- Email: [email protected]
Evidence of multiple methods of torture in a case from Sri Lanka
Journal of Forensic and Legal Medicine 67 (2019) 15–18
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine journal homepage: www.elsevier.com/locate/yjflm
Evidence of multiple methods of torture in a case from Sri Lanka Samadhi Dandeniya Arachchi , Rohan Ruwanpura
T
∗
Karapitiya Teaching Hospital, Sri Lanka
ARTICLE INFO
ABSTRACT
Keywords: Torture Extreme practices Near death experience Mock execution
Torture, which violates human rights, is still being practiced worldwide despite of all the bound rules and regulations. Although “beating” is the commonest method applied, other physical, psychological and sexual methods are often being practiced. 1975 Tokyo declaration defines torture and the doctor's role in managing torture. Injury identification and accurate dating are major challenges faced by medical professionals in dealing with cases of torture. Inadequacy of the history and late presentation are another major issues that often interfere with proper medico-legal management. It would be wise for the professional who is involved in management of torture cases to be thorough of ‘Istanbul protocol’ which contain the first set of internationally recognized standards for effective examination of torture victim. This case report discusses some of the entities such as beating, water torture, mock execution and other psychological methods, and rear occurrence of hanging with near death experience.
1. Introduction
2. Case history
Torture, which has universally been declared as an unacceptable practice since it violates the fundamental human rights of an individual as well as the society, is still being practised throughout the world in more than half of the countries.1 In spite of both international and local rules and regulations concerning fundamental rights, which are on continuous amendments, different people, parties and organizations in various levels, regardless of all the efforts taken to prevent them, mutilate these rights. The “Torture Victim Protection Act” is a statute that allows the filling of civil suits in the USA against individuals who are acting in an official capacity or against any foreign nation that has committed to torture and/or extrajudicial killing.2 The torture is not common at present, but there had been several reports that individual elements of Sri Lankan law enforcement authorities still practice torture or ill-treatment of detainees while under custody and perhaps, a small proportion of the general public and mass media still tolerate it as a usual part of the law enforcement activities, although the constitution of Sri Lanka has branded the torture as one of the gravest fundamental rights violation. Different studies have shown a similarity of methods of torture practised in Sri Lanka with that of other countries.3 Among them, the battery in custody is the most commonly used method identified.4 The present case of a survivor of torture highlights the different techniques of torture and the importance of accurate interpretation of injury patterns and their timing.
On July 2018, an alleged victim of torture was brought to the Emergency Trauma Care Unit in Tertiary Care Hospital with complaints of severe bodily pain and haematuria and referred for the medico-legal examination after the initial clinical management. According to the victim's statement, he had been interrogated by six police officers, while he was riding a motorcycle with his friend who is a suspect of an alleged robbery. Since the arrest, he was kept blindfold by placing a plastic bag over the head and face, detained in a hall-like space and was deprived of water and food throughout the night. On the following day, they have removed his head cover and applied the hand and leg cuffs. Then, he has been dragged along the cement floor and taken inside a bathroom and assaulted with fists and feet, and by an iron cable all over the body, including the perineum. Further, his head was forcefully submersed into a bucket of water several times. He claimed that his perineum was rubbed with a gasoline-filled polythene bag and pepper powder, and then trampled with a shoe. In addition to the application of physical force, he was verbally abused with filthy words, and once he had been subjected to mock execution with a shotgun. Finally, he has been suspended through his neck with a coir rope that passed through the roof-mounted railing wheel, and torturers have raised him by pulling the other end of the ligature until his feet were merely above the floor for few seconds and then released. This manoeuvre has been repeated for six to seven times, during which the victim has experienced burning sensation over the face, followed by a
∗
Corresponding author. E-mail address: [email protected] (S. Dandeniya Arachchi).
https://doi.org/10.1016/j.jflm.2019.07.007 Received 17 April 2019; Received in revised form 13 July 2019; Accepted 22 July 2019 Available online 23 July 2019 1752-928X/ © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura
Fig. 1. Partially healed abraded ligature mark.
