Documentation of torture and cruel, inhuman or degrading treatment of children: A review of existing guidelines and tools

Child torture as a form of child abuse: An exploratory study of investigative aspects among 42 offenders

BACKGROUND

Torture has traditionally been described in the context of politically motivated abuse. Torture of children in the familial context is a less studied phenomenon, with scholarly articles focused on legal or medical viewpoints. Analysis from a frontline professional's perspective is virtually nonexistent in the literature.

OBJECTIVE

The present study seeks to identify the common features of child torture and assist law enforcement, medical, and child protection agencies in earlier identification and inform more effective investigative and intervention strategies.

PARTICIPANTS AND SETTING

A convenience sampling method was used to identify and collect cases involving severe child maltreatment consistent with torture. The sample included 42 offenders and 35 victims, representing 20 households.

METHODS

Researchers reviewed and extracted data from law enforcement case files, to include investigative, medical, and child protective services (CPS) reports, as well as recorded law enforcement interviews of offenders/witnesses and child forensic interviews. Descriptive and frequency statistics were generated.

RESULTS

Offenders were often female (57 %), most commonly biological mothers (38 %), with a history of violence (57 %). Prior CPS reports were noted in 85 % of cases, less than half of which were substantiated. In over half of the cases (55 %), law enforcement discovered digital documentation of the torture. Over half (54 %) of the victims died as a result of the torture.

CONCLUSIONS

This study demonstrated how CT is a distinct form of child maltreatment that is especially severe and pervasive. Recognition, assessment and documentation of the unique constellation of physical and psychological abuse are key to an efficient intervention.

Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences

OBJECTIVES

Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability.

DESIGN

The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines.

SETTING

The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway.

PARTICIPANTS

Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted.

RESULTS

Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned.

CONCLUSIONS

We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.

Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study

INTRODUCTION

Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment.

METHODS AND ANALYSIS

This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses.

ETHICS AND DISSEMINATION

The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.

A rare case of child abuse from early modern Lithuania

The aim of this article was to describe the outcome of a probable case of physical abuse in the remains of a child dating from the 16^th-18^th centuries CE. The skeleton of a subadult was recovered during archaeological excavations carried out in the village of Užubaliai, located in Alytus in southern Lithuania, and subsequently curated in the Faculty of Medicine at Vilnius University. The bones of this child were observed macroscopically and then submitted for radiological investigation. In order to speculate on the presence of abuse, features such as the presence, quantity, and type of injuries were considered. Stages of healing and the occurrence of additional nonspecific stress markers, such as linear enamel hypoplasia or Harris lines, were also recorded. The remains revealed the presence of lesions showing three stages of healing, including antemortem and perimortem fractures. Periosteal reactions were also observed on many of the bones. Traumas with high specificity for abuse, such as rib and scapular fractures, were assessed. Finally, endocranial new bone formation was also noted as a possible sign of neglect. The pattern of observed injuries showed evidence that was compatible with a case of physical abuse.