Which topics are covered in this project?
An un-linked title denotes a chapter still undergoing the editing process. The chapters in each section next due to be published are marked with an asterisk. All of the chapters should be live by Christmas 2025.
What?
This subject may be traumatising. Read the below guidance first.
What is torture?
What is environmental torture?
What is physical torture?
What is psychological torture? *
What is sexual torture?
What is the relevant International Human Rights Law?
What is the Istanbul Protocol?
How?
How is torture prevention monitored?
How may we guard against complicity? *
How should cases be documented?
How should survivors be managed?
How should we approach vicarious trauma?
How should we promote human rights?
What should I know about…?
Have you considered that detained women have particular needs?
Asphyxiation
Beating
Burning and electrocution
Capital punishment
Corporal punishment
Crucifixion
Detained women
Drowning and waterboarding
Female genital mutilation *
Fixation and restraint
Flogging and falaka
Were you aware that prolonged solitary confinement is torturous?
Forced exercise and
stress positions
Forced genital examination
Forced labour
Hunger striking
Hyper-extension and suspension
Malnutrition and starvation
Ocular torture
Post-traumatic stress disorder
Sleep deprivation
Solitary confinement
Why do a medical project about torture?
Commonplace
Right from the start, Integritas has taught routinely about torture and ill-treatment (TAIT). This is because our business is international offender healthcare, and TAIT is commonplace in places of detention around the world.
Gap in the market
Many texts are either legal or else require prior knowledge of IHRL
We decided to write an entire book about TAIT because, viewed from our perspective as an international medical NGO with a heart for detainees, we felt there was a large gap in the literature when it came to entry level, internationally relevant, medically orientated teaching about it.
Much of what sits on library shelves and on the worldwide web is written from a legal perspective or assume prior knowledge of international human rights law (IHRL). Yet the grassroots doctors and other healthcare professionals (HCPs) interfacing with the majority of victims most certainly are not lawyers! The few medical texts tend to be both highly specialist and narrow in focus. And there’s also a great deal of stereotyped misinformation.
So we are both pleased to be offering this, our second book project, to supplement the world literature on this most tragic of subjects.
Who is it for?
Non-specialist medics
This book has been written at a level appropriate for non-specialist HCPs who, having been deployed in a place of detention anywhere in the world, find themselves face-to-face with tortured or otherwise ill-treated patients for the very first time.
As most clinicians are far from proficient in legalese, we have gone to some trouble to include lay explanations of the relevant legislation.
Primary audience
Therefore, its primary target audience is grassroots HCPs who are:
Grassroots HCPs are at the heart of our training service
working in, or considering applying to work in, places of detention - that’s police stations, jails, prisons, young offender institutions, secure children’s homes, immigration detention centres and forensic & other locked psychiatric units;
coming into contact with detainees, asylum seekers or refugees within the community - for example, in primary care centres, emergency departments or outpatient clinics;
learning about the subject as part of their undergraduate or postgraduate education.
Secondary audience
That said, it’s been written in a style accessible to all HCPs as well as non-HCPs who would like to gain a medical perspective on a particular topic.
A human rights organisation’s administrator may appreciate a written guide, to aid his/her understanding of a medical expert’s notes about examination findings.
A lawyer may appreciate a concise explanation of a torture technique that (s)he believes his/her client may have experienced.
A prison governor may appreciate reading a medical perspective on why his/her prison’s HCPs are unwilling to cooperate with the discipline staff over a particular issue.
A victim may find it informative and even therapeutic to read a medical perspective on what happened to him/her. And if, sad to say, HCPs were involved in the abuse, it may be therapeutic for him/her to learn that such errant HCPs are a distinct minority within the world of healthcare.
And you never know - by going back to basics, even a seasoned medical expert may pick up a thing or two!
But should I read it?
Distress
We have taken measures (detailed below) to lessen the potential for readers feeling traumatised from engagement with this material. However, there is no getting around the fact that learning about torture and ill-treatment can be emotionally hard-going. It is a rare (some might argue, psychologically abnormal) person who doesn’t find man’s inhumanity to man a distressing topic. Please ensure that you have adequate personal support before accessing this material. We do not have the manpower to support distressed readers. We can though signpost to Befrienders Worldwide and Samaritans UK.
Contra-indication
We urge you to read this material for the right reasons, not out of morbid curiosity. It is unsuitable for children. Even for adults, we advise caution, particularly for anyone - HCP or otherwise - with post-traumatic stress disorder (PTSD), severe mental illness, or a history of physical or sexual abuse. Anyone who has been a victim of torture or ill-treatment should not access this material without professional support.
Professional
It should also be remembered that this material is a professional resource written specifically for HCPs. It would be highly inappropriate for non-HCPs to use it with a view to trying to diagnose and treat victims of torture and ill-treatment.
What else should I know about this book?
International
This resource is multi-national
Integritas is a very small NGO, yet our HCPs are privileged to work behind bars in many different parts of the world. In contrast, the vast majority of HCPs, lawyers and large NGO workers work in just one country or continent.
