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Wednesday 26th June is the United Nations’ International Day in Support of Victims of Torture https://www.un.org/en/events/torturevictimsday/ - an important day for all those concerned about the conditions of detention worldwide. Torture is a crime under international law and cannot be justified under any circumstances. Below, Brenda van den Bergh and Marie Brasholt from DIGNITY – Danish Institute against Torture https://dignity.dk/en/ examine what torture is and its relevance to the prison setting in a short video and in the accompanying article below.
‘All prisoners shall be treated with the respect due to their inherent dignity and value as human beings. No prisoner shall be subjected to, and all prisoners shall be protected from, torture and other cruel, inhuman or degrading treatment or punishment, for which no circumstances whatsoever may be invoked as a justification. The safety and security of prisoners, staff, service providers and visitors shall be ensured at all times’ (UN Mandela Rules, 2015).
Torture is best defined as:
‘any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.’
(UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1984)
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Every day, more than 10 million people are kept in prisons globally and even more are held behind locked doors when including police stations, psychiatric hospitals, military detention centers and asylum centers. It is often behind these locked doors, out of sight of the public, that torture and other cruel, inhuman or degrading treatment or punishment (in short: ill-treatment) takes place.
In 1984, the United Nations adopted the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UN CAT, 1984), which aims to prevent torture and ill-treatment. Today, 158 countries have ratified the UN CAT, yet implementation needs to be assured. Torture is known to take place in at least 131 countries around the world, affecting millions of persons every year including close relatives of the direct victims. Exact prevalence rates are unknown and vary widely between regions and countries.
Torture occurs in many different ways, and unfortunately new methods are invented regularly. A frequent typology used is to distinguish between physical, psychological and sexual torture. However, this distinction is partly artificial, and there is a significant overlap between the categories.
Health consequences
Torture and ill-treatment often have severe physical, psychological, and social consequences for the victim. Many suffer from chronic physical pain years after their experience as well as psychological symptoms and conditions such as anxiety, Post-Traumatic Stress Disorder, and depression. These conditions in turn may lead to loss of job, family problems etc.
All victims of torture have the right to rehabilitation as outlined in article 14 of the UN CAT. This right can only be secured if the victims are identified and relevant authorities are notified.
Prevention and documentation of torture
It is a huge challenge to prevent torture and ill-treatment from happening, but several measures have proven to be effective.
Basic protective safeguards are key. These include the rights of a detainee to, within 24 hours after his/her arrest, have access to a lawyer, be able to contact a family member, and have an initial medical examination. The initial medical examination is essential for detecting cases of torture, but also for detecting acute or chronic diseases which need medical treatment.
Regular monitoring of places of detention is thought to be one of the most effective preventive measures. At the national level, this includes internal inspections, judicial inspections, and independent external inspections, which are carried out by national human rights institutions, sometimes human rights NGOs, as well as national preventive mechanisms (NPMs) in countries who have ratified the Optional Protocol to the UN CAT (OPCAT) (UN, 2006). At the international level, monitoring bodies include the International Committee of the Red Cross (ICRC) and the Subcommittee on Prevention of Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (SPT). At the regional level, the European Committee for the Prevention of Torture (CPT) and the Inter-American Commission on Human Rights are examples of independent, preventive monitoring bodies operational in Europe and America respectively. Many monitoring teams include doctors, who would typically look at the health aspects in the place of detention including how the health care system is functioning and which factors inside the institution may influence a detainee’s health and well-being, such as food, ventilation, access to exercise etc. Health care services for detainees are directly relevant to the prevention of ill‑treatment, as restricted access to health care or an inadequate level of health care services can very well lead to situations falling within the scope of ‘inhuman and degrading treatment’.
International law obliges governments to investigate and document cases of torture and ill-treatment and to punish those responsible in a comprehensive, effective, prompt, and impartial manner. Therefore, identification and documentation of cases of torture is crucial. Prison health staff plays an important role here, because they are likely to meet victims while there may still be noticeable acute physical signs from the torture, such as bruises and wounds that may disappear over time without leaving any permanent marks.
