Sri Lankan male examined April 2013Photo displayed with well-informed patient consent

A World-wide Epidemic of TortureNew Internationalist, from Amnesty data 1999-2000

Firmer Faster FairerFooter for all Home Office Reasons for Refusal letters, 2011-13

“You claim to have scars on your back. However the mere fact of the existence of scars does not, in itself, indicate that the injuries were sustained in the manner you have described.”Home Office Reasons for Refusal (of asylum) letter 2013

“... well known that many persons who were held in IDP camps at the end of the conflict scarred themselves so that on release they could make allegations that the Sri Lankan government had tortured them.”Letter from British High Commission (BHC) Colombo 11 May 2011, cited as evidence that appellant's scars were inflicted by proxy to support a false claim for asylum

“....the information provided in the photographs have not been supported by a medical report....You are therefore not considered to have made a genuine effort to substantiate your claim.”Home Office Reasons for Refusal (of asylum) letter 2013

“The factual accuracy of statements recorded in this letter has been assessed for immigration purposes only”.Header for all Home Office Reasons for Refusal letters, 2011-13

Clinician collusion in torture

“Juan Mendez won't die: you can electrocute him again”Argentina (prison doctor) 1976

“Steve Biko won't die; you don't need to take him to hospital”South Africa (prison doctor)

“It is our humanitarian mission at Gitmo (and compliant with the WMA Declaration of Malta) to force feed hunger strikers” US (military doctor, IOM, Washington DC) April 8. 2013

“No scars seen” UK (Campsfield immigration detention centre doctor, R35 report) 2007

Actual count = 15

“I saw no bruises on his face”(Basra) British Army doctor, evidence to Baha Mousa enquiry

Roles of health workers in opposing torture

Rescue from torture centre rare

Early treatment of survivors (? in secret) - ?10%

Helping them escape anecdotal

Documentation for asylum fairly common (UK)

Discrediting false statements made under torture rare

Assisting with recovery very common (UK)

Exposing torturers rare

Redress rare

Prevention – campaigning publicity, legal and political

Abuse: a Triangle or a Pyramid?

Bystander Bystander

Victim Perpetrator Victim Perpetrator

Active Witness

Where possible, an active clinical witness examines, treats, documents, reports and publicises abuse

“....I will keep them from harm and injustice”From modern translation of Hippocratic oath Edelstein, L et al. (trans) Ancient Medicine (1987) Johns Hopkins University Press.

But few of us are so heroic as to speak truth to power when this carries serious risk, and some collude in abuse of patients or worse

Risks:death gaol /torture sanctions? career? Syria > Bahrain > Basra > UK

MAKING IT SAFER TO OPPOSE,AND MORE DANGEROUS TO COLLUDE IN

TORTURENeed to use existing MECHANISMS and build stronger ones to

PROTECT ethical practitioners“Because I have to follow GMC guidelines, and can rely on solidarity of colleagues, I can and must put the patient first”

EDUCATE by-standing clinicians“I have a duty to report this....”

SANCTION colluding health professional, discourage others“He got struck off for that; I'd better not do it....”

What can clinicians do to prevent torture or help survivors and with whom?

Recognition in everyday practiceWhy does this patient have PTSD and claudication in their feet?

Documentation: Letters and medico-legal reportsUK asylum: HBF, FfT, MJFor Britons and other tortured abroad: Redress, Reprieve

Campaigning: Medact Preventing Torture Working Group