Apag

Greetings from the Philippines where I'm working at our base in the City of Olongapo. And last week, our housekeeper's granddaughter and I popped out for an absolutely ginormous box of popcorn over a film. When we got to the cinema, we had a choice between the blockbusting John Wick 4 and a far less well-known Filipino film. So Apag it was...

What’s the Plot?

‘Apag’ is an abbreviation of ‘Hapag Kainan’, the Kapambangan (one of the major Filipino languages) term for dining table. Communal dining is a massive part of many Filipino occasions, and the film opens with two unrelated families - one rich and the other poor - going to the same market at the same time to buy food for their respective family feasts.

After scrabbling around the market looking for food they can afford, the poorer father and daughter set off for home in their family's trike - a motorbike with covered sidecar. Then tragedy strikes: the richer son crashes into them in his family's huge pick-up truck.

What happens next? Well, I'm not going to say because I really want you to go and see this amazing film and I don't want to spoil the plot for you! And don't worry if, like me, you are not exactly fluent in Kapambangan: as well as having English sub-titles, the cinematography is as clear as it is beautiful. Shot in the gorgeous region of Pampanga, I was thrilled to see that the jail part of the story appears to have been filmed in the real Pampanga Provincial Jail - a secure environment I've worked in many times before the pandemic.

Raising a case

No, rather than spilling the beans, I'll just explain what happens in general when there's a nasty accident or deliberate wrongdoing in the Philippines. Perhaps surprisingly, decisions about whether or not to prosecute someone are not so much in the hands of the police. No, in the Philippines and many other non-Western countries, a complainant or his/her family must 'raise a case'. Otherwise neither criminal nor civil court proceedings may get underway.

As a European prison doctor who's given evidence many times in my homeland’s criminal courts and less often in its separate civil courts, the Philippines’ mixed criminal and civil system came as a bit of a surprise when I first started working here in 2015. Now though, a few years down the line, I’ve just about got the hang of it - at least, enough to give evidence in a local court case last year. And true enough, when the verdict was announced, the criminal penalty of imprisonment was meted out alongside the civil penalty of the accused being directed to pay compensation to the family of the alleged victim.

And often it really does come down to a question of money. In countries that do not have easy-access benefits systems for those who find themselves in dire straits, the family of a badly injured or deceased breadwinner is often left with no choice other than to 'raise a case' - if they are to get the compensation necessary for their financial survival.

Out for revenge

So, does our film's poorer family get compensation? Are their lives transformed for the better as a result? Does the rich family's son get punished? And how do the various members of the poor family deal with the tragedy? I'll leave you to find out for yourself! (That said, if you do want to read more about the plot, here’s a more detailed review from a regional newspaper.)

But drawing to a close now, there's a saying in British English (as opposed to Taglish - the mixture of Tagalog and English spoken in the Philippines): 'Revenge is a dish best served cold'. And that's certainly the case in Apag.

All the compensation in the world does not soothe a grieving heart. In my career, I've seen so very many men imprisoned for the most atrocious acts of revenge. Yet they aren't made any happier for having taken their pound of flesh. Bitterness takes root on both sides. A vicious cycle of tit-for-tat violence is created. It goes round and round and round and round.

Father forgive them

So what does God think about revenge? He's not a fan. He knows that lack of forgiveness often causes more grief than the original wrong. That's just one of the reasons why Jesus commanded us to forgive:-

Then Peter came to Jesus and asked, “Lord, how many times shall I forgive my brother or sister who sins against me? Up to seven times?” Jesus answered, “I tell you, not seven times, but seventy-seven times.”
(Matthew 18:21-22)

And let's not forget that small but golden nugget of the Easter story, when Jesus put his teaching into practice for himself:-

When they came to the place called the Skull, they crucified him there, along with the criminals - one on his right, the other on his left. Jesus said, “Father, forgive them, for they do not know what they are doing.”
(Luke 23:33-35)

If Jesus could forgive his torturous executioners, then we can at least try to forgive our transgressors. It isn't a passive, easy choice. No, it is a painful, hard act of the will. But let’s not forget that our Lord Jesus knows just how hard forgiveness can be. And so whenever we're tempted to lash out, we can take our hurt and pain to him - one who can empathise with our weaknesses (Hebrews 4:15) - in prayer:-

 One day Jesus was praying in a certain place. When he finished, one of his disciples said to him, “Lord, teach us to pray, just as John taught his disciples.” He said to them, “When you pray, say: “‘Father, hallowed be your name, your kingdom come. Give us each day our daily bread. Forgive us our sins, for we also forgive everyone who sins against us. And lead us not into temptation.’”
(Luke 11:1-4)

Dr Rachael Pickering is our Chief Medical Officer

PS If you’ve found this article helpful or enjoyable, please consider praying for and/or donating towards our work.

Easter suffering down the ages

This Easter in the Philippines

This Easter I’m in the Philippines, the most incredibly beautiful and diverse South-East Asian archipelago nation with complex religious traditions partly rooted in Roman Catholicism. Since 2015 and barring the first two years of the COVID-19 Pandemic, I’ve spent approximately a fifth of my working life based out here. I even have a second home here.

I absolutely love the Philippine people. Their warmth and respect are second to none. And although I still have much to learn, I’m now very comfortable with many of their perspectives and customs - save for one…

Volunteers for flagellation

Self-flagellating Filipino

This is the third or fourth Easter I’ve celebrated out here. And although I appreciate much about the Roman Catholic Church’s celebration of Easter, one thing I have not adjusted to is the non-orthodox yet widespread practice of voluntary self-flagellation and even voluntary crucifixion every Good Friday.

