Highlights
- •Forensic medical and psychological evaluations aid the complex asylum process.
- •Torture occurs widely, and survivors are common among foreign-born US patients.
- •Both patient and physician factors hinder obtaining a history of torture.
- •Certain practices help healthcare professionals care for torture survivors.
- •Survivors’ long-term somatic and psychological disorders require coordinated care.
ABSTRACT
Torture occurs worldwide. Survivors seeking asylum are detained and must complete
a complicated legal process to prove a “well-founded fear of persecution” if returned
to their home countries. Forensic evaluations guided by the United Nations Istanbul
Protocol increase asylum grant rates. Medical evaluation emphasizes skin examination,
which can provide strong evidence of torture. Female genital mutilation/cutting, a
basis for asylum, is classified according to the World Health Organization. Many resettled
refugees and foreign-born immigrants at urban healthcare facilities have been tortured,
but few report it to physicians due to factors affecting both survivors and physicians.
Specific torture methods can cause characteristic long-term sequelae. Painful somatic
disorders of mind-body interaction and psychological disorders are common. Practices
derived from cultural factors and traumatized individuals’ feedback enhance management
of survivors. Individual and group psychotherapy provide modest proven benefit, but
assessment is limited. Physicians and psychotherapists should coordinate care.
Keywords
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