Patterns of torture among forcibly displaced Eritreans in California: A cross-sectional study

P. Suzanne Portnoy; Alejandro Diaz; Jenna Kupa; Isabelle Rocroi; Emily Tatel; Kala Mehta; Nicholas Nelson

doi:10.7146/torture.v31i1.121786

Authors

P. Suzanne Portnoy Northern California Human Rights Clinic and CommuniCare Health Center
Alejandro Diaz Northern California Human Rights Clinic
Jenna Kupa Northern California Human Rights Clinic
Isabelle Rocroi Northern California Human Rights Clinic
Emily Tatel University of California, San Francisco
Kala Mehta University of California, San Francisco School of Medicine
Nicholas Nelson Northern California Human Rights Clinic

DOI:

https://doi.org/10.7146/torture.v31i1.121786

Keywords:

asylum seekers, tortures, physical assessment, scars

Abstract

Abstract

Introduction: Unprecedented global increases in involuntary migration have created large populations of forcibly displaced people, who are disproportionately likely to have experienced abuse and torture. We undertook this study to better understand the frequency and consequences of specific types of torture and abuse within an immigrant population in our community, San Francisco, East Bay.

Methods and Results: We conducted a cross-sectional study of 59 Eritreans seeking asylum in the United States presenting to a human rights clinic for forensic medical and psychological evaluations. Demographic features of individuals, reported history and specific types of torture, and physical and psychological sequelae were analyzed. Over 300 instances of torture were reported, an average of about 6 per person. The primary forms of torture reported were beating and forced positioning, and many others were reported sporadically. 90% of asylum seekers examined had clinical findings which were consistent with the torture they reported, and some physical findings had clinical as well as forensic significance. 86% met diagnostic criteria for post-traumatic stress disorder.

Discussion: Forcibly displaced people are likely to have witnessed and experience violence, deprivation, and abuse, and for this reason bear a disproportionate burden of physical, psychological, and social morbidity. Our study describes the epidemiology of torture and its consequences in a specific population, and demonstrates why understanding local and general epidemiology of torture and other forms of abuse is necessary to provide excellent biopsychosocial care to forcibly displaced people.

Author Biographies

P. Suzanne Portnoy, Northern California Human Rights Clinic and CommuniCare Health Center

Suzanne Portnoy is a board-certified family nurse practitioner. She received her master’s degree from Samuel Merritt University (2011) and her doctorate in nursing practice from Oregon Health & Science University (2017). She is trained on forensic asylum examination by Physicians for Human Rights. In 2014, she began performing medical and psychological forensic asylum evaluations at the Highland Human Rights Clinic. In 2018, she joined Richard Fine People’s Clinic at Zuckerberg San Francisco General Hospital. In addition to performing forensic evaluations, Suzanne works to build community capacity by training clinicians on forensic exam techniques and mentoring peers one-on-one.

Alejandro Diaz, Northern California Human Rights Clinic

Alejandro Díaz, MD
Attending Physician Department of Medicine
Director Community Outreach & Home Visit Program | Internal Medicine Residency Program
Associate Medical Director | Highland Human Rights Clinic
Highland Hospital
1411 East 31st Street | Oakland, CA 94602
(510)535-7689 (Office) | (510)718-5218 (Pager)

Jenna Kupa, Northern California Human Rights Clinic

Jenna Kupa is a senior at Tufts University in Boston. She has been accepted into Tufts Unversity Medical School with matriculation date of September 2021. Ms. Kupa was a research assistant on the project.

Isabelle Rocroi, Northern California Human Rights Clinic

Isabelle Rocroi graduated Summa Cum Laude with a Bachelor of Arts Chemistry from Barnard College in New York. She is currently working as a research assistant in the University of Oxford, Department of Psychiatry. Ms. Rocroi was a research assistant for this project.

Emily Tatel, University of California, San Francisco

Emily is a nurse practitioner specializing in women's health and documentation and management of female genital cutting. She was a contributing author to this research and an active member of the Highland Human Rights Clinic.

Kala Mehta, University of California, San Francisco School of Medicine

Associate Professor, Epidemiology & Biostatistics
University of California,San Francisco School of Medicine
550 16th. Street
San Francisco CA 94158
415-205-8780
Kala.Mehta@ucsf.edu

Kala is an Associate Adjunct Professor in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. Kala also teaches clinical research methods to undergraduates, medical students, residents, fellows, and international faculty. She uses different styles in her teaching including traditional ‘brick and mortar’ as well as cutting-edge online education technologies. She is also faculty of the SFBUILD, a pipeline program to promote diversity in science. In this program she works with undergraduate students, teaches them clinical research skills, and then works with them to find research placements in labs at UCSF and San Francisco State University.

In terms of research, Kala focuses on both domestic and international vulnerable populations. Her early work examines disparities in older adult health. Her more recent work focuses on the intersection of social entrepreneurship and health in a global context. From 2011-2014, she was a faculty affiliate of the Stanford Graduate School of Business, where she led a research evaluation on the impact of a management and transportation intervention on health in Zambia. Her current research evaluates a large maternal and child health intervention in Bihar, India.

