TORTURE 3 2020 Journal on Rehabilitation of Torture Victims and Prevention of Torture Physiotherapy for torture survivors: Is there evidence of its utility in torture rehabilitation? - Part II VOLUME 30, NO 3, 2020, ISSN 1018-8185 TORTURE Journal on Rehabilitation of Torture Victims and Prevention of Torture Content Published by the International Rehabilitation Council for Hunger: Deprivation and manipulation of food as a torture method. State Torture Victims (IRCT), Copenhagen, Denmark. of the art in research and ways forward TORTURE is indexed and included in MEDLINE. Citations from the articles indexed, the indexing terms and the Pau Pérez-Sales 3 English abstracts printed in the journal will be included in the databases. Special Section. Physiotherapy for torture survivors - Part 2 Volume 30, No 3, 2020 Guest Editor: Eric Weerts ISBN 1018-8185 International survey of the utilization of physiotherapy in treatment The Journal has been published since 1991 as Torture centers for survivors of torture – Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture, and was relaunched as Torture Laura Pizer Gueron and MaryAnn de Ruiter 20 from 2004, as an inter national scientific core field journal on torture. Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya Editor in Chief Pau Pérez-Sales, MD, PhD Laura Pizer Gueron, Arobogust Amoyi, Winnie Chao, Justine Chepngetich, Editorial Assistant Jepkemoi Joanne Kibet, Stephen Nyambok and Joseph Wesonga 27 Chris Dominey, LL.M Acceptability of a physiotherapeutic pain school treatment in trauma- Editorial advisory board affected populations in the Middle Eastern & Northern African region Bernard L. Duhaime, B.C.L., LL.B., LL.M. Gavin Oxsburgh, PhD Anne-Mette Karrer, Ane Kirstine Viller Hansen, Marie Louise D. Hans Draminsky Petersen, MD Oestergaard and Linda Nordin 43 Jens Modvig, MD, PhD Jim Jaranson, MD, MA, MPH Perspectives John W. Schiemann, PhD, MA José Quiroga, MD Collaborative effort to increase the physiotherapist’s competence in Lenin Raghuvanshi, BAMS rehabilitation of survivors of torture Mariana Castilla, MSc Nora Sveaass, PhD Maria Nordheim Alme, Rolf Vårdal, Djenana Jalovcic, Ilona Fricker, Sarah S. Megan Berthold, PhD, LCSW Peters, Patricia Rocca, William Hale, Esra Alagöz, Nika Leskovsek, Aicha Steven H. Miles, MD Benyaich, Emer McGowan, Anna Pettersson, Line M. Giusti, Michel Landry, Tania Herbert, DClinPsy Carina Boström, Rachael Lowe, Kjersti Wilhelmsen and Joost van Wijchen 61 Guest editor - Physiotherapy for torture survivors Eric Weerts Scientific Articles Editorial support in this issue Violence and torture against migrants and refugees attempting to reach Naila Kosar the European Union through the Western Balkans Correspondence to Marta Guarch-Rubio, Steven Byrne and Antonio Manzanero 67 IRCT Vesterbrogade 149, building 4, 3rd floor, “A random system”: The organisation and practice of torture rehabilitation 1620 Copenhagen V, Denmark services in Norway Telephone: +45 44 40 18 30 Email: [email protected] Moa Nyamwathi Lønning, Anette Bringedal Houge, Inga Laupstad and Ann Evy Aasnes 84 Subscription http://irct.org/media-and-resources/publications#torture-journal Looking for stability: Experiences of rehabilitation for Congolese survivors The Journal is free of charge. of torture in Athens and the role of the Congolese community in their The views expressed herein are those of the authors and support can therefore in no way be taken to reflect the official opinion of the IRCT. Maria-Angeliki Psyrraki, Emilie Venables, Christos Eleftherakos, Nathalie Front page: Mogens Andersen, Denmark Severy, Declan Barry, Nikos Gionakis, Maria Episkopou, Aikaterini Layout by Pedro López Andradas Komita and Gianfranco De Maio 101 Printed in Lithuania by KOPA. Book Review The torture doctors. Human rights crimes and the road to justice by Steven Miles. Pau Pérez-Sales 113 Letter to the editor EMDR as an evidence-based therapy for trauma – A reply to the Independent Forensic Expert Group’s statement on conversion therapy. Oliver Piedfort Marin, Isabel Fernandez and Carol Miles 117 Response to EMDR Association letter on conversion therapy. Asger Kjaerum 120 Call for papers 122 3 EDITORIAL Hunger: Deprivation and manipulation of food as a torture method. State of the art in research and ways forward Pau Pérez-Sales, Editor-in-Chief* Deprivation of food is one of, if not the oldest objective measures. Food deprivation is method of punishment. Hunger and famine defined as a food intake below the dietary are described in the Bible as a way of retri- required minimum energy level. There bution when God was offended. There are are different ways to measure it, reviewed accounts of the use of forced imposition of below. Food deprivation is