This practice jars with me most particularly because I have expertise in the detection and prevention of torture and ill-treatment, and so sometimes I have to examine torture victims who have been flogged. And a severe flogging was just part of the barbaric execution method inflicted on Jesus at the original Easter…

The original Easter in Israel

The Roman form of crucifixion was the ultimate control mechanism: feared by everyone within the Roman Empire, it acted as both deterrent and punishment…

Victim of crucifixion

The very first Easter saw God the Son, Jesus suffering and dying at the hands of others. He did so not because he wanted to - he wasn’t a masochist. Rather, he begged God the Father to spare him from his forthcoming ordeal:-

My Father, if it is possible, may this cup be taken from me.
(Matthew 26:39)

But it was not to be. Jesus was arrested, tried, sentenced, tortured and executed. This makes him history’s most famous torture victim.

SENTENCED FOR US

So, why was Jesus sentenced to death? Not because God the Father was a cosmic child abuser - a charge levelled by some modern-day liberal theologians. No, Jesus was executed in our place for our sins.:-

But he was pierced for our transgressions, he was crushed for our iniquities;
the punishment that brought us peace was on him, and by his wounds we are healed.
(Isaiah 53:5)

All we have to do is accept this incredible gift…

For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.
(John 3:16)

… and follow the teachings of Jesus, our incredible Saviour:-

Then Jesus said to his disciples, “Whoever wants to be my disciple must deny themselves and take up their cross and follow me.
(Matthew 16:24)

With no disrespect intended, try as I might, I cannot understand why anyone who has truly understood Easter would perform self-flagellation. As I often say, ‘Jesus was tortured and died - so we don’t have to’.

Taking up our cross

So what did Jesus mean when he said we should take up our cross and follow him? Did he mean that we should self-harm every Easter? No! Did he mean that we should look for ways to goad those who are in a position to torture and execute us? Again, no!

No, by ‘follow me’ he meant that we should decide to follow his teachings. And by ‘take up his cross’ he meant that committing to follow him was not a nice, vague concept but a profound and self-denying lifestyle decision.

And yes, both then and now, following Jesus may lead to punishment and death. It is thought that the vast majority of Jesus’ original disciples met violent ends. But they did not volunteer to suffer and die, and they did not hurt themselves. No, they merely carried out their Lord’s final set of earthly instructions - with fatal consequences:-

Then Jesus came to them and said, “All authority in heaven and on earth has been given to me. Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.”
(Matthew 28:18-20)

Almost two thousand years later, crucifixion is rare (though still crops up from time to time) and so thankfully I have yet to be asked to examine a case - fatal or otherwise. Yet there are many other ways to become a martyr…

WarTime Easter in Germany

The date on which Easter is celebrated fluctuates, as it is tied to the lunar rather than solar calendar. And by macabre coincidence, this Easter Sunday (9th April 2023) marks the 78th anniversary of the 1945 martyrdom - just eight days after that year’s Easter Sunday - of a great Christian hero…

Victim of hanging

Pastor Dietrich Bonhoeffer
(Image provided by Encyclopædia Britannica)

Pastor Dietrich Bonhoeffer was German born and raised. Yet he steadfastly opposed Nazi dictatorship and championed Christian discipleship, despite the unwelcome yet inevitable cost.

He participated in rescuing Jews. He refused to cooperate with the Nazification of the German Church. And he was linked to attempts to overthrow Hitler.

He didn’t want to suffer and die. Even though he was doing these incredibly dangerous things, which he knew risked capture and death, he was also planning for the future of the church after World War II. He even planned for his personal future - by getting engaged to be married!

Finally though, the inevitable happened: he was arrested in April 1943. He spent the last two years of his life in detention. Firstly, he was put in Tegel Prison, Berlin awaiting trial. Next he was sent to Buchenwald concentration camp. And then finally he was transferred to Flossenbürg concentration camp for a quick show trial. He was hanged the very next day, on 9th April 1945, just one month before Germany surrendered. During his detention he suffered both physically and psychologically; the manner of his death by hanging was also possibly more cruel than some biographies state.

During his years as a prisoner he lived a life devoted to Christ, sharing God’s offer of salvation with fellow prisoners and prison officers. He also wrote fervently to friends, family, and his fiancée. Posthumously his letters and some of their replies were compiled into a well-known book, Letter and Papers From Prison. Reading these letters is both encouraging and humbling.

CONSIDERING the suffering

Bonhoeffer had lived experience of Matthew 16:24. He also witnessed much suffering of others, and during his imprisonment he wrote:-

We must learn to regard people less in the light of what they do or omit to do, and more in the light of what they suffer.
(Letters and Papers from Prison)

How true. Yet how often do we fail to evaluate people in light of their past, their trauma and their suffering, rather than reacting directly to their words and behaviour?

JamMING The Wheel

Also whilst behind bars, Bonhoeffer wrote what may be his most famous quotation:-

Medieval torture wheel

We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.
(Letters and Papers from Prison)

This sentence encapsulated all that he lived for. He did not simply write and teach on the morals and ethics of the Christian life. He lived it too. His firm belief was not just in helping those crushed by the weight of this world’s injustices, but in radically intervening for the oppressed and averting the course of injustice so as to stop ‘the wheel of injustice’ from moving on to crush others in the future. And it cost him his life.

Future easters behind bars

Logo of our expertise and advocacy services

As a Christian faith-inspired organisation with a heart for detainees, we are inspired by the life and words of Bonhoeffer. All too often, we discover modern-day victims with wounds that need bandaging and wheels that need jamming.

Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.
(Proverbs 31:8-9)

May God bless you this Easter.

Dr Rachael Pickering, adapted from the 2019 article co-authored with Dr Esme MacKrill

PS we always welcome prayers and donations for the Gerry Serrano Centre.

International Day in Support of Victims of Torture

On June 26th we remembered the UN International Day in Support of Victims of Torture. This date was chosen as it marks the day when the UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) was implemented as a legal instrument in 1987.

History of torture prevention

In 1948 the Universal Declaration of Human Rights was adopted by the United Nations General Assembly states in Article 5:-

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Then in 1975 the General Assembly adopted the Declaration of the Protection of All Persons from Being Subjected to Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, condemning torture and providing methods to prevent it.

Progress was made in the following two decades and eventually in 1984 the CAT was published, coming into force in 1987. This prohibits torture in all its forms and declares it cannot be justified under any circumstances.

How we support victims of torture

Regardless of whether they are signatories to national and international humanitarian laws forbidding ill-treatment, interrogation methods are brutal in many parts of the world both rich and poor. Rule of law may not prevail. And cultures of inter-prisoner violence (IPV) are often ignored or even encouraged by the authorities.

I signed my confession because I knew I would be beaten until I did. It was an easy decision.
(Detainee with strike marks on torso)

We utilise our expertise & advocacy in the detection and prevention of torture & ill-treatment. Patients, clinicians, relatives and legal representatives contact us for expert advice and advocacy. We also cooperate with the embassies of countries concerned that their citizens detained overseas are being torture or ill-treated.

The Gerry Serrano Centre is an institution based at Integritas House Olongapo in the Philippines. It provides healthcare, expert witness, advocacy, research and training for and about detainees past and present, especially those who have been tortured or ill-treated within the Western Pacific and South-East Asia.

The Gerry Serrano Centre is named in honour of the late Mr Gerry Serrano who was a long-term detained patient we were proud to know, care, and advocate for. He spent more than two decades behind bars facing many challenges but eventually, after 22 years, he was found innocent and released. He was free but his body could not recover sufficiently and he sadly died a year or so after release. Before he died, Gerry agreed that his story should be used in our work - promoting offender healthcare and opposing ill-treatment. And so we decided to preserve his memory by naming this centre after him.

Our advocacy and expertise work are needed more than ever to oppose ill-treatment and torture. In Spring 2021 we highlighted the many forms that torture and ill-treatment may take and how, despite international legal standards, torture still continues to this day. If you have been moved to support victims of torture and you’d like to support our anti-torture & ill-treatment work, we welcome donations towards the Gerry Serrano Centre.

The Ms Maxwell Series: Is it torture?

This week we finish our series pegged around the topic of torture, which made British news headlines in early Spring 2021 when Ghislaine Maxwell’s brother, Ian, spoke out against what he felt were torturous conditions in her New York jail. She is apparently being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations.

Previously: is sleep deprivation torture?

During this series we have asked ‘What is torture?’, ‘How small is too small?’ for a jail cell, and ‘What’s diet got to with it?’. And most recently we asked, ‘Is sleep deprivation torture?’ Over in Europe, a landmark case in the European Court of Human Rights (ECtHR) concluded that sleep deprivation, used as part of five techniques used in interrogation, amounted to inhuman and degrading treatment, but not torture. For Ghislaine over in the United States of America (USA) though, sleep deprivation as a consequence of suicide monitoring during the night could be an over-reaction and indeed counter-productive, unless that monitoring matched her level of risk. Whether sleep deprivation is inflicted for the purposes of interrogation, suicide surveillance or it is a result of other biopsychosocial factors from living in prison, it can have lasting health consequences that no human deserves.

Conclusions

Is it ill-treatment?

If Ghislaine is indeed being held in a 6x9ft (1.8x2.7m) cell with no natural light, under constant surveillance, and with terrible food and water rations as her brother reports, then could this amount to ill-treatment? According to the Nelson Mandela Rules (NMR), which the USA (as a member of the United Nations (UN) General Assembly) has to abide by, it could well be the case:-

• Has she been held for 22 hours a day, for more than 15 consecutive days as defined as solitary confinement, so breaching rules 44 and 45?

• Has her microwaved food lost its nutritional value to the extent that it is inadequate for health and strength, so breaching rule 22?

• Has there been insufficient attention to minimum floor space and lighting in her cell, so breaching rule 13?

If the answer to any of these question is an objective yes, then it may fairly be said that she has been subjected to cruel, inhuman or degrading treatment.

But is it torture?

Moving on from an objective yes to the above ill-treatment questions, then - as torture is a subset of ill-treatment - it may be that Ghislaine is being tortured. Let’s see…

We can’t use the European Convention on Human Rights (ECHR) or its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), as she is not being held in Europe. Even if we could use these conventions, they do not actually define the torture that they ban. Instead, ECtHR judges sometimes rule on whether a particular case of alleged ill-treatment could be said to amount to torture.

We can’t utilise the UN’s Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) and monitoring by its mandated Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) to inspect her jail and look for evidence of torture, as the USA is not signed up to OPCAT. And even if USA jails did qualify for SPT inspections, this monitoring body does not have publicly available standards by which to judge cell size, nutrition, lighting and sleeping conditions.

