What the bones remember: Doctors from IRCT partner PCATI share their experiences of documenting torture

Left to right: Dr. David Senesh, Dr. Bettina Birmanns, and Dr. Revital Arbel.

Left to right: Dr. David Senesh, Dr. Bettina Birmanns, and Dr. Revital Arbel.

Detecting signs of torture, often years after they have been caused, can be a tough task. However, due to advancing techniques in medical documentation of torture, physicians are able to establish the injuries inflicted by torture and the best methods of rehabilitation. Three physicians from IRCT partner Public Committee Against Torture in Israel (PCATI) share their experiences.

(Article adapted from ‘The Hottest Place in Hell’ by Einat Fishbain, first published in Hebrew (here) and summarised in English by +972 magazine.)

For Dr Revital Arbel, torture was not something she had witnessed when her work with PCATI first begun. “Although I have been working in the field for years, particularly with victims of sexual assault, I will always remember a case following the pregnancy of an Eritrean refugee who was raped in Sinai,” she says.

“When she came in to deliver the baby she was accompanied by an interpreter for the first time, and they told me the story. Slowly the things she had been through in Sinai began to sink in. Like other refugee women imprisoned in Saharonim, she had not been able to undergo a termination of pregnancy at an early stage.”

Just as Dr Arbel realized realised the suffering, she received an invitation to participate in the first-ever training program in Israel for physicians and psychologists teaching ways to locate and diagnose torture victims.

The training, an ongoing project organised by PCATI and the International Rehabilitation Council for Torture Victims (IRCT), provides training in the forensic aspects of torture. The knowledge is used to identify victims and to provide evidence in court or in other formal examinations, such as applications to the United Nations to receive refugee status.

Arbel now knows much more about torture in Israel and around the world than she thought possible. “Torture leaves marks,” she says, “and these remain in the body many years after the event. The interrogators may be careful not to leave blue bruises, but today we can also identify what’s under the skin – what the bones remember.”

A personal relationship with torture

For clinical psychologist Dr David Senesh, he understands torture all too well. Captured and imprisoned in an Egyptian jail for 40 days during the 1973 Yom Kippur War, Dr Senesh has a personal relationship with torture which enhances his professional, medical understanding of its effects.

“I’m post-traumatic,” he says openly. “The guys who were held prisoner with me can’t figure out what I’m doing; how what we went through brought me to identify with the experience of occupation and treat Palestinians who have undergone torture. But from my perspective it’s a logical continuation.”

Neurologist Dr Bettina Birmanns, who works in the same hospital as the other physicians in Jerusalem, attempts to explain why she found herself repeatedly dealing with the topic of torture. “I’m increasingly convinced that when a state permits torture, it damages the fabric of the state and destroys trust between citizens the authorities. Even if ‘regular’ citizens do not believe that they will be affected, the fact that someone in an official position is allowed to use serious violence and deliberately cause someone else pain and suffering, damaging their inner kernel and soul – and we know that this happens – that destroys society. I cannot accept that.”

The three doctors admit that they paid a heavy emotional price for their participation in the series of workshops. Alongside theoretical sessions discussing methods of torture around the world, trainee participants also diagnosed actual cases, engaged in role-playing exercises, and confronted professional and personal dilemmas.

“There’s a reason why the training program attracted relatively long-serving physicians,” Arbel suggests. “I think this work demands maturity, and I’m glad that I didn’t suggest that any of our interns join it. Maturity is important in order to act properly and cope with the difficult exposure to the people involved and their stories. You also require moderation – you cannot be too extreme in either direction, but need a mature view of life.”

‘You just can’t ignore torture anymore’

But they feel that with trainings such as these – and with the sharing of knowledge and mechanisms to ensure states comply with their anti-torture obligations – torture can be stopped across the globe.

“You reach a point where you just can’t ignore [torture] anymore,” says Dr Birmanns. “You hear the traumatic stories, and you see the victims after they were tortured – what they experienced has an impact on their health, their psychological condition, and their relations with their wives, children, and with society at large.”

“People undergo personality changes. They’ll never be the same as they were before they were tortured. They were all imprisoned afterwards and didn’t receive treatment. So first they are tortured during interrogation, which results with various kinds of problems. And then their imprisonment kind of freezes the situation, and when they are released all kinds of issues and experiences erupt and those around them don’t know how to cope with it. People are happy to see them out of jail, but they are not really the same people who went into jail, partly because of the torture.

“I still believe that a law-abiding state should not deliberately cause pain and suffering and ruin someone’s life. There should be a border that remains uncrossed, beyond any discussion.”

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