"TORTURE AND OTHER FORMS OF MALTREATMENT - Medical, Legal & Social Dimension" Thessaloniki, 1-3 December 1995

Transcription

1 MEDICAL 1 REHABILITATION CENTER BFOR TORTURE VICTIMS BALKAN CONFERENCE "TORTURE AND OTHER FORMS OF MALTREATMENT - Medical, Legal & Social Dimension" Thessaloniki, 1-3 December 1995 "New Clinical Views as Torture Sequelae" Maria Piniou-Kalli , LYKABETTUS STREET, ATHENS - GREECE, TEL , , FAX

2 New Clinical Views as Torture Sequelae Maria Piniou-Kalli *** Aparticular interesting aspect of torture clinical description is the increasing accuracy of interrelating the clinical image to the kind of torture which was used. In the Medical research of the centers, this specification of torture deriving from the clinical image is considered to be a cornerstone. The clinical description of injuries caused by torture has to be simple and accurate, to be based on merely medical methodology and to be spread as a piece of knowledge to all doctors who work for this cause. The systematic observation of elements, their analysis with simple statistic methods, as well as the use of x-ray diagnosis and of the micromethods of clinical biochemistry are considered to be invaluable means for the research. All medical specialities have a broad field of research and thus contribute to the study of torture sequelae. The malfunctions of the respiratory, digestive and heart-vessel systems as well as skin abuses and endocrinologic troubles are considered to be torture sequelae. The medical team of the Danish Section of Amnesty International studied the results of phalanga to 35 Greek victims who had been tortured during the dictatorship and described the closed compartment syndrome, while Dr Veli Lok, professor in Orthopaedics suggested a seintigraphic study as a method of diagnosis for the phalanga. After that, this torture was stopped in the region of Izmir. Another outstanding research is the elaboration of special methods for the tracing and proof of secret torture caused by thermal and chemical factors. A Danish medical research on the creation of tissue alterations on the skin which appears by skin necrosis and blistering centers, considers these alterations as a proof for the use of electric current. With regard to rare or unknown torture, which appear in the form of medical treatment, such as the use drugs which cause pain or hallucinations (aloperidine) etc, we will have to engage all our

3 imagination, perception and scientific knowledge in order to reveal them. The medical proof of the torture sequelae is in reality a motive for the legislators in their effort to adopt measures for the prevention of torture. As it was discovered that the critical period of submitting torture is during the interrogation. Amnesty International suggested, in the 12 Point Programme for the abolition of torture, some measures that can offer a significant protection to prisoners during the interrogation process, such as: The prisoners' examination by the doctor at the moment of the arrest. The presence of a doctor during the stage of interrogation if the prisoner asks so. The examination and registration by a doctor of the prisoners' physical and psycho condition before and after the interrogation, without the presence of guards, as well as the capability of the doctor to intervent - in case it is necessary - in favour of the protection of the prisoner' s health. During the study on the torture sequelae, Rasmusen et al (1977) brought forward the query about the probable existence of a "torture syndrome", of a whole of specific symptoms, described by torture victims; this syndrome is similar to the concentration camp syndrome regarding the common justifying factor, which is stress. But the difference between the torture syndrome and the concentration camp and war sailor syndromes is that its pathogenesis lies in sharp stress. All three syndromes have common neurological and psychological symptoms. Except from the effort of defining and describing a probable torture syndrome, the scientific study of torture sequelae by the medical groups of Amnesty International as well as by the medical centers around the world (especially by the Medical Rehabilitation Center for Torture Victims of Copenhagen) has described new clinical images, which develop after specific torture. ANNEX 1 Syndromes due to Physical Torture

