Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context
Summary: Background: Since March 2011, more than 1 million people, mostly men, have been arrested, detained, and tortured by the Assad regime. Published literature does not reflect the evolution of symptoms after male sexual and physical violence in detention. This cohort study examines the constel...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537023005503 |
| _version_ | 1797347068492120064 |
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| author | Coleen Kivlahan Mohammad AlSharif Ingrid Elliott Agustin Garcia Pereira Zina Hallak Reem Yonso Ahmad Odaimi Naser AlHafez Mahmoud Aswad |
| author_facet | Coleen Kivlahan Mohammad AlSharif Ingrid Elliott Agustin Garcia Pereira Zina Hallak Reem Yonso Ahmad Odaimi Naser AlHafez Mahmoud Aswad |
| author_sort | Coleen Kivlahan |
| collection | DOAJ |
| description | Summary: Background: Since March 2011, more than 1 million people, mostly men, have been arrested, detained, and tortured by the Assad regime. Published literature does not reflect the evolution of symptoms after male sexual and physical violence in detention. This cohort study examines the constellation and evolution of self-reported symptoms after male conflict-related sexual violence (CRSV) in Syrian state detention. Methods: Sexual, psychological, and physical symptoms and conditions experienced by a cohort of 106 male detainees after CRSV in Syrian regime detention were evaluated over a ten-year period (2012–2022). Men sought forensic medical expert evaluations (FMEs) to document torture and later consented to semi-structured interviews (SSIs), a median of 8.8 years after their detention. A standard data collection tool was used to assess symptoms and conditions during FMEs (Time 3), and at the time of the SSI (Time 4), during which men also reported symptoms experienced during detention (Time 1) and after detention release (Time 2). Findings: 30.2% of men spent more than 1 year in detention and 9.4% were detained >5 years. 90% reported being slapped, punched, kicked, hit with objects, 60.4% of men reported torture with multiple devices, and 48.1% reported being burned or electrocuted. Multiple sexual violence types were reported during detention: 97.2% forced nudity, 45.3% violence to genitals or anus, 30.2% collective sexual humiliation, and 9.4% rape. Men recalled nearly universal presence of acute pain, bleeding wounds, skin infections, sleep disturbances, fear, sadness, anxiety, and despair during detention. By Time 4, acute physical and psychological conditions were fading or absent, while scars, avoidance, intrusive memories, lack of trust, self-isolation, chronic pain, anger, and low self-esteem were reported by ≥50%. The most persistently reported symptoms following detention through the SSI included scars, pain, intrusive memories, and avoidance in ≥50% of men. At the SSI, 26.4% of men reported erectile dysfunction and 23.6% challenges with sexual relations. Interpretation: Men reported persistent symptoms and conditions years after CRSV, torture and detention. The unique constellation of findings and their evolution in male CRSV survivors, particularly increasing rates of anger, distrust, and self-isolation, must urgently inform design and delivery of support services and health care. Funding: This study was funded by the United Kingdom Foreign Commonwealth and Development Office and the Arts and Humanities Research Council through the project ‘Understanding and Addressing the Impact of Invisibility on Conflict-Related Male Sexual Violence in Syria'. |
| first_indexed | 2024-03-08T11:42:22Z |
| format | Article |
| id | doaj.art-4fc1cf5d2da647b2bd8e156f7c2b2db8 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-08T11:42:22Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-4fc1cf5d2da647b2bd8e156f7c2b2db82024-01-25T05:23:31ZengElsevierEClinicalMedicine2589-53702024-01-0167102373Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in contextColeen Kivlahan0Mohammad AlSharif1Ingrid Elliott2Agustin Garcia Pereira3Zina Hallak4Reem Yonso5Ahmad Odaimi6Naser AlHafez7Mahmoud Aswad8Department of Family Medicine, University of California San Francisco, USA; Synergy for Justice, London, United Kingdom; Corresponding author. Department of Family and Community Medicine, University of California San Francisco, USA University of California, San