Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences.

OBJECTIVES: Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability. DESIGN: The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines. SETTING: The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway. PARTICIPANTS: Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted. RESULTS: Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned. CONCLUSIONS: We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.

Stop Rubber Bullets. The use of kinetic energy projectiles and torture in the Spanish State.

INTRODUCTION: Rubber bullets are projectiles whose use is potentially lethal. Between 1976 and 2017, they have caused at least 23 deaths and dozens of injuries in Spain, many of them serious, with loss of sight being the main type. In the period 2000 - 2020 alone, more than 40 people have been affected. METHODS: We review the legal framework, human impacts that go far beyond statistics and medical and psychosocial approaches. RESULTS: The paper focuses on key learnings in survivors' organisation, the process towards the prohibition of these weapons and strategic litigation, forensic documenta-tion and political advocacy.

Health impact of electric discharge weapons, a review of case studies.

INTRODUCTION: Electrical discharge weapons (EDWs) are increasingly used by law enforcement around the globe as a less lethal option to firearms. Concerns have been raised about their use, inter alia from the UN Committee Against Torture (UNCAT). The purpose of this manuscript is to provide an overview of case studies to assess the health consequences of EDW exposure. METHODS: Medline and Pubmed were searched for case studies on EDWs without restriction on language or date. Screening was first at abstract level and then at full article level. Articles were excluded if they were not case studies, concerned children under 15 years old or were off topic. A PRISMA flow dia-gram was created. RESULTS: A total of 71 studies were included, and they demonstrate a wide range of health consequences from minor injuries to lethal conditions. The injuries can be classified as direct and indirect, i.e., related to the use itself (e.g., penetration by darts) and related to falls and burns following neuromuscular incapacitation and ignition of flammable fluids. Cardiac incidents - some being fatal - as well as eye injury were the health consequences found most reported. Description of pain and mental suffering related to EDW exposure was lacking in the reviewed case studies. Dis-cussion: Evidence in the reviewed case reports demonstrates that EDWs have in fact led to physical and most likely mental suffering and even death, notwithstanding the epidemiological limitations of case reports in establishing causality at population level. When assessing patients and when doc-umenting cases where persons may have been exposed to EDWs, including torture and ill-treatment cases, it is important to be aware of the different types of health consequences.

Peace between Israel and Palestine?

Talking to a relative of mine who lives in Israel, we exchanged by email about the Hamas terrorist attack and the brutal re-sponse of the Israeli Armed Forces that affected the entire Pal-estinian population of Gaza. He spoke to me about the moral right of the Jewish people to exist and I replied that the Pales-tinian people also had the moral right to exist. That ended the respectful dialogue we had. The Palestinian people's right to ex-ist remained unanswered.

Prison overcrowding and ill-treatment: sentence reduction as a reparation measure. A view from Latin America and Europe.

INTRODUCTION: In recent years mass protest movements have taken to the streets in many countries across the world. Despite strong international and domestic legal protections for the right to freedom of peaceful assembly and other fundamental human rights, entire assemblies are frequently labelled violent and less lethal weapons are used to disperse them. METHODS: This article examines the weapons often used by police against public assemblies. Focusing on striking weapons (batons), chemical irri-tants, kinetic impact projectiles and stun grenades, the article uses examples from various countries to illustrate how these weapons are being used and the associated human rights and health impacts. Re-sults: Worrying trends identified include the use of dangerous or untested equipment, such as thermal foggers to deploy chemical irritants; the use of inherently abusive weapons, such as whips or sjam-boks; and the increasing use of certain types of munitions, specifically indiscriminate kinetic impact projectiles. DISCUSSION: The article seeks to support medical and legal professionals becoming more familiar with the weapons being used in the countries they practice in, the effects of those weapons, and clinical aspects in the presentation and care of those exposed.

Trade in torture tools threatens detainees and protestors everywhere - it must be banned.

