Although international human rights and humanitarian law consistently prohibit torture under any circumstance, torture and ill treatment of detainees occur in more than half of the world's countries.1,2 In their assessment of the frequency of torture reported by adults who had been born in foreign countries and who were attending an urban outpatient clinic, Eisenman and colleagues show the importance of recognizing torture in primary care settings. Clinicians have knowledge and expertise that enable them to document the physical and psychological manifestations of torture and to provide rehabilitative services. Torture survivors may present to physicians with medical or psychosomatic problems that do not immediately suggest their traumatic experiences. Primary care physicians have a unique opportunity to recognize the problem of torture in the communities they serve and to participate in the efforts to treat these problems. During the past 20 years, a movement for the care of survivors of torture has made remarkable progress in restoring health and well-being to those affected by torture.
Physicians have played a critical role in preventing torture by documenting physical and psychological evidence of it. Such documentation brings evidence of torture to light so that perpetrators may be held accountable for their actions and the interests of justice may be served. In August 1999, the first comprehensive international guidelines for the documentation of physical and psychological evidence of torture and ill treatment were developed in the The Istanbul Protocol, submitted to the United Nations High Commissioner on Human Rights last year.3 The manual is the result of 3 years of analysis, research, and drafting undertaken by more than 75 experts in law, health, and human rights representing 40 organizations or institutions from 15 countries.
In the United States, physicians can contribute greatly to the health and well-being of survivors of torture by conducting medical evaluations of asylum applicants to assess possible physical and psychological evidence of torture. Political asylum enables survivors of torture to escape their persecutors and to begin rebuilding their lives. Clinicians interested in this work should contact organizations such as Physicians for Human Rights in Boston (phrusa@igc.apc.org) and Survivors International in San Francisco (SurvivorsIntl@msn.com).
In their capacity as health educators, physicians also have a responsibility to inform government and society of the adverse health effects of torture and other traumatic human rights abuses and to oppose them. Such information may be of critical importance in shaping international and national policy. Also, in providing testimony for applicants for political asylum who allege that they have been tortured, physicians have the opportunity to educate members of the judicial system who may have limited understanding of the problem of torture.
Increasingly, health professionals are recognizing the importance of protecting and promoting human rights as necessary preconditions for individual and community health.4,5 When health is understood as a state of “complete physical, mental, and social well-being, and not just the absence of disease or infirmity,”6 health professionals recognize an ethical responsibility to protect and promote human rights to provide the conditions for health and well-being. In this regard, health professionals who document medical evidence of torture and provide rehabilitative services are contributing to establishing a culture of human rights in the health sector and in society.
Torture is a profound concern for the world community. Its purpose is the deliberate destruction of not only the physical and emotional well-being of people but also, in some instances, the dignity and will of entire communities. It concerns all members of the human family because it impugns the very meaning of our existence and our hopes for a brighter future. Health professionals cannot afford to stand by as silent witnesses to the incalculable human suffering that is caused by torture and other human rights violations. At stake is not only the well-being of individuals and communities and our professional credibility as healers, but also the safeguarding of our humanity for centuries to come.
Competing interests: None declared
References
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