Torture and torture practices in Tanzania: Knowledge, attitudes and practice among medical professionals.

INTRODUCTION: Medical professionals have a key role in addressing torture and need an awareness and knowledge of torture in relation to rehabilitation approaches, prevention and international standards. This study was undertaken with the aim of assessing the current knowledge, attitudes and practices of medical professionals in Tanzania, creating a baseline for possible future interventions. METHODS: Both quantitative and qualitative data were collected. A cross-sectional survey was carried out using an interviewer-administrated structured questionnaire with 31 questions. Five focus group discussions were held. 386 medical professionals participated in the study representing primary, secondary and tertiary levels of health care in five regions of mainland Tanzania: Arusha, Dar es Salaam, Kigoma, Mara and Mbeya. RESULTS: Around 95% of all professionals acknowledged the existence of torture in Tanzania, but only 7% could correctly identify six different acts as being actual acts of torture according to the definition of the UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Less than 15% were aware of relevant international standards like the Istanbul Protocol and the Mandela Rules. Up to 57% perceived that torture could be acceptable under certain circumstances. About 68% of all professionals reported to have encountered torture victims. The majority (82.9%) saw themselves as competent in the management of torture victims, but only 22% had received training specifically focusing on torture and its consequences. Most were interested in learning more on the subject. CONCLUSION: While medical professionals may be aware of the existence of torture in the country and report encountering torture victims in their daily work, both the professionals' skills and attitudes with regards to torture require development to intensify the work against torture in Tanzania. Intervention strategies should target training in medical schools and in-service training for medical profesionals at all levels within the health care system.

Voices of torture survivors in Tanzania: A qualitative study.

INTRODUCTION: No published research has been found on torture in Tanzania, but individual cases were documented by human rights organisations. The aim of this study was to explore the salient physical, mental and social effects of torture in the country, and help-seeking behaviour by giving voice to a group of torture survivors in Dar-es-Salaam and Zanzibar City (Zanzibar). METHODS: This explorative qualitative study consisted of 14 semi-structured in-depth interviews (12 males, 2 females) of which eight took place in Dar-es-Salaam and six in Zanzibar. Informants were selected purposefully through a mix of snowball and convenience sampling. Both the Standards for Reporting Qualitative Research (SRQR) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed. RESULTS: Using the UNCAT definition of torture, all informants reported having been tortured within the past two years. The most common form of torture was beating with clubs to the joints. Other torture included, but was not limited to, gun shot, toenail removal and 'poulet roti'. The most common physical consequence was persistent pain. Psychological consequences included suicidal ideation and sleep problems. Most interviewees lost their jobs as a result of the torture incident, instigating a cascade of financial and social problems. CONCLUSION: The findings present informants' exposure to deliberate torture at the hands of public authorities. Informants confirmed their exposure to torture methods that had been previously reported by nongovernmental organisations. They also talked about exposure to more advanced, and previously undocumented, torture methods. Informants displayed a dire need for mental and physical health care, but had limited access to such care. Research is needed to better understand the magnitude, prevalence and context of torture in Tanzania.

Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis.

UNLABELLED: People detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injection drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally. HCV incidence among general detainees was 1.4 per 100 person-years (py; 95% confidence interval [CI]: 0.1, 2.7; k = 4), and 16.4 per 100 py (95% CI: 0.8, 32.1; k = 3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% (95% CI: 23%, 29%; k = 93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k = 51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k = 1) and Australasia (35%; 95% CI: 28%, 43%; k = 9). We estimate that 2.2 million (range: 1.4-2.9 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000). CONCLUSION: HCV is a significant concern in detained populations, with one in four detainees anti-HCV-positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis, and treatment of HCV infection among detained populations is urgently required.

Imprisonment and women's health: concerns about gender sensitivity, human rights and public health.

The health of prisoners is among the poorest of any population group and the apparent inequalities pose both a challenge and an opportunity for country health systems. The high rates of imprisonment in many countries, the resulting overcrowding, characteristics of prison populations and the disproportionate prevalence of health problems in prison should make prison health a matter of public health importance.Women prisoners constitute a minority within all prison systems and their special health needs are frequently neglected. The urgent need to review current services is clear from research, expert opinion and experience from countries worldwide. Current provision of health care to imprisoned women fails to meet their needs and is, in too many cases, far short of what is required by human rights and international recommendations. The evidence includes a lack of gender sensitivity in policies and practices in prisons, violations of women's human rights and failure to accept that imprisoned women have more and different health-care needs compared with male prisoners, often related to reproductive health issues, mental health problems, drug dependencies and histories of violence and abuse. Additional needs stem from their frequent status as a mother and usually the primary carer for her children.National governments, policy-makers and prison management need to address gender insensitivity and social injustice in prisons. There are immediate steps which could be taken to deal with public health neglect, abuses of human rights and failures in gender sensitivity.

Охрана здоровья женщин в местах лишения свободы: руководство к действию и перечни контрольных вопросов для оценки действующей политики и практики

Предлагаемые в настоящем документе перечни контрольных вопросов являются важным инструментом, способствующим повышению качества и безопасности медико-санитарной помощи женщинам в местах лишения свободы, и разработаны в качестве подспорья для анализа и оценки действующей политики и практики в области охраны здоровья женщин, находящихся в заключении, Эти контрольные перечни составлены на базе совместной Декларации Европейского регионального бюро ВОЗ и Управления ООН по наркотикам и преступности (Киевской декларации) «Охрана здоровья женщин в местах лишения свободы. Устранить несправедливость на гендерной почве в области здравоохранения в местах лишения свободы» и вошедшего в ее состав справочно-аналитического документа, опубликованного в апреле 2009 г.. Несмотря на то, что главным образом эти контрольные перечни адресованы тем, кто принимает решения и формирует политику в этой сфере, а также администрациям и медицинскому персоналу пенитенциарных учреждений, между собой они очень тесно связаны. Они могут быть полезны также организациям гражданского общества, которые занимаются этими вопросами или осуществляют мониторинг ситуации, касающейся положения женщин и охраны их здоровья в местах лишения свободы.

Women’s health in prison: action guidance and checklists to review current policies and practices

The checklists in this document are an important tool in ensuring greater safety and better quality medical care for women in prison, and are designed to assist a review of current policies and practices relating to women’s health in prisons. They follow from the Declaration on women’s health in prison: correcting gender inequity in prison health and a background paper on women’s health in prison, published in April 2009 by the World Health Organization Regional Office for Europe and the United Nations Office on Drugs and Crime, and are therefore based on the evidence presented. While the checklists are aimed primarily at decision- and policy-makers, senior prison managers and prison health staff, there are important interconnections between them. They can also be useful for civil society organizations working on or monitoring the situation of women and their health in prison settings.