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Sri Lankan male examined April 2013 Photo displayed with well-informed patient consent.

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Presentation on theme: "Sri Lankan male examined April 2013 Photo displayed with well-informed patient consent."— Presentation transcript:

1 Sri Lankan male examined April 2013 Photo displayed with well-informed patient consent

2 A World-wide Epidemic of Torture New Internationalist, from Amnesty data

3 Firmer Faster Fairer Footer for all Home Office Reasons for Refusal letters, 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 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,

4 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 No scars seen UK (Campsfield immigration detention centre doctor, R35 report) 2007 Actual count = 15

5 I saw no bruises on his face (Basra) British Army doctor, evidence to Baha Mousa enquiry

6 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

7 Abuse: a Triangle or a Pyramid? Bystander VictimPerpetratorVictimPerpetrator Active Witness Where possible, an active clinical witness examines, treats, documents, reports and publicises abuse

8 ....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 Risks: death gaol /torture sanctions? career? Syria > Bahrain > Basra > UK

9 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....

10 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

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