Fig. 3. Irregular mark under the chin.
diminution of the level of consciousness at the peak of constrictionpressure on the neck. By the end of the second day of detention, he was taken to the police station and finally admitted to the hospital when he fainted inside the cell. There was no history of either a medical disease, a surgical ailment or a psychiatric illness. 3. Examination and investigation findings He was of average build and brown in complexion with curly black hair. He was initially bed-ridden due to bodily pain, and by the third day, he has slightly recovered to walk with difficulty. There were two tattoo marks in the right upper arm and right side of the upper chest. The systemic examination was unremarkable, except for having a diffuse tenderness over the abdomen. There were no petechial haemorrhages or any other feature of asphyxia. There were characteristic injuries on the left side and posterior aspect of the neck, and under the chin (Figs. 1, 2 & 3) consisted of scabbed abraded ligature mark of about 1 cm in width. The mark was commencing on the upper aspect of the left anterior triangle of the neck at the margin of the chin and extending obliquely downwards towards the base of the neck. The mark appeared irregular and incomplete at several points while it was absent in the right lateral aspect of the neck. Partially healed linear abrasions with superficial lacerations were present on the upper back of the chest over the right scapular region, which were indicative of the repeated whipping with an iron cable (Figs. 4 and 5). A group of scabbed abrasions placed in a semicircular manner over the left side of the forehead could have been produced by the alleged blunt-force battering and dragging along the floor. There was an infected wound around the ankle, which was suggestive of applying ankle cuff as revealed in the history. A Healing patterned imprint abrasion observed on the penis was in keeping with the history of trampling with a shoe (Fig. 6). The preliminary investigations, including plain radiographs of the entire body, were normal. The urine full report revealed 10–15 pus cells and 20–25 red cells. An ultrasound scan of the abdomen and the cystoscopy examinations were unremarkable.
Fig. 4. Linear marks on back of the left upper arm.
Fig. 5. Injuries on back of the chest.
Fig. 6. Patterned abrasion on glans penis.
The examination of the forensic psychiatrist showed that the victim was free of psychological sequelae of an alleged traumatic experience. He was conservatively managed during the hospital stay with
Fig. 2. Ligature mark on back of the neck. 16
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura
abuse.11 The prevalence of sexual torture is higher among women12,13 than men. Post-traumatic stress disorder [PTSD] has shown a strong association of long-term sequelae of torture, but depression and somatoform disorders are also found frequently.14 Female gender and old age are shown as risk factors for PTSD.15 The plain radiographs of the entire body of the patient did not reveal any fractures. Nevertheless, it would be difficult to reliably exclude the possibility of hidden lesions, as the periosteal fractures are invisible in plain radiographs. Bone scintigraphy will be helpful in such situations, especially in the circumstances of miniature fractures of the ribs. The clinical examination of victims of torture is one of the essential duties of a judicial medical officer. According to local regulations, an alleged victim of torture need to be referred for medico-legal examination by the police, courts, human rights commission etc. The sequel to torture can be acute or chronic. Because of the purposeful delay in seeking medical care, a victim with characteristic acute injuries can hardly be seen. The time-lapse alter the injury patterns, complicates the identification of injuries and its interpretation. Here, in this case, some of the lesions showed secondary infections, which made the dating of the wound more complicated. Apart from that, naturally expected non-corporation by the law enforcement, absence of trace material and scarcity of circumstantial data poses added challenges to the medical examiner handling a case of alleged torture. On the other hand, the Clinical Forensic Physician should always be cautious while distinguishing self-inflicted injuries from those of distinct assault, as some of the victims may purposefully mislead the examiners with malingered lesions. The swift management of torture victims demands that it is essential for health care workers as well as legal professionals to possess comprehensive knowledge on all aspects of torture and need to be trained about investigation and documentation of torture. Moreover, the victim is eligible for compensation, considering the degree of physical and psychological disabilities on him.
