Quantifying medical evaluations of torture survivors: An analysis of 63 narrative reports from Denmark

Authors

  • Brenda Van den Bergh Senior Public Health Advisor, DIGNITY Danish Institute against Torture, Copenhagen, Denmark. Correspondence to: bb@dignity.dk
  • Kristine Wichmann Madsen Student Assistant, DIGNITY Danish Institute against Torture, Copenhagen, Denmark
  • Lisa Michaelsen Senior Medical Doctor, Capital Region, Denmark. Member of Amnesty International’s Medical Group
  • Amra Reko Medical Doctor, Capital Region, Denmark, Member of Amnesty International’s Medical Group
  • Maja Bendtsen Medical Doctor, Capital Region, Denmark, Member of Amnesty International’s Medical Group
  • Marie Brasholt Medical Director, DIGNITY Danish Institute against Torture, Copenhagen, Denmark
  • Jens Modvig Senior Medical Doctor, DIGNITY Danish Institute against Torture, Copenhagen, Denmark

DOI:

https://doi.org/10.7146/torture.v36i2.169589

Keywords:

torture and ill-treatment, health, documentation of torture, istanbul protocol

Abstract

Introduction

Denmark receives asylum seekers who allege to have experienced torture in different geographical and political contexts. The Istanbul Protocol provides internationally recognized guidelines for medico-legal documentation of such incidents. Doctors from Amnesty International’s Medical Group regularly conduct medical evaluations of asylum seekers, that were analyzed to assess the prevalence and patterns of alleged torture methods and their health consequences.

Methods

Data from medical evaluations were coded, entered into a database, and subsequently exported to RStudio 4.4.3 (1) for analysis. Torture methods were grouped into physical, sexual, psychological, and deprivation categories. Symptoms were summarized for two periods, i.e. within one month after the alleged torture, and at the time of the medical evaluation.

Results

63 evaluations were carried out during 2013-2025 in persons aged 12-70 years and born in 18 different countries. Collectively, 103 torture episodes were reported with a mean number of distinct torture methods of 10.7 per person. Exposure to physical torture methods was reported by 96.8%, psychological torture by 87.3%, deprivation by 81.0%, and sexual torture by 39.7%. Most episodes occurred in police stations (33.0%) and prisons (17.5%). Many reported physical symptoms at time of evaluation, and 85.7% of individuals scored an HTQ above 2.5, suggestive of PTSD. Torture episodes reported by women were significantly more likely to include sexual torture. Significant associations were found between teléfono and hearing loss, and between falanga and reduced sensation in lower limbs.

Discussion

This study illustrates the additional epidemiological value of transforming narrative reports into systematically structured data that allows for hypothesis-generating analyses of torture exposure and health outcomes and offers opportunities to explore patterns over time and across contexts. Wider adoption of standardized documentation analytical frameworks and complementary quantitative health measures may contribute to a more comprehensive understanding of the health consequences of torture and other ill-treatment.

References

Amnesty International Danmark. (2024). Sårbare udlændinge bag tremmer: En helbredsundersøgelse af frihedsberøvede udlændinge i Udlændingecenter Ellebæk og deres adgang til sundhed. https://amnesty.dk/wp-content/uploads/2024/06/Saarbare-udlaendinge-bag-tremmer_Amnesty-International-Danmark_Final_27.06.2024.pdf

Amris, K., Jones, L. E., & Williams, A. C. D. C. (2019). Pain from torture: Assessment and management. PAIN Reports, 4(6), e794. https://doi.org/10.1097/PR9.0000000000000794

Andersen, M. H., Kruse, A., Frederiksen, H. W., Ahmadi, A., & Norredam, M. (2020). Health status of refugees newly resettled in Denmark. Danish Medical Journal, 67(12).

