U.S. Department of Justice

Office of Justice Programs

810 Seventh Street, NW

Washington, DC 20531

Janet Reno

Attorney General

Daniel Marcus

Acting Associate Attorney General

Laurie Robinson

Assistant Attorney General

Noël Brennan

Deputy Assistant Attorney General

Kathryn M. Turman

Director, Office for Victims of Crime

Office of Justice Programs

World Wide Web Homepage:

http://www.ojp.usdoj.gov

Office for Victims of Crime

World Wide Web Homepage:

http://www.ojp.usdoj.gov/ovc/

For grant and funding information contact:

Department of Justice Response Center

1–800–421–6770

NCJ #178911

This document was prepared by Peter Dross, Center for Victims of Torture, Minneapolis, Minnesota. The opinions,

findings, conclusions, and recommendations expressed in this document are those of the author and do not

necessarily represent the official position or policies of the U.S. Department of Justice.

The Office for Victims of Crime is a component of the Office of Justice Programs, which also includes the Bureau

of Justice Assistance, the Bureau of Justice Statistics, the National Institute of Justice, and the Office of Juvenile

Justice and Delinquency Prevention.


i

Contents

Message from the Director ................................................................................... ii

Introduction ............................................................................................................ 1

The Extent of Torture ............................................................................................ 3

Torture Defined ...................................................................................................... 3

The Intent of Torture ............................................................................................. 4

The Aftereffects of Torture ................................................................................... 4

Solutions in the Community .................................................................................... 5

Minnesota Establishes New Program for Torture Survivors ................................. 8

Implications: Opportunities for Collaboration ........................................................ 9

Additional Resources ........................................................................................... 10

Treatment Centers for Survivors of Politically Motivated Torture....................... 11
ii

Message from the Director

Adapting to a new environment is a complicated and overwhelming experience

for all new immigrants and refugees who have fled unsafe conditions in their

native countries. For refugees who are also survivors of politically motivated

torture, this transition is even more difficult because of the physical and

psychological consequences of the torture they endured.

Politically motivated torture is practiced or condoned in more than 100 nations

around the world, and it is estimated that 400,000 torture survivors live in the

United States today. They are from Africa, parts of Eastern Europe, the Middle

East, South America, and Southeast Asia. Survivors come from all walks of life.

They come to the United States with great hope but also with long-term emotional

scars.

The Office for Victims of Crime (OVC) sponsored a meeting in October 1998 for

nearly 300 health care and human service professionals to learn about the emerging

and specialized practice of providing care and rehabilitative services to survivors

of politically motivated torture. The meeting featured presenters from treatment

centers for torture survivors around the world. This Report, prepared by the

Minneapolis Center for Victims of Torture, summarizes the issues raised at the

meeting. Such issues include the aftereffects of torture on survivors and their

families; how treatment centers intervene to help victims deal with the physical

and psychological aftermath of victimization; and, most importantly, how treatment

centers collaborate with and provide training to victim assistance personnel and

allied professionals. The intent of such collaboration and training is to better enable

professionals to identify refugees who have been victims of political torture, further

their healing, and build their hope for a future without victimization.

The meeting helped providers identify the special needs of torture survivors and

explore ideas for potential collaborations among treatment centers, OVC, other

government agencies, and nonprofit victim service organizations. This effort to

raise issues is only the beginning. We need to know more about torture victims,

such as their gender, age, country of origin, and where they are settling. We also

need to know what victim service providers and advocates can do to respond more

effectively to their needs.

Kathryn M. Turman

Director

Office for Victims of Crime
1

Introduction

On October 7, 1998, nearly 300 health care and human service professionals

gathered in Minneapolis, Minnesota, to learn about the emerging and specialized

practice of providing care and rehabilitative services to survivors of politically

motivated torture. Titled Caring for Torture Survivors, the conference featured

presenters from treatment centers for torture survivors from around the world.

In conjunction with the conference, representatives from 14 centers serving

torture survivors in the United States assembled for their first national meeting.