symptomatic treatment and discharged after five days, and reviewed after three weeks to ensure that he was physically and mentally stable. 4. Discussion The word ‘torture’ originates from an old Latin stem of “Torquere,” meaning “to twist”.5 The forensic practitioners in Sri Lanka follows the basic guidelines of the Tokyo Declaration 1975, and directions of Istanbul Protocol 1 when managing a case of torture, which defines torture as, “a deliberate, systematic or wanton infliction of physical or mental suffering by one or more person acting alone or on the order of an any authority to force another person to yield information to make a confession or for any other reason.“6 It is a punishable offence under the laws governing the fundamental human rights and according to the Chapter III:11 of the Constitution of Sri Lanka,7 affirming that “no person shall be subjected to torture, inhumane treatment or cruel punishment”. The Supreme Court and Human Rights Commission of Sri Lanka are vested with executive powers of investigating into alleged cases of torture. Methods used in torture can be physical, mental or sexual in nature. The present case report discloses several physical and psychological methods of torturing applied against the victim. Beating is a commonly practised physical method of torture. Chronic pain, as long-term sequelae, is mainly noted with beating (eg.phalanga) and positional torture, as well as in hanging.8 A severe physical battery could be life-threatening due to neurogenic or hypovolaemic shock, renal failure or by damage to the visceral organ. Torture had been practised as a mean of legal punishment of culprits of serious crimes, known as “thirty-two torture complex” during the ancient Lankan Kingdoms. It may be simple as suspension through the wrist or finger or may be complex as popular methods like, among others, the so-called Strappado (Palestinian hanging), Dharma chakra hanging 9 etc. In this case, the victim had been suspended by passing a rope around his neck, which is quite unusual as a method of torture and hardly reported among torture survivors because such practices invariably endanger the life of the victim and may even result in a fatal outcome. Fortunately, the victim of this case was able to survive despite several trials of neck compression that lead to an ultimate near-death experience. However, any other signs of asphyxia such as petechiae and subconjunctival haemorrhages were not present at the time of examination, probably due to concise and controlled episodes of application of pressure on the neck. According to circumstantial data, both state actors and terrorists may subject detainees to torture and extra-judicial execution. However, the pathology of torture has not been well described. This is due to the lack of autopsies performed on victims of torture, mostly due to the disposal of the bodies of the victims by their torturers.10 Mock execution poses severe psychological trauma that frightens the victim with a feeling of inevitability of his death in a short while, and the nightmare is further exacerbated by verbal threatening, blindfolding, and the mock firing of an unloaded gun kept close to the head. “Water torture”, is another method widely practised worldwide, which encircles variety of techniques used to inflict physical and psychological harm to the victim, e.g., dumping or pouring of water (also called waterboarding), hosing female victims’ genital areas, simulated drowning etc. In this particular case, the victim was exhausted by repeated submersion of his head into a bucket of water. The water torture usually leaves no injuries unless complications are set-in. On the other hand, extensive water torture may result in unbearable pain, especially with waterboarding, lung or brain damage, or asphyxial death, and there is also a probability to sustain bodily injuries according to the manner of resistance and restraint. Female victims of torture are also reported in some countries, most commonly due to the behavioural problems of a spouse as well as physical harassment following involvement in politics. Rape and other types of sexual abuse are common in this group rather than physical
5. Conclusion Proper injury identification and accurate dating are crucial in medico-legal management of cases of torture. The present case highlights the two typical injury patterns of torture, namely, blunt impact trauma and injuries of stress positions that occurred from suspension 9 and use of extreme methods of torture that endangers victims’ life. The overall injury pattern of the present victim confirms the nature of deliberate infliction of lesions while detained in custody. References 1. Ozkalipci O, Scholar C. The Istanbul Protocol: international standards for the effective investigation and documentation of torture and ill-treatment. The Lancet. 1999 Sep 25;354(9184):1117. 