Asylum seekers are one of the hottest issues of our time. But all over the world, countries are closing the doors to people fleeing persecution because their claims of torture cannot be proved. That鈥檚 where Hermann Vogel comes in. A consultant radiologist at one of Hamburg鈥檚 major hospitals, Vogel travels the world medically assessing claims of persecution. He makes sure that prisoners aren鈥檛 being tortured, and can tell if someone鈥檚 been beaten or physically abused, even if there are no external signs. All you need, he told John Bonner, is the humble X-ray.
How do you detect torture?
Torture can take many different forms-psychological, chemical, physical beatings and sexual violence are all widely used. The victims of torture can experience lasting psychological trauma, which is why doctors from many different disciplines must be involved in its investigation and treatment. As a radiologist, I can identify the pathological changes in the bones and soft tissues which are characteristic in different types of torture. This can prove not only that ill-treatment has occurred but approximately when it happened, as the healing process may take several months. The evidence on the age of an injury will help confirm the story of a victim when they are applying for political asylum.
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Is it possible to identify injuries in soft tissues?
Ordinary X-rays will show up injuries to the bone or the presence of foreign bodies. A common form of torture is to force metal objects beneath the fingernails. I have an X-ray showing a fragment of wire left in the finger joint of one such victim. There are other techniques such as computer-aided tomography and magnetic resonance imaging which can show up injuries to the nervous system or other soft tissues soon after they have been inflicted. MRI will also reveal chronic injuries to these tissues. The problem, of course, is that these methods are expensive and may not be easily available in the countries where the torture is alleged to be taking place.
What are the more difficult forms of torture to prove?
Acts of sexual aggression, such as rape. This often happens to prisoners of both sexes. However, one of my colleagues in Berlin believes that it is possible to carry out a proper scientific investigation. He asks the victim to describe their ordeal. If their story is true, they will show characteristic autonomic nervous system responses such as sweating, pupil dilation and increased heart rate that are impossible to fake.
Are there characteristic forms of torture in different countries?
Falaca is one of the commonest forms of torture, used widely in some Arab countries. It involves beating the victim on the soles of their feet and causes characteristic fractures of the bones of the feet visible on a X-ray. Other methods are used in particular countries. Palmatoria is a method used in Guinea-Bissau in Africa and involves blows aimed at the tibia bone of the shin. There are no fractures but bleeding within the periosteal membrane covering the bones causes an onion-skin pattern of layers of calcified tissue which can still be recognised years after the event.
So how common is torture, and who are its victims?
According to the UN, torture is carried out in more than a third of its 188 member states. It is not restricted to governments of any particular ideology. In many Western democracies, ill-treatment of prisoners is used to discipline them, but it could be classed as torture. In those countries where torture is common, the victims may come from all social classes, age groups, religions and professions. Most torture is carried out by police or other security services working officially or unofficially on behalf of the state.
And are other groups involved too?
Yes. In some countries, acts which we would class as torture are a common punishment for political or religious crimes. I have seen a case of a 14-year-old Iranian girl arrested by the revolutionary guards, or pasdaran, for the 鈥渃rime鈥� of wearing make-up. She had parts of her fingers cut off by the 鈥減etite guillotine鈥�, an instrument used in that country during the rule of the Shah. She eventually escaped to the International Rehabilitation Council for Torture Victims (IRCT) centre in Copenhagen, where doctors verified her story. It is important to add that the victims are not the only ones affected by the torture: it is also used to terrorise other people such as their friends and family.
Is medical evidence always accepted in support of an application for political asylum?
Western governments are obviously keen to restrict the numbers seeking political asylum and to prevent so-called economic refugees. They will often see doctors working for refugee organisations as parties in the process and not as neutrals, so documentary evidence such as X-rays is very important because it is objective. The big problem is getting that evidence. If a person arriving in Germany or any other European Union country claims political asylum, they are held at the airport and do not officially enter the country. Usually they cannot be taken to a hospital for examination and so it is important that the evidence of torture is gathered in the country where it has taken place.
Can medical evidence also disprove the claims of asylum seekers?
Yes. It is a big problem for doctors because there is always a risk that they will idealise the victims of torture and believe their story without a proper critical assessment. In France, I have seen cases where people arriving from Africa have claimed that they had been burnt with cigarette ends. The scars were on the underside of the hands, close to the wrist, which is not a typical place for such injuries to be found. It was discovered that the scars were caused by an initiation rite in which young men pushed thorns into the skin and then set them alight.