Aprigio, I., & Gauer, G. (2024). The centrality of humiliation in complex posttraumatic stress disorder. Journal of Trauma & Dissociation, 25(5), 674–690. https://doi.org/10.1080/15299732.2024.2383182

Argo, A., Albano, G. D., Pulin, G., Ferorelli, D., Solarino, B., Midiri, M., Puntarello, M., Ferrero, L., Spina, C. L., Tullio, V., Calascibetta, G., Geraci, S., Malta, G., & Zerbo, S. (2026). The forensic evaluation of torture in asylum seekers: International literature comparison and inter-rater agreement analysis. Legal Medicine, 83, 102848. https://doi.org/10.1016/j.legalmed.2026.102848

Ba, I., & Bhopal, R. S. (2017). Physical, mental and social consequences in civilians who have experienced war-related sexual violence: A systematic review (1981–2014). Public Health, 142, 121–135. https://doi.org/10.1016/j.puhe.2016.07.019

Başoğlu, M. (Ed.). (1998). Torture and its consequences: Current treatment approaches. Cambridge University Press.

Breslau, N. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216. https://doi.org/10.1001/archpsyc.1991.01810270028003

Busch, J., Hansen, S. H., & Hougen, H. P. (2015). Geographical distribution of torture: An epidemiological study of torture reported by asylum applicants examined at the Department of Forensic Medicine, University of Copenhagen. Torture Journal, 25(2), 12–21.

Bushnell, J., McLeod, D., Dowell, A., Salmond, C., Ramage, S., Collings, S., Ellis, P., Kljakovic, M., & McBain, L. (2005). Do patients want to disclose psychological problems to GPs? Family Practice, 22(6con), 631–637. https://doi.org/10.1093/fampra/cmi080

Campbell, T. A. (2007). Psychological assessment, diagnosis, and treatment of torture survivors: A review. Clinical Psychology Review, 27(5), 628–641. https://doi.org/10.1016/j.cpr.2007.02.003

Carinci, A. J., Pankaj, M., & Christo, P. J. (2010). Chronic pain in torture victims. Current Pain and Headache Reports, 14(2), 73–79. https://doi.org/10.1007/s11916-010-0101-2

Clément, R., Lebossé, D., Barrios, L., & Rodat, O. (2017). Asylum seekers alleging torture in their countries: Evaluation of a French center. Journal of Forensic and Legal Medicine, 46, 24–29. https://doi.org/10.1016/j.jflm.2016.12.011

Dalgaard, N. T., Bjerre, K., & Thøgersen, M. H. (2021). Twenty seven years of treating survivors of torture and organized violence – associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD. European Journal of Psychotraumatology, 12(1), 1904712. https://doi.org/10.1080/20008198.2021.1904712

De C Williams, A. C., & Van Der Merwe, J. (2013). The psychological impact of torture. British Journal of Pain, 7(2), 101–106. https://doi.org/10.1177/2049463713483596

Diaz, M., & Wallin Lundell, I. (2025). Hidden Scars: The impact of torture, traumatic brain injury, and PTSD on executive functions - a narrative review. Torture Journal, 35(1). https://doi.org/10.7146/torture.v35i1.152750

Dibaj, I. S., Halvorsen, J. Ø., Kennair, L. E. O., & Stenmark, H. I. (2020). Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain: – a narrative review. Torture Journal, 30(2), 35–57. https://doi.org/10.7146/torture.v30i2.119788

Domovitch, E., Berger, P. B., Wawer, M. J., Etlin, D. D., & Marshall, J. C. (1984). Human torture: Description and sequelae of 104 cases. Canadian Family Physician Medecin De Famille Canadien, 30, 827–830.

Franceschetti, L., Magli, F., Merelli, V. G., Muccino, E. A., Gentilomo, A., Agazzi, F., Gibelli, D. M., Gambarana, M., De Angelis, D., Kustermann, A., & Cattaneo, C. (2019). The effect of the medico-legal evaluation on asylum seekers in the Metropolitan City of Milan, Italy: A pilot study. International Journal of Legal Medicine, 133(2), 669–675. https://doi.org/10.1007/s00414-018-1867-8

Goldfeld, A. E., Mollica, R. F., Pesavento, B. H., & Faraone, S. V. (1988). The physical and psychological sequelae of torture. Symptomatology and diagnosis. JAMA, 259(18), 2725–2729.