The meeting, which was sponsored by the Office for Victims of Crime (OVC),

included a focus group session in which participants explored ideas for potential

partnerships and collaborations among the treatment centers, OVC, State and

local government, and nongovernmental victim services organizations.

As a result of international and national meetings about politically motivated

torture, the Center for Victims of Torture (CVT) prepared this Report to inform

victim services providers about the special needs of torture survivors as they

struggle to heal their wounds and begin new lives in the United States.
2
3

The Extent of Torture

Politically motivated torture is practiced or condoned in more than 100 nations.

Tens of thousands of people fall victim to the ravages of torture every year.

An estimated 400,000 torture survivors live in the United States today. Studies

have estimated that up to 30 percent of all refugees are torture survivors. If a

community has a refugee population, then it is likely torture survivors live there and

are suffering from the debilitating aftereffects of torture described in this Report.

Torture survivors represent an “invisible” population in communities across

the United States. Torture is a painful, shaming, and humiliating experience;

it is extraordinarily difficult for survivors to talk about what happened to them.

Treatment centers in the United States and abroad report that torturers frequently

tell their victims “no one will ever believe this happened to you — you’ll always

be alone with this.” Consequently, survivors fear that they will not be believed.

In addition, many survivors have family members who live in danger of detention

and torture in their countries of origin, and survivors fear for the safety of their

families if they disclose the abuses. Treatment centers have reported numerous

instances in which loved ones have been detained and tortured when it has become

known that the survivor has fled the country. The fact that torture is such a

shaming experience, usually involving rape or other forms of sexual assault or

humiliation perpetrated against both women and men, also keeps survivors

suffering in silence.

Torture Defined

The United Nations definition recognizes that torture is practiced by people

“acting in an official capacity,” which is an important point because torture

can and does occur outside the hands of governments and government officials.

In many countries, paramilitary or death squads that are officially disavowed by

Many survivors have

family members who live

in danger of detention

and torture in their

countries of origin, and

survivors fear for the

safety of their families if

they disclose the abuses.

The United Nations Convention Against Torture, 1984, defines torture as

any act by which severe pain or suffering, whether physical or mental,

is intentionally inflicted on a person for such purposes as obtaining

from him or a third person information or a confession, punishing

him for an act he or a third person has committed or is suspected of

having committed, or intimidating or coercing him or a third person

for any reason based on discrimination of any kind, when such pain

or suffering is inflicted by or at the instigation of or with the consent or

acquiescence of a public official or other person acting in an official

capacity.
4

the established government, but often are supported and promoted in surreptitious

ways, perpetrate torture. Rebel groups and armies that do not respond to national

or international standards — but may control large segments of a population — also

perpetrate torture. The human tragedies in places like Ethiopia, Liberia, Rwanda,

Somalia, and republics of the former Yugoslavia vividly illustrate this point.

In the United States, torture occurs in cyclical patterns of family violence, ritualistic

abuse, and satanic cult practices; torture under these conditions may occur in other

countries as well. With increasing frequency, torture is reported as an intrinsic part

of the illicit drug trade around the world and urban violence associated with drugs

and other criminal activities. Although the treatment centers listed at the end of

this document confine their care to survivors of politically motivated torture, many

have referral networks that can help survivors of domestic abuse and ritualistic and

satanic cult practices.

The Intent of Torture

Although politically motivated torture is used to extract information or force

confessions, another purpose has emerged since the Convention Against Torture

definition was adopted in 1984. Torture is used to destroy individuals by instilling

fear throughout communities. It is a culture-transforming event that is intended to

create societies based on fear, which leads to apathy as a community’s means of

self-preservation against retaliation. As a method of controlling society, torture is

the single most effective weapon against democracy.

Torturers target community leaders, often grassroots leaders, who lack the political

power to protect themselves. They are often highly educated people of remarkable

accomplishment and distinction in their home countries. For example, of the new

clients at the Center for Victims of Torture during 1997, 69 percent had some

college education, 43 percent were college graduates, 54 percent held positions

categorized as professional, associate professional, legislator/manager, or skilled

laborer, and 20 percent were students.

