1. Trauma and detention Why doctors are needed Pétur Hauksson, Warsaw, 13 Dec 2011

2. Why doctors are needed For 1. assessing the trauma and 2. assess the health care services' approach to and treatment of that trauma Pétur Hauksson, Warsaw, 13 Dec 2011

3. Doctors are needed for assessing the trauma Pétur Hauksson, Warsaw, 13 Dec 2011

4. Psychological consequences vs mental health consequences of trauma/torture (and trauma without traceable consequences)

5. Aetiology risk factors symptoms diagnosis prognosis treatment

6. What are we doing?

7. Medicalizing a human tragedy A western diagnostic system imposed on “normal” responses to extreme trauma

8. Post-traumatic stress syndrome (PTSD) Torture syndrome? Depression, anxiety disorders, psychosis, substance abuse, neuropsychological impairment, personality disorders

9. Dual loyalty of the prison doctor Independence Confidentiality Effectiveness Trust Presence of officers during examinations?

10. Impunity for perpetrators - a factor in PTSD Therefore, impunity should be of concern to doctors

11. Degrading treatment such as: isolation overcrowding impoverished regime lack of outdoor exercise inhuman material conditions

12. Degrading treatment Why oppose? Because it is a Medical problem or Human Rights Violation?

13. Message to the authorities from NPMs with a doctor and without a doctor e.g. regarding health consequences of ill-treatment - What about the “consequences” of degrading treatment? i.e. of being subject to a violation of human rights. Is a doctor needed for that?

14. Judicial importance of the NPM's / doctor's statements on health consequences of ill treatment e.g. when the ill treatment is accepted and generally used by the same judiciary, arguments must be strong and persuasive.

15. We ask prison doctors to not only describe medical findings in the records, but ALSO the victim's explanation and any allegations there might be, AND the doctor's opinion on the compatibility of the allegations and the medical findings. The same should be expected from the NPMs' doctors

16. If the NPMs come across a case of injury or physical consequences of suspected ill- treatment, there must be a way to determine the compatibility.

17. Non-medical monitors should at a minimum be able to describe physical signs of possible ill-treatment in detail in order to get an opinion on them from an outside doctor (IMAP?) and ask for their opinion, including of the compatibility with any allegations.

18. What about possible mental health consequences of ill-treatment? Can non-medical monitors be expected to describe the psychiatric signs and symptoms that might have resulted from ill-treatment? Is it also possible to describe this in detail and ask the opinion of an outside psychiatrist? Answer: Yes, to a certain degree.

19. Health care services

20. Assessing the quality and quantity of the provision of health care, including the capability of the services to deal with trauma properly, confidentially, independently and effectively, in order to have a preventive effect

21. Independence from prison management. Under MoJ or MoH? Staff recruitment.

22. Doctor-patient relationship sufficient trust, allowing a preventive role of health care staff

23. Facilities Equipment Availability of proper medication

24. Participation of health care staff in ill-treatment? E.g. assessing wether the victim can tolerate more ill-treatment Assessing capacity for isolation - not conducive to formation of a doctor-patient relationship

25. The doctor-patient relationship Why the big fuss?

26. What can NPMs without doctors do then? Can they assess mental health consequences of torture/ill-treatment? Can they assess health care services in prisons?

27. Many policy matters are not merely medical issues e.g. prevention of health consequences of ill-treatment. Is this degrading treatment or not? Who decides?

28. Limits of the role of the doctor Others may be more qualified e.g. in assessing whether conditions are degrading or treatment is adequate

29. Is a doctor needed? Depends on the doctor