2. Correale J. The torture victim protection Act: a vital contribution to international human rights enforcement or just a nice gesture. Pace Int'l L. Rev. 1994;6:197. 3. De Zoysa P, Fernando R. Methods and Sequelae of Torture: A Study in Sri Lanka. 4. Moisander PA, Edston E. Torture and its sequel—a comparison between victims from six countries. Forensic Sci Int. 2003 Nov 26;137(2-3):133–140. 5. Galperin w, Torture and truth: the new ancient world By Page duBois New York and Lon-don: Routledge. Toflure and Truth Asks what it Means to Us to Know that “Ancient Greeks and Romans Routinely Tortured Slaves as Part of Their Legal Systems”(p. 4). Its Answer Problematizes Two Standard Self-Congratulatory Ways of Viewing Classical Antiquity. 1991; 1991:162. 6. Declaration of Tokyo. Adopted by the World Medical Association, Tokyo, Japan. October 1975; October 1975. 7. The Constitution of the Democratic Socialist Republic of Sri Lanka. 1978; 1978. 8. Thomsen AB, Eriksen J, Smidt-Nielsen K. Chronic pain in torture survivors. Forensic Sci Int. 2000 Feb 28;108(3):155–163. 9. Jayasooriya R. Torture Country. Lakbimanews 24 October. 2010; 2010 Available at: http://www.janasansadaya.org/page.php?id=310&lang=en. 10. Pollanen MS. The pathology of torture. Forensic Sci Int. 2018;284 85-11. 11. Edston E, Olsson C. Female victims of torture. Journal of Forensic and legal medicine. 2007 Aug 1;14(6):368–373. 12. Oosterhoff P, Zwanikken P, Ketting E. Sexual torture of men in Croatia and other
17
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura conflict situations: an open secret. Reprod Health Matters. 2004 Jan 1;12(23):68–77. 13. Lunde I, Ortmann J. Prevalence and sequelae of sexual torture. The Lancet. 1990 Aug 4;336(8710):289–291. 14. Ramsay R, Gorst-Unsworth C, Turner S. Psychiatric morbidity in survivors of organised state violence including torture: a retrospective series. Br J Psychiatry. 1993
Jan;162(1):55–59. 15. Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev. 2008 Jan 1;28(1):36–47.
18
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine journal homepage: www.elsevier.com/locate/yjflm
Evidence of multiple methods of torture in a case from Sri Lanka Samadhi Dandeniya Arachchi , Rohan Ruwanpura
T
∗
Karapitiya Teaching Hospital, Sri Lanka
ARTICLE INFO
ABSTRACT
Keywords: Torture Extreme practices Near death experience Mock execution
Torture, which violates human rights, is still being practiced worldwide despite of all the bound rules and regulations. Although “beating” is the commonest method applied, other physical, psychological and sexual methods are often being practiced. 1975 Tokyo declaration defines torture and the doctor's role in managing torture. Injury identification and accurate dating are major challenges faced by medical professionals in dealing with cases of torture. Inadequacy of the history and late presentation are another major issues that often interfere with proper medico-legal management. It would be wise for the professional who is involved in management of torture cases to be thorough of ‘Istanbul protocol’ which contain the first set of internationally recognized standards for effective examination of torture victim. This case report discusses some of the entities such as beating, water torture, mock execution and other psychological methods, and rear occurrence of hanging with near death experience.
1. Introduction
2. Case history
Torture, which has universally been declared as an unacceptable practice since it violates the fundamental human rights of an individual as well as the society, is still being practised throughout the world in more than half of the countries.1 In spite of both international and local rules and regulations concerning fundamental rights, which are on continuous amendments, different people, parties and organizations in various levels, regardless of all the efforts taken to prevent them, mutilate these rights. The “Torture Victim Protection Act” is a statute that allows the filling of civil suits in the USA against individuals who are acting in an official capacity or against any foreign nation that has committed to torture and/or extrajudicial killing.2 The torture is not common at present, but there had been several reports that individual elements of Sri Lankan law enforcement authorities still practice torture or ill-treatment of detainees while under custody and perhaps, a small proportion of the general public and mass media still tolerate it as a usual part of the law enforcement activities, although the constitution of Sri Lanka has branded the torture as one of the gravest fundamental rights violation. Different studies have shown a similarity of methods of torture practised in Sri Lanka with that of other countries.3 Among them, the battery in custody is the most commonly used method identified.4 The present case of a survivor of torture highlights the different techniques of torture and the importance of accurate interpretation of injury patterns and their timing.
