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One of the more shocking revelations after the United States government authorized torture post-September 11, 2001 was the involvement of health professionals. Doctors, nurses and medics were silent when prisoners were abused, physicians and psychologists helped design abusive interrogations, and interrogations were monitored by health professionals.

Steve Miles, MD, is a CVT board member and expert on medical ethics, human rights and international health care at the University of Minnesota Medical School. Rosa Garcia-Peltoniemi, PhD, is senior consulting clinician at CVT and has lectured extensively on refugee and torture survivor mental health. In the first of three blog posts, Steve and Rosa discuss how health care professionals worldwide are complicit in torture, as well as how governments try to prevent health professionals from documenting and providing care to victims. Read Part II here and Part III here.

Steve Miles, MD

Steve Miles

Describe how doctors are complicit in torture.
Steve Miles:
Doctors are extensively involved in torture, routinely involved in almost every country. Sometimes they are overseeing torture, sometimes they are keeping prisoners alive who are not supposed to die. Sometimes they’re designing methods that don’t leave scars and often they’re involved in creating false medical records or death certificates to conceal torture.

In addition, doctors don’t report torture when police or families will bring persons or bodies, and doctors will refuse to receive at a hospital or clinic, thereby refusing to create a medical record or perform an autopsy. Or doctors are aware because of their work in prisons or police stations and don’t report torture.

Rosa Garcia-Peltoniemi

Rosa Garcia-Peltoniemi

Rosa Garcia-Peltoniemi: In the 1990s I visited Turkey with Elizabeth Lira, a psychologist from Chile [an early practitioner of torture rehabilitation] and Joanne Meehan, a social worker at CVT, as part of a consultation with the Human Rights Foundation of Turkey and their torture rehabilitation centers. We along with many other international organizations attended a trial to make our presence known. The trial was of a physician and a lawyer who worked at the foundation’s center in Adana, Turkey. It was interesting in terms of the accusations how the state, in this case the Turkish state, used laws on the books to perversely close this center by accusing the physicians of a crime. By not telling the state that they were seeing torture victims and disclosing the names of those victims, they were accused by the state of committing a crime, which is a perverse use of their law to get at this center.

Previously courts had ordered the center to turn in medical records and individuals who collaborated with the center and refused to recognize doctor/patient confidentiality. This was a case where physicians were involved in documenting and denouncing torture, but the government was putting pressure on the center.

Steve: Rosa, do you think in that case they’re putting pressure for denouncing torture or putting pressure to harass human rights groups that they were afraid would fully document torture.

Rosa: Exactly.

Steve: That was harassment of human rights groups.

Rosa: In this case, the human rights group was doctors who got together to form this foundation to provide health services including psychotherapy for victims of torture. Don’t you think it shows the power and willingness of the state in going after physicians?

Steve: Absolutely.

Why do governments involve doctors?
Steve: A couple of reasons: Sometimes the regime doesn’t want somebody to die. Democratic regimes in particular – and that includes regimes with fairly loose definitions of democracy – will want doctors part of the system of designing non-scarifying torture. The United States example is entirely typical. There is an encyclopedia of torture: Torture and Democracy [author Darius Rejali]. As the human rights movement becomes stronger, there is a greater need to break prisoners down without scarring, and doctors are integral to those efforts.

What is the scope of the problem today?
Steve: There are two ways to look at it. If you take the long view, historically, going back to the 1700s, torture has never been smaller than today. We have greatly decreased torture through three means: The Enlightenment, when governments largely agreed to abandon torture in Europe. That resulted in decisions by major churches to abandon torture as well. Third, years ago, slavery, while it still exists, is vastly less common and that resulted in a massive reduction in torture.

On the other hand, torture is practiced probably by 60 percent of world countries, around 300 million people are tortured out of the world’s population of 70 billion people.

How are doctors held accountable?
Steve: After World War II, we saw a whole bunch of new codes to address and prevent medical and psychological complicity of torture, but no system of accountability. There is no system for holding medical boards and courts accountable for holding physicians accountable. In 1975, Greece and Portugal, held doctors accountable. Since 1975, we’re seeing a steady and exponential rise in these cases. Now, 80 to 90 docs have been punished. What’s interesting is the cases have been clustered in Chile, Uruguay, Rwanda, Argentina, Brazil. These countries have systems for holding doctors accountable. Some countries have punished a doctor symbolically: the United Kingdom, Greece and Sri Lanka. Vast numbers of countries haven’t punished any doctors and that’s true of the United States.

Continue reading Steve and Rosa’s conversation – Part II here and Part III here.