Abstract.

Background: Political violence and suppression can have complex psychological effects on society as a whole. Since access to reliable data in countries where oppression and suppression are prevalent is not easy, the process of studying and researching in these countries is difficult.

Methods and Prospects: Authors have considered integrating data from Iran, the experiences of exiles, and credible international sources on torture and widespread executions in order to examine the country’s socio-psychological situation.

The data includes cases of human rights violations, such as violence against women, harassment and persecution of political activists, torture and execution of juveniles, indicating a widespread policy of suppression in Iran over the past four decades. This policy of suppression has had a significant long-term impact on the mental health of the general public and has resulted in other social and economic problems, creating a psychological burden for the people of Iran.

Outcome: Although the mental health of society is influenced by various factors, based on the limited information we have from inside Iran, it can be speculated that these pressures significantly contribute to the increase of physical and mental problems in the country and create a difficult situation, especially for health and mental health professionals in detention centers.

Preface.:

Political violence and oppression can have psychological and social effects on different levels of society. Studying these effects in countries with high levels of oppression, such as Iran, is difficult from within the country. Some international organizations, including the World Medical Association (WMA) and United Nations agencies, present a vivid and frightening image of the country’s situation.

Before the regime change (in 1357), Iran had signed the International Covenant on Civil and Political Rights (CCPR) on April 4, 1968. However, the current regime has not signed human rights treaties such as the United Nations Convention against Torture or the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (1).

The United Nations has repeatedly expressed concern about the widespread and arbitrary use of the death penalty in Iran. Reports from the UN Special Rapporteur on the human rights situation in the Islamic Republic of Iran indicate that prisoners of conscience, including journalists, dual citizens, and protesters, are arbitrarily detained, held in inhumane conditions, and denied access to medical care (2). This is a violation of minimum standard rules for the treatment of prisoners (the Mandela Rules). In addition, the Iranian government has been preventing all UN human rights special rapporteurs from accessing the country for decades.

It is evident that there is almost no research data available on the prevalence and impact of various forms of abuse and harassment in Iran. In this paper, the authors examine independent secondary sources such as reports from the United Nations High Commissioner for Refugees and Amnesty International, as well as reputable publications that report on relevant events and accounts.

The injured have been exiled and paid attention to. Available information and observations show that (the Iranian government) frequently uses torture and execution as punishment (2) and Transparency International reports a high level of corruption (ranked 140 out of 180).

“Transparency International – Iran”).

The Oath of Physicians and Upcoming Difficulties.

Based on the World Medical Association (WMA) report, prison health officials (in some cases) prevent patients from receiving treatment and there is concern about the accuracy of documentation related to the cause of death of patients. Even doctors are forced to confirm false clinical records to cover up human rights violations (3).

It will be difficult to prosecute and punish agents of harassment and torture in international courts, as Iran has not ratified the Rome Statute of the International Criminal Court. This statute allows international courts to hold accountable and try perpetrators of crimes and human rights violations, if local governments fail to investigate and prosecute them (4).

(Dr.) Ahmad Reza Jalali, a dual citizen physician residing in Sweden and a researcher in crisis and unforeseen events management, who also teaches at universities in Italy and Belgium, has been unjustly sentenced to death. Despite having a record of international scientific collaborations, he has been prevented from receiving medical treatment since his arrest in 2016, despite his deteriorating physical condition (5).

AIDS is usually ignored in Iran because the people at risk of this disease are primarily homosexuals and injection drug users. These are two groups that face discrimination and are at risk of arrest and execution. Two doctors named Kamyar and Arash Alaei, who were providing medical care to these prisoners, were arrested (2). Iranian doctors are in a difficult position in this regard; on one hand, they are committed to their medical oath and international laws, and on the other hand, they are at risk of harassment and imprisonment by prison officials.

Historical events that have had an impact on public health.

30 studies conducted on depression in nurses show that 22% of them suffer from depression, which is higher than the prevalence of depression in the general population, while in hospitals we need nurses with good mental health (6).

The widespread prevalence of distress and mental health problems in Iran can be attributed to various factors such as economic and social conditions, and similar issues that indicate harassment and oppressive behavior towards citizens by the government.

The effects of the long-term war between Iran and Iraq (1980-1988) and the psychological disturbances caused by war (PTSD) in returning soldiers and their families as secondary victims have been somewhat studied. The authors of this research found that the level of cortisol hormone (stress hormone) in the children of returning soldiers has decreased after being exposed to war, which likely indicates the effects of psychological damage (7). On July 17, 1988, Iran officially accepted UN Resolution 598, which had been proposed in 1987, and informed the UN Secretary-General (8). Until then, Ayatollah Khomeini had prevented all efforts to end the war initiated by Iraq. Khomeini used the war conditions to suppress political opponents, execute countless individuals, and pursue the Islamic Revolution in neighboring countries (10). Only in 1988, a large number of political prisoners were executed, with Amnesty International recording the names of 4400 disappeared prisoners (11). The execution

Widespread use of torture.

