Better monitoring and evidence-gathering, the results suggest, will be crucial in helping the country overcome its criminal justice system's history of torture and abuse. And the study indicates that the incidence of torture may already be declining, as Mexico struggles to emerge from seven decades of repressive and secretive rule.
The study — based on an anonymous survey of all federal forensic doctors who perform required medical examinations on Mexican detainees — will be published in the April 23 issue of the Journal of the American Medical Association by a team from the Nobel Prize-winning human rights organization Physicians for Human Rights and the University of Michigan Health System.
The survey reveals that far more torture of detainees is occurring in the Mexican criminal justice system than has been officially reported.
Two-thirds of the doctors reported that at least one detainee they had examined in the past year alleged they had been tortured or ill-treated while in police custody. About half the doctors said they had documented evidence of such abuse in at least one detainee in the last year.
Nearly half of the physicians consider torture a severe problem facing Mexico's criminal justice system, but more than half say it has declined in the last five years.
The study was initiated by, and conducted with the full support of, the Mexican Attorney General's Office. The Mexican government of President Vicente Fox was elected in 2000 on pledges to respect human rights and the rule of law, including ensuring Mexico's adherence to international treaties against torture. No government officials were involved in the analysis or publication of the study results.
"Torture and ill treatment of detainees continues to be a significant problem in Mexico, and effective documentation of torture is necessary to prevent it and hold perpetrators accountable," says Michele Heisler, M.D., MPA, the U-M researcher who is the new paper's lead author. "This study provides baseline data that should help the Mexican government's efforts to confront and address this issue."
Most of the physicians surveyed reported that the monitoring and accuracy of the medical exams are inadequate. A vast majority said that better training, photographic equipment and standardized protocols are needed to overcome the problem.
Heisler, a former human rights program officer at the Ford Foundation, is now a lecturer in the U-M Department of Internal Medicine and an investigator at the Ann Arbor Veterans Affairs Center of Excellence. She conducted some of the analysis while she was a Robert Wood Johnson Clinical Scholar at the U-M Medical School.
"Torture and ill treatment of detainees commonly occur in more than half the world's countries, and can have devastating physical, psychological and social health consequences," Heisler explains. Groups such as PHR have sought to investigate and document the problem through medical evidence. PHR was a leading force in developing international standards for the effective investigation and documentation of torture and ill treatment, now published in a United Nations manual known as the "Istanbul Protocol."
Forensic physicians, who examine detainees while they're in police custody, are among the best potential sources of information on such torture and ill treatment — but only if they have the training and equipment to perform adequate exams, the ability to conduct exams without police oversight, and the freedom to document and report their findings openly.
Mexico requires state and federal detainees to be examined by forensic physicians, and the country's constitution and laws prohibit torture or use of pain and suffering to get information from or punish suspects, prisoners and potential informants. But under the single-party government that ruled Mexico since the 1920s, torture was known to be widespread and hidden.
Fox's rise to power and pledge to put an end to the practices have been seen as positive steps, but last month, the human rights group Amnesty International issued a report saying torture was still occurring with impunity.
In December 2001, as part of broader efforts to strengthen judicial and police procedures to prevent torture, the Mexican Attorney General consulted PHR about training and standardizing protocols for federally employed forensic physicians. As part of that consultation, the PHR and U-M researchers set out to survey all the federally employed forensic physicians and a sample of those employed by Mexico's states.
As Heisler notes, "Often, independent human rights organizations must document abuses in situations where governments are seeking to thwart any independent investigations of practices. In this case, though, it was the Mexican Attorney General's office that took the initiative in contacting PHR about helping to implement the Istanbul Protocol's recommendations in Mexico. This is the first initiative of this kind, and will be used to inform future efforts to implement the Istanbul Protocol in other countries."
Together, the state and federal forensic physicians surveyed are responsible for examining the 130,000 state prisoners and 47,000 federal prisoners, of which 62,000 and 13,000, respectively, are detainees who have been indicted but not sentenced. Exams are done at the time of detention and first court appearance.
The vast majority of the forensic physicians who received the Spanish-language survey responded, and their anonymous answers to the 80 questions were candid. Nearly all defined torture in accordance with internationally accepted definitions. In all, 93 federal forensic physicians (81 percent of those contacted) completed the survey, along with 91 state forensic physicians (92 percent of those contacted).
Among the obstacles to accurate torture documentation that the physicians cited were limited forensic evidence, which many said was due to police efforts to minimize physical signs of violence. About a third of the federal physicians and two-thirds of state physicians cited insufficient monitoring and accuracy of the exams as problems. Three-quarters of the federal physicians had never used photographic equipment to document physical signs of torture, and 58 percent said they didn't have such equipment available.
Virtually all the physicians, state or federal, said better training, increased monitoring, and a standard evaluation form could help improve documentation of torture.
"Based on these forensic doctors' reports, torture in Mexico is a significant problem and is facilitated by many different medical and legal factors," says Heisler. "But the Mexican government is taking this problem seriously. As in other countries where torture occurs, the official doctors who examine detainees can play an important role — through their investigations and documentation — to help end these practices. To do this, though, they need effective training, support and equipment, and quality monitoring. As important, they need autonomy and procedural safeguards within a broader judicial system that enforces respect for human rights."
In addition to Heisler, the study's authors include PHR researchers Alejandro Moreno, M.D., MPH, Allen Keller, M.D., and Vincent Iacopino, M.D., Ph.D., and Sonya DeMonner, MPH, of the Robert Wood Johnson Clinical Scholars Program.
Journal
JAMA