What are some of the most common physical signs of a person having experienced torture?
As there are multiple forms of torture, there are also multiple symptoms that can indicate that a patient has been subjected to torture:
a) Dermatological (related to the skin) - wounds, scars, burns (e.g. due to burns with cigarettes, heated instruments, scalding liquid or a caustic substance), changes in skin pigmentation, distorted, thickened nails and cicatricial alopecia (hairloss due to scarring). Abdominal surgical scars may confirm a history of splenectomy or nephrectomy (surgical removal of spleen or kidney) which may have followed trauma.
b) Neurological - sensory changes, weakness, wasting, or loss of deep reflexes. These neurological signs may be due to a penetrating wound, suspension, traction or compression as well as nutritional deficiencies.
c) Fractures and dislocations - these may be acute or x-rays may show gross mal-union or non-union due to lack of treatment provision.
d) Respiratory - persistent lung pathology may result from repeated ducking or forced inhalation of chemicals or dust
e) Persistent pain, stiffness and generalised weakness, and headaches - due to repeated direct trauma, psychological stress and/or nutritional deficiency.
f) Musculoskeletal - signs may include painful limitation of all shoulder movements (can be due to positional torture, using suspension, stretching limbs apart, prolonged constraint of movement, forced positioning), recurrent dislocation, winging of the scapula (shoulder blade; from Palestinian hanging) and hip injuries from forcible abduction (movement outwards) of the hip.
g) Genitals - testes smaller in size with reduced sensation is suggestive of previous trauma and hesitancy/dribbling may suggest penile trauma with strictures. Rape or sexual abuse often leave no physical evidence, but if very violent insertion has occurred there may be scarring around the vulval or perianal region. Anal fissures may occur, however, these may also be due to constipation. Rape and sexual violence may also result in pregnancy, sexually transmitted infections and sexual dysfunction.
h) Internal injuries - blows to the head may produce a traumatic cataract or retinal detachment, sensori-neural hearing loss, fractured nasal bones, septal deformity and anosmia (loss of sense of smell), loss or loosening of teeth and deep cuts of the tongue or mucosa of the cheeks. Punches or blows directly to the ears may rupture eardrums. Repeated concussions may result in epilepsy, loss of short-term memory, confusion or dementia.
Source: Medical Justice, 2002.
- Palestinian hanging: the victim is lifted up from the ground by a rope attached to the wrists, which are tied behind the back, and then the victim is dropped partially to the ground with a jerk
- Submarine: a type of torture where the victim’s face is covered with a plastic bag and submerged in (dirty) water, urine, or excrement
If physical evidence of torture exists it is important to document accurately as it can provide confirmatory evidence of the patient’s own accounts. However, the absence of physical evidence cannot be interpreted to suggest torture has not occurred, as many acts of violence frequently leave no marks or scars, and on many occasions this is intentional to prevent use as evidence in court (UN, 1999).