Author Affiliations: Physicians for Human Rights, Boston, Mass (Drs Heisler, Moreno, Keller, and Iacopino); Department of Internal Medicine, University of Michigan School of Medicine and Ann Arbor Veterans Affairs Health System, Ann Arbor (Dr Heisler and Ms DeMonner); Health Law Department, Boston University School of Public Health; Boston Center for Refugee Health and Human Rights, Boston Medical Center; and Austin Medical Education Programs, Brackenridge Hospital, Austin, Tex (Dr Moreno); Bellevue/NYU Program for Survivors of Torture, New York University School of Medicine, New York, NY (Dr Keller).
Context International and Mexican human rights organizations have documented
torture of detainees (ie, those held and indicted but not sentenced) in all
31 states and the Federal District of Mexico, but little is known about the
attitudes and experiences of forensic physicians examining detainees.
Objective To assess forensic physicians' experiences with and attitudes toward
the nature and extent of torture and ill treatment among detainees examined
in the previous year.
Design, Setting, and Participants With the support of the Mexican Office of the Federal Attorney General,
as part of a larger initiative to implement governmental reforms to eradicate
torture in Mexico, an anonymous, self-administered, written, 80-item survey
designed to assess correspondence of physician practices and attitudes with
international standards on forensic investigation and documentation of torture
was distributed to all federal forensic physicians (n = 115) and a convenience
sample of state forensic physicians (n = 99) in Mexico in 2002.
Main Outcome Measures Estimates of the numbers of federal detainees medically evaluated and
numbers of cases of suspected, alleged, and documented torture or ill treatment
among federal detainees; factors interfering with documentation of forensic
evidence; physicians' attitudes toward torture; measures that would help them
document torture; and recommendations for reform.
Results Survey responses were received from 93 (81%) federal and 91 (92%) state
forensic physicians. Forty-nine percent of federal physicians and 58% of state
physicians reported that torture is a severe problem for detainees in Mexico.
Federal physicians estimated that they had conducted 26 445 to 30 650
or more medical evaluations of the 13 000 federal detainees in the past
year and that between 1658 and 4850 of these detainees had alleged torture;
these physicians also estimated that they had documented evidence of torture
in a range of 285 to 1090 cases. Forty percent of respondents had suspected
torture and/or ill treatment of detainees examined during the previous year,
64% had examined detainees who alleged these practices had occurred, and 49%
had documented forensic evidence of torture among these detainees. Respondents
reported that lack of photographic equipment and services (58%), inadequate
monitoring and accuracy of medical examinations (36%), inadequate documentation
of torture (29%), limitations in their training (28%), fear of reprisals for
documenting torture (23%), and fear of coercion by police officials (18%)
are factors that interfere with documentation of torture and ill treatment
of detainees. Respondents further reported the need for additional training
(98%), standardized protocols and documentation procedures for use in cases
of alleged or suspected torture and/or ill treatment (81%), and monitoring
to ensure the quality and accuracy of medical evaluations (95%).
Conclusions Torture and ill treatment of detainees is a major problem in Mexico
facilitated by multiple medical and legal factors. Mexican forensic physicians
support measures to improve forensic documentation of torture and ill treatment
Heisler M, Moreno A, DeMonner S, Keller A, Iacopino V. Assessment of Torture and Ill Treatment of Detainees in MexicoAttitudes and Experiences of Forensic Physicians. JAMA. 2003;289(16):2135-2143. doi:10.1001/jama.289.16.2135