However, the USA is signed up to the UN’s more basic Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). And according to CAT, torture requires a particular action to have:-

• caused severe pain or suffering, whether physical or mental;

  and

• been intentionally inflicted for such purposes as:-

  • obtaining information or a confession from the victim or another person,

  • punishment for a suspected or actual deed committed by the victim or another person,

  • intimidation or coercion of the victim or another person,

  • or discrimination of any kind;

  and

• been inflicted by a public official or other person acting in an official capacity.

Pain or suffering arising only from, inherent in or incidental to lawful sanctions such as corporal or capital punishment is specifically excluded.

So, to consider whether Ghislaine’s conditions are torturous according to the letter (as opposed to the spirit) of the USA’s legal obligations under the international humanitarian law it has chosen to sign up to, we must establish affirmative answers to all of the following questions:-

1. Is it causing severe mental or physical pain or suffering?

   • Severity is a completely subjective concept. In healthcare, we use a scale from 0 (no pain) to 10 (agony) for people to rate their pain. The major downside to this though is that one person’s 10 is another person’s 5. So this severity stipulation within CAT is the major sticking point for our conclusion.

2. Is its purpose to get information or a confession, or else to punish, intimidate, coerce or discriminate?

   • It’s difficult for third parties like us to establish the exact purpose or purposes.

3. Is it not a lawful sanction of corporal or capital punishment?

   • This is easy to answer. Yes, it is most definitely not a lawful act of corporal punishment.

4. Is it authorised or conducted by a state official?

   • Again, this is fairly easy to answer. Yes, it will be being authorised by her state prison managers and it will be being carried out by state prison officials (eg guards and cooks), although it’s possible that some of the poor cooking is being done by fellow prisoners.

Letter of the law

So, the long and the short of it is that no, according to the letter of the law, Ghislaine is not being tortured.

Spirit of the law

But really, is it right that a certain action may be judged torturous in one country yet non-torturous in another? Why is it that nations including ‘leaders of the free world’ such as the USA may belong to Club UN without ratifying OPCAT? Even signing up to the more basic CAT is optional. After all, Council of Europe member states are obliged to sign up to the CPT on top of the ECHR.

And as an aside, considering that information obtained under duress is often inaccurate, it is surely concerning that the majority (the USA along with China and Russia) of the five permanent members of the UN Security Council (the UN body charged with maintaining international peace and security) are OPCAT signatories.

But let’s return to the fact that what is deemed torture in one state is deemed non-torturous in another. Where is the equivalence? Where is the justice? So many of the world’s 11 million prisoners eat terrible food and live 24/7 in cramped, dark cells - with the full knowledge of their country’s officials. Others are kept alone for months and years at a time. At the very least, this is discrimination against people who are deprived of their liberty. It is surely perverse that we need to argue about semantics in order to decide if these poor people are being tortured! Just how malnourished, lonely, cramped and light deprived does a human being have to be before the law will consider protecting him or her?!

A higher law

As we are a Christian faith-inspired NGO, we also look to an additional set of rules to guide our work - God’s Laws as set out in the Bible.

The Bible has much to say about how to live in just societies. In a nutshell, it rests on how we treat one another. In the New Testament, Jesus teaches his followers ‘The Golden Rule’ as well as ‘The Greatest Commandment’:-

“So whatever you wish that others would do to you, do also to them, for this is the Law and the Prophets.”

Matthew 7:12

Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbour as yourself.’ All the Law and the Prophets hang on these two commandments.”

Matthew 22: 36-40

Loving our neighbours - that is, others living within our culture - as ourselves is a wonderful principle, regardless of one’s faith. Let’s ask ourselves, ‘Would I wish to live day in, day out in a tiny, dark cell? Would I want to eat bland, unhealthy food for breakfast, lunch, and dinner? And would I want to live my life under constant scrutiny?’ If our answers are ‘No, No and No’ then consider: ‘How can I not speak up whilst this is happening to my neighbours?’

At Integritas Healthcare, we advocate for those who are tortured or otherwise ill-treated because we believe that every human being is made equal with innate worth and dignity. We are called to treat everyone with the kindness and compassion we ourselves would want. Taking inspiration from Matthew 25:37-39, whatever we do in the service of others, we do in love of our fellow man and in our love for God:-

“For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.”… “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.”

A glimmer of hope

We end this series with some recent good news that provides a glimmer of hope for prisoners in solitary confinement in the USA.

From next year, the State of New York has agreed to ban solitary confinement exceeding 15 days, so as to ensure compliance with the Nelson Mandela Rules. This new law will include screening for suicide risk and the development of rehabilitation units for those who would otherwise have been sent to solitary confinement.

It may only be one law, but it could be the start of a nationwide change in how detainees are treated within the USA’s penal system. It is also the beginning of being able to hold certain USA detention centres accountable for any discrimination against vulnerable patient groups who are disproportionately sent to solitary confinement and who are generally more poorly treated within many of the world’s penal institutions. So watch this space!

If you have been moved by this series on torture and you’d like to support our anti-torture & ill-treatment work, we welcome donations towards the Gerry Serrano Centre.

The Ms Maxwell Series: Is sleep deprivation torture?

We return to our series pegged around the topic of torture, which made British news headlines in early Spring 2021 when Ghislaine Maxwell’s brother, Ian, spoke out against what he felt were torturous conditions in her New York jail. She is apparently being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations.

Previously: What’s diet got to do with it?

After exploring the questions of ‘What is torture?’ and ‘How small is too small?’ for a jail cell, we discussed ‘What’s diet got to with it?’. The UN’s Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) stipulate food must be nutritious and a detainee must have ready access to drinking water. However, whether or not allegedly inedible food could be considered ill-treatment amounting to torture as defined by the UN’s Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) is doubtful. Either way though, it’s neither necessary nor proportionate punishment for detainees to be without access to nutritious food and reasonable quality water.