Treatment centers across the United States report that their clients have similar

levels of education and accomplishment. Clients receiving care include business,

labor, religious, farm, and human rights leaders; attorneys and journalists; university

professors and students; and physicians and nurses. The common thread linking

these clients is that they were tortured because of what they thought, said, did,

or represented.

The Aftereffects of Torture

Torturers brutally abuse their victims using physical and psychological tactics.

Some tactics are more sophisticated than others, but all leave long-term emotional

scars.

Torture survivors throughout the world exhibit similar symptoms, including chronic

pain in muscles and joints, severe depression and anxiety, intense and incessant

 T orture is used to

destroy individuals by

instilling fear throughout

communities.
5

nightmares, guilt and self-hatred, impaired memory, the inability to concentrate, the

inability to form and maintain meaningful relationships, and frequent thoughts of

suicide. In 1997, 74 percent of new clients at CVT were diagnosed with either

posttraumatic stress disorder or major depressive disorder, and 67 percent of new

clients were diagnosed with both disorders.

These are clinical terms, however, and often do not convey the misery that torture

survivors endure daily. Treatment centers report that the following types of cases

are common:

❒ Clients who sleep in chairs so they won’t dream.

❒ Clients who cannot eat without vomiting.

❒ Clients who experience panic attacks when they hear an automobile backfire.

❒ Clients who cannot turn off the lights at night because in the dark they see the

uniformed men who raped them night after night.

In addition, other stresses intensify the trauma. For example, new clients at CVT

in 1997 reported an average length of detention of 420 days. The average number

of family members who either were killed or had disappeared was 2.0, whereas

the average number of family members imprisoned and/or tortured was 1.3.

The average client was detained and imprisoned more than once.

Although torture is perpetrated primarily against adults, it affects all members of

a survivor’s family. About 20 percent of CVT’s clients were tortured as children,

usually as a weapon against their parents. Nevertheless, the torture of a parent

can have a profound effect on a child who is born years after the torture occurred.

This finding is consistent with studies of Holocaust survivors, who confirmed that

children and grandchildren of survivors have higher levels of psychological

disabilities than their peers. Children of torture survivors experience many of the

following symptoms:

❒ Learning problems, including memory and/or concentration problems.

❒ Violent play or artwork.

❒ Frequent illness or complaints of aches and pains.

❒ Frequent trips to the nurse’s office or bathroom.

❒ Sudden changes in mood or behavior.

❒ Behavioral problems.

❒ Excessive fear and anxiety.

❒ Avoidance of anything that reminds the child of a traumatic event or country

of origin.

 T he average number

of family members who

either were killed or had

disappeared was 2.0,

whereas the average

number of family

members imprisoned

and/or tortured was 1.3.
6

Treatment centers also report that increasingly their adult clients are separated

from children and other loved ones when they begin programs of care. In 1997,

76 percent of CVT’s new clients had children. Of that number, 56 percent were

separated from one or more of those children at intake. And of the 54 percent

of new clients who were married, 65 percent were separated from their spouses

at intake.

Separation from loved ones exacerbates the psychological problems experienced

by survivors. It also complicates the treatment process, as survivors struggle with

issues such as feelings of guilt over having escaped and leaving loved ones behind,

the difficulty in attempting to function effectively as a parent from afar, or the

constant worry over the safety of their loved ones. These separations may last

years, so when families are reunited there also may be difficulties in relearning

complex family relationships.

Survivors also may fear law enforcement personnel, an understandable

consequence of being tortured by the police, the military, or other security

forces. They also may fear medical personnel because, in many cases, health

care workers either participated in the torture or revived the victim to face more

abuse. (This is one reason why torture survivors often will not seek health care

services, waiting instead until an emergency or health care crisis arises.)

