Torture and Public Health
Introduction
Historically, the practice of torture focused on the dyad of the torturer and his or her victim in the quest to obtain information. In the past few decades it has become clear that the impact of torture is far beyond the individual and includes society as a whole. The practice of torture is an attempt to instill fear in the community, not merely to oppress a single individual, and as such, the public health impact of torture is far reaching. In response to increasing recognition of torture as a public health problem, a field of research is evolving which seeks how best to help survivors. International law has also provided mechanisms to hold perpetrators accountable. However, the ultimate human rights and public health goal is to prevent torture from occurring at all.
Defining Torture
Torture has been practiced over the centuries, at times in public view and often with social and government sanction. But it was only in the wake of the atrocities of World War II that torture was publicly condemned as an abuse of human rights. Article 5 of the Universal Declaration of Human Rights (1948), proclaimed that “No one shall be subjected to torture or cruel, inhuman or degrading treatment or punishment” The World Medical Association’s Declaration of Tokyo (1975) provided the first explicit definition of torture, declaring that it was the “deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.” Ten years later, governments united to denounce state-sponsored torture when they ratified the Convention Against Torture and Other Cruel Inhuman or Degrading Treatment or Punishment (1984) which defines torture as:
any act by which severe pain or suffering, whether physical or mental is intentionally inflicted on a person for such purposes as obtaining from him or her or a third person information or a confession, punishing him for an act he or a third person has committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising from, inherent in or incidental to lawful sanctions.
Today there are many international and regional instruments prohibiting torture and ill-treatment, which are listed in Table 18.1 Some of those declarations and treaties have helped develop mechanisms by which torture can be monitored and perpetrators held accountable, which is discussed further on.
Table 18.1 International instruments on the absolute prohibition of torture and ill treatment
Universal texts on torture |
The United Nations Charter |
International Covenant on Civil and Political Rights |
Optional Protocol to the International Covenant on Civil and Political Rights |
International Covenant on Economic, Social and Cultural Rights |
Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment |
Convention on the Rights of the Child |
International Convention on the Elimination of All Forms of Racial Discrimination |
Convention on the Elimination of All Forms of Discrimination Against Women |
Optional Protocol to the Convention on the Elimination of Discrimination against Women |
Convention on the Prevention and Punishment of the Crime of Genocide |
International Convention on the Suppression and Punishment of the Crime of Apartheid |
Nonbinding texts adopted by the UN |
Universal Declaration of Human Rights |
Declaration on the Protection of All Persons from Being Subjected to Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment |
Vienna Declaration and Programme of Action |
Declaration on the Elimination of Violence Against Women |
Declaration on the Protection of Women and Children in Emergency and Armed Conflict |
United Nations Standard Minimum Rules for the Administration of Juvenile Justice |
United Nations Rules for the Protection of Juveniles Deprived of Liberty |
Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment |
Basic Principles for the Treatment of Prisoners |
Standard Minimum Rules for the Treatment of Prisoners Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment |
Basic Code of Conduct for Law Enforcement Officials |
Basic Principles on the Use of Force and Firearms by Law Enforcement Officials Guidelines on the Role of Prosecutors |
Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power |
Declaration on the Human Rights of Individuals who are not Nationals of the Country in which They Live |
Declaration on the Protection of all Persons from Enforced Disappearance |
United Nations Declaration on the Elimination of All Forms of Racial Discrimination |
Declaration on the Right and Responsibility of Individuals, Groups, and Organs of Society to Promote and Protect |
Universally Recognized Human Rights and Fundamental Freedoms |
Prohibition of torture in humanitarian law |
Common Article 3 of the Geneva Conventions |
Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field |
Geneva Conventions for the Amelioration of the Condition of Wounded, Sick, and Shipwrecked Members of Armed Forces at Sea |
Geneva Convention relative to the Treatment of Prisoners of War |
Geneva Convention relative to the Protection of Civilian Persons in Time of War |
Protocol I Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts |
Protocol II Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts |
Prohibition of torture in the international criminal court and the ad hoc tribunals |
Statute of the International Criminal Tribunal for the Former Yugoslavia |
Statute of the International Criminal Tribunal for the Rwanda |
Rome Statue of the International Criminal Court |
Regional texts concerning torture |
African Charter on Human and Peoples’ Rights |
African Charter on the Right and Welfare of the Child |
American Convention on Human Rights |
Inter-American Convention to Prevent and Punish Torture Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women |
Inter-American Convention on the Forced Disappearance of Persons |
European Convention for the Protection of Human Rights and Fundamental Freedoms |
European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment |
Resolution 690(1979) on the Declaration on the Police |
Recommendation No. R(87) 3 of the Committee of Ministers to Member States on the European Prison Rules |
Recommendation No. R(98) 7 of the Committee of Ministers to Member States concerning Ethical and Organizational Aspects of Health Care in Prisons |
Recommendation No. R(99) 3 of the Committee of Ministers to Member States on the Harmonization of Medico-Legal Autopsy Rules |
Concluding Document of the Third Follow-up Meeting (OSCE/CSCE) |
Document of the Copenhagen Meeting of the Conference on Human Dimension and the OSCE |
Document of the Moscow Meeting of the Conference on the Human Dimension of the OSCE |
Charter for Human Security |
Charter of the Fundamental Rights of the European Union |
Guidelines to EU policy towards third countries on torture and other cruel, inhuman or degrading treatment or punishment |
The Cairo Declaration on Human Rights in Islam |
Arab Charter on Human Rights |
Compiled by L. Piwowarczyk from International Rehabilitation Council for Torture Victims (2006) International Instruments and Mechanisms for the Fight Against Torture: A Compilation of Legal Instruments and Standards on Torture. Copenhagen: IRCT. http://www.irct.org/Default.aspx?lD=159&M=News&PID=5&NewsID=39
Epidemiology
As the global community has turned its attention to torture, reporting of torture has increased. The Amnesty International (AI) Annual Report (2006) showed that torture and ill-treatment currently occur in 150 countries. However, torture still goes underreported. Survivors often choose not to disclose their experiences because of fear of putting themselves and their families in further danger, impairment of memory resulting from torture, cultural sanctions, or simply as a coping strategy (Mollicia and Caspi-Yavin, 1991). Therefore, it is difficult to determine the true prevalence of torture.
Complex humanitarian disasters, characterized by massive population dislocation, are often accompanied by an erosion of international humanitarian law and a breakdown of security which put individuals at greater risk of being subject to torture. Torture is frequently an element of war, conflict, ethnic and religious persecution, and ethnic cleansing, although it can also be an isolated event. Today, there are 9.2 million refugees and approximately 10 million people of concern (asylum seekers, returned refugees, internally displaced persons, stateless persons, and others) who are at high risk for human rights abuses (UN High Commission for Refugees, 2006). Torture can be found in 5–30% of the world’s refugees, and in even higher percentages in certain ethnic groups (Baker, 1992; Jaranson et al