ORIGINAL RESEARCH Psychosocial consequences of widespread of torture and sociopolitical pressure in Iran Siroos Mirzaei, Homayoun Alizadeh, Seyed Zarei, Reem Alksiri Abstract health of a society is determined by multiple fac- Background: Violence and political repres- tors, we conclude from the very limited data avail- sion in general may have a complex psychosocial able from inside Iran that political repression is not impact on societies. Studying these effects in the only such factor, but can be assumed to be at countries with a high grade of repression based on least contributing significantly to the increasing reliable data from inside the country is difficult, physical and mental health problems in the country, mainly due to risks facing researchers. Methods creating a difficult position for health profession- and results: The authors developed a strategy to als especially in detention facilities. Key words: integrate available data from inside Iran, exiled Iran, mental health, torture, repression, trauma. survivors, and reliable international sources to investigate the psychosocial situation in the coun- Introduction try, where torture and execution are used frequent- Violence and political repression may have a ly. Data on human rights violations, including psychosocial impact on different levels of a society. violence against women, persecution of political Studying these effects in countries with a high activists, and torture and execution of teenagers degree of repression such as Iran is difficult from indicate pervasive strategy of repression in Iran in inside the country. A number of international the last four decades. This thereby has caused sub- organizations, including the World Medical stantial long term public mental health impact and Association (WMA) and UN institutions have continue to cause other social and economic prob- nonetheless provided an objective and frightening lems and to create a burden on the Iranian popula- picture of the situation in this country. tion. Conclusion: Although, general psychosocial Iran signed the CCPR - International Cove- nant on Civil and Political Rights - prior the pre- Siroos Mirzaei. sent regime (4.4.1968) but has after change to the Organization for Support of Victims of Torture and present regime not signed standard humanitarian War, Viena, Austria. documents such as the UN Convention against Correo-e: [email protected] Torture, nor the important OPCAT (Optional Pro- Homayoun Alizadeh. MA. tocol to the Convention against Torture and Other Independent HR expert, Viena, Austria. Cruel, Inhuman or Degrading Treatment or Pun- Correo-e: [email protected] ishment) (1). Seyed Zarei. Hemayat Organization for Support of Victims of The United Nations (UN) has repeatedly Torture and War, Viena, Austria. voiced concern regarding widespread Correo-e: [email protected] indiscriminate use of the death penalty in Iran. Reports from the UN Special Rapporteur on the Reem Alksiri. Independent HR expert, Viena, Austria. Situation of Human Rights in the Islamic Republic of Iran indicate that prisoners of conscience, Received: July, 2019. including journalists, individuals with dual Accepted: November, 2020. citizenship, and protesters are being detained Conflict of interests: none arbitrarily on vaguely worded charges, held in Statement of Human Rights: This publication does poor condition and denied access to health care (2). not involve any human participants or animals. This represents a violation of the Minimum Social Medicine (www.socialmedicine.info) -37 - Volume 14, Number 1, January April 2021. Standard rules for the treatment of prisoners detention or execution. Two physicians, Kamiar (Mandela rules). and Arash Alaei, who provided medical care for Additionally, the Iranian Government has over these prisoners have been arrested (2). Iranian decades denied all nominated UN- Special doctors face a difficult choice between threats of Rapporteurs on Human Rights in Iran access to the persecution and violation of national and/or country (2). international medical ethics. Obviously, there are nearly no research data available on the prevalence and respective impact Historical events with impact on public health of different aspects of persecution in Iran from A total of 30 studies looking for depression in inside the country. In this manuscript, authors nurses were investigated. The overall prevalence follow a review of secondary independent sources of depression in nurses in a review of 30 studies such as UNHCR and Amnesty International, in was 22%, which was higher than the prevalence of addition to selected peer reviewed publications depression among the general population. There is related to the discussed issues from inside Iran and a need for psychologically healthy nurses at from exiled survivors. Available data and observations show that torture and execution are hospitals 6). used frequently (2), and a high corruption index The relatively high prevalence of many (rank 140/180) has been reported by transparency indicators of distress and mental health problems international in Iran might be related to a number of social, (https://www.transparency.org/en/countries/iran). economic or other factors, indicating persecution or a repressive society. Restrictions for physicians in following their The effects of the long-lasting war between ethical guidelines Iran and Iraq (1980-1988) have been partially According World Medical Association (WMA) studied in regard to post-traumatic stress disorder health professionals have been prevented from (PTSD) in veterans and their family members as treating patients, raising concerns about the secondary victims. The authors of that study found veracity of documentation related to the cause of decreased cortisol levels in progeny of veterans death of patients, and physicians have been forced after rearranging the groups to reflect previous to support clinically inaccurate documentation to history of PTSD, possibly indicating to a transgen- hide human rights violations (3). erational effect of trauma (7). On 17 July 1988, Persecution of perpetrators in international Iran notified the Secretary-General of its formal courts will be difficult as Iran has not ratified the acceptance of resolution 598, which was already Rome statute that would permit a court on crimes proposed by the UN in 1987 (8). Until this time, against humanity in situation where the local Ayatollah Khomeini had blocked all attempts to government ignores investigation and prosecution end the war, which Iraq initiated (9). He used op- of crimes, but Universal Jurisdiction might be an portunity of the “forced war” to eliminate the po- effective instrument to persecute perpetrators in litical opponents by numerous executions and other countries (4). planned to expand the revolution to neighbor Ahmadreza Djalali is a physician of disaster countries (10). In 1988 there was a series of execu- medicine who has been wrongfully sentenced to tion of political prisoners. Amnesty Internation- death in Iran. He is an Iranian-born resident of al recorded the names of > 4,400 disappeared pris- Sweden, who teaches at universities in Italy and oners during this time (11). Execution is also used Belgium, and whose work involves international on homosexual teenagers and child offenders scientific collaboration. Since his arrest in 2016, against strong criticism by the UN bodies, even in he has been refused medical care despite those with mental disabilities (2). deteriorating health (5). HIV has been neglected in Iran probably Widespread of Torture because of the fact that those at risk for this Data on the widespread use of torture have disease are primarily homosexuals and patients been published by the UN (2) and data of Iranian with substance abuse, groups who are refugees as discussed later confirm the wide discriminated against and are at highest risk for spread use of torture. Social Medicine (www.socialmedicine.info) -38 - Volume 14, Number 1, January April 2021. Our own data from examining of survivors of and Abdolreza Soudbakhsh, from Kahrizak prison, torture from Iran using the “Istanbul protocol” (12) were murdered after having examined inmates indicate the use of systematic torture methods such who had been tortured and raped (21). as psychological torture, beating the whole body, Members of minorities constitute a significant suspension, falanga, burns with cigarettes, and part of the prison population. Further, minorities sexual torture of women and men. This has been suffer from discrimination in the academics, for confirmed to a major extent in other studies (13- example, many Baha’i have been reportedly 15). expelled from universities or their applications of Busch et al. reported that in a group of Iranian admission are rejected (2). refugee survivors of torture different methods were used, including burning (38%), electrical Systematic Violence against Women torture, and sexual torture (25%) (13). Dehghan In a patriarchal society, with many restrictions recently reported on the high prevalence of sexual on females, economical pressure, physical and/or torture of Iranian and Kurdish refugees (14). There sexual violence threaten women's health. are also reports of anal torture with hard objects in According to the Office of the United Nations men (15). The wide-spread historical use of torture High Commissioner for Human Rights (OHCHR) in Iran, including the time prior to “revolution”, is Iran has not ratified the Convention on the even documented in a dedicated