Torture survivors seeking political asylum in the United States face particular

problems. Asylum seekers have up to 1 year after arriving to file petitions for

asylum. After filing these petitions, they must wait 150 days before applying for

a work permit. Until they receive this permit, they are prohibited from working;

they endure a period of forced idleness that heightens a survivor’s sense of

loneliness and isolation. During this time, survivors also are ineligible for federally

funded assistance programs in the areas of housing, food, income, and health care

(except emergency care). They also live in constant fear that they will be returned

to their home countries and back into the hands of torturers.

Torture survivors endure abuses in other countries that under American civil

and criminal law would be crimes. Once in this country, they are often victimized

again because of the precarious circumstances in which they live. They may

become victims of burglaries, robberies, assaults, rapes, and other forms of sexual

assault because the offender knows the crime will go unreported. The concept of

revictimization was a common theme at the OVC-sponsored focus group; it may

point the way toward a greater degree of collaboration among treatment centers,

OVC, and victim services organizations.

Solutions in the Community

As torture and its effects on survivors have become more widely understood

across the United States, more specialized treatment centers for torture survivors

have been created. Since the Minneapolis Center for Victims of Torture was

founded in 1985, 13 other treatment centers have been formed in cities that include

Baltimore, Chicago, Dallas, Denver, Los Angeles, New York, and San Francisco.

Separation from loved

ones. . .complicates the

treatment process. . .
7

These centers are places where survivors can heal from deep physical and

emotional wounds and build productive lives. They are places where survivors

are believed; they are truly places of hope and healing.

The centers’ organizational structures vary. Most engage physicians, psychiatrists,

psychologists, nurses, and social workers in the care and rehabilitative process.

Some employ full- and part-time professional staff; others rely more extensively

on volunteer care providers. Some are independent, nonprofit organizations;

other programs are run by parent organizations that offer a variety of services to

refugees, immigrants, and asylum seekers.

Regardless of organizational structure, every center manages a long-term process

that begins with establishing a trusting relationship with a care provider. Torture

destroys a victim’s capacity to trust others, so a survivor’s ability to engage in a

trusting relationship is a necessary first step in the healing process.

At the outset of the treatment process, it is critical for centers to ensure clients

have safe and stable places to live, as well as enough food to eat and clothes

to wear. Whether this task is performed by paid staff or volunteers, providing

a healing environment is a heavy financial burden for U.S. treatment centers.

Their clients are largely asylum seekers with few, if any, sources of economic

or social support.

In the early stages of treatment, many organizations place a high priority on

addressing the physical aftereffects of torture. Physicians and nurses play a key

role in this process, as they help survivors understand that their bodies can heal

from physical wounds. As their bodies heal, clients begin to believe that their minds

can heal.

Long-term psychotherapy is critical in the treatment process used by most centers.

Psychotherapists help clients begin to talk about their experiences, understand that

their psychological symptoms are a normal response to severe trauma, and begin

to look forward to a better future.

The length of the treatment process varies with the individual. Some clients use

services available at treatment centers for just a few months; others are engaged

in the process for several years. In a study of clients at CVT between 1991 and

1995, the average length of the treatment process was 18 months.

Treatment centers for torture survivors have developed a body of knowledge and

experience that is unique. Increasingly, they have begun to share that knowledge

and experience through training programs that benefit many practitioners who

come into contact with refugee populations. For example, centers in Chicago,

Minneapolis, New York, and San Francisco have presented training programs

for asylum officers and other officials of the U.S. Immigration and Naturalization

Service. Many centers present ongoing training programs for health care and

human service professionals, such as physicians, psychiatrists, psychologists,

nurses, and social workers, as well as medical students, interns in psychology and

social work, refugee resettlement workers, English-as-a-second-language (ESL)

instructors, school officials, and government social service workers.

Treatment centers

for torture survivors

have developed a body

of knowledge and

experience that is

unique. Increasingly,

they have begun to share

that knowledge and

experience through

training programs that

benefit many practitioners

who come into contact

with refugee populations.
8

These training programs vary in scope. They range from helping participants

gain a basic awareness of the effects of torture on survivors, their families, and

communities to programs that help participants develop specialized skills for

providing care. They also help participants learn how to identify torture survivors

and make appropriate referrals for care within local communities. In some cases,

participants learn how to interview torture survivors without retraumatizing them

or how to work with interpreters when providing services to torture survivors.