often combined hunger or starvation in places of detention with Food manipulation, a term referred to and concentration camps worldwide. Sur- the quality, aspect, taste or contamina- prisingly, however, the quantity and quality of tion of the food provided to an individual academic research on the subject is unusually (DIGNITY, 2016). low. (Rubin, 2019). It is neither mentioned 3. Starvation. Refers to a deficiency in as a torture method in source handbooks caloric intake severe enough to be below (i.e. Rejali, 2009) nor in the Istanbul Pro- the level needed to maintain an organism’s tocol, which mentions it marginally con- life. While the purpose of a reduction in cerning conditions of detention without any food supply can be to temporarily debili- other mention or guidance within its pages tate the individual physically and psycho- (UNHCR, 1999). In this Editorial, we would logically, in starvation, the purpose is to like to update the medical and psychologi- produce unbearable pain and eventually, cal research on the impacts of starvation as as a consequence, slow death. a torture method and suggest some tentative 4. Malnutrition is the specific effect conclusions and avenues for further research. of having a deficiency of one or more essential nutritional components (ie. 1. Definitions and conceptual map thiamine deficit, iron deficiency produc- ing anemia) without necessarily receiv- 1. Hunger. Refers to the subjective sensation ing an insufficient daily energy intake. of wanting or needing food. Hunger is an evolutionary adaptive signal essential for 30, Number 3, 2020 TORTURE Volume survival that directs attention towards Objective measures of food deprivation. food acquisition in a similar way that pain Defining and measuring an individual’s food is a signal of bodily harm and a signal of needs is a challenge given variations in rela- threat (Al-Shawaf, 2016). tion to gender, age, health status and level 2. Food Deprivation. Provided that hunger of physical activity. Based on reports by the is a subjective sensation, in human rights World Health Organization (WHO) and the research sometimes is better to work with Food and Agriculture Organization of the *) Editor-in-Chief. Correspondence to: [email protected] https://doi.org/10.7146/torture.v30i3.123318 International Rehabilitation Council for Torture Victims. All rights reserved. 4 EDITORIAL United Nations1, for a moderately active 70 ensure daily food provision for all family kg individual (1.75 × BMR) between the ages members. The idea of food insecurity has of 30 and 60, the daily energy requirement also been applied to monitoring detention (or approximate Total Energy Expenditure centers. For instance, in a country-wide study (TEE)) is 3000 kcal/day (44 kcal/kg/day) for in Malawian prisons, 95% of inmates consid- men and 2500 kcal/ day (36 kcal/kg/day) for ered themselves food insecure (i.e. uncertain women. The recommended WHO baseline that they could get enough food the following protein delivery to avoid starvation in humans day). 61% of the prisoners reported feelings of is ~ 0.75 g/kg/day. (FAO & WHO, 2005). anxiety over availability of food. Approximately Based on the Minnesota study (see 22% of the prisoners stated they slept hungry below), Wischmeyer, (2017) has suggested at night, 12% reported staying a whole day that food-deprivation produces starvation and night without eating and 62% of the pris- when intake is below 30 kcal/kg/day and 0.9 g oners used, they themselves believed, shame- protein/kg/day. For an average 70 Kg person ful means of obtaining food, such as begging this is 2100 calories2 and 36 gr. of proteins. or stealing from other inmates (Moloko et al., In monitoring visits to detention centers 2017). There are excellent reviews and pro- or in the context of analyzing the use of mass posals of food insecurity measurements, from starvation as a war weapon, an alternative short scales to complex multidimensional measure is to estimate the percentage of in- measures (Coates et al., 2003; A. D. Jones et dividuals with protein-energy malnutrition al., 2013; Leroy et al., 2015; Pérez-Escamilla and, ideally, to perform a follow up after some & Segall-Corrêa, 2008). months. For instance, a study of nutritional status in a women’s prison in Anatinomora Legal definition and jurisprudence (Madagascar) found that the proportion of At an individual level, Rule 22 of The Nelson undernourished female prisoners was 38.4%, Mandela Rules establishes the duty to provide including those who were pregnant and lactat- ‘food of nutritional value adequate for health ing. Undernutrition was related to the intake and strength, of wholesome quality’. The Prin- of two meals a day instead of three (p = 0.003), ciples and