Hooberman, J. B., Rosenfeld, B., Lhewa, D., Rasmussen, A., & Keller, A. (2007). Classifying the torture experiences of refugees living in the United States. Journal of Interpersonal Violence, 22(1), 108–123. https://doi.org/10.1177/0886260506294999

Hougen, H. P. (1988). Physical and psychological sequelae to torture. A controlled clinical study of exiled asylum applicants. Forensic Science International, 39(1), 5–11. https://doi.org/10.1016/0379-0738(88)90113-2

Hvidegaard, M., Lanng, K., Meyer, K., Wejse, C., & Hvass, A. M. F. (2023). What are the characteristics of torture victims in recently arrived refugees? A cross-sectional study of newly arrived refugees in Aarhus, Denmark. International Journal of Environmental Research and Public Health, 20(14), 6331. https://doi.org/10.3390/ijerph20146331

Lunde, I., & Ortmann, J. (1990). Prevalence and sequelae of sexual torture. The Lancet, 336(8710), 289–291. https://doi.org/10.1016/0140-6736(90)91814-Q

Lunde, I., Rasmussen, O. V., Wagner, G., & Lindholm, J. (1981). Sexual and pituitary-testicular function in torture victims. Archives of Sexual Behavior, 10(1), 25–32. https://doi.org/10.1007/BF01542672

Mandel, L., & Worm, L. (2007). Documentation of torture victims. Implementation of medico-legal protocols. Torture Journal, 17(1), 18–26.

Masmas, T. N., Møller, E., Buhmannr, C., Bunch, V., Jensen, J. H., Hansen, T. N., Jørgensen, L. M., Kjaer, C., Mannstaedt, M., Oxholm, A., Skau, J., Theilade, L., Worm, L., & Ekstrøm, M. (2008). Asylum seekers in Denmark—A study of health status and grade of traumatization of newly arrived asylum seekers. Torture Journal, 18(2), 77–86.

Milewski, A., Weinstein, E., Lurie, J., Lee, A., Taki, F., Pilato, T., Jedlicka, C., & Kaur, G. (2023). Reported methods, distributions, and frequencies of torture globally: A systematic review and meta-analysis. JAMA Network Open, 6(10), e2336629. https://doi.org/10.1001/jamanetworkopen.2023.36629

Modvig, J., & Quiroga, J. (2020). Torture methods and their health impact. In M. D. Evans & J. Modvig (Eds.), Research handbook on torture (pp. 410–431). Edward Elgar Publishing. https://doi.org/10.4337/9781788113960.00024

Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180(2), 111–116.

Mundy, S. S., Foss, S. L. W., Poulsen, S., Hjorthøj, C., & Carlsson, J. (2020). Sex differences in trauma exposure and symptomatology in trauma-affected refugees. Psychiatry Research, 293, 113445. https://doi.org/10.1016/j.psychres.2020.113445

Norredam, M., Crosby, S., Munarriz, R., Piwowarczyk, L., & Grodin, M. (2005). Urologic complications of sexual trauma among male survivors of torture. Urology, 65(1), 28–32. https://doi.org/10.1016/j.urology.2004.08.006

Office of the United Nations High Commissioner for Human Rights (2022). Istanbul Protocol: Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment (2022 ed). https://www.ohchr.org/en/publications/policy-and-methodological-publications/istanbul-protocol-manual-effective-0

Olsen, D. R., Montgomery, E., Bøjholm, S., & Foldspang, A. (2006). Prevalent musculoskeletal pain as a correlate of previous exposure to torture. Scandinavian Journal of Public Health, 34(5), 496–503. https://doi.org/10.1080/14034940600554677

Olsen, D. R., Montgomery, E., Carlsson, J., & Foldspang, A. (2006). Prevalent pain and pain level among torture survivors: A follow-up study. Danish Medical Bulletin, 53(2), 210–214.