In other cases, training programs are presented for health care and victim service

professionals who can provide some level of specialized care within their institutions.

In addition, participants may learn how to avoid “vicarious traumatization,” a

situation in which care providers are profoundly affected by the experiences of

their clients.

With support from the State of Minnesota, CVT has launched a statewide training

program for school officials concerned about learning and behavioral problems

exhibited by rapidly growing immigrant and refugee student populations. Through

this project, teachers, administrators, guidance counselors, ESL instructors, nurses,

psychologists, and others learn about the impact of torture, war trauma, and other

human rights atrocities on children. Participants learn how they can support these

children and address their learning and behavioral problems.

Minnesota Establishes New Program

for Torture Survivors

For the past 2 years, officials at the Minnesota Center for Crime Victim Services

(MCCVS) have worked with representatives from CVT to learn more about the

special needs of torture survivors. They reviewed literature, met with staff, and

toured CVT to gain a better understanding of this emerging field.

During the summer of 1998, the MCCVS Sexual Assault Program issued a

Request for Proposals seeking applicants for a new initiative to provide services

to sexual assault survivors who also are survivors of politically motivated torture.

MCCVS made available $75,000 for the initiative, of which $65,000 was drawn

from Victims of Crime Act funds and $10,000 from the State. The grant was

awarded to CVT. Through this grant, CVT is providing direct services to survivors,

including medical and psychological assessments and care, social services, and

advocacy. Interpreter costs also are included in the grant.

In addition, working closely with the Minnesota Coalition Against Sexual Assault,

CVT will provide training to sexual assault advocates who are likely to come into

contact with torture survivors. CVT is conducting a survey of sexual assault

organizations throughout Minnesota to design effective training programs that meet

the needs of groups working with diverse refugee and immigrant populations.

CVT is conducting a

survey. . .to design

effective training

programs that meet the

needs of groups working

with diverse refugee and

immigrant populations.
9

Implications:

Opportunities for Collaboration

The development of a national network of treatment centers for torture survivors

has important implications for victim services providers who interact with refugee

and immigrant communities. Although all centers in this network have waiting lists,

they take referrals for direct services and provide care to torture survivors as

resources allow. In many cases, the centers make referrals to other sources of

assistance and support in their communities.

Treatment centers also provide training to a variety of individuals and organizations

that may encounter torture survivors in their work. The training sessions are

designed to give care providers an understanding of the special needs of torture

survivors as they struggle to regain their lives. The training also provides

guidance in identifying signs of torture and in working with survivors without

retraumatizing them.

Training can be tailored to meet the needs of sponsoring organizations, such as

victim services advocates, immigration attorneys, health care and human service

organizations, refugee resettlement groups, and Federal, State, and local officials.

Treatment centers encourage these constituencies to inquire about training, explore

the possibility of collaborating with the centers, and become more aware of

survivors’ needs.

However, treatment centers may have difficulty funding such training programs

because they have limited financial resources. If State crime victim services

organizations learned more about the treatment centers operating in their States,

a collaboration might produce model projects aimed at supporting training and

direct care for survivors.

Treatment centers

also provide training. . .

The training sessions

are designed to give

care providers an

understanding of the

special needs of torture

survivors as they struggle

to regain their lives.
10

Additional Resources

Publication

Caring for Victims of Torture, 1998. Edited by James M. Jaranson, M.D., M.A.,

M.P.H. and Michael K. Popkin, M.D.

“Caring for Victims of Torture contains all the collective wisdom of some

of the most respected international experts in the treatment of victims of

government torture — all distinguished physicians, including pioneers in the

field of traumatic stress. Contributors discuss the most recent advances in

knowledge about government-sanctioned torture and offer practical approaches

to the diagnosis and treatment of torture victims.