4 1. Post concussion syndrome (Kostaljanetz et al, 1981) 2. Closed compartment syndrome (Bro. Rasmussen and Rasmussen 1978, 1982) 3. Blast injuries syndrome 4. Food strike haemolysis (Euchre, 1985) 5. Handcuff neuropathy (Massey and pleet, Smith, 1981) 6. Cold shoulder syndrome ANNEX 2 Syndromes due to Physical and Psychological Torture 1. Concentration camp syndrome (Hermann and Frygesen, Eitinger, 1968) 2. War sailor syndrome (Askevold, 1980) 3. Post traumatic stress disorder 4. Survivor syndrome (Korangi, Ninderland, 1968) 5. Persecution syndrome (Lederer, 1985) The medical treatment and the health rehabilitation of persons who survived torture are obligations of the doctors and the state. The victims' rehabilitation is defined by the Article 14 of the United Nations' Convention, which has been approved by our country, and refer that "... the victim of a torture act has the right to rectification and has legal right to a proper compensation, including the means for the soonest possible rehabilitation... ". The effort was launched in an international level by the doctors of Amnesty International and particularly by the Danish Medical Group, which sent doctors to Greece, in order to examine victims tortured by phalanga. In March 1974, the I International Medical Seminar of Amnesty International has taken place in Athens. It was organised by Greek and Danish doctors and 100 participants (doctors) coming from 15 countries attended it. The conclusion of the seminar was the formation of a committee which had a coordinative role in activities concerning the medical research of torture sequelae, their prevention and the medical treatment of the victims.

5 The first Center was founded in Copenhagen by Dr Inge Genefke. With the help of the Copenhagen Center, about 70 other Centers have been established in various countries; among them was the Greek Center. The International Council for the rehabilitation of torture victims was founded in order to coordinate the corresponding centers all over the world. Our Center was founded six years ago. Since its establishment up to today, we have undertaken the care of over 500 victims who mostly come from the Middle East and Africa. Methods of Torture Systematic and non systematic heatings 387 Phalanga 243 Sexual abuses 132 Burnings 101 Pharmaceutical torture 2 Hangings 35 Electroshocks 215 Particular torture 108 Body Injuries Skin 392 Urigenital system 58 Nervous system 18 Locomotor system 271 Peptic system 192 Cardiopulmonary system 56 Teeth 23 Torture sequelae on the Skin Acommon characteristic of tortured people is that their skin becomes the mirror of their suffering. Skin is a register where the signs of recent or older torture are perceived. Usually a great part of the torture sequelae in the skin desappears within a short period after

6 torture has been inflicted. Linear or irregular cicatrices after blunt violence appear in some cases as permanent changes in the skin. Burns apparently often give rise to the following permanent sequelae in the skin: Cicatrices with central atrophy and a hypertrophic peripheral zone apparent after exposure to a cigarette or to an electrode. Also many skin diseases as are psoriasis, eczema, orticaria and alopecia may be provoked after the infliction of a physical and psychological trauma. Most of the time one finds it difficult to correlate these clinic symptoms with precedent torture, but the infliction of torture is verified by the account of the survivor. In addition, the evidence of torture found in the skin is highly important in the cases that a certificate is needed for the application of a survivor to become accepted as a refugee in our country. In the Symposium of Istanbul we presented a case of traumatic alopekia after electroshock on the head. Torture sequelae at the Urinegenital system The procedure or rather better the philosophy of the torturer is closely associated with the intimidation of the victim and not only with physical pain or rendering the victim more fearful. In this respect the most appropriate system seems to be the urinegenital one. The process of intimidation starts from the time that the victim is forced to put off his clothes and stand up naked to the point of mutilations. Within this continuum a resourceful inventiveness of the methods of torture is registered. An approach to classification 1. Damage of the urinegenital system for both sexes: a. Blind traumas - Raptures of the kidneys: Strong heatings Results: Dysfunction of the operation of kidneys b. Blind traumas - Rapture of bladder: Strong heatings c. Blind traumas - Rapture of urithra: Strong heatings to perineon Results: strictures of urithra, highly disagreeable consequences