Ostergaard, L. S., Wallach-Kildemoes, H., Thøgersen, M. H., Dragsted, U. B., Oxholm, A., Hartling, O., & Norredam, M. (2020). Prevalence of torture and trauma history among immigrants in primary care in Denmark: Do general practitioners ask? European Journal of Public Health, 30(6), 1163–1168. https://doi.org/10.1093/eurpub/ckaa138

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73. https://doi.org/10.1037/0033-2909.129.1.52

Pérez-Sales, P. (2020). Psychological Torture: Definition, Evaluation and Measurement. In M. D. Evans & J. Modvig (Eds.), Research handbook on torture (pp. 432–454). Edward Elgar Publishing. https://doi.org/10.4337/9781788113960.00025

Peters, S., Rogers, A., Salmon, P., Gask, L., Dowrick, C., Towey, M., Clifford, R., & Morriss, R. (2009). What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. Journal of General Internal Medicine, 24(4), 443–449. https://doi.org/10.1007/s11606-008-0872-x

Petreca, V. G., & Burgess, A. W. (2024). Long-term psychological and physiological effects of male sexual trauma. The Journal of the American Academy of Psychiatry and the Law, 52(1), 23–32. https://doi.org/10.29158/JAAPL.230076-23

Rathke, H., Poulsen, S., Carlsson, J., & Palic, S. (2020). PTSD with secondary psychotic features among trauma-affected refugees: The role of torture and depression. Psychiatry Research, 287, 112898. https://doi.org/10.1016/j.psychres.2020.112898

Roberts, S. T., Watlington, C. G., Nett, S. D., & Batten, S. V. (2010). Sexual trauma disclosure in clinical settings: Addressing diversity. Journal of Trauma & Dissociation, 11(2), 244–259. https://doi.org/10.1080/15299730903502961

Robinson, J. W., & Roter, D. L. (1999). Psychosocial problem disclosure by primary care patients. Social Science & Medicine, 48(10), 1353–1362. https://doi.org/10.1016/S0277-9536(98)00439-0

RStudio Team. (2026). RStudio: Integrated Development for R. RStudio (Version 2026.6.0.242) [Computer software]. http://www.rstudio.com/.

Silove, D. (1999). The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. The Journal of Nervous & Mental Disease, 187(4), 200–207. https://doi.org/10.1097/00005053-199904000-00002

Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537–549. https://doi.org/10.1001/jama.2009.1132

Thomas, J. C., & Kopel, J. (2023). Male victims of sexual assault: A review of the literature. Behavioral Sciences, 13(4), 304. https://doi.org/10.3390/bs13040304

Thomsen, A. B., Eriksen, J., & Smidt-Nielsen, K. (2000). Chronic pain in torture survivors. Forensic Science International, 108(3), 155–163. https://doi.org/10.1016/S0379-0738(99)00209-1

Turner, S., & Gorst-Unsworth, C. (1990). Psychological sequelae of torture: A descriptive model. British Journal of Psychiatry, 157(4), 475–480. https://doi.org/10.1192/bjp.157.4.475

United Nations. (1984). Convention against torture and other cruel, inhuman or degrading treatment or punishment. https://www.ohchr.org/Documents/ProfessionalInterest/cat.pdf

Williams, A. C. D. C., Peña, C. R., & Rice, A. S. C. (2010). Persistent pain in survivors of torture: A cohort study. Journal of Pain and Symptom Management, 40(5), 715–722. https://doi.org/10.1016/j.jpainsymman.2010.02.018

World Health Organization. (1946). Constitution of the World Health Organization. https://www.who.int/about/governance/constitution

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Published

2026-10-01

How to Cite

Van den Bergh, B., Wichmann Madsen, K., Michaelsen, L., Reko, A., Bendtsen, M., Brasholt, M., & Modvig, J. (2026). Quantifying medical evaluations of torture survivors: An analysis of 63 narrative reports from Denmark. Torture Journal, 36(2). https://doi.org/10.7146/torture.v36i2.169589