Download רופאים ועינויים

1.7.2008
Medical Teams: Prevent Torture
1.
The physician shall not countenance, condone or participate in the
practice of torture or other forms of cruel, inhuman or degrading procedures,
whatever the offense of which the victim of such procedures is suspected,
accused or guilty, and whatever the victim's beliefs or motives, and in all
situations, including armed conflict and civil strife.
2.
The physician shall not provide any premises, instruments, substances or
knowledge to facilitate the practice of torture or other forms of cruel, inhuman
or degrading treatment or to diminish the ability of the victim to resist such
treatment.
From the World Medical Association Declaration of Tokyo, Guidelines for
Physicians Concerning Torture and other Cruel, inhuman or Degrading
Treatment in Relation to Detention and Imprisonment. 1
The physician shall not participate in any activity which involves torture, cruelty
or the degrading of another human being, irrespective of that individual’s
actions, the charges leveled against him or his beliefs.
A physician shall not provide medical authorization for the infliction of torture
and shall not provide medical knowledge, instruments or medication for this
purpose.
A physician who examines a detainee or prisoner who is liable to undergo
interrogation or torture, shall strictly observe the confidentiality of medical
information placed at his disposal and shall not make use of it for purposes of
interrogation or torture.
A physician who is witness to interrogation or torture, carried out in violation of
international treaties, shall report the fact to the appropriate authority.
A physician shall not be present at a place where interrogation or torture are
being carried out.
http://www.wma.net/e/policy/c18.htm 1
The Israel Medical Association undertakes to support any physician who
observes these rules.
(Reches, Avinoam, “IMA ratifies the Tokyo Declaration: Physicians may not
participate in interrogations and torture” Zman HaRefua, Dec. 2007-Jan. 2008,
in Hebrew).
What is Torture
The intentional infliction of severe physical or mental pain or suffering for a
specific purpose, such as gaining information, punishment or intimidation.
Intentional infliction of physical or mental suffering in order to obtain information
or a confession, to punish, to intimidate or to discriminate.
Examples
 Sleep deprivation by "intensive interrogation"
 Deprivation of food and drink for protracted periods of time
 Prolonged exposure to extreme temperature or noise.
 Prolonged exposure to artificial light during day and night
 Sensory deprivation (isolation from light, sound, touch, smell, human
contact)
 False arrests of family members of interrogated persons, threats of house
demolition as a means of exerting psychological pressure
 Physical violence including blunt blows, slaps, fist blows, and kicks.
 Tight shackling of the wrists and shaking of the body causing severe pain
 Painful postures: the victim’s body is twisted over the chair or stool, he is
forced to squat on his toes for long periods of time, he is forced to stand
with his hands up in the air for long periods of time while passing urine
and stool, shackling to the chair, shackling of hands to each other and
to the chair behind the interrogated person’s back
 Prevention of adequate medical care.
Clinical findings that may indicate abuse/torture:
Skin:
Acute skin lesions
 Acute lesions that are not characteristic of a known disease: Contusions
(commonly known as bruises), Abrasions (or grazes), Incisions (including
stab wounds), Lacerations (also, commonly but confusingly, known as
cuts), Burns and scalds.

Scattered lesions with change of color and hair on skin, sensitivity to
touch, a combination of new and old lesions in uncharacteristic areas.

Lesion characterized by a change in color, hair and texture of skin in the
shape of the tool of torture (handcuffs, metal net)
Post-torture Clinical findings

