Transcript Sri Lankan male examined April 2013 Photo displayed with

Sri Lankan male examined April 2013
Photo displayed with well-informed patient consent
A World-wide Epidemic of Torture
New Internationalist, from Amnesty data 1999-2000
Firmer Faster Fairer
Footer 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
Victim
Perpetrator
Bystander
Victim
Active
Witness
Perpetrator
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
death
Syria >
Risks:
gaol /torture sanctions?
Bahrain >
Basra >
career?
UK
MAKING IT SAFER TO OPPOSE,
AND MORE DANGEROUS TO COLLUDE IN
TORTURE
Need 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 practice
Why does this patient have PTSD and claudication in their feet?
Documentation: Letters and medico-legal reports
UK asylum: HBF, FfT, MJ
For Britons and other tortured abroad: Redress, Reprieve
Campaigning: Medact Preventing Torture Working Group