Kala received her DSc. in Epidemiology from the Erasmus University Medical School in Rotterdam, the Netherlands, and has obtained post-graduate specialization in epidemiology and clinical research from the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

Nicholas Nelson, Northern California Human Rights Clinic

Highland Hospital Internal Medicine Resident Training Program, Core Faculty
Medical Director, Human Rights Clinic
Affiliated Faculty, Berkely Center for Social Medicine
Assistant Clinical Professor of Medicine, UCSF

References

Amnesty International. Map of Secret Prison Network in Eritrea Pinpoints “Infrastructure of Repression.” (8 May 2013) https://www.amnestyusa.org/press-releases/map-of-secret-prison-network-in-eritrea-pinpoints-infrastructure-of-repression/, accessed 16 April 2019.

Abu Suhaiban, H., Grasser, L. R., & Javanbakht, A. (2019). Mental health of refugees and torture survivors: a critical review of prevalence, predictors, and integrated care. International journal of environmental research and public health, 16(13), 2309.

Bullard KM et al. Prevalence of diagnosed diabetes in adults by diabetes type – United States, 2016. MMWR Morb Mortal Wkly Rep. 67(12):359-61.

Dyer C. Doctors have authority to assess injuries from alleged torture, says Supreme Court. BMJ. 12;364:l1121 (2019)

Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA 2003:290:627-34.

Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? West J Med. 2000;172:301-304

Freburger, J. K., Holmes, G. M., Agans, R. P., Jackman, A. M., Darter, J. D., Wallace, A. S., Castel, L. D., Kalsbeek, W. D., & Carey, T. S. (2009). The rising prevalence of chronic low back pain. Archives of internal medicine, 169(3), 251–258. https://doi.org/10.1001/archinternmed.2008.543

Gebreyesus T, et al. Violence en route: Eritrean women asylum seekers experiences of sexual violence while migrating to Israel. Health Care for Women International. 5:1-23 (2019). [Epub ahead of print]

Gebreyesus T. et al, Life on the margins: the experiences of sexual violence and exploitation among Eritrean asylum-seeking women in Israel. BMC Women’s Health 18:35 (2018)

Ignatieff M, Keeley J, Ribble B, McCammon K. The Refugee and Migration Crisis: proposals for action, UN Summit 2016. Brookings Institution 2016.

Jaranson JM, Butcher J, Halcon L, et al. Somali and Oromo refugees: correlates of torture and trauma history. Am J Public Health. 2004;94:591-8.

Krug EG et al., eds. World report on violence and health. Geneva, World Health Organization, 2002.

Lijnders L. Caught in the borderlands: Torture experienced, expressed, and remembered by Eritrean asylum seekers in Israel. Oxford Monitor of Forced Migration 2:1;64-76 (2012)

Marshall GN, Schell TL, Elliot MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294:571-9.

McKenzie KC, Bauer J, Reynolds PP. Asylum seekers in a time of record forced global displacement: the role of physicians. J Gen Intern Med. 2019 Jan; 34(1):137-43.

Metalios EE, Asgary RG, Cooperman N, et al. Teaching residents to work with torture survivors: experiences from the Bronx Human Rights Clinic. J Gen Intern Med. 2008;23(7):1038-1042. doi:10.1007/s11606-008-0592-2

Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice. Crosby S, Norredam M, Paasch-Orlow MK, Piwowarczyk L, Heeren T, Grodin HA. J Gen Intern Med 2006;21:764-8.

U.S. Census Bureau. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_5YR_B05006&prodType=table, [accessed 4/23/2019]

UN High Commissioner for Refugees (UNHCR), Global Trends: Forced Displacement In 2018, 2019. https://www.unhcr.org/globaltrends2018/. [Accessed 19 June 2019]

UN High Commissioner for Refugees (UNHCR), UNHCR Mid-Year Trends 2018, 2018. https://www.unhcr.org/5c52ea084.pdf. [Accessed 24 April 2019]

United Nations, General Assembly, Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, (10 December 1984, United Nations)

United Nations, Human Rights Council. Detailed findings of the commission of inquiry on human rights in Eritrea. A/HRC/32/CRP.1 (8 June 2016)

United Nations, Human Rights Council. Report of the commission of inquiry on human rights in Eritrea. A/HRC/29/42 (4 June 2015)

United Nations, Human Rights Council. Report of the commission of inquiry on human rights in Eritrea. A/HRC/32/47 (9 May 2016)

United Nations, Office of the High Commissioner for Human Rights. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment ("Istanbul Protocol"), HR/P/PT/8/Rev.1 (9 August 1999)

Virchow, R. Report on the typhus epidemic in Upper Silesia. Collected Essays on Public Health and Epidemiology. Rather LJ, ed. Boston, Mass: Science History Publications; 1985:204–319.

Zerai W. A Study on Female Genital Mutilation in Eritrea. Norweigan Church Aid Programmes in Eastern Africa. (January 2003)

Patterns of torture among forcibly displaced Eritreans in California: A cross-sectional study

Authors

DOI:

Keywords:

Abstract

Author Biographies

P. Suzanne Portnoy, Northern California Human Rights Clinic and CommuniCare Health Center

Alejandro Diaz, Northern California Human Rights Clinic

Jenna Kupa, Northern California Human Rights Clinic

Isabelle Rocroi, Northern California Human Rights Clinic

Emily Tatel, University of California, San Francisco

Kala Mehta, University of California, San Francisco School of Medicine

Nicholas Nelson, Northern California Human Rights Clinic

References

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