Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013.

Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation. 296 patients except one 5-year-old child were included in the study. Of the 296 patients; 175 were male, 120 were female, and one was a transgender individual. The highest number of applications was received by the Istanbul center with 216 patients. The mean age of applicants was 33.85, and the age range was 15-71 years. While 268 of applicants (91%) stated that they had been exposed to Riot Control Agents, 62 patients suffered only chemical exposure who had no other traumatic injuries whereas 234 patients suffered at least one blunt trauma injury. Blunt trauma injuries are due to being shot by gas canisters in 127 patients (43%), by plastic bullets in 31 patients (10%). 59 patients (20%) were severely beaten, and 30 patients (10%) were injured by pressurized cold water ejected by water cannons. Thirteen patients (4.4%) suffered injuries that caused loss of vision or eye. Psychiatric evaluations were carried out for 117 patients while 43% of them were diagnosed with Acute Stress Disorder. Post Traumatic Stress Disorder and Major Depressive Disorder followed this diagnosis. This study includes the medical evaluation of injuries allegedly sustained during Gezi Park demonstrations in 2013 as a result of several methods of demonstration control and/or by being exposed to Riot Control Agents. The aim is to discuss different types of injuries due to those methods and health consequences of Riot Control Agents.

Diagnosis of torture after 32 years: assessment of three alleged torture victims during the 1980 military coup in Turkey.

Torture is a crime against humanity and it is frequently encountered in countries that have a history of military intervention such as Turkey. Torture still exists despite absolute prohibition by human rights and humanitarian law. More than 1 million people were tortured in Turkey since 1980 coup d'état. Documentation of medical evidence is a prominent step for prevention of torture. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol) provides international standards for medical documentation of torture. A holistic approach to trauma stories together with physical and psychological findings has been the main frame of the Protocol. The aim of this study is to discuss physicians' responsibility for prevention of torture, and to emphasize the importance of holistic approach to the assessment of particularly chronic patients. A team of two forensic medicine experts and a psychiatrist examined three male patients, who allegedly had been tortured severely during the 1980 military coup. The team arranged necessary referrals and diagnostic examinations. After conducting a comprehensive medical examination, some physical and psychological findings of trauma were observed and documented even after 32 years. The medico-legal evaluation and documentation of these cases many years after torture under the guidance of Istanbul Protocol were presented and significance of psychological assessment was especially emphasized. Furthermore, possible evidence of torture after a long period and physicians' responsibility for prevention of torture is discussed.

Demonstration control agents: evaluation of 64 cases after massive use in Istanbul.

An uncontrolled use of "demonstration control agents" commonly known as "teargas agents" has recently been a common practice in Turkey. One of the first massive uses of these agents had been during a meeting of the North Atlantic Council and NATO in 2004, in Istanbul. After the demonstrations, 64 patients were evaluated and treated by the Human Rights Foundation of Turkey. Their files have been reviewed retrospectively and were classified regarding age, sex, physical findings related of chemical agents, and other injuries.The patients were received 1 to 9 days after the chemical gas exposure. The maximum referral was 35 patients on the day of the gas exposure. The last application was 9 days after the exposure. Complaints and physical findings/symptoms were highest during the first 3 days.This study has been carried out to reveal the short- and long-term aftereffects of "demonstration control agents." The safety and effects of these agents are discussed in this article, based on our findings and existing references.

A significant diagnostic method in torture investigation: bone scintigraphy.

Torture appears to be a permanent feature in countries, which have experienced military coups or ruled by oppressive governments in the past, such as Turkey. The Human Rights Foundation of Turkey (HRFT) was established in 1990 to serve torture victims, mainly those who were the victims of the 1980 military regime. Since then the HRFT has been providing rehabilitation and documentation for torture survivors. Bone scintigraphy can be one of the diagnostic methods to reveal trauma, particularly after several years when it is challenging to find any physical or radiological evidence. The HRFT's Istanbul Branch referred 97 of their applicants for bone scintigraphy between 1992 and 2010. In this retrospective survey of 97 cases, 17 of them were female and 80 of them were male. Several aspects were evaluated, including working conditions, change of torture methods practiced in certain time periods, time since torture and duration of exposure to torture in comparison with findings of bone scintigraphies. The torture methods varied from beating to falanga, electric shock, suspension and several other types of torture within the period of practice, although beating was a common denominator among all. The findings were classified according to time since torture and duration of exposure to torture. More than half of the cases (59%) had a detectable bone lesion on bone scintigraphy, and the detectable bone lesion on scintigraphy increased significantly with the duration of exposure to torture, particularly among cases who had been subjected to torture for a longer period (8 days and more). Bone scintigraphy should be considered as a valuable non-invasive diagnostic method to assess and document long term torture practices and/or cases with no detectable marks upon physical examination.

The role of jurisdiction on persistence of torture in Turkey and public reflections.

Torture still is a serious problem in Turkey. There has been a very effective struggle against torture, particularly for effective documentation by health professionals. The Istanbul Protocol has been taken into consideration by the ministry of health, and procedural safeguards with standardized medicolegal documentation had been a part of daily medicolegal practice. However, measures taken on the basis of effective documentation is not sufficient without effective investigation of which the role of jurisdiction is most prominent. Impunity is highly responsible for the persistence of torture, although procedural safeguards on medical examination and medicolegal documentation have had an influence for the decrease of the total number of cases. The Anatolia Agency had distributed information on the total number of punishments in 2007, which drew a more hopeful picture with 5,082 punishments among 33,000 law enforcement officials who had been taken to court. Nevertheless, a press conference held by the Human Rights Foundation of Turkey revealed that this information was not true. They revealed that the cases taken to the court were mostly because of ill treatment instead of torture, and a great majority of these officers had been acquitted between the years 1989-2005. Administrative measures had also been highly insufficient, and among 922 personnel who had been under investigation, only 8 of them had had punishment. The Human Rights Association has had a research on impunity, and only 15% of law enforcement officials who had been taken to the court were ever convicted of their crimes, and all of these punishments had been suspended. Research on cognitive behaviour of judges and prosecutors revealed that they think human rights might threaten the security of the state. This result only clarifies the cause of impunity, thus persistence of torture. The Istanbul University Istanbul Faculty of Medicine, Department of Forensic Medicine, has an outpatient clinic in which torture survivors are examined, and alternative medicolegal documentation is carried out. These patients who were able to have a medicolegal document are observed to benefit from psychotherapy, thus impunity should not only be surmounted for the eradication of torture, but also the healing of the wounds of torture survivors.