Background

Types of Torture

The aim of torture is to obtain information or a confession, to incriminate a third person, to take revenge, or to establish a reign of terror within a community by breaking the body and the mind of the victim. Perpetrators seldom kill their victims or leave permanent physical marks, as corpses and scars are powerful evidence during a criminal process (1-5).  

Several techniques are practiced to keep physical marks at a minimum. One method involves hitting a victim with a blunt instrument or covering the skin with fabric to decrease the chances of producing lacerations. Another technique done to cover up transient physical lesions is to carry out most of the physical torture during the initial phases of detention, allowing enough time for lesions such as echhymosis and edema to resolve (3-5).

Classification of torture into physical, mental, and sexual categories, though helpful for discussion, is somewhat artificial since most victims often endured all of them simultaneously. Torture not only affects a victim’s entire person, but also generally has long-lasting and devastating sequelae for his or her family and the community at large (1-8).

1. Blunt trauma
Blunt trauma can be divided into three categories: crushing injuries, whipping, and beatings (1-4). Fingers and genitalia are frequent targets for crushing injuries. Objects commonly used to crush victims include riffle butts, pliers, heavy rollers, or even the body weight of the perpetrators. Beatings are one of the two most common forms of torture, the other being threats (4, 2). Certain forms of beatings have received specific names. For instance "telefono" (the telephone) consists of hitting both ears simultaneously with the palms of the hands. Beating the soles of the feet with a solid object is called "falanga," which has the purpose of disabling the victim and preventing him or her from escaping (1, 5-7).

2. Penetrating Injuries
Penetrating injuries are produced by gunshot wounds, flying shrapnel from explosions, and stabbing—which includes slash and scratch cuts. Perpetrators typically shoot their victims in the lower limbs to prevent any possible escape (7). Objects used for stabbing include, but are not limited to needles, razor blades, knives, bayonets, and various sharp objects such as glass, scrap metal, and rods.

3. Suspension
Victims of torture may be suspended by their wrists or ankles for several hours or even days (4-5,7). Frequently, victims are suspended as high as possible and then released suddenly, causing different forms of blunt trauma such as bruises, fractures, and dislocations. Perpetrators also suspend their victims transiently from the earlobes (4-5,7). Male victims of torture may also endure a form of suspension in which heavy objects are hung from their genitalia.

Certain forms of suspension have received specific names. "La barra” (the rod), also called the chicken or the wheel of Buddha, consists of tying down the wrists with the ankles while keeping the knees completely flexed. A rod is passed under the knees and in front of the elbows, and then the victim is suspended by lifting the rod (5,7). "La bandera" (the flag) consists of tying down both wrists on the back of the victim and then suspending the person by the hands. "The Palestinian suspension" consists of suspending the victim with one hand facing forward and the other one facing backwards (7). Finally, "el quirofano" consists of leaving the upper half of the victim’s body suspended in the air, while the victim is lying down and facing up (5).

4. Burns
Victims of torture may endure chemical, thermal, and electric burns. A wide variety of objects are used to inflict this type of injury: cigarettes, hot irons, gas torch, ice, hot liquids like water and oil, electricity from power outlets or stunt guns, acids, and other caustic materials (1-11).

5. Asphyxiation
Perpetrators asphyxiate their victims by covering their faces with a plastic bag (dry asphyxiation or dry "submarino"), submerging their faces in fluids (wet asphyxiation or wet "submarino"), and by forcing their victims to inhale chemicals or dust. In general, filthy water, urine, or excrements are used to carry out the wet "submarino" (1-11).

6. Electric Shocks
Electric shocks are commonly used in South America and Africa. Sources of electric shocks include power outlets, portable generators, cattle probes, and stunt guns (1-11). Electric probes are often placed on sensitive organs, such as earlobes and genitalia.

7. Forced Human Experimentation
During the Nuremberg Trials, physicians were indicted, tried, and convicted for committing crimes against humanity, including forced human experimentation. Although the Nuremberg Code prohibits forced human experimentation, health professionals continue to participate in such activities. Unfortunately, the participation of health professionals in torture goes beyond forced experimentation and includes engaging in torture or in its cover-up by giving false medical certificates (12).

8. Traumatic Removal of Tissue and Appendages
Earlobes, hair, and nails are often removed traumatically. In addition, an explosive wave may produce avulsion of soft tissues.

9. Extreme Physical Conditions
Victims of torture recount several different forms of extreme conditions. Many victims have endured detentions inside prison cells where a human being only fits squatting, as well as exposure to adverse climatic conditions without shading, water, or appropriate clothing. Others have been forced to remain standing or assume difficult postures for days without rest (1-11).

10. Sexual Torture
Sexual torture includes sexual humiliation (e.g. pejorative comments), trauma to genitalia (e.g. suspension of heavy objects from the genitalia, castration, instrumentation), and rape. The international Crime Tribunals for Rwanda and the former Yugoslavia charged rape as a war crime. Rape is used effectively to terrorize entire communities. In Rwanda and the former Yugoslavia, for instance, women were frequently raped in front of relatives or their communities, leaving them ostracized, repudiated by husbands and other relatives.

11. Mental Torture
Almost all victims of torture suffer some form of mental torture. Direct threats to him/her or to a relative are by far the most common form of torture. Other forms of mental torture include sensory deprivation, poor conditions during detention, mock executions, long interrogations, and being forced to torture another person, witness the torture of another person, or watch killings and rapes. Sensory deprivation includes detention in complete darkness, exposure to bright lights and constant noises, or sleep deprivation. Lack of food, potable water, toilet, bed, windows, aeration, medical care, and communication are examples of poor conditions during detention (1-11). Mental suffering unique to refugees include enduring battlefield conditions, uprooting, and life in a refugee camp (1-11).

References:
1. Shrestha NM and Sharma B. Torture and Torture Victims – A Manual for Medical Professionals. Center for Victims of Torture, Katmandu, Nepal, 1995.

2. Mcivor RJ and Turner SW. Assessment and Treatment Approaches for Survivors of Torture. British J. Psychiatry 1995;166: 705 – 711.

3. Forrest D. The Physical After-Effects of Torture. Forensic Science International 1995; 76: 77 – 84.

4. Petersen HD and Rasmussen OV. Medical Appraisal of Allegations of Torture and the Involvement of Doctors in Torture. Forensic Science International 1992; 53: 97 – 116.

5. Rasmussen OV. Medical Aspects of Torture. Danish Medical Bulletin 1990; 37(Supplement 1): 1 – 88.

6. Goldfeld AE, Mollica RF, Pesavento BH, Stephen VF. The Physical and Psychological Sequelae of Torture – Symptomatology and Diagnosis. JAMA 1988; 259(18): 2725 – 2729).

7. Skylv G. Physical Sequelae of Torture. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 39 – 53.

8. Sommier F, Vesti P, Kastup M and Genefke IK. Psychosocial Consequences of Torture: Current Knowledge and Evidence. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 56 – 68.

9. Weinstein HM, Dansky L, and Iacopino V. Torture and War Trauma Survivors in Primary Care Practice. West J Med 1996; 165: 112 – 118.

10. Iacopino V, Ozkalipci O, Schlar C. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (The Istanbul Protocol).
Available at: http://www.phrusa.org/research/torture/index.html [Accessed 05/11/01].

11. American College of Physicians. The Role of the Physician and the Medical Profession in the Prevention of International Torture and in the Treatment of its Survivors. Ann Int Med 1995;122: 607 – 613.

12. Annas GJ and Grodin MA. The Nazi Doctors and the Nuremberg Code - Human Rights and Human Experimentation. Oxford University Press, New York, NY; 1992.