With social upheaval, economic strain, and political unrest growing, peaceful demonstrations worldwide are increasingly met with brutal tactics by law enforcement and security forces. The UN Special Rapporteur on Torture outlines her call for States to negotiate a new international treaty to ban the manufacture, use and trade in "torture tools" and regulate the trade in law enforcement equipment. Her proposal outlines two critical components: a prohibited list of items that she has deemed to be inherently cruel, inhuman or degrading, and a second controlled list of ordinary law enforcement equipment that has a high risk of misuse. Effective international regulation is imper-ative to curb the indiscriminate use of force by law enforcement and to uphold human dignity. Improved national regulation is also required. Research has revealed a pervasive market for these items, with more than 335 companies in 54 countries manufacturing or promoting the most egre-gious torture instruments. Major producers include China, the EU, and the USA, with emerging economies also contributing significantly. The outsourcing of public functions to private security companies further exacerbates the issue, underscoring the pressing need for robust national and international regulations.

Physical therapy for survivors of torture: A scoping review.

BACKGROUND: Torture can result in impaired functional mobility, reduced quality of life, and persistent pain. Physical therapy (PT) is recommended for holistic care of survivors of torture (SOT), however there are limited evidenced-based guidelines. We conducted a scoping review to identify and describe the approach and gaps in knowledge around the PT treatment of SOT. METHODS: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Re-views. Nine databases were searched. Eligible sources involved PT treatment for SOT. Interventions were categorized into themes based on recommendations from the Physiotherapy and Refugees Edu-cation Project: 1) trauma-informed care, 2) body-awareness and empowerment, 3) pain management. RESULTS: The final analysis included 15 sources. Eight sources included all three themes; three of these eight sources were research studies examining outcomes following the PT intervention. While out-comes of these studies were significant for improvement among the PT groups, results must be taken cautiously due to methodological limitations of the trials. Studies assessing treatment that included only one theme resulted in no differences between the control and intervention groups. CONCLUSIONS: We describe the scope of the literature regarding PT for SOT. A trauma-informed PT approach, co-ordinated with pain management, and body-awareness and empowerment interventions may address the complex needs of survivors. However, rigorous studies of this three-themed approach are lacking. As SOT seek medical services, healthcare providers must be prepared to care for these vulnerable people. Physical therapists are encouraged to utilize a holistic approach, and to examine outcomes of this approach for SOT.

Experience and struggle of a survivor of eye mutilation by rubber bullets.

My name is Carles Guillot and I am 52 years old. On 17 July 2001, 23 years ago now, during a protest against the illegal as-sault and eviction of a squatted house, the Kasa de la Muntan-ya, a national police officer shot me point-blank in the face and permanently damaged my right eyeball. As the neighbourhood was taken over by the police, we had to wait a few hours before we could go to a hospital. Finally, some colleagues took me to the Bellvitge Hospital, the furthest hospital in the area, to avoid being identified by the police. The prognosis was clear: I would be one-eyed for life.The first days and weeks were very hard. Pain, headaches, and anger, a lot of anger.

The Movement in Resistance against Eye Aggressions by MOCAO as a social movement for justice, reparation and the right to peace and freedom in Colombia.

The collective action of MOCAO, Movimiento en resistencia contra las agresiones oculares del ESMAD (Escuadrón Móvil An-tidisturbios) is a social strateg y to demand access to justice and the fulfilment of guarantees of reparation and non-repetition in Colombia. A brief account of significant events in our trajecto-ry as a social movement is presented, together with our letter of petitions to the national government as victims and survivors of ocular aggressions in the framework of police violence. Al-though ESMAD today has been reformed under the name of the Unit for Dialogue and Maintenance of Order (UNDMO), we consider that there have not yet been structural changes to ensure that its function is related to protecting the constitution-al right to social protest.

Aggravated solitary confinement in Turkey. A form of institutionalised torture.

