.It is now just over thirty years since we published a potential framework for under-standing how survivors of organised state vi-olence react to complex and severe trauma (Turner and Gorst-Unsworth, 1990). We argued that no single psychological process underpins the reactions to this experience, and therefore, there can be no unitary torture syndrome, but rather a series of understandable psychological pathways activated to varying degrees by dif-ferent experiences, leading to diversity of emo-tional response, with implications for recovery and treatment. We also asked family doctors about health needs of refugees (Ramsay and Turner, 1993), and it is wonderful to see how the evidence on treatment options has devel-oped since then, especially in recent years. In this paper, looking back over the last thirty years, in celebration of the anniversary of Torture journal, I will focus on political, legal and forensic aspects of forced migration.