Francisco, USA.Lawyers and Doctors for Human Rights, https://ldhrights.orgSynergy for Justice, London, United KingdomInsight Centre for Data Analytics, University of Galway, Galway, IrelandLawyers and Doctors for Human Rights, https://ldhrights.orgLawyers and Doctors for Human Rights, https://ldhrights.orgLawyers and Doctors for Human Rights, https://ldhrights.orgLawyers and Doctors for Human Rights, https://ldhrights.orgLawyers and Doctors for Human Rights, https://ldhrights.orgSummary: Background: Since March 2011, more than 1 million people, mostly men, have been arrested, detained, and tortured by the Assad regime. Published literature does not reflect the evolution of symptoms after male sexual and physical violence in detention. This cohort study examines the constellation and evolution of self-reported symptoms after male conflict-related sexual violence (CRSV) in Syrian state detention. Methods: Sexual, psychological, and physical symptoms and conditions experienced by a cohort of 106 male detainees after CRSV in Syrian regime detention were evaluated over a ten-year period (2012–2022). Men sought forensic medical expert evaluations (FMEs) to document torture and later consented to semi-structured interviews (SSIs), a median of 8.8 years after their detention. A standard data collection tool was used to assess symptoms and conditions during FMEs (Time 3), and at the time of the SSI (Time 4), during which men also reported symptoms experienced during detention (Time 1) and after detention release (Time 2). Findings: 30.2% of men spent more than 1 year in detention and 9.4% were detained >5 years. 90% reported being slapped, punched, kicked, hit with objects, 60.4% of men reported torture with multiple devices, and 48.1% reported being burned or electrocuted. Multiple sexual violence types were reported during detention: 97.2% forced nudity, 45.3% violence to genitals or anus, 30.2% collective sexual humiliation, and 9.4% rape. Men recalled nearly universal presence of acute pain, bleeding wounds, skin infections, sleep disturbances, fear, sadness, anxiety, and despair during detention. By Time 4, acute physical and psychological conditions were fading or absent, while scars, avoidance, intrusive memories, lack of trust, self-isolation, chronic pain, anger, and low self-esteem were reported by ≥50%. The most persistently reported symptoms following detention through the SSI included scars, pain, intrusive memories, and avoidance in ≥50% of men. At the SSI, 26.4% of men reported erectile dysfunction and 23.6% challenges with sexual relations. Interpretation: Men reported persistent symptoms and conditions years after CRSV, torture and detention. The unique constellation of findings and their evolution in male CRSV survivors, particularly increasing rates of anger, distrust, and self-isolation, must urgently inform design and delivery of support services and health care. Funding: This study was funded by the United Kingdom Foreign Commonwealth and Development Office and the Arts and Humanities Research Council through the project ‘Understanding and Addressing the Impact of Invisibility on Conflict-Related Male Sexual Violence in Syria'.http://www.sciencedirect.com/science/article/pii/S2589537023005503Syrian Arab RepublicMalesCRSVTortureDetentionSRH |
| spellingShingle | Coleen Kivlahan Mohammad AlSharif Ingrid Elliott Agustin Garcia Pereira Zina Hallak Reem Yonso Ahmad Odaimi Naser AlHafez Mahmoud Aswad Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context EClinicalMedicine Syrian Arab Republic Males CRSV Torture Detention SRH |
| title | Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context |
| title_full | Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context |
| title_fullStr | Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context |
| title_full_unstemmed | Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context |
| title_short | Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolutionResearch in context |
| title_sort | long term physical and psychological symptoms in syrian men subjected to detention conflict related sexual violence and torture cohort study of self reported symptom evolutionresearch in context |
| topic | Syrian Arab Republic Males CRSV Torture Detention SRH |
| url | http://www.sciencedirect.com/science/article/pii/S2589537023005503 |
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