Now: sleep deprivation

More recent news reports have shone light on new bruising around Ghislaine’s eyes, suggesting she is now suffering from sleep deprivation as a result of being woken by torchlight repeatedly throughout the night as part of her suicide watch.

The suicide prevention in jails and prisons guidance written by the World Health Organisation (WHO) recognises that adequate monitoring of suicidal prisoners is important to prevent deaths, especially during the night:-

Adequate monitoring of suicidal inmates is crucial, particularly during the night shift (when staffing is low) and in facilities where staff may not be permanently assigned to an area (such as police lockups).

The guidance also understands that the ‘level of monitoring should match the level of risk’. If Ghislaine’s New York jailors have conducted risk assessments that clearly identify her being high risk of suicide, then constant surveillance may be necessary for her own safety. However, if Ian Maxwell’s claims are true and her jailors are acting purely out of an excessive fear for their own reputation, then her level of monitoring is truly excessive and could even be counter-productive. And, as the Judge presiding over Ms Maxwell’s case has already suggested, she could have an eye covering to help her sleep despite frequent nightly checks. So why didn’t someone think of it before?

The Nelson Mandela Rules, which are designed to maintain a prisoner’s human rights and dignity, include guidance on sleeping arrangements:-

All accommodation provided for the use of prisoners and in particular all sleeping accommodation shall meet all requirements of health, due regard being paid to climatic conditions and particularly to cubic content of air, minimum floor space, lighting, heating and ventilation.

Darkness is essential for good quality sleep. As levels of light decrease at the end of the day our body produces the hormone melatonin, which causes muscle relaxation and the feeling of tiredness, which in turn initiates sleep. Light exposure during the night may impede this natural rhythm, provoking periods of wakefulness. Therefore, appropriate lighting, or lack of it, at night time is an important right for prisoners.

Sleep deprivation and interrogation

Historically, the technique of depriving a prisoner of sleep has been used for the for purpose of obtaining a confession or other information. Sleep deprivation was one of five techniques employed by the British Military as an interrogation method during the 1970s. In the European Court of Human Right’s trial Ireland v. the United Kingdom, it was concluded:-

... Although the five techniques, as applied in combination, undoubtedly amounted to inhuman and degrading treatment, although their object was the extraction of confessions, the naming of others and/or information and although they were used systematically, they did not occasion suffering of the particular intensity and cruelty implied by the word torture as so understood. ...

The Court concludes that recourse to the five techniques amounted to a practice of inhuman and degrading treatment, which practice was in breach of [the European Convention on Human Rights] Article 3.

Whether sleep deprivation is inflicted for the purposes of interrogation or it is a result of other biopsychosocial factors, what might be the health consequences?

The importance of sleep

It is common knowledge that a lack of sleep can impact health and wellbeing. In the short term, it reduces concentration and increases irritability. Ongoing sleep deprivation decrease the immune system’s defence against infectious diseases - not a welcome thought during a worldwide pandemic! It also increases the risk of heart disease and diabetes with serious consequences for life quality and expectancy.

How can prisoners achieve better sleep?

Achieving good sleep in prison is a challenge. The stress and chaos of prison life, sometimes compounded by drug and alcohol use, or a mental health problem, often lead to sleepless nights.

Many of the environmental factors in prison cannot be changed, but it is both easy and important to empower prisoners to choose small things that can have a positive impact on their quality of sleep. This is called ‘sleep hygiene’. Making these small changes also increases their sense of control, which is a rare and precious sensation for most of the world’s detainees.

PILs

Our picture-heavy, word-light Insomnia Patient Information Leaflet (PIL) has been designed especially to help prisoners with sleep hygiene. We are in the early stages of an ongoing project to translate our detainee-friendly PILs into multiple languages and make them freely available on our website. This will make them readily accessible to individuals and organisations involved in supporting many of the world’s 11 million detainees. If you have a heart for helping detainees improve their own health and wellbeing, you could donate to our work or (if you’re suitably skilled) join us as a translator.

So Is Ghislaine Maxwell being tortured?

Next time we will reflect on this series’ findings and decide…

If Ian Maxwell’s allegations are true, is Ghislaine being ill-treated in a manner that could be said to amount to torture?

Until then…

Crucifixion: the ultimate form of torture

Today, Good Friday, is recognised by Christians around the world as the anniversary of Jesus being crucified. And so, to honour this, we are taking a short break from our series pegged around the alleged ill-treatment of Ghislaine Maxwell. Instead, we are examining crucifixion.

What is crucifixion?

Crucifixion is a torturous form of execution, more associated with history than the modern day. Its name is derived from the Latin words crucifixio and crucifixus, meaning to fix to a cross. Crucifixion crosses were made of wood and came in a variety of shapes and sizes though they generally had both vertical and horizontal beams that slotted together. That said, it is also possible to crucify someone without an actual cross, by attaching their spread arms and their feet to any suitable surface such as a tree trunk.

What are its origins?

Though it originated in other societies, the Roman Empire perfected crucifixion as a form of torture. Roman crucifixion was a long, slow journey to death with the maximum amount of fear, pain and other suffering along the way. It was the ultimate threat to those who might be tempted to step out of line.

Who got crucified?