On July 2018, an alleged victim of torture was brought to the Emergency Trauma Care Unit in Tertiary Care Hospital with complaints of severe bodily pain and haematuria and referred for the medico-legal examination after the initial clinical management. According to the victim's statement, he had been interrogated by six police officers, while he was riding a motorcycle with his friend who is a suspect of an alleged robbery. Since the arrest, he was kept blindfold by placing a plastic bag over the head and face, detained in a hall-like space and was deprived of water and food throughout the night. On the following day, they have removed his head cover and applied the hand and leg cuffs. Then, he has been dragged along the cement floor and taken inside a bathroom and assaulted with fists and feet, and by an iron cable all over the body, including the perineum. Further, his head was forcefully submersed into a bucket of water several times. He claimed that his perineum was rubbed with a gasoline-filled polythene bag and pepper powder, and then trampled with a shoe. In addition to the application of physical force, he was verbally abused with filthy words, and once he had been subjected to mock execution with a shotgun. Finally, he has been suspended through his neck with a coir rope that passed through the roof-mounted railing wheel, and torturers have raised him by pulling the other end of the ligature until his feet were merely above the floor for few seconds and then released. This manoeuvre has been repeated for six to seven times, during which the victim has experienced burning sensation over the face, followed by a
∗
Corresponding author. E-mail address: [email protected] (S. Dandeniya Arachchi).
https://doi.org/10.1016/j.jflm.2019.07.007 Received 17 April 2019; Received in revised form 13 July 2019; Accepted 22 July 2019 Available online 23 July 2019 1752-928X/ © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura
Fig. 1. Partially healed abraded ligature mark.
Fig. 3. Irregular mark under the chin.
diminution of the level of consciousness at the peak of constrictionpressure on the neck. By the end of the second day of detention, he was taken to the police station and finally admitted to the hospital when he fainted inside the cell. There was no history of either a medical disease, a surgical ailment or a psychiatric illness. 3. Examination and investigation findings He was of average build and brown in complexion with curly black hair. He was initially bed-ridden due to bodily pain, and by the third day, he has slightly recovered to walk with difficulty. There were two tattoo marks in the right upper arm and right side of the upper chest. The systemic examination was unremarkable, except for having a diffuse tenderness over the abdomen. There were no petechial haemorrhages or any other feature of asphyxia. There were characteristic injuries on the left side and posterior aspect of the neck, and under the chin (Figs. 1, 2 & 3) consisted of scabbed abraded ligature mark of about 1 cm in width. The mark was commencing on the upper aspect of the left anterior triangle of the neck at the margin of the chin and extending obliquely downwards towards the base of the neck. The mark appeared irregular and incomplete at several points while it was absent in the right lateral aspect of the neck. Partially healed linear abrasions with superficial lacerations were present on the upper back of the chest over the right scapular region, which were indicative of the repeated whipping with an iron cable (Figs. 4 and 5). A group of scabbed abrasions placed in a semicircular manner over the left side of the forehead could have been produced by the alleged blunt-force battering and dragging along the floor. There was an infected wound around the ankle, which was suggestive of applying ankle cuff as revealed in the history. A Healing patterned imprint abrasion observed on the penis was in keeping with the history of trampling with a shoe (Fig. 6). The preliminary investigations, including plain radiographs of the entire body, were normal. The urine full report revealed 10–15 pus cells and 20–25 red cells. An ultrasound scan of the abdomen and the cystoscopy examinations were unremarkable.
Fig. 4. Linear marks on back of the left upper arm.
Fig. 5. Injuries on back of the chest.
Fig. 6. Patterned abrasion on glans penis.
