Survivors of Torture: Prevalence in an Urban Emergency Department

Abstract

Objectives: Torture has been documented in 132 countries, and approximately 400,000 survivors of torture reside in the United States. It is unknown if torture survivors seek medical care in emergency departments (EDs). The authors set out to estimate the prevalence of survivors of torture presenting to an urban ED.Methods: A cross-sectional survey of ED patients was performed by convenience sampling from October 2008 to September 2009 in a large urban teaching hospital in New York City. ED patients not of a vulnerable population were consented and entered into the study. Participants were asked two screening questions to ascertain if they were self-reported survivors of torture. For exploratory purposes only, these individuals were further queried about their experiences. The detailed responses of these self-reported survivors of torture were compared to the United Nations Convention Against Torture (UNCAT) definition by a blinded, independent panel.Results: Of 470 study participants, 54 individuals (11.5%, 95% confidence interval [CI] = 8.6% to 14.4%) self-reported torture. Nine (16.7%) had ongoing physical disabilities, 30 (55.6%) had recurrent intrusive and distressing memories, 42 (77.8%) never had a physician inquire about torture, and only eight (14.8%) had requested political asylum. Of these self-reported survivors of torture, 29 (53.7%) met the UNCAT definition, for an adjudicated prevalence of 6.2% (95% CI = 4.3% to 8.7%).Conclusions: Self-reported survivors of torture presented to this urban ED, and a significant proportion of them met the UNCAT definition of a torture survivor. Continuing torture-related medical and psychological sequelae were identified, yet there was a low rate of asylum-seeking. Only a minority were previously identified by a physician. These data suggest an unrecognized public health concern and an opportunity for emergency physicians to intervene and refer survivors of torture to existing community resources.

Characterization of the Demographics and Psychiatric Co-Morbidites Among Clients of a Human Rights Clinic in Miami-Dade County, Florida, United States

“…Notably, 82% of the HRC cohort reported episodes of torture and/or human rights abuses; prevalence estimates of torture history vary from 6.6% at an urban primary care clinic to 11.5% in an urban emergency department cohort, and often go unreported [ 20 - 21 ]. Furthermore, the asylum-seekers’ legal affidavits reveal a wide variety of types of abuse suffered including persecution of marginalized political sects in Ethiopia, gang violence in Honduras and El Salvador, and sexual assault in Haiti and the Bahamas.…”

“…Moreover, the HRC cohort's prevalences of these mental health conditions are much higher than estimates for the general South Florida population (8.4% PTSD and 11.6% MDD) or United States (3.5% PTSD and 6.7% MDD) populations (see Figure 1) [18][19]. Notably, 82% of the HRC cohort reported episodes of torture and/or human rights abuses; prevalence estimates of torture history vary from 6.6% at an urban primary care clinic to 11.5% in an urban emergency department cohort, and often go unreported [20][21]. Furthermore, the asylum-seekers' legal affidavits reveal a wide variety of types of abuse suffered including persecution of marginalized political sects in Ethiopia, gang violence in Honduras and El Salvador, and sexual assault in Haiti and the Bahamas.…”

Estimating the Costs of Torture: Challenges and Opportunities

“…A consensus on torture prevalence levels in host countries, such as the ones derived from meetings of technical experts in the field is lacking. Several studies support prevalence levels of victims of torture between 5 and 35 % among refugees [46,48,49]. In Switzerland, Wicker found a prevalence rate of 30 % for torture survivors among recognised refugees [50].…”

“…Presently, it affects millions of people in about 112 countries according to Amnesty International [9]. In some population groups (prisoners, refugees, or even patients in health-care services), prevalence levels can be high, yet vary widely according to the literature [7][8][9][10][11][12].…”

Asylum Seekers: Our Patients at the Border

“…In one study of a New York City emergency department, more than threequarters of self-reported survivors of torture had never been asked by a physician about this crucial aspect of their history. 6 Seeking out foundational training in trauma-informed care-that is, best practices in interacting with survivors of diverse traumas-and learning to document human rights abuses as described in the United Nations' Istanbul Protocol is a first step you can take towards both aiding asylum seekers and augmenting our standard clinical acumen.…”