Health care settings should be places where human rights are realized. Yet, too often, they are places where human rights are severely abused, sometimes amounting to torture or cruel, inhuman, and degrading treatment. This abuse is especially prevalent in the care of socially marginalized groups— people living with HIV, ethnic minorities, sexual and gender minorities, people who use drugs, and people with intellectual disabilities or mental health problems—who may be deemed “deviant,” “incompetent,” and in need of evaluation or “curative” treatment through the health care system.

International law explicitly protects patients in health settings against torture. Most human rights prohibitions against torture encompass abuses ranging from torture to cruel and inhuman treatment to degrading treatment. There are a number of factors that distinguish between these three categories of abuse: (1) the severity of pain or suffering that is inflicted; (2) the intention and purpose of the infliction of the pain or suffering; and (3) the lawful sanctions inherent in or incidental to the pain or suffering. This manual is concerned with addressing any conduct covered by these categories in health care settings. This includes prisons, detention centers, and any other sites in which health care is provided.

There are many national, regional, and international mechanisms designed to promote accountability for and to prevent torture and cruel, inhuman, and degrading treatment, yet these mechanisms are rarely applied to health facilities. While human rights abuses, such as forced sterilization and abortion, denial of essential pain relief, and the use of involuntary detention as “treatment,” involve a host of different rights violations, advocacy through anti-torture mechanisms provides an additional, important tool for combating such abuses. This manual is designed as a resource for organizations that advocate against abuse in health care—including international, regional, and national human rights organizations; groups focused on particular health care abuses; anti-torture groups; and the treaty bodies themselves.

This manual describes 20 anti-torture mechanisms from the United Nations (UN) and from African, European, and Inter-American human rights systems and provides illustrative examples to explain how to use these mechanisms to fight torture in health settings. It provides a brief introduction to each system and examines the treaty-based and charter-based organs that address torture in each system. A set of questions accompanies each mechanism, exploring its mandate, procedure, possibilities for engagement, and prior work on torture in health care. The manual also includes a glossary of basic human rights terms.