7 2. Damage in the genital male system a. Damages of genitals: traumas and raptures Results: Damage of the testicles b. Scrotal damages: gross inflammation effects from electroshock c. Damage of pennis urithra : on account of heavy heatings Results: Dysfunction of sexual ability (particularly electroshocks inside the urithra with amplified strictures) 3. Of all the various methods the most prominent is the combined physical and psychological torture that brings about an unbalance in the physic function and can produce the worst picture and prediction from all the rest torture methods. Usually there is a concomitant sequential rape with whatever way. The clinical semiology of damage and traumas are classic. The treatment approach is also classic without novel ways of treatment for these special cases. It is nevertheless noted that: 1. In every single case there must be a control over the sexual ability of the male subject. 2. Although there are not apparent signs of traumas with the passing of time still the clinical examination proves irreparable damages. 3. The combination of structural damages of the mental integrity of the survivor, that has a direct impact on the sexual capacity, together with physical injuries in this area are almost impossible to be treated. Torture sequelae at the Nervous system Neurological semiology, as observed in individuals who have suffered torture: 1. Spastic paresis, resulting from cranio-cerebral lesion, or lesion of the spinal cord, during torture. 2. Lesser paresis resulting from injuries in nerve complexes, or in peripheral nerves. 3. Post-traumatic symptomatic epilepsies. 4. Organic psychosyndromes of post-traumatic -causation, characterised by memory disruptions (and primarilly, disruptions of the recent memory) and loss of the above psychic-mental functions.

8 5. Distinct derangements in the form of difficulties in the sensory perception or neuralgias, resulting from injury. 6. Disorders of the rectum and the cyst resulting from infuries of the spinal cord and the sacrum. Very frequently there are somatic syndromes resulting from the activation of the transformation mechanism, consisting mainly - and to a high degree - of headaches, sweating, symptoms of colitis and sleep disorders. Symptoms related to the psychic sphere: Stress, depression, misinterpretative mood, associatitive delirium or even aggressiveness. In serious cases, retreat from the world that can even develop into apersistent return of the Ego ad ipsum. The therapeutical treatment has been implemented according to individual needs with ami depressive medicines accompanied with supportive psychotherapy. From our Center's experience as well as from the RCTs, is occured that psychotherpay is the main part of the treatment. Torture sequelae at the Peptic system Alarge number of survivors appeared to have problems with their peptic system, as are gastritis, ulcer, anorexia, frequent vomits, irritable colon syndrome. Torture sequelae at the Cardiopulmonary system Acommon phenomenon particularly concerning individuals who have suffered beatings and electroshock on the chest is the emergence of symptoms like compulsive contractions, difficulty in breathing, arterial hypertasis, cardiac ache. The adopted treatment is symptomatic. Torture sequelae at the Locomotor system Another system that is highly inflicted by torture is the locomotor. So, very often, there emerge difficulties in the motion of the arm joints of the spinal cord and of legs. In the examination we focus in changing the function of joints, ligaments, bones and muscles. Changed,

9 joint mobility, sequelae following the breaking of bones, tendinitis, bursitis and the tearing over of ligaments were often registered. As we are informed by the international bibliography a great number of victims of torture develop the fibrositis syndrome. Causes for this symptom are not as yet traced. Also on account of muscle damage there develops myoglobinaemia and myoglobinaria in most of the cases after suffering heavy heatings. In our country, we have, up to now, witnessed very few but also very serious denouncements of torture taking place in police stations during inquiries. So, our Center has developed a number of activities in this concern. Two consequent times we have denounced the actions of policemen and have denounced the actions of policemen and have additionally applied for the permission to examine the victims medically. Unfortunately both times we were denied the permission, but we intend in the future to ask for clinical and laboratory examinations. Especially in the examination we will concentrate on the presence of myoglobine in the urine, which is a revealing testimony of infliction of torture. Another helpful experience gained in this field during the time of dictatorship in Greece is the familiarity we obtain with the closed compartment syndrome associated with phalanga torture. Torture sequelae on Teeth Many victims of torture present a series of dental problems due to the physical abuse, malnutrition and lack of proper dental care during their time of imprisonment. Both dental decay and periodontal disease are prevalent, however, the most severe problems are the result of traumatic injuries to the teeth, jaws or temporomandibular junctions. The most common findings include fractured or avulsed teeth, fractures of the maxilla or mandible and injuries to the TMJ resulting in abnormal and traumatic occlusion. Lack of proper treatment and poor wound healing can cause pain, inflammation, cronic dysfunction and ankylosis of the TMJ. In reviewing, I would like to say that torture produce new clinical views that its recognition has probative value for the punishment of the torturers and the doctor is called to make the diagnosis and also to help the lawyer so as "impunity" and continuous crime will not exist anymore.