Featured Journal Content
Jun 29, 2019 Volume 393Number 10191p2563-2654, e45
Caring for patients who have been tortured in detention
People who have been tortured while in detention are among our most vulnerable patients. Clinicians who care for these patients might likewise feel vulnerable and ill-equipped to manage the complex health-care needs of victims. Torture and detention on their own have health impacts, but together exact a physical and psychological toll on individuals that can be long-lasting and profound. A third of asylum seekers and over 40% of refugees are estimated to be victims of torture. That health-care delivery can trigger memories of trauma, fear of officials, and mistrust of institutions compounds the challenges clinicians face in caring for people who have been tortured in detention.
International instruments exist, such as the so-called Mandela rules (UN Standard Minimum Rules for the Treatment of Prisoners) and a World Medical Association declaration, which lay out the basic principles to be applied in the health care of those in detention who have been tortured or subject to inhuman or degrading treatment. Now, a more specific set of quality standards has been developed by the Faculty of Forensic and Legal Medicine (FFLM) of the Royal College of Physicians. Their guidance is welcome.
The FFLM’s 12 quality standards are intended to help physicians, nurses, paramedics, and others establish good practice in the identification, documentation, and reporting of torture, and improve the treatment and quality of life for victims. The new standards also aim to empower health-care professionals to maintain their ethical obligations to patients if in conflict with the requirements of detention authorities. The standards are comprehensive, detailed, and direct, and cover areas such as sexual torture, children, mental capacity, and vicarious traumatisation.
These guidelines should be disseminated widely to enable clinicians everywhere to build the capacity, confidence, and compassion to manage the complex needs of patients who have been tortured. These standards should also be used to challenge detaining authorities to improve their standards of detention health care.
Summary – Quality standards for healthcare professionals working with victims of torture in detention
The Faculty of Forensic & Legal Medicineof the Royal College of Physicians
The Faculty of Forensic and Legal Medicine of the Royal College of Physicians (FFLM), whose work focuses on the care of the vulnerable, has acknowledged expertise in setting clinical standards for police custody healthcare and sexual offence medicine. The healthcare professionals who work with Victims of Torture (HWVT) working group, established by the FFLM to produce these quality standards, has drawn on wider expertise from Freedom from Torture, Helen Bamber Foundation, Medical Justice, UK Association of Forensic Nurses, the Royal College of Psychiatrists, and the British Association for Sexual Health and HIV. The document has benefited from review by survivors of torture, an international expert in solitary confinement, Physicians for Human Rights, the International Rehabilitation Council for Torture Victims, Dignity Institute, the International Red Cross, the Royal College of General Practitioners Secure Environments Group, NHS England, the British Medical Association Ethics Committee. We are grateful for all the support offered by the above named to the HWVT working group of the FFLM.
PDF: Summary – Quality standards for healthcare professionals working with victims of torture in detention