The examination of the forensic psychiatrist showed that the victim was free of psychological sequelae of an alleged traumatic experience. He was conservatively managed during the hospital stay with
Fig. 2. Ligature mark on back of the neck. 16
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura
abuse.11 The prevalence of sexual torture is higher among women12,13 than men. Post-traumatic stress disorder [PTSD] has shown a strong association of long-term sequelae of torture, but depression and somatoform disorders are also found frequently.14 Female gender and old age are shown as risk factors for PTSD.15 The plain radiographs of the entire body of the patient did not reveal any fractures. Nevertheless, it would be difficult to reliably exclude the possibility of hidden lesions, as the periosteal fractures are invisible in plain radiographs. Bone scintigraphy will be helpful in such situations, especially in the circumstances of miniature fractures of the ribs. The clinical examination of victims of torture is one of the essential duties of a judicial medical officer. According to local regulations, an alleged victim of torture need to be referred for medico-legal examination by the police, courts, human rights commission etc. The sequel to torture can be acute or chronic. Because of the purposeful delay in seeking medical care, a victim with characteristic acute injuries can hardly be seen. The time-lapse alter the injury patterns, complicates the identification of injuries and its interpretation. Here, in this case, some of the lesions showed secondary infections, which made the dating of the wound more complicated. Apart from that, naturally expected non-corporation by the law enforcement, absence of trace material and scarcity of circumstantial data poses added challenges to the medical examiner handling a case of alleged torture. On the other hand, the Clinical Forensic Physician should always be cautious while distinguishing self-inflicted injuries from those of distinct assault, as some of the victims may purposefully mislead the examiners with malingered lesions. The swift management of torture victims demands that it is essential for health care workers as well as legal professionals to possess comprehensive knowledge on all aspects of torture and need to be trained about investigation and documentation of torture. Moreover, the victim is eligible for compensation, considering the degree of physical and psychological disabilities on him.
symptomatic treatment and discharged after five days, and reviewed after three weeks to ensure that he was physically and mentally stable. 4. Discussion The word ‘torture’ originates from an old Latin stem of “Torquere,” meaning “to twist”.5 The forensic practitioners in Sri Lanka follows the basic guidelines of the Tokyo Declaration 1975, and directions of Istanbul Protocol 1 when managing a case of torture, which defines torture as, “a deliberate, systematic or wanton infliction of physical or mental suffering by one or more person acting alone or on the order of an any authority to force another person to yield information to make a confession or for any other reason.“6 It is a punishable offence under the laws governing the fundamental human rights and according to the Chapter III:11 of the Constitution of Sri Lanka,7 affirming that “no person shall be subjected to torture, inhumane treatment or cruel punishment”. The Supreme Court and Human Rights Commission of Sri Lanka are vested with executive powers of investigating into alleged cases of torture. Methods used in torture can be physical, mental or sexual in nature. The present case report discloses several physical and psychological methods of torturing applied against the victim. Beating is a commonly practised physical method of torture. Chronic pain, as long-term sequelae, is mainly noted with beating (eg.phalanga) and positional torture, as well as in hanging.8 A severe physical battery could be life-threatening due to neurogenic or hypovolaemic shock, renal failure or by damage to the visceral organ. Torture had been practised as a mean of legal punishment of culprits of serious crimes, known as “thirty-two torture complex” during the ancient Lankan Kingdoms. It may be simple as suspension through the wrist or finger or may be complex as popular methods like, among others, the so-called Strappado (Palestinian hanging), Dharma chakra hanging 9 etc. In this case, the victim had been suspended by passing a rope around his neck, which is quite unusual as a method of torture and hardly reported among torture survivors because such practices invariably endanger the life of the victim and may even result in a fatal outcome. Fortunately, the