“Organized into six main sections, this annotated volume provides an overview

of the history and politics of torture and rehabilitation; guidance in identifying

and defining the sequelae of torture; a framework for assessment and treatment;

specific treatment interventions; and a discussion of ethical implications. In the

final section, physicians working in the field offer firsthand accounts and address

how they are trying to balance politics with caregiving.

“Focusing on the physician’s role, this book is chiefly a clinical guide. But for

advanced-level students, it serves as a thorough, up-to-date text and reference

work. Religious leaders, lawyers, politicians, human rights advocates, and torture

victims themselves will find it a valuable resource as well.”
11

Treatment Centers for Survivors

of Politically Motivated Torture

California San Diego Survivors of Torture International

P.O. Box 151240

San Diego, CA 92175

Phone: 619–582–9018

Fax: 619–582–7103

California San Francisco Survivors International of Northern California

447 Sutter Street, #811

San Francisco, CA 94108

Phone: 415–765–6999

Fax: 415–765–6995

California Santa Clara Institute for the Study of Psychopolitical Trauma

Kaiser-Permanente Child Psychiatry Clinic

900 Lafayette Street, #200

Santa Clara, CA 95950

Phone: 408–342–6545

Fax: 408–342–6540

California Venice Program for Torture Victims

604 Rose Avenue

Venice, CA 90291

Phone: 562–494–5444

Fax: 213–481–1023

Colorado Denver Rocky Mountain Survivor Center

1547 Gaylord Street, #100

Denver, CO 80206

Phone: 303–321–3221

Fax: 303–321–3314

Connecticut West Hartford Khmer Health Advocates

29 Shadow Lane

West Hartford, CT 06110

Phone: 860–561–3345

Fax: 860–561–3538

Illinois Chicago Marjorie Kovler Center for the Treatment

 of Survivors of Torture

4750 North Sheridan Road, Suite 300

Chicago, IL 60640

Phone: 773–271–6357

Fax: 773–271–0601
12

Maryland Baltimore Advocates for Survivors of Trauma and Torture

201 East University Parkway, Suite 440

Baltimore, MD 21218

Phone: 410–554–2504

Fax: 410–243–5642

Minnesota Minneapolis Center for Victims of Torture

717 East River Road

Minneapolis, MN 55455

Phone: 612–626–1400

Fax: 612–626–2465

Missouri St. Louis Training and Treatment for Survivors of

 Severe Trauma

Casa Arco Iris

4400 Arco

St. Louis, MO 63110

Phone: 314–652–9618

New York Jackson Heights Travelers Aid/Victims Service

74-09 37th Avenue, Room 412

Jackson Heights, NY 11372

Phone: 718–899–1233 x105

Fax: 718–457–6071

New York New York Bellevue/New York University Program for

 Survivors of Torture

New York University School of Medicine

Division of Primary Care Internal Medicine

550 First Avenue

New York, NY 10016

Phone: 212–263–8269

Fax: 212–263–8234

Oregon Eugene Amigos de los Sobrevivientes

P.O. Box 50473

Eugene, OR 97405

Phone: 541–484–2450

Fax: 541–485–7293

Texas Dallas Center for Survivors of Torture

1304 South Hampton

Dallas, TX 75208

Phone: 214–330–3045

Fax: 214–331–7214

Virginia Falls Church Center for Multicultural Human Services

701 West Broad Street, Suite 305

Falls Church, VA 20046

Phone: 703–533–3302 x43

Fax: 703–237–2083
U.S. Department of Justice

Office of Justice Programs

Office for Victims of Crime

Survivors of Politically Motivated Torture:

A Large, Growing, and Invisible Population of

Crime Victims

For copies of this publication and/or additional information, please contact:

Office for Victims of Crime Resource Center (OVCRC)

Box 6000

Rockville, Maryland 20849-6000

Telephone: 1–800–627–6872 or

301–519–5500

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E-mail questions to askovc@ncjrs.org

Send your feedback on this service to tellncjrs@ncjrs.org

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