Last January 2023, 36 international jurists, journalists and pol-iticians from 8 countries were part of the International Delega-tion Against Isolation that travelled to Turkey to hold meetings with civil society organisations and political circles regarding the prison situation1 . The Delegation was divided into three groups travelling to different cities: Ankara, Amed and Istan-bul. The three groups met on 28 January in Istanbul for an International Forum against Isolation.

Ill-treatment in the Chilean prison system - an analysis of reports presented by the National Institute of Human Rights (INDH) and their handling by the legal actors.

INTRODUCTION: Prisons in Latin America are often described as violent and lawless places. This article analyses the Chilean case. We want to find out how complaints of ill-treatment are investigated if the victim is in prison. Our hypothesis is that the response to the phenomenon, both in the prose-cution of the perpetrators and in the protection of its victims, does not take into consideration the guidelines established in international standards, especially those contained in the Istanbul Proto-col. METHODS: We analysed a total of 124 complaints of ill-treatment filed by the Chilean National Human Rights Institute (INDH). RESULTS: An excessive amount of time elapses between the alleged ill treatment, the filing of complaints, the use of protective measures, and the termination of the cases. There are serious deficiencies in the investigations carried out by the Public Prosecutor's Office, and therefore, most of the complaints are not clarified and end up being shelved. We conclude that, through both the actions of the judges and the prosecutors in the processing of the complaints, when it comes to investigating acts of ill-treatment inside Chilean prisons, the standards of the Istanbul Protocol are not met.

Degradation as salvation: Reflections on El Salvador's punitive prison model.

The pictures of shaven men with naked upper bodies, sitting in rows back-to-back with fellow prisoners in close proximity, sur-rounded by heavily armed guards, encapsulates the essence of El Salvador's ongoing "war on gangs".

New project sheds light on the worldwide use of solitary confinement.

Solitary Confinement.

Presence of Inmates with Mental Health Problems in Detention and Correctional Centers in the Republic of Kosovo.

BACKGROUND: Conventions adopted by the United Nations and Council of Europe pay special importance to the treatment of prisoners with mental health problems. Their treatment is close-ly related to respect for human dignity, and the prohibition of torture, cruel and degrading treatment or punishment. The Eu-ropean Court of Human Rights, in many cases, has ruled that the detention of a mentally-ill person can raise issues under Ar-ticle 3 of the European Convention on Human Rights and that the lack of adequate medical care can result in treatment in con-travention of this article. The Republic of Kosovo is not a mem-ber of the United Nations and Council of Europe. However, it has incorporated in its Constitution a number of Conven-tions adopted by the United Nations and Council of Europe. Also, Kosovo has adopted a legal framework which prohibits torture, cruel and degrading treatment or punishment in ac-cordance with the international human rights standards. The Constitution also provides that human rights and fundamen-tal freedoms guaranteed by the Constitution shall be interpret-ed in accordance with the case law of the European Court of Human Rights. METHODS: Review of Ombudsperson's, Committee for the Prevention of Torture, Prison Health Department of Kosovo Ministry of Health reports, as well as reports of the NGOs in Kosovo.

Evidence Against Use of Nitrogen for the Death Penalty.

This Viewpoint discusses the recent use of forced nitrogen inhalation as capital punishment in Alabama and describes the body of evidence indicating that forced nitrogen inhalation is an inhumane practice.

The Role of Fingernails in Death Investigation.

ABSTRACT: In forensic pathology, forensic onychology studies fingernails and toenails for medicolegal purposes. It mainly deals with DNA profiling from nails, toxicological analysis for detecting poisons, and the collection of trace evidence present under the nails. Injuries to fingernails and their interpretation for medicolegal purposes are the neglected areas of this study. We have discussed the most common types of fingernail injuries and their significance. We found that their notification has significant value in drowning cases, defense wounds on the palm, self-inflicted cuts, burns, electrocution, blunt trauma, physical assault, sexual offenses, and other issues like torture. We emphasize the examination of fingernails in the autopsy and medicolegal clinical examination for better administration of law and justice.

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.