Patterns and evidence of human rights violations among US asylum seekers.

BACKGROUND: Asylum seekers report exposure to human rights violations associated with a range of psychological and medical sequelae. Clinical evaluators can provide forensic evaluations that document evidence associated with their reports of persecution. The aim of this study was to characterize the forms of abuse experienced by asylum seekers, the psychological consequences of abuse, and the frequency with which clinician-evaluators found evidence that corroborated asylum seekers' reports. METHOD: We completed a retrospective chart review of 121 asylum seekers who received pro bono medical-legal evaluations through a human rights program and analyzed data using the constant comparative method. RESULTS: Eighty-eight percent of the clients reported experiencing multiple human rights abuses. Ninety-one percent of the clients who received psychological evaluations presented with symptoms associated with depression, anxiety, or trauma and stressor-related disorders. Clinician-evaluators found physical or psychological evidence consistent with the clients' reports in 97% of cases. Forms, perpetrators, and psychological consequences of abuse varied significantly by gender and geographic region. DISCUSSION: Asylum seekers report diverse forms of persecution in their countries of origin that differ by gender and geographic region. Clinician-evaluators overwhelmingly found physical and psychological evidence consistent with the asylum seekers' accounts of persecution.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip.

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

State of the Art: the Not-So-Great Wall of America.

PURPOSE OF REVIEW: This paper aims to review the literature regarding the impact of Donald Trump's candidacy and presidency on the health of immigrants in America. RECENT FINDINGS: The increase in detentions of alleged undocumented immigrants under the Trump presidency, especially his administration's attempts to detain children apart from their families, have placed thousands into conditions that can have long-lasting physical and mental health effects. Similarly, the Trump administration's efforts to increase deportations and restrict legal immigration has lead to immigrants' seeking fewer health-care resources for fear of jeopardizing their or their loved ones' chances of remaining in this country. The rhetoric used and policies pursued by Donald Trump have had a measurable adverse impact on the health of documented and undocumented immigrants in America.

Análisis de la producción científica mundial sobre esterilización forzada de mujeres con discapacidad entre 1997 y 2016 / World scientific production analysis in forced sterilization of women with disabilities between 1997-2016

Objetivo: Caracterizar la literatura publicada durante dos décadas (1997-2016) en todo el mundo, en inglés y español, sobre esterilización forzada de mujeres con discapacidad. Método: Se realizó un estudio bibliométrico descriptivo, longitudinal-retrospectivo. Se estudiaron los indicadores de productividad, colaboración y materias. Se empleó la herramienta de evaluación CASP (Critical Appraisal Skills Programme) como marco basado en la evidencia para la revisión de artículos originales y revisiones de la literatura. Resultados: Se recopilaron 139 documentos, en los cuales participaron 114 instituciones de 24 países. Los resultados muestran que la mayor productividad se concentra entre 2007 y 2016, existe un predominio de autoría femenina, de difusión en formato revisión de literatura, en idioma inglés y que proviene mayoritariamente de las universidades y del activismo de mujeres con discapacidad. Conclusiones: Se concluye que este tema ha sido insuficientemente estudiado en ambos idiomas; no obstante, se observa una tendencia al crecimiento. En sus contenidos se impone la denuncia de esta práctica como vulneración de derechos humanos, con mayor énfasis tras la Convención sobre los Derechos de las Personas con Discapacidad. La violencia contra las mujeres con discapacidad es un problema de salud mundial, y esta ha sido una de sus manifestaciones con menor visibilidad en la literatura. Que los gobiernos, profesionales de salud y comunidades tengan acceso a este conocimiento aumenta su concienciación y las probabilidades de erradicar toda forma de violencia

Objective: To explore world scientific production in forced sterilization of women with disabilities between 1997 and 2016, written in English and Spanish. Method: We carried out a descriptive, retrospective longitudinal study. The bibliometrics indicators of productivity, collaboration and subject-matter were studied. Critical Appraisal Skills Programme (CASP) was used as an evidence-based framework to evaluate original articles and literature reviews. Results: A total of 139 documents were studied, in which 114 institutions from 24 countries participated. The results show that the greatest productivity was between 2007 and 2016, with predominance of studies written by female authors, based on literature review methodology, written in the English language. The majority of the authors were affiliated with a university and from activism of women with disabilities rather than any other organization. Conclusions: It is concluded that while insufficiently explored in either language, there is a growing interest in this issue. There is a prominent focus in the literature on denunciation of this practice as a violation of human rights, with greater emphasis after The Convention on the Rights of Persons with Disabilities. Violence against women with disabilities is a global health problem; one of its manifestations has been the practice of forced sterilization, which has received relatively little attention in the literature. Governments, health professionals and communities must have access to this knowledge, awareness and the likelihood of eradicating all forms of violence must be increased

Hospital detention of mothers and their infants at a large provincial hospital: a mixed-methods descriptive case study, Lubumbashi, Democratic Republic of the Congo.

