Amone P'Olak Kennedy
Department of Psychiatry, Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre, The Netherlands.
Torture. 2009;19(2):102-17.
Although torture in adults is well documented, studies that document its use against children, especially during war, are rare. This study documented the use of torture against children and its physical and psychological consequences during the war in Northern Uganda.
Changes to the skin were examined by medical assistants, photographs taken, and allegations of torture verified in an interview and the case histories filed upon admission to the rehabilitation centres. The sample included 183 children aged 12 to 18 (mean age 14.8, SD 2.9) of which 60 were physically examined in two rehabilitation centres. The impact of torture was assessed using the Impact of Event Scale Revised (IES-R) in a multiple regression model.
Medical examinations showed visible evidence of physical trauma. Torture methods included burns, beatings, carrying heavy objects, gunshots, cuts with bayonets and machetes, long distance treks, etc. resulting into scars and keloids in different parts of the body. The scars were consistent with injuries inflicted on purpose. The children scored highly on the subscales of IES-R indicating severe symptoms of posttraumatic stress. The experience of torture explained between 26 to 37 per cent of the variance in symptoms of posttraumatic stress.
The physical trauma is consistent with histories and reports filed upon admission to the rehabilitation centres indicating that the children were indeed tortured. As a result of the torture, the children were psychologically distressed. The challenge for clinicians is to employ a holistic approach of treating survivors of torture by recognising not only the physical complaints but stress symptoms as well. This is because the mental states of debilitation, dependency, dread and disorientation that is induced in victims may have long-lasting consequences just like the physical and psychological consequences.
虽然成人遭受酷刑的情况有充分记录，但记录针对儿童使用酷刑的研究，尤其是在战争期间，却很罕见。本研究记录了乌干达北部战争期间针对儿童使用酷刑的情况及其身心后果。
由医疗助理检查皮肤变化、拍照，并在访谈中核实酷刑指控，同时在儿童入住康复中心时记录病历。样本包括183名12至18岁的儿童（平均年龄14.8岁，标准差2.9岁），其中60名在两个康复中心接受了身体检查。使用修订后的事件影响量表（IES-R）在多元回归模型中评估酷刑的影响。
医学检查显示有身体创伤的明显证据。酷刑方法包括烧伤、殴打、搬运重物、枪击、用刺刀和大砍刀切割、长途跋涉等，导致身体不同部位出现疤痕和瘢痕疙瘩。这些疤痕与故意造成的伤害相符。儿童在IES-R子量表上得分很高，表明有严重的创伤后应激症状。酷刑经历解释了创伤后应激症状变异的26%至37%。
身体创伤与入住康复中心时记录的病史和报告一致，表明这些儿童确实遭受了酷刑。由于遭受酷刑，这些儿童出现了心理困扰。临床医生面临的挑战是采用整体方法治疗酷刑幸存者，不仅要认识到身体不适，还要认识到压力症状。这是因为受害者所产生的虚弱、依赖、恐惧和迷失方向的精神状态可能会产生长期后果，就像身心后果一样。