We have intentionally written with a multi-national audience in mind. Location is absolutely key!
So, for example, the way that a prison HCP in a Western European member state of the Council of Europe should respond to a disclosure of torture is vastly different from the wise response of a HCP in a non-European country with an atrocious human rights record and an absent national preventive mechanism.
Non-profit permissions
This book project is decidedly non-profit!
All of the PDFs are, and will remain, free for all - free to read, download, print out, distribute both in print and electronically, and quote from. They may be included in third party materials such as PowerPoint presentations provided that our copyright is respected and that we are credited on each occasion. We do not though permit co-badging without prior permission.
Once published, the e-book (see below) will be very affordable to buy. And even that charge will be waived for anyone making a reasonable request.
None of the contributors - peer authors, editors and illustrator - were paid for their work and time. And they will not be taking e-book royalties. All e-book income will be ring-fenced into supporting our expertise service.
Who contributed to it?
Peers
We set about achieving the entry-level focus by actually using non-specialists to research and write the first draft of each chapter.
Most of these ‘peer authors’ were, at the time of their involvement, medical students studying on a special study project, Medics & Justice, which we ran for the University of Leeds up until the pandemic. In fact, it was these students who brought to our attention that their healthcare library did not contain a textbook on this subject.
Medics & Justice students learning to advocate for vulnerable patient groups through a mocked-up medico-political debate
We also involved a few qualified doctors without experience in offender healthcare. We are extremely grateful to each and every one of our peer authors. Without them, we wouldn’t have been able to achieve the entry-level, non-specialist angle anything like as easily.
Editors
We appointed two series editors who each brought complementary skills to the editing table.
Rachael is passionate about teaching this subject to HCPs
Our chief medical officer,
Dr Rachael Pickering is the senior editor. She brought expertise borne of 20 years’ experience working in international offender healthcare and her examination of countless tortured and ill-treated detainees. When necessary, she sought additional opinions from other experts and we are very grateful for their invaluable assistance.
Medical student, now Dr Alice Barber acted as junior editor until the middle of the pandemic. Coming from the same demographic as the peer authors, she brought a lovely literary flair and an incredible eye for detail. We are so grateful for all the time and effort she volunteered.
Partly due to issues arising from the pandemic, and partly because of large differences in the quality and quantity of the peer drafts, the editorial process has actually taken more than seven years!
Dr Pickering has had to make significant changes - corrections, deletions and additions - to almost all of the peer-written drafts, some far more than others. This proved necessary - to ensure accuracy, to give a consistent level of detail, and to include medically therapeutic conclusions. The result is a series of chapters that may be read in isolation but which also harmonise.
The editorial team is attempting to run the final drafts by each peer author, but this is not always possible. Most of the peers are now qualified doctors and so no longer use their student email addresses, yet several are not traceable via the UK’s NHS.net email system. We welcome contact from any such peer. For this reason as the very least, Dr Pickering has taken on the role of corresponding co-author of every chapter, and she takes responsibility for their accuracy.
Illustrator
Sarah-Louise has been illustrating with us for a decade!
Our incredibly talented volunteer medical illustrator, Miss Sarah-Louise Bedford painted all of the pictures. And we are so very grateful for all the time and skill she poured into this project.
As she is an expert by experience in locked mental health units, her paintings are grounded in the reality of hands-on knowledge about deprivation of liberty. She used oil paints for vibrant colours. And she put an awful lot of thought and consideration into the planning and detail of each painting.
We took the decision to have her paint blank faces on victims, perpetrators, and third parties such as HCPs. We minimised the depiction of blood and other body fluids. And except for the illustration of chapters dealing specifically with the abuse of women, the figures are intentionally unisex.
What’s next for this project?
e-Book
Although initially we had planned to print a hard copy of the book, escalating costs in the wake of the pandemic make that unfeasible - for now. In this day and age though, e-books seem to be the way to go - certainly in many countries. They are also so much easier to update.
An English language e-book containing all of the material is in the pipeline. We are aiming for publication around New Year 2026 or, at the latest, Easter 2026.
Translation
Eventually, we would like to have each PDF available in all seven of the most commonly used medical languages - Arabic, English, French, Mandarin, Portuguese, Russian and Spanish.
We’d also like to have the e-book published in French and possibly Spanish as well as English.
We are always looking for volunteer translators. Please get in touch if you’re interested in translating one or more of the chapters, whether into one of the seven tongues mentioned above or into another language.
Evolution
Torture and ill-treatment has existed since time immemorial. It won’t go away. Instead, it will merely continue to mutate and evolve. In response to this eternal scourge, we’d like this book to grow and evolve, with new chapters being added from time to time and old chapters revised whenever appropriate. So watch this space, and do get in touch if you’d like to make a suggestion or offer to get involved!
Continue to remember those in prison as if you were together with them in prison, and those who are mistreated as if you yourselves were suffering.
Hebrews 13:3
