The Lancet on Sexual Abuse of Tamil Prisoners in Sri Lanka

The Lancet, a UK based medical Journal, is one of the most prestigious medical journals in the world. The following article was published in its most recent issue (10 June 2000)


The sexual abuse of men in detention in Sri Lanka
To estimate the frequency and consequences of the sexual abuse of men in detention in Sri Lanka, we reviewed records of all Sri-Lankan men who had been referred to the Medical Foundation for the Care of Victims of Torture between January 1997, and December, 1998. Those on whom medicolegal reports had been written were identified and the necessary information extracted. For the purposes of this paper, sexual abuse comprises assaults to the genitals, non-consensual sexual acts, and objects pushed through the anus. Rape was classed as non-consensual anal penetration with a penis.

Medicolegal reports were written by 17 doctors that supported the allegations of torture in Sri Lanka made by 184 Tamil men who had been referred during this period. During the interview and examination, an assessment was made about the demeanour of the patient, and the reliability of his history. 74 (40%) were aged between 25 and 30 at the time of the analysis, so they would have been several years younger when they were detained and tortured by the Sri-Lankan authorities, principally the army. 25 (13%) were younger than 25 when they were first seen at the Medical Foundation, 71 (38%) were aged 30-40 years, and 14 (6%) were older than 40. There was no significant difference in the proportion of each age-group who said they had been sexually abused.

Of the 184 men, 38 (21%) said they had been sexually abused during their detention. Three (7%) of the 38 said they had been given electric shocks to their genitals, 26 (68%) had been assaulted on their genitals, and four (9%) had sticks pushed through the anus, usually with chillies rubbed on the stick first. One said he had been forced to masturbate a soldier manually, three had been made to masturbate soldiers orally, and one had been forced with his friends to rape each other in front of soldiers for their "entertainment".

Of the men who said they had been sexually abused, 11 reported being raped as part of that sexual abuse; this represents 5% of the total number of men on whom reports were written. The men who had been raped were much younger, on average, than the men who said they had not been raped. This suggests that the soldiers choose the younger and more vulnerable men to rape.

Of the 38 men who had been sexually abused, only four (10%) had scarring of the genitals, and none of them were found to have significant scarring around the anus. Since there are very rarely any physical signs caused by acute sexual assault of men,1 it is not surprising that there were so few men with physical signs of their sexual abuse. The injuries were: thickening and tenderness of final 1-2 cm on urethra of a man who described a soldier pushing an object inside his penis; a scar on the base of shaft of penis of a man who said that soldiers had repeatedly slapped a heavy desk drawer shut on it; an irregularly defined defect in the foreskin of a man who said that soldiers had tied some string around his penis and pulled, tearing off a piece of his foreskin; and a cigarette burn on the scrotum of a man who said that soldiers had stubbed cigarettes out on his genitals.

Of the 184 men, 45 (24%) described a range of psychological symptoms that included difficulty getting to sleep, waking with nightmares, jumpiness and irritability, behaviour to avoid being reminded of the detention, and depression. These are all symptoms of post-traumatic stress disorder (PTSD). 29 (15%) men had many of the symptoms of PTSD, but not enough to be consistent with the full diagnosis. Of these, only two (5%) gave a history of sexual abuse. 43 (23%) of the men described disturbance of their sleep as their only psychological symptom. Of these, five (13%) had a history of sexual abuse. Two (1%) men were anxious, but had no other psychological symptoms. 65 (35%) of the men said that they did not have any psychological symptoms. Of these, ten (26%) gave a history of sexual abuse.

Sexual abuse in detention starts with forced nudity, which many of the Sri Lankan detainees described. This is usually associated with verbal sexual threats and mocking, which adds to the humiliation and degradation of being tortured. In 37 (20%) of the men in this study, this psychological sexual abuse was followed by physical abuse, and 5% were raped by or at the instigation of their captors.

There is some awareness of sexual assault in detention in Sri Lanka in the general population, and for those to whom this happened, it was a form of physical assault used in the course of interrogation. Rape of men in detention has never been discussed in the press, so those who had been raped would not have been prepared. Most said they had been taken out individually by the soldiers on guard and raped. Most were not able to describe the detail of the rape, because they did not have the language to explain what happened. They felt that they had been picked because they were young. Most were telling of the experience for the first time in their interview at the Medical Foundation. Most of these men had not told the authorities, particularly because they were too ashamed. Shame is a very real deterrent to seeking all forms of help for both male and female victims of rape.

Other difficulties for male rape victims are caused by common myths about male rape, for example, the belief that men cannot get an erection and ejaculate under duress. However, it is well-recognised that males can be physiologically sexually aroused by emotions including anger, fear, and pain.2 It is also believed that someone who had been raped would not be emotionless when describing the experience. In the initial description of the (female) "rape-trauma syndrome", victims were said to exhibit one of two styles, the "expressive" and the "controlled". In one study3 79% of male rape victims were classed as "controlled"--calm, controlled, or subdued. The other common myth is that the guards, not being homosexual themselves, would not want to commit homosexual acts. Again, however, the evidence suggests that the motivation for sexual assault of men is the demonstration of complete control over the victim,2 and that the perpetrators do not perceive themselves or their acts as homosexual.4

Torture is defined by the UN as the deliberate infliction of physical and psychological pain by or with the acquiescence of a person acting in an official capacity, with one of several intentions including the intimidation of the victim or third parties. It is an aggravated form of degrading and inhuman treatment. Sexual abuse in detention is always torture. Rape is an attack dominated by feelings of power and anger, rather than being primarily an expression of sexual desire.

We believe that sexual abuse of Tamil men in detention is common in Sri Lanka. Although in this sample the proportion was 20%, the true number is probably higher as some will not have reported it.

Sri Lanka is a signatory to the UN Convention against Torture, and as such must prevent, investigate, and punish all cases of torture. The authorities in Sri Lanka must take action now to stop the torture, sexual assault, and rape of detainees.

M Peel, A Mahtani, G Hinshelwood, D Forrest

Medical Foundation for the Care of Victims of Torture, London, NW5 3EJ, UK

1 Howitt J, Rogers D. Adult Sexual Offences and Related Matters. In: McLay WDS, ed. Clinical forensic medicine. London: Greenwich Medical Media, 1996; 193-218.

2 Groth AN, Burgess AW. Male rape: offenders and victims. Am J Psychiatr 1980; 137: 806-10 [PubMed].

3 Kaufman A, Divasto P, et al. Male rape victims: noninstitutionalised assault. Am J Psychiatr 1980; 137: 221-23 [PubMed].

4 Sagarin E. Prison homosexuality and its effect on post-prison sexual behaviour. Psychiatry 1976; 39: 245-57 [PubMed].

Courtesy: Lancet 2000; 355: 2067 - 2070