BACKGROUND: The practice of detaining people who are unable to pay for health care services they have received is widespread in many parts of the world. We aimed to determine the proportion of women and their infants detained for inability to pay for services received at a provincial hospital in the Democratic Republic of the Congo during a 6-week period in 2016. A secondary objective was to determine clinical and administrative staff attitudes and practices about payment for services and detention. METHODS: This mixed-methods descriptive case study included a cross-sectional survey and interviews with key informants. RESULTS: Over half (52%) of the 85 women who were in the maternity ward at Sendwe Hospital and eligible for discharge between August 5 and September 15, 2016 were detained for 1 to 30 days for outstanding bills of United States dollars (USD) 21 to USD 515. Women who were detained were younger, poorer, and had more obstetric complications and caesarean sections than other women. In addition, over one quarter of the infants born to these women had died during delivery or in the first three days of life. Key informant interviews normalized detention as an unfortunate but inevitable consequence of patient poverty and health system resource constraints. CONCLUSIONS: Detention of women and their infants is common at this hospital in the DRC. This represents a violation of human rights and a systemic failure to ensure that all people have access to essential health services and that they not suffer financial hardship due to the price of those services.

[World scientific production analysis in forced sterilization of women with disabilities between 1997-2016]. / Análisis de la producción científica mundial sobre esterilización forzada de mujeres con discapacidad entre 1997 y 2016.

OBJECTIVE: To explore world scientific production in forced sterilization of women with disabilities between 1997 and 2016, written in English and Spanish. METHOD: We carried out a descriptive, retrospective longitudinal study. The bibliometrics indicators of productivity, collaboration and subject-matter were studied. Critical Appraisal Skills Programme (CASP) was used as an evidence-based framework to evaluate original articles and literature reviews. RESULTS: A total of 139 documents were studied, in which 114 institutions from 24 countries participated. The results show that the greatest productivity was between 2007 and 2016, with predominance of studies written by female authors, based on literature review methodology, written in the English language. The majority of the authors were affiliated with a university and from activism of women with disabilities rather than any other organization. CONCLUSIONS: It is concluded that while insufficiently explored in either language, there is a growing interest in this issue. There is a prominent focus in the literature on denunciation of this practice as a violation of human rights, with greater emphasis after The Convention on the Rights of Persons with Disabilities. Violence against women with disabilities is a global health problem; one of its manifestations has been the practice of forced sterilization, which has received relatively little attention in the literature. Governments, health professionals and communities must have access to this knowledge, awareness and the likelihood of eradicating all forms of violence must be increased.

Gender Differences in Violence and Other Human Rights Abuses Among Migrant Workers on the Thailand-Myanmar Border.

We describe human rights violations against migrant workers at the Thailand-Myanmar border, and evaluate differences by gender and industry. This mixed methods study pairs key informant interviews ( n = 40) with a cross-sectional quantitative survey of migrant workers from Myanmar ( n = 589) recruited via respondent-driven sampling. Key informants described significant hazards during migration, including deception, theft, and physical and sexual abuse, the latter primarily for women. Quantitative results confirmed prevalent mistreatment and abuse, with significant gender differences, most notably women's disproportionate burden of sexual abuse. Current evidence on the nature of experiences, and significant differences by gender, can position prevention and response programming.

Monitoring and reporting attacks on education in the Democratic Republic of the Congo and Somalia.

The United Nations' Monitoring and Reporting Mechanism is charged with documenting six grave violations against children in a time of conflict, including attacks on schools. Many of these incidents, however, remain unreported across the globe. This study explores whether or not a local knowledge base of education and child protection actors in North and South Kivu Provinces, Democratic Republic of the Congo, and in Mogadishu, Somalia, could contribute to a more complete record of attacks on education in those areas. Hundreds of semi-structured interviews were conducted with key informants across the three settings, and in total 432 attacks on education were documented. Purposive samples of these reports were verified and a large majority was confirmed. Local non-governmental organisations and education institutions were most knowledgeable about these incidents, but most never reported them to a monitoring authority. The study concludes that attack surveillance and response were largely insufficient, and recommends investing in mechanisms that utilise local knowledge to address these shortcomings.

Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe.

Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.

Types of abuse and risk factors associated with elder abuse.

