Kivlahan Coleen, AlSharif Mohammad, Elliott Ingrid, Pereira Agustin Garcia, Hallak Zina, Yonso Reem, Odaimi Ahmad, AlHafez Naser, Aswad Mahmoud
Department of Family Medicine, University of California San Francisco, USA.
Synergy for Justice, London, United Kingdom.
EClinicalMedicine. 2023 Dec 14;67:102373. doi: 10.1016/j.eclinm.2023.102373. eCollection 2024 Jan.
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.
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).
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.
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.
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'.
自2011年3月以来，超过100万人（大多数为男性）遭到阿萨德政权的逮捕、拘留和折磨。已发表的文献未反映男性在被拘留期间遭受性暴力和身体暴力后症状的演变情况。这项队列研究调查了叙利亚国家拘留所中与冲突相关的男性性暴力（CRSV）后自我报告症状的组合及演变情况。
对106名在叙利亚政权拘留所中遭受CRSV的男性被拘留者在十年期间（2012年至2022年）所经历的性、心理和身体症状及状况进行了评估。这些男性寻求法医专家评估（FME）以记录折磨情况，随后同意进行半结构化访谈（SSI），这发生在他们被拘留中位数8.8年后。使用标准数据收集工具在FME期间（时间3）以及SSI时（时间4）评估症状和状况，在此期间，这些男性还报告了被拘留期间（时间1）和拘留释放后（时间2）所经历的症状。
30.2%的男性被拘留超过1年，9.4%被拘留超过5年。90%的人报告曾被扇耳光、拳打脚踢、用物体击打，60.4%的男性报告遭受过多种手段的折磨，48.1%的人报告曾被烧伤或电击。在被拘留期间报告了多种性暴力类型：97.2%为强迫裸体，45.3%为对生殖器或肛门的暴力，30.2%为集体性羞辱，9.4%为强奸。男性回忆起在被拘留期间几乎普遍存在急性疼痛、伤口出血、皮肤感染、睡眠障碍、恐惧、悲伤、焦虑和绝望。到时间4时，急性身体和心理状况正在消退或不存在，而≥50%的人报告有疤痕、回避、侵入性记忆、缺乏信任、自我孤立、慢性疼痛、愤怒和自卑。通过SSI报告的被拘留后最持续存在的症状包括≥50%的男性有疤痕、疼痛、侵入性记忆和回避。在SSI时，26.4%的男性报告有勃起功能障碍，23.6%的人在性关系方面存在问题。
男性报告在CRSV、折磨和拘留多年后仍存在持续的症状和状况。男性CRSV幸存者独特的症状组合及其演变情况，尤其是愤怒、不信任和自我孤立发生率的上升，必须紧急为支持服务和医疗保健的设计与提供提供依据。
本研究由英国外交、联邦及发展办公室和艺术与人文研究理事会通过“理解和应对无形因素对叙利亚与冲突相关的男性性暴力的影响”项目资助。
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