When a health carer becomes a torturer, key report by the UN Special Rapporteur on torture

By | 5 March 2013

GENEVA – The United Nations Special Rapporteur on torture, Juan. E. Méndez, today called for an international debate on abuses in health-care settings that may cross a threshold of maltreatment equivalent to torture or cruel, inhuman or degrading treatment or punishment.

“Medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement and specific intent, it is torture,” Mr. Méndez warned during the presentation of his latest report* to the UN Human Rights Council, which illustrates some of these abusive practices in health-care settings and sheds light on often undetected abusive practices backed by health-care policies.

The groundbreaking report analyses all forms of abuse labeled as ‘health-care treatment’ which try to be premised or justified by health-care policies. It also identifies the scope of State’s obligations to regulate, control and supervise health-care practices with a view to preventing maltreatment under any pretext and the policies that promote these practices and existing protection gaps.

“There are unique challenges to stopping ill-treatment in health-care settings due, among other things, to a perception that, while never justified, certain practices in health-care may be defended by the authorities on grounds of administrative efficiency, behaviour modification or medical necessity,” the expert underscored.

In his report, Mr. Méndez explores an emerging recognition of different forms of abuses against patients and individuals under medical supervision:

Compulsory detention for medical conditions 
“Compulsory detention for drug users is common in so-called rehabilitation centres. Sometimes referred to as drug treatment centres or ‘reeducation through labour’ centres or camps, these are institutions commonly run by military or paramilitary, police or security forces, or private companies.”

“In some countries, a wide range of other marginalized groups, including street children, persons with psychosocial disabilities, sex workers, homeless individuals and tuberculosis patients, are reportedly detained in these centres.”

Reproductive rights violations 
“Examples of such violations include abusive treatment and humiliation in institutional settings involuntary sterilization; denial of legally available health services such as abortion and post-abortion care; forced abortions and sterilizations; female genital mutilation; violations of medical secrecy and confidentiality in health-care settings, such as denunciations of women by medical personnel when evidence of illegal abortion is found; and the practice of attempting to obtain confessions as a condition of potentially life-saving medical treatment after abortion.”

Denial of pain treatment
“Governments must guarantee essential medicines – which include, among others, opioid analgesics – as part of their minimum core obligations under the right to health, and take measures to protect people under their jurisdiction from inhuman and degrading treatment.”

Persons with psychosocial disabilities 
“Severe abuses, such as neglect, mental and physical abuse and sexual violence, continue to be committed against people with psychosocial disabilities and people with intellectual disabilities in health-care settings.”

“There can be no therapeutic justification for the use of solitary confinement and prolonged restraint of persons with disabilities in psychiatric institutions; both prolonged seclusion and restraint may constitute torture and ill-treatment.”

“Inappropriate or unnecessary non-consensual institutionalization of individuals may amount to torture or ill-treatment as use of force beyond that which is strictly necessary.”

Marginalized groups 
“Persons living with HIV/AIDS are reportedly turned away from hospitals, summarily discharged, denied access to medical services unless they consent to sterilization, and provided poor quality care that is both dehumanizing and damaging to their already fragile health status.”

“A particular form of ill-treatment and possibly torture of drug users is the denial of opiate substitution treatment, including as a way of eliciting criminal confessions through inducing painful withdrawal symptoms.”

“There is an abundance of accounts and testimonies of lesbian, gay, bisexual, transgender and intersex persons being denied medical treatment, subjected to verbal abuse and public humiliation, psychiatric evaluation, a variety of forced procedures such as sterilization, State-sponsored forcible anal examinations for the prosecution of suspected homosexual activities, and invasive virginity examinations conducted by health-care providers, hormone therapy and genital-normalizing surgeries under the guise of so called ‘reparative therapies.’”

“Persons with disabilities are particularly affected by forced medical interventions, and continue to be exposed to non-consensual medical practices.
Women living with disabilities, with psychiatric labels in particular, are at risk of multiple forms of discrimination and abuse in health-care settings.”

For the Special Rapporteur, the significance of categorizing abuses in health-care settings as torture and ill-treatment, as examining abuses in health-care settings from a torture protection framework, “provides the opportunity to solidify an understanding of these violations and to highlight the positive obligations that States have to prevent, prosecute and redress such violations.”

The report will be further discussed at a side event on “Towards Preventing Torture and Ill-treatment in Health-care settings”.

(*) Read the full report by the Special Rapporteur: http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf


Juan E. Méndez (Argentina) was appointed by the UN Human Rights Council as the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment in November 2010. He is independent from any government and serves in his individual capacity. Mr. Méndez has dedicated his legal career to the defense of human rights, and has a long and distinguished record of advocacy throughout the Americas. Learn more, log on to: http://www.ohchr.org/EN/Issues/Torture/SRTorture/Pages/SRTortureIndex.aspx

Check the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: http://www2.ohchr.org/english/law/cat.htm

The Special Rapporteur is also presenting two country reports during the current Human Rights Council’s session:
Tajikistan – http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A-HRC-22-53-Add1_en.pdf 
Morocco – http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A-HRC-22-53-Add-2_en.pdf

Check the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CAT.aspx 

For more information and media requests, please contact Ms. Sonia Cronin (+41 22 917 91 60 /scornin@ohchr.org) or write to sr-torture@ohchr.org.

For media inquiries related to other UN independent experts:
Xabier Celaya, UN Human Rights – Media Unit (+ 41 22 917 9383 / xcelaya@ohchr.org)

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