PRINCIPLES: Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. This study aimed to identify types of elder abuse and to investigate its associated risk factors. METHODS: Retrospective analyses of 903 dossiers created at an Independent Complaints Authority for Old Age in the Canton of Zurich, Switzerland, from January 1, 2008 to October 31, 2012. Characteristics of victims and perpetrators, types of abuse, and associated risk factors related to the victim or the perpetrator were assessed. Bi- and multivariate analysis were used to identify abuse and neglect determinants. RESULTS: A total of 150 cases reflected at least one form of elder abuse or neglect; 104 cases were categorised as abuse with at least one type of abuse (overall 135 mentions), 46 cases were categorised as neglect (active or passive). Psychological abuse was the most reported form (47%), followed by financial (35%), physical (30%) and anticonstitutional abuse (18%). In 81% of the 150 cases at least two risk factors existed. In 13% no associated risk factor could be identified. Compared with neglect, elders with abuse were less likely to be a nursing home resident than living at home (odds ratio [OR] 0.02, 95% confidence interval [CI] 0.00-0.19). In addition, they were more likely to be cohabiting with their perpetrators (OR 18.01, 95% CI 4.43-73.19). CONCLUSION: For the majority of the reported elder abuse cases at least two associated risk factors could be identified. Knowledge about these red flags and a multifaceted strategy are needed to identify and prevent elder abuse.

Incommunicado detention and torture in Spain:Part I: The Istanbul Protocol Project in the Basque Country.

There is increasing evidence to show that torture is a serious problem in the Basque Country. Whilst such evidence can be found in reports of international human rights monitoring bodies, sentences of Spanish and international courts, and empirical studies, they are limited in not having followed the Istanbul Protocol (IP) in order to evaluate the reliability of torture. A working group composed of professional associations of psychiatrists, psychologists, physicians and lawyers, in collaboration with the University of the Basque Country, conducted a four-year study on the medical and psychological consequences of torture in incommunicado detainees, including an assessment of credibility in line with the IP. The methodological design included a multi-level peerreviewed blind assessment and input by an external expert (from the Independent Forensic Expert Group facilitated by International Rehabilitation Council for Torture Victims (IRCT)). A sample of 45 Basque people held in short-term incommunicado detention under anti-terrorist legislation (between 1980 and 2012) in Spain who had reported ill-treatment or torture was selected. The findings are divided into four papers: the present introductory paper; the second analyses the credibility of the allegations of torture and introduces an innovative methodology that enhances the IP, the Standardized Evaluation Form (SEC); the third provides an analysis of the methods of torture and introduces the concept of Torturing Environments; and, in the last paper, the psychological and psychiatric consequences of incommunicado detention are analyzed. The collection of papers are intended to be useful not only in the documentation of torture in the Basque Country and Spain, but also as an innovative example of how the IP can be used for research purposes.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol.

BACKGROUND: The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture. OBJECTIVE: Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP. METHOD: Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent. FINDINGS: According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports. INTERPRETATION: When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.

Incommunicado detention and torture in Spain, Part III: 'Five days is enough': the concept of torturing environments.

BACKGROUND: Torture is changing in western societies, evolving from pain-producing torture to more subtle mixed psychological methods that are harder to detect. Despite this, there is not an adequate understanding of the complexities of contemporary psychological techniques used in coercive interrogation and torture. METHODS: The interrogation and torture techniques used on 45 detainees held in short-term incommunicado detention in Spain during the period 1980-2012 were analyzed. The list of torture categories set out in the Istanbul Protocol (IP) were assessed quantitatively. Software-aided qualitative analysis of the testimonies was conducted, using both inferential and deductive approaches to deduce a classification of torture techniques from the point of view of the survivor. FINDINGS: The most frequent methods according to the IP categories used against detainees were isolation and manipulation of environment (100%), humiliation (93%), psychological techniques to break down the individual (91%), threats (89%) and forced positions and physical exercises until extenuation (80%). Additionally, with a frequency of between 51 and 70%, mild but constant blows, being forced to witness the torture of others, hooding (mainly dry asphyxia) and unacceptable undue conditions of detention were also frequent. Sexual torture was also widespread with sexual violence (42%), forced nudity (38%) and rape (7%). Qualitative analysis showed that most detainees were submitted to coercive interrogation using a wide array of deceptive techniques. This is often a central part of the torturing process, frequently used in conjunction with many other methods. It was found that giving false or misleading information or making false accusations was most frequently used, followed by maximization of responsibility or facts and giving false information regarding relatives or friends. Different patterns of harsh interrogation, ill-treatment and torture are described that appear to have been tailored to the profile of Basque detainees. INTERPRETATION: The study shows the need to improve the conceptualization of psychological torture suggested by the IP. Key to this view is the idea that we must not concern ourselves with 'torture methods' but with Torturing Environments. The concept of Torturing Environments is defined and proposed as a focus for future study.

Conflict, Displacement, and IPV: Findings From Two Congolese Refugee Camps in Rwanda.

This study describes the prevalence and correlates of past-year intimate partner violence (IPV) among displaced women. We used bivariate and multivariate analyses to assess the relationships between IPV and select variables of interest. Multivariate logistic regression modeling revealed that women who had experienced outsider violence were 11 times as likely (adjusted odds ratio [AOR] = 11.21; confidence interval, CI [5.25, 23.96]) to have reported IPV than women who had not experienced outsider violence. IPV in conflict-affected settings is a major public health concern that requires effective interventions; our results suggest that women who had experienced outsider violence are at greater risk of IPV.