Torture : quarterly journal on rehabilitation of torture victims and prevention of torture最新文献

Introduction: Prison overcrowding can be defined in different ways, and no universal definition exists. More than 120 countries report prison occupancy rates above their own capacity. This paper provides an overview of legal and health implications of overcrowding, analyses potential causes, and provides examples of how different countries utilised non-custodial measures to reduce overcrowding to disseminate good practices as inspiration for other contexts.

Methods: Desk study based on literature searches in medical (Pubmed and Medline) and legal sources, including Google Scholar on legal opinions, Global Lex and decisions of UN treaty bodies and regional human rights mechanisms supplemented by online searches for grey literature. In addition, examples from other countries were sought to corroborate and illustrate the points made.

Results: A range of international standards exist that provide for the conditions and treatment of people in prisons to prevent prison overcrowding and protect them from its consequences. Nonetheless, overcrowding is persistent across many countries. It is often associated with violations of human rights, including, among others, the right to be free from torture and ill-treatment, the right to health, and the right to liberty and security. The underlying factors contributing to overcrowding vary and include, among others, overuse of imprisonment, excessive use of pre-trial detention, lack of access to a lawyer and underutilisation of non-custodial measures as an alternative to detention. Non-custodial measures can be applied throughout the criminal justice process, and some countries have successfully managed to reduce their prison populations by implementing such measures.

Discussion: Overcrowding affects many aspects of prison life, impeding the provision of a humane and rehabilitative environment. Beyond the harm caused to persons in prisons, this may negatively impact society at large in terms of security, public health, and economy. Political will is essential in reducing prison overcrowding.

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.

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.

Dear Editor-in-chief: Thank you for focussing on this troubling subject in your issue 1/2024. It confirms that many of the difficulties involved are similar worldwide. Countries that use less-lethal weapons include Switzerland, the only Western European democracy besides France to employ multiple kinetic impact projectiles. Our rubber scattershot is comparatively small and light but has led to an uninterrupted series of severe eye injuries since 1980. Legal authorities have long questioned whether these were due to rubber ammunition, though ophthalmologists always knew what was going on. Communication channels were non-existent, and monitoring remains a challenge. Please see my recent open-access review in Eye (Fierz, 2024) for details. I would like to add the odd point to your commendable editorial (Pérez-Sales et al., 2024). The common denominator is that eye injuries require eye doctors.

Introduction: The integration of livelihood support with mental health and psycho-social support (MHPSS) seems crucial for the rehabilitation of torture survivors in low- and middle-income countries (LMICs). This study aimed to explore the intersec-tionality of poverty and mental health, and the integration of livelihood support with-in MHPSS frameworks related to the rehabilitation of torture survivors in LMICs.

Method: A cross-sectional study was conducted using a semi-structured questionnaire distributed to members of the International Rehabilitation Council for Torture Victims (IRCT) in LMICs (n=25). The questionnaire explored the perception of IRCT centres in LMIC countries regard-ing the extent to which poverty contributes to poor mental health outcomes among torture sur-vivors and the effectiveness of integrating livelihood support into MHPSS interventions.

Results: The study highlighted the significant economic challenges faced by torture survivors, indicating a high prevalence of extreme poverty among this group. The study found that 92% of respondents believed that poverty and mental health outcomes of torture survivors are strongly linked. Eco-nomic and social inequalities were identified as key determinants of mental health, emphasizing the need to address these inequalities in rehabilitation programs for torture survivors.

Discussion: The study underscores the critical connection between poverty, mental health, and the experience of torture. In the view of most IRCT centres, the integration of livelihood support with MHPSS is essential for addressing economic disparities and promoting long-term resilience among survivors. The results highlight the need to conduct long-term longitudinal studies that provide support to this perception. The study recommends enhancing coordination among stakeholders, addressing cultural and social barriers, securing sustainable funding, and developing strategies to integrate livelihood support with MHPSS for torture survivors. According to participants, rehabilitation programmes should include economic empowerment, mental health support, and social integration, to contribute to a holistic recovery, long-term resilience, and overall well-being.

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.

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.

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.

Background: Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern in refugee populations exposed to trauma and displacement. Traditional treatments for PTSD often involve lengthy interventions. However, there's a growing interest in exploring more condensed, intensive treatments to improve outcomes and accessibility for refugees.

Objective: This study aimed to evaluate the acceptability, and preliminary effects of an intensive brief trauma-focused PTSD treatment (ITT) program delivered to refugees at the Swedish Red Cross Treatment Center for Persons Affected by War and Torture in Uppsala, Sweden.

Method: Ten participants were enrolled in the study and received ITT over five consecutive weekdays comprising Eye Movement Desensitization and Reprocessing Therapy (EMDR), prolonged exposure (PE), and physical activity (PA). Acceptability was assessed by analyzing journal notes, and clinicians' and patients' open-ended responses to sets of questions designed to elicit the patients' experiences and potential adverse events. Baseline and follow-up data regarding PTSD (i.e., PCL-5 and CAPS-5), disability (i.e., Whodas-12), and anxiety or depression (i.e., HSCL-25) were collected and analyzed.

Results: The study demonstrated that ITT is an acceptable and viable treatment option for refugees with PTSD. No serious adverse events were reported, although some found the treatment very taxing. Overall, the ordeals were perceived as worthwhile. The statistical analyses showed substantial and significantly reduced PTSD symptoms, and anxiety levels i.e., CAPS-5 (Cohen's d 1,91; CI 95% 0.77-3.02), PCL-5 (Cohen's d 1,31; CI 95% 0.43 -2.15) Anxiety subscale of HSCL-25 (Cohen's d 1.47; CI 95% 0.49 -2.41). Reductions in depression symptoms and disability were also observed but were non-significant.

Conclusions: The results suggest that this brief and massed treatment program for refugees with PTSD is a well-received and preliminary effective treatment option. Identifying less suitable candidates and conducting larger, controlled studies with longer follow-up periods are needed to establish ITT's efficacy in this population.