victim of this case was able to survive despite several trials of neck compression that lead to an ultimate near-death experience. However, any other signs of asphyxia such as petechiae and subconjunctival haemorrhages were not present at the time of examination, probably due to concise and controlled episodes of application of pressure on the neck. According to circumstantial data, both state actors and terrorists may subject detainees to torture and extra-judicial execution. However, the pathology of torture has not been well described. This is due to the lack of autopsies performed on victims of torture, mostly due to the disposal of the bodies of the victims by their torturers.10 Mock execution poses severe psychological trauma that frightens the victim with a feeling of inevitability of his death in a short while, and the nightmare is further exacerbated by verbal threatening, blindfolding, and the mock firing of an unloaded gun kept close to the head. “Water torture”, is another method widely practised worldwide, which encircles variety of techniques used to inflict physical and psychological harm to the victim, e.g., dumping or pouring of water (also called waterboarding), hosing female victims’ genital areas, simulated drowning etc. In this particular case, the victim was exhausted by repeated submersion of his head into a bucket of water. The water torture usually leaves no injuries unless complications are set-in. On the other hand, extensive water torture may result in unbearable pain, especially with waterboarding, lung or brain damage, or asphyxial death, and there is also a probability to sustain bodily injuries according to the manner of resistance and restraint. Female victims of torture are also reported in some countries, most commonly due to the behavioural problems of a spouse as well as physical harassment following involvement in politics. Rape and other types of sexual abuse are common in this group rather than physical
5. Conclusion Proper injury identification and accurate dating are crucial in medico-legal management of cases of torture. The present case highlights the two typical injury patterns of torture, namely, blunt impact trauma and injuries of stress positions that occurred from suspension 9 and use of extreme methods of torture that endangers victims’ life. The overall injury pattern of the present victim confirms the nature of deliberate infliction of lesions while detained in custody. References 1. Ozkalipci O, Scholar C. The Istanbul Protocol: international standards for the effective investigation and documentation of torture and ill-treatment. The Lancet. 1999 Sep 25;354(9184):1117. 2. Correale J. The torture victim protection Act: a vital contribution to international human rights enforcement or just a nice gesture. Pace Int'l L. Rev. 1994;6:197. 3. De Zoysa P, Fernando R. Methods and Sequelae of Torture: A Study in Sri Lanka. 4. Moisander PA, Edston E. Torture and its sequel—a comparison between victims from six countries. Forensic Sci Int. 2003 Nov 26;137(2-3):133–140. 5. Galperin w, Torture and truth: the new ancient world By Page duBois New York and Lon-don: Routledge. Toflure and Truth Asks what it Means to Us to Know that “Ancient Greeks and Romans Routinely Tortured Slaves as Part of Their Legal Systems”(p. 4). Its Answer Problematizes Two Standard Self-Congratulatory Ways of Viewing Classical Antiquity. 1991; 1991:162. 6. Declaration of Tokyo. Adopted by the World Medical Association, Tokyo, Japan. October 1975; October 1975. 7. The Constitution of the Democratic Socialist Republic of Sri Lanka. 1978; 1978. 8. Thomsen AB, Eriksen J, Smidt-Nielsen K. Chronic pain in torture survivors. Forensic Sci Int. 2000 Feb 28;108(3):155–163. 9. Jayasooriya R. Torture Country. Lakbimanews 24 October. 2010; 2010 Available at: http://www.janasansadaya.org/page.php?id=310&lang=en. 10. Pollanen MS. The pathology of torture. Forensic Sci Int. 2018;284 85-11. 11. Edston E, Olsson C. Female victims of torture. Journal of Forensic and legal medicine. 2007 Aug 1;14(6):368–373. 12. Oosterhoff P, Zwanikken P, Ketting E. Sexual torture of men in Croatia and other
17
Journal of Forensic and Legal Medicine 67 (2019) 15–18
S. Dandeniya Arachchi and R. Ruwanpura conflict situations: an open secret. Reprod Health Matters. 2004 Jan 1;12(23):68–77. 13. Lunde I, Ortmann J. Prevalence and sequelae of sexual torture. The Lancet. 1990 Aug 4;336(8710):289–291. 14. Ramsay R, Gorst-Unsworth C, Turner S. Psychiatric morbidity in survivors of organised state violence including torture: a retrospective series. Br J Psychiatry. 1993
Jan;162(1):55–59. 15. Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev. 2008 Jan 1;28(1):36–47.
18