In general, Roman crucifixion was the fate of the lowliest in society. It was inflicted upon slaves, peasants and criminals, but rarely to Roman citizens. It was famously deployed on slaves in 71 BC when 6000 followers of the rebel slave leader Spartacus were crucified along the Via Appia - the road extending south from Rome, the very heart of the Roman Empire. And zipping forward a couple of generations to history’s most famous crucifixion, on the original Good Friday in 30 or 33 AD, Jesus was crucified between two thieves:-

When they [the Romans] came to the place called the Skull, they crucified him there, along with the criminals - one on his right, the other on his left. Jesus said, “Father, forgive them, for they do not know what they are doing.”
(Luke 23:32-34)

Over the next few years, it is thought that many of Jesus’ original followers were crucified - as punishment for spreading the message of Christianity. And during the subsequent two millennia in certain parts of the world, Christians - that is, followers of Jesus Christ - have sometimes suffered the same fate as their Lord.

Even today, crucifixion occasionally pops up in the news as having been used as a method of killing someone or as a means of inflicting extreme non-fatal violence.

Flogging and mocking

There is no doubt that crucifixion is a torturous form of execution. But even before Jesus picked up His cross and walked to His execution site, He was tortured in other ways.

It was not uncommon for the Romans to beat and maim their victims prior to crucifying them. A whip of three leather tails studded with metal balls and pieces of bone was used to inflict deep wounds across the condemned person’s shoulders and back. These wounds exposed muscle and could even damage internal organs. Many victims did not survive this ordeal - and so at least were spared the actual cross.

And along with the physical torture He endured, Jesus was also tortured psychologically:-

He [Pontius Pilate, the Roman Governor in Jerusalem] had Jesus flogged, and handed him over to be crucified…They [the Roman soldiers] put a purple robe [a symbol of royalty] on him, then twisted together a crown of thorns and set it on him.  And they began to call out to him, “Hail, king of the Jews!”. Again and again they struck him on the head with a staff and spit on him. Falling on their knees, they paid homage to him. And when they had mocked him, they took off the purple robe and put his own clothes on him. Then they led him out to crucify him.
(Mark 27:15-20)

Crucifixion as SLOW torture

If a condemned person managed to survive his pre-crucifixion flogging, he would then have the ignominious task of carrying his own cross - or at least its horizontal crossbeam - to his site of execution. Jesus was so weak after His flogging that He had to have assistance carrying His cross. But then He finally arrived at Jerusalem’s execution site, which was named Golgotha - the local word for skull - because it sat on top of a rockface that looked remarkably like the front of a skull and can still be seen today. And there He was nailed to His cross:-

This man [Jesus] was handed over to you by God’s deliberate plan and foreknowledge; and you, with the help of wicked men, put him to death by nailing him to the cross.
(Acts 2:23)

His cross was then set upright in a hole in the ground, and He was left to hang - suspended by His nailed limbs - until He died. And today, various forms of suspension remain popular methods of torture.

A Roman crucifixion victim’s death could be a long time coming, taking up to several days. And so, as happened in the Easter Story, an executioner would sometimes inflict further injury to hasten death:-

Now it was the day of Preparation [for the Jewish feast of the Passover], and the next day was to be a special Sabbath [rest day]. Because the Jewish leaders did not want the bodies left on the crosses during the Sabbath, they asked Pilate to have the legs broken and the bodies taken down. The soldiers therefore came and broke the legs of the first man who had been crucified with Jesus, and then those of the other. But when they came to Jesus and found that he was already dead, they did not break his legs. Instead, one of the soldiers pierced Jesus’ side with a spear, bringing a sudden flow of blood and water.
(John 19:31-34)

Many medical papers have tried to understand the pathology underlying death from crucifixion, noting it was likely multifactorial and included the after-effects of flogging, haemorrhage and dehydration causing hypovolaemic shock, and asphyxia caused by impairment of respiratory movement. Regardless of the exact mechanism of death though, it is surely an excruciating way to die.

Why was jesus crucified?

As a Christian faith-inspired organisation, we recognise the ultimate sacrifice that Jesus made for us at Easter, giving His life for us. The pain He endured physically, spiritually and mentally are more than any human being should have to bear. But for our sake He, God on earth, entered our broken world in human form to die so that we wouldn’t have to:-

Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death - even death on a cross!
(Philippians 2:6-8)

If you’d like to know more about why Jesus came to Earth and died on the cross, you might like to look at this simple cross-shaped leaflet, which we created especially for detainees wanting to understand the Easter Story:-

Click image to download PDF

But What about now?

On this Good Friday, as every Good Friday, we remember one sobering episode of barbaric violence from the First Century. Still, although it does still occasionally occur, these days crucifixion is seen as old fashioned. In its place, other - supposedly more ‘modern’ - forms of torture and execution now wreak havoc around the globe.

Why oh why do we human beings continue to inflict torture and cruel, inhuman & degrading treatment on each other? It seems that nothing will stop it. Indeed, it is tempting to think that opposing torture & ill-treatment is a completely futile endeavour!

But it’s not.

Just as Good Friday was not the end of Jesus’ story, we should not give up hoping that torture & ill-treatment will end some day. In defeating death, Jesus paved a way for our reconciliation with God and everlasting life with Him. Through that we have genuine cause for hope in a better world and a better life to come. We can look forward to that day:-

He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away.
(Revelation 21:4)

Still for now, whilst still having one eye on the future, we and all other Christians must live in day-to-day obedience with God’s mandate to fight on behalf of the vulnerable:- 

Learn to do right; seek justice. Defend the oppressed…
(Isaiah 1:17)

And this includes victims of torture & ill-treatment.

Happy Easter.