If an asylum seeker is able to prove their claims of being tortured, what help do they receive in rebuilding their lives?
The IRCT centre in Copenhagen was the first and is still the largest of its kind, but now there are also centres in other cities-Berlin, London, Paris, Stockholm, and so on. They are doing excellent work in treating victims and helping them cope with the physical and psychological aftermath. However, it must be said that the people who are able to leave their home country and get to these centres are often the ones with the least severe injuries. In those cases where the person has suffered major physical injuries, the torturers often find it easier to kill them and dispose of the body rather than risk being found out.
Has medical evidence ever led to the arrest and punishment of the perpetrators of torture?
It is very disappointing, but no. In Turkey, torture is supposed to be illegal but it occurs in most police stations. At least there it has been possible to prove that torture has occurred and the victims have been released. But in most countries torture is incredibly difficult to prove in the courts. We can hope that things may change in the future. The IRCT has been asked to help investigate the torture and disappearance of opponents of the Pinochet regime in Chile. I understand from Inge Genefke, the founder of the IRCT, that she will be visiting Santiago in a few weeks鈥� time.
Are scientific methods for investigating torture likely to deter the perpetrators?
Torture will continue until the people responsible for authorising it are forced to stop. If science can provide evidence that torture has taken place, the torturers will look for new ways which cannot be detected.
Such as?
The methods used in Turkey for torturing people with electric shocks have changed because of the efficient work of local activists in diagnosing torture. They used to apply one electrode to one of the victim鈥檚 fingers and the other to his penis or toes. This left cell damage that could be detected in tissue samples taken from the site of the electrode. Now they are soaking the victim in water and applying larger electrodes, which does not cause local damage to tissue. My Turkish colleagues have asked me to investigate whether it will be possible to detect any effects of the electric current when it is applied this way. I am confident that it will by using an MRI scan. We will be carrying out research at my hospital, examining patients who have received electric shocks during defibrillation procedures to restore the function of their hearts.
How did you first get involved in helping torture victims?
In the 1980s, a group of Iranian soldiers were sent to my department and I was confronted with the effects of chemical weapons during the Iran-Iraq war. I was already involved in classifying the type of injuries coming into the radiology departments of developing countries as a result of violence. They are often very different from those I was used to seeing at home in central Europe. Afterwards I began collecting radiological evidence of injuries caused by war. I then felt I should also look at the twin sister of war-torture. I contacted the IRCT in Copenhagen and was invited to examine their medical files and evaluate them to help the doctors working on the cases.
You have also investigated human rights abuses in the countries where they occurred, haven鈥檛 you?
Because they know of my interest in documenting these abuses of human rights, I have worked closely for more than 17 years with organisations such as the IRCT and Amnesty International. I have been part of teams investigating incidents in a number of countries, from Chad and the former Yugoslavia to Israel and Palestine. Last month, I was invited to visit Turkey as part of a team that included Inge Genefke.
Governments of countries where torture occurs must resent investigations by foreigners. Have you ever been physically threatened during these trips?
No, but there can be some intimidation- unnecessary delays at airports, or being videotaped by the police. I have also been warned not to leave my hotel at night, but I have never been physically threatened. It is very different for the doctors who are involved in treating the injuries of the victims in their own country. This is the reason for my recent visit to Turkey. I was part of a group observing the trial of two doctors who were members of the Turkish Human Rights Foundation, which has five centres in Turkey where victims of torture are treated.
What had happened?
Alp Ayan and G眉nseli Kaya had been illegally imprisoned for more than three months. They worked at a centre in Izmir and were accused of being involved in a violent confrontation with police at the funeral of a man who died in prison. Last year a senior gynaecologist called Zeki Uzun, who is another doctor at the centre, was charged with providing medical treatment for members of an illegal organisation, the Kurdish separatist group, PKK. He was acquitted after the Turkish Medical Association produced documentary evidence that he had been tortured by the security forces.
You have also helped highlight torture through an exhibition. What impact did that have?
About two years ago, my group was asked by Amnesty International to put together an exhibition of radiographs showing images of violence to help publicise its work. This has been shown in a number of cities in Germany and abroad. The reactions of the public surprised us. It was a novel approach to explaining the problem and that intrigued them, but they did not feel threatened by what they saw. Most visitors became very thoughtful when looking at the exhibits. They can now decide for themselves whether they are prepared to accept these abominations.