Scarring, change of color and hair – these can appear after a certain
period has elapsed following the cause of the injury. Therefore, their
absence does not testify that no wound had been caused.
Muscles and skeleton:
 Fractures in an uncharacteristic location: nasal bones, palm root, ribs,
vertebrae.
 Bone and joint deformation caused by injury or lack of adequate care
following injury.
 Compartment Syndrome to calf following beating on the soles of the
feet
 Sensitivity to touch, light pressure or passive or active movement of a
limb or joint
 Movement restriction
 Multiple fractures at different healing stages
 Peripheral neuropathy due to prolonged pressure or nerve tear (Brachial
Plexus, palm of hand, foot)
Head and Neck:
 Lesions on skin and fractures in bones in the area of the skull, face; head
and neck Or spinal cord.
 Brain trauma and edema, subdural Hematoma and retinal abrasions
due to shacking.
 Head aches, changes in the state of consciousness or mental condition,
or cognitive impairment.
 Spasms (general, partial or complex)
 Damage to ear drum, ear inflammation and decline in hearing
 Damage to eyeball and vision problems
Mental:
 Acute Stress reaction
 Post Traumatic Stress Disorder
 Various degrees of depression
 Panic disorder with or without Agoraphobia
 Anxiety Disorder
 Dissociative disorder including amnesia
 Acute or chronic psychotic disorder
 Somatoform Disorder including Conversive Disorder
 Enduring personality changes
 Sexual dysfunction
 Substance abuse disorders
General:
Blunt trauma may not show visible signs but may cause severe sometimes
delayed internal damage: Hemorrhage, Hemopneumothorax, Lung Contusion,
spleen rupture etc.
The Ten Commandments
1. Medical Teams shall not collaborate in any way with interrogation
involving torture and/or other cruel, inhuman or degrading treatment.
2. You shall not be present where torture is employed
3. You shall not share your medical knowledge with the torturers or those
designing methods of torture
4. You shall not divulge medical information regarding victims to the
torturers
5. Actively oppose torture
6. Document evidence of torture in the medical files of the victims – either
torture reported to you by the victims, or evidence of torture you have
directly witnessed during or after its occurrence.
7. Report evidence of torture that you have witnessed, diagnosed, or
heard of even if by hearsay evidence.
8. Treat victims of torture only by consent.
9. Catergorically prevent – by medical order – the return of a detainee to
interrogations involving torture or to the facility where s/he underwent
torture .
10. Offer physical and mental support to the victims of torture.
Reporting Mechanisms, Support Mechanisms
We are fully aware of the fact that today there is no systematic solution that can
enforce the obligation to report torture and at the same time give concrete
protection to whistleblowers. Policy makers deny the existence of torture, and we
therefore believe that a systematic and institutionalized solution will only be
consolidated only through concerted demands by the medical teams who meet
the dire results of this dangerous practice.
Until such an institutional solution is implemented, the following organizations ensure
counseling and full secrecy to those who report torture. PHR-Israel will give legal
protection to anyone whose place of work is endangered due to his or her
opposition to torture.
Physicians for Human Rights – Israel
Tel: 03-6873718
Fax: 03-6873029
Email: [email protected]
You can contact: Hadas Ziv, Executive Director at 054-6623232, who is assisted by
PHR-Israel's ethic committee. Secrecy assured.
The Israeli Medical Association
Tel: 03-6100444, chairperson of ethics committee: Prof. Avinoam Reches,
IMA's hotline to Human Rights and Ethical dilemmas: Att. Sharon Nissan on: 036100474, for details please see:
http://www.ima.org.il/imahebnew/T1.asp?p=2&n=7957
Bibligoraphy:
 http://www.fco.gov.uk/Files/KFile/MidtHb.pdf
 World Medical Associations e-learning course for doctors working in
prisons. The course was produced by the Norwegian Medical
Association and its Hebrew version was translated by PHR Israel. It is
now accessible in: http://www.ima.org.il/
Author of this leaflet: Dr. Zeev Wiener
Research and Editing of Hebrew Version: Dr. Wiener, Hadas Ziv, Chris
Sommervile and Dr. Ruchama Marton
The project steering committee: Dr. Kobi Arad, Dr. Noa Bar Haim, Dr. Zeev
Wiener, Dr. Garciella Carmon, Dr. Ruchama Marton, Dr. Dganit Sharon