Dr Esme MacKrill with Dr Rachael Pickering

PS If you’d like to support our anti-torture & ill-treatment work, we welcome donations towards the Gerry Serrano Centre.

The Ms Maxwell Series: How small is too small?

Last week: what is torture?

Last week we started to revisit the topic of torture as it had made the British news once again when Ghislaine Maxwell’s brother, Ian, spoke out against the apparently torturous conditions in her New York jail. Mr Maxwell reported his sister is being held unnecessarily under constant surveillance, in a 6x9ft (1.8x2.7m) cell with no natural light, and with terrible food & water rations.

However, as we discussed, deciding whether Ghislaine is being tortured is complex. The United Nations (UN) Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) contains a complex definition of torture, which can be difficult to interpret. And, although the United States of America (USA) has signed the CAT, it has not signed the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). So the UN’s Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) cannot inspect her cell within one of the USA’s many prisons and other places of detention.

Even if the USA was signed up to OPCAT, the SPT does not have published standards by which to judge whether - as Ian Maxwell claims - Ghislaine’s living space is indeed too cramped, too short on natural light & too lacking in privacy or if her food is really all that bad.

However, if Ghislaine was incarcerated in Europe, she would be held by a member state of the Council of Europe (CoE). All such states are automatically signed up to both its European Convention on Human Rights (ECHR) and its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which, through inspections by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), tries to ensure that the ECHR’s prohibition of torture is respected.

How small is too small?

So then, if for some reason Ghislaine was extradited to Europe, she and her cell may just be lucky enough to be inspected by a delegation from the CPT, which does have well-known standards. Let’s consider purely its standard on living space, which is the most objectively assessable of the complaints raised by Ian Maxwell on her behalf…

According to the CPT, each detainee should have ‘6m² for a single-occupancy cell + sanitary facility’ or ‘4m² of living space per prisoner in a multiple-occupancy cell + fully-partitioned sanitary facility’. By this definition then, Ghislaine’s single-occupancy 6x9ft (1.8x2.7m) cell - at ~4.9m² - is too small. Whether or not it could be considered ill-treatment amounting to torture - as per either the UN’s definition or the deliberation of judges sitting at the European Court of Human Rights (ECtHR) - is a far more complex, thorny question.

How does nelson mandela come into this issue?

Within International Humanitarian Law, prisoners’ basic needs must be met and their human dignity maintained. And so, in 2015, the United Nations revised its 1955 Standard Minimum Rules for the Treatment of Prisoners, now known as the Nelson Mandela Rules - as the late President of South Africa was, in his earlier years, very famously ill-treated whilst behind bars.

These 122 rules provide guidance on all aspects of a prisoner’s journey from admission right through to release. Regarding solitary confinement, rules 44 and 45 state:-

44. For the purpose of these rules, solitary confinement shall refer to the confinement of prisoners for 22 hours or more a day without meaningful human contact. Prolonged solitary confinement shall refer to solitary confinement for a time period in excess of 15 consecutive days.

45. 1. Solitary confinement shall be used only in exceptional cases as a last resort, for as short a time as possible and subject to independent review, and only pursuant to the authorization by a competent authority. It shall not be imposed by virtue of a prisoner’s sentence.

What about her lack of privacy?

We do not know the exact amount of time per day that Ghislaine is confined to her cell. We also do not know whether she is allowed day-to-day interaction with other detainees. However, in his interview Ian Maxwell stated the following:-

Ghislaine has been in prison now for nearly 250 days and counting… she is under 24 hour round-the-clock surveillance with ten cameras, including one that moves and tracks her movements. And on top of that there are four guards that are looking at her, and presumably there is another guard looking at the camera feeds. She is not allowed to move into the corners of her cell and she’s not allowed to be within two and a half feet of the cell door. That is her existence every day.

As we mentioned last week, Ian Maxwell intimated that - subsequent to Mr Epstein’s high profile suicide last year whilst in prison - Ghislaine is under constant surveillance due to the authorities’ fear that she too may try to end her life whilst in custody. However, he does not believe that she is a suicide risk, making this level of monitoring a ‘grotesque over-reaction’.

What should be done to prevent suicide in custody?

The World Health Organisation (WHO) has written guidance on suicide prevention in jails and prisons. This document explains that a thorough risk assessment process should be completed for every prisoner when they are admitted to the prison and advises on appropriate management techniques as and when necessary.

Adequate monitoring of truly suicidal prisoners is necessary, given that hanging can cause serious brain damage within three minutes and death within five to seven minutes.

The use of camera technology has become increasingly popular as an alternative to prison guard watches. Even so it still requires surveillance of camera footage and prompt action. The guidance say:-

Moreover, most inmates dislike constant observation if it occurs without emotional support and respect. Therefore, camera surveillance should never be utilized as a substitute for the officer’s observation of the suicidal inmate and, if used, should only supplement the direct observation of staff.

If Ghislaine’s New York jailors have conducted risk assessments that clearly identify her being high risk of suicide, then constant surveillance may be a necessity for her own safety. However, if Ian Maxwell’s claims are true and her jailors are acting purely out of an excessive fear for their own reputation, then her level of monitoring is truly excessive and could even be counter productive.

But what’s in a name?

However, let’s for a moment leave aside the varying degrees of both lack of privacy and cramped cells endured by Ghislaine and very many others of the world’s ~11 million prisoners. Instead, let’s consider the undeniable psychological and physical health consequences to keeping prisoners in any sort of secure environment where perpetual confinement and frequent observation are the orders of the day…

The COVID-19 pandemic lockdown has imposed on a massive percentage of the world’s free citizens has given us a tiny taste of the psychological sequelae of imprisonment. It is therefore unsurprising that detainees, especially those who have been kept in confined conditions, suffer from anxiety, panic, insomnia, paranoia, aggression and depression. These psychological symptoms in turn can increase the risk of self-harm and suicide.