The Istanbul Protocol – Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment is a set of international guidelines on how to document torture and its consequences (UN, 2004). The Istanbul Protocol is written for the professionals most frequently involved in the documentation of torture, i.e. doctors, psychologists, and lawyers.
To conclude, doctors and other health professionals, including prison doctors, play a central role in the identification of torture victims, in the documentation and prevention of torture and ill-treatment, and in the rehabilitation of victims. The expertise and attitudes of health professionals including prison health professionals is therefore a crucial tool in the fight against torture and ill-treatment around the world.
By Brenda van den Bergh MSC MPH and Marie Brasholt MD, DIGNITY – Danish Institute against Torture
DIGNITY – Danish Institute against Torture
DIGNITY – Danish Institute against Torture is a non-governmental organization based in Copenhagen, Denmark, fighting for a world where fewer people are subjected to torture and victims of torture are helped to a better life (www.dignity.dk/en). DIGNITY has a rehabilitation clinic, where victims of torture who are currently residing in Denmark obtain treatment and support. Apart from its rehabilitation work, the organization focusses on the prevention of torture and documentation of cases of torture, both in Denmark and across the world. In Denmark, DIGNITY monitors places of detention and is part of the National Preventive Mechanism together with the Parliamentary Ombudsman and the Danish Institute for Human Rights.
DIGNITY cooperates with local partners, including civil society organizations, state actors and research institutions, in more than 20 countries around the world to prevent and combat torture in detention and other places, where people are deprived of their liberty.
Examples of interventions include the establishment and teaching of independent prison monitoring teams, training in medical and legal documentation of torture, criminal justice reform, coalition building, training of the judiciary in international conventions and human rights standards, dissemination of knowledge about effective investigation, and prison research.
The Health team in DIGNITY develops and disseminates knowledge on both the health consequences of torture and health-related preventative measures. This is carried out through research projects, publication of articles, and development of manuals and factsheets. Manuals currently in development include a manual on how to monitor health in places of detention, and, in collaboration with other departments in DIGNITY, a general manual on monitoring places of detention as well a manual on basic documentation of cases of torture.
For an overview of recently published factsheets on the health consequences of different torture methods, see the publications from Dignity: https://dignity.dk/en/publications/.
Relevant publications and links:
APT (2004). Monitoring places of detention. A practical guide. Association for the Prevention of Torture, Geneva, April 2004. Available at: https://www.apt.ch/content/files_res/monitoring-guide-en.pdf
APT. Detention Focus. Database on prison topics and human rights standards. Association for the Prevention of Torture, Geneva. Available at: https://www.apt.ch/detention-focus/
DIGNITY. Factsheets on torture methods and their health consequences. DIGNITY Danish Institute against Torture, Copenhagen. Available at: https://dignity.dk/en/publications/
DIGNITY. Health team. See: https://dignity.dk/en/dignitys-work/health-team/
UN (1984). United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. United Nations General Assembly, 1984. Available at: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CAT.aspx
UN (2004). Istanbul Protocol – Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment and Punishment. United Nations Office of the High Commissioner on Human Rights, New York and Geneva, 2004. Available at: https://www.ohchr.org/documents/publications/training8rev1en.pdf
UN (2006). Optional Protocol to the UN Convention against Torture and other Cruel, Inhuman, or Degrading Treatment or Punishment. United Nations Office of the High Commissioner on Human Rights, New York and Geneva, 2006. Available at: https://www.ohchr.org/EN/ProfessionalInterest/Pages/OPCAT.aspx
UN (2010). Bangkok Rules (United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders). United Nations, New York, 2010.
UN (2015). Mandela Rules (United Nations Standard Minimum Rules for the Treatment of Prisoners). United Nations, 2015. Available at: https://www.unodc.org/documents/commissions/CCPCJ/CCPCJ_Sessions/CCPCJ_24/resolutions/L6/ECN152015_L6_e_V1503048.pdf