Detainees kept under such conditions are also at higher risk of a range of physical effects such as joint and back pain, deterioration of eyesight, lethargy and cachexia.

Are such conditions ill-treatment? And could they be said to amount to torture, as defined by the UN’s CAT or as interpreted by the ECtHR’s judges? You try to decide. But either way, it’s neither necessary nor proportionate punishment for offending human beings in general to be kept in such conditions.

So what about her diet and exposure to sunlight?

Although the above symptoms may be caused purely by psychological stress, they cannot often be separated from the physical consequences of poor diet and lack of sunlight. And so next week we will focus on Ian’s claims that Ghislaine receives practically inedible food and is not given enough exposure to natural light.

How may such allegations be assessed?

What are the potential health consequences of such ill-treatments?

And are they ill-treatments that could be said to amount to torture?

Until next time…

Dr Esme MacKrill with Dr Rachael Pickering

The Ms Maxwell Series: What is torture?

Torture made the British news once again last week when Ghislaine Maxwell’s brother, Ian, spoke out against the allegedly torturous conditions in her New York jail. She stands accused of helping the late sex offender Jeffrey Epstein - the former friend & associate of British Prince Andrew - to groom young girls for sexual exploitation.

Currently on remand whilst awaiting a trial scheduled for July, she has been persistently denied bail. Ian Maxwell intimated that, subsequent to Mr Epstein’s high profile suicide last year whilst in prison, she is under constant surveillance due to the authorities’ fear that she too may try to end her life whilst in custody. Apparently she is being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations...

To our mind, an obvious question lurking behind this storyline is…

What is torture and who gets to decide when it’s been committed?

Let’s find out…

What exactly is torture?

In 1988 The United States of America (USA) signed the United Nations (UN) Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). This convention was adopted by the United Nations General Assembly as a way of upholding both Article 5 of the Universal Declaration of Human Rights (UNDHR) and Article 7 of the International Covenant on Civil and Political Rights (ICCPR):-

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. (Article 5 of UNDHR)

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. (Article 7 of ICCPR)

Article 5 of CAT defines torture in a very specific way:-

For the purposes of this Convention, the term "torture" means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

This sounds most comprehensive, doesn’t it? Is it in fact too comprehensive and, at the same time, too lenient? Because now we’re wondering…

• How do we decide if someone else’s pain or suffering is severe?

• Why is a torturous action suddenly non-torturous if it’s been done by people other than agents of the state acting in official capacities?

• And why are certain undeniably painful and (some might say) barbaric actions - such as flogging, finger or hand amputation, and death by stoning - non-torturous if they are the outpourings of a particular country’s laws?

Alongside CAT, there is the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). This was produced subsequent to CAT, to ensure that State Parties - that is, countries signed up to CAT - could be held accountable to it:-

The objective of the present Protocol [OPCAT] is to establish a system of regular visits undertaken by independent international and national bodies to places where people are deprived of their liberty, in order to prevent torture and other cruel, inhuman or degrading treatment or punishment.

Though as its name suggests, OPCAT is optional. So a country signing up to CAT but not OPCAT will not have the UN’s Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) inspecting its prisons and other places of detention. The USA is yet to sign OPCAT. But even if it did qualify for SPT inspections, this monitoring body does not have published standards by which to judge knotty problems like how small is too small a prison cell.

What happens if we throw geopolitics into the mix?

As well as being an American citizen incarcerated in her own country, Ghislaine also holds two European citizenships - English and French. So it would be interesting to consider how this situation might be judged if she’d been arrested whilst in Europe…

In comparison to worldwide countries signed up to CAT, all European countries (except for Belarus, which - in common with the USA - still performs executions and so is ineligible for membership) are members of the Council of Europe (CoE), which means that they are signed up to both its European Convention on Human Rights (ECHR) and its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which details a mechanism for ensuring that the ECHR’s prohibition of torture is respected:-

No one shall be subjected to torture or to inhuman or degrading treatment or punishment. (Article 3 of ECHR)

There shall be established a European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (hereinafter referred to as “the Committee” [the CPT]). The Committee shall, by means of visits, examine the treatment of persons deprived of their liberty with a view to strengthening, if necessary, the protection of such persons from torture and from inhuman or degrading treatment or punishment. (Article 1 of the Convention on the Prevention of Torture)

Therefore, unlike the UN’s optional buy-in to CAT and OPCAT, all CoE member states are obliged to comply with Article 3 of the ECHR and the Convention on the Prevention of Torture. In other words, every European prison outside of Belarus is fair game for a mandatory inspection by the CPT, which is to the Convention on the Prevention of Torture as the SPT is to OPCAT.

Moreover, the ECHR does not actually define the torture that it bans. Instead, judges at the European Court of Human Rights (ECtHR) play the ECHR as a living legal instrument when deciding if an alleged case of ill-treatment could be said to amount to torture.

So then, what does this mean for Ghislaine?

Next week we will start to explore issues relating to Ghislaine’s brother’s claims about her cramped cell, inedible food, constant surveillance, and lack of natural light.

How may such allegations be assessed?

What are the potential health consequences of such ill-treatments?

And are they ill-treatments that could be said to amount to torture?

Until next week…

Dr Esme MacKrill with Dr Rachael Pickering