The United Nations has published its findings on widespread use of torture (2) and the data from Iranian refugees, which we will discuss further, confirms the accuracy of these findings. Our information from torture victims in Iran, based on the “Istanbul Protocol” (2), indicates systematic use of various methods of torture such as psychological torture, beating the entire body, hanging, whipping, burning with cigarettes, and sexual harassment of both men and women, which has been largely confirmed by other studies (13-15).

Other research on Iranian refugees who have been tortured shows that various methods such as burning (38%), electric shock and sexual abuse (25%) have been used (13). Recently, R. Dehghan has reported widespread use of sexual abuse against Iranian refugees (14). There are also reports of anal torture of men with hard objects. Widespread torture in Iran, including before the revolution (57), is a subject that has motivated the creation of a museum called “Torture Museum” (16). In many countries, criminals are prosecuted and damages are compensated for the victims. But in a country like Iran, there is no fair and legal prosecution, and torture is carried out by government agents based on religious beliefs (17).

The assassination of Iranian Kurdish leaders in Vienna and Berlin (18) showed that even opponents of the (Iranian) government are not safe in democratic countries. Morville and his colleagues investigated a group of refugees in Danish asylum centers.

Forty-three individuals – including Iranians – who were mostly victims of torture and were between 20 and 50 years old, despite the physical and psychological damages, had significant daily activities (ADL) (19). Paribeh and colleagues examined the long-term psychological consequences of torture in the country and the differences between volunteers for treatment and those who were not volunteers for treatment (20). Thirty-four victims who are struggling with psychological consequences of torture have been studied in Germany. Depression, anxiety, and physical disorders (somatic symptoms) along with severe comorbidities (complex pain) and psychological disorders resulting from the event (PTSD) were the most common diagnoses. Volunteers for treatment showed more signs of psychological damage, especially severe psychological disorders resulting from the event (PTSD).

Based on the above data and various reports, torture is one of the common phenomena in Iranian prisons. However, there is no way to follow up on these claims in the judicial system of Iran. Two doctors working in Karaj prison, named Ramin Pourandarjani and Abdolreza Soudbakhsh, were killed after becoming aware of torture and abuse of prisoners (21).

A large portion of prisoners are minorities (religious and ethnic). In addition, minorities also face discrimination in universities. For example, many Bahais do not have the opportunity to enter universities or are expelled after being accepted (2).

Organized violence against women.

In a patriarchal society, numerous challenges, economic pressures, and physical and/or sexual violence put women’s health at risk. According to the Office of the United Nations High Commissioner for Human Rights (OHCHR), Iran has not signed the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) (1). According to the Civil Law (Islamic Republic), women are deprived of equal rights with men, including in marriage, divorce, and child custody, and are constantly suppressed for protesting against compulsory hijab. The punishment for women who do not observe Islamic hijab in public can range from flogging, up to two months in prison, or a fine (2). Several women’s rights activists have also been imprisoned (22).

In this regard, and in order to reduce domestic violence in Iran, not only the immediate removal of obstacles and the use of all methods including changing laws and budgetary, promotional, judicial and administrative measures has been proposed (23), but also a platform for victims to seek justice must be provided.

New research shows that it is necessary to improve the performance of welfare and social service organizations in order to recognize and treat domestic violence, and appropriate educational guidelines should be developed (24).

Another study on victims of sexual violence indicates that victims had significant differences in terms of sexual arousal, sexual pleasure, sexual psychoanalysis, pain, and sexual satisfaction (25).

According to the findings of the Shiraz Women’s Health Study Group, the most common disorder is social dysfunction (78%) followed by physical disorders (somatic symptoms) (62%). Psychological disorders were reported by 64% of married women, making it the most prevalent difficulty among them. Out of the total 265 participants whose husbands were in prison, 65% were found to have psychological disorders. The results of this study show that women who have experienced more time in prison suffer from psychological disorders much more than others. The study group suggested that policymakers pay more attention to the mental health of poor Iranian women (26). In addition, violence against women in northeastern Iran has also been studied. Socio-economic factors such as education level, men’s employment status, and addiction to tobacco and drugs have been identified as influential factors in the occurrence of violence against women (27). Furthermore, there is another group, known as “voluntary arsonists,” who attack women who oppose mandatory hijab and women

Mental-Emotional Well-being in Society and Among Prisoners.

As the quality of life related to health (HRQOL) is generally low among elderly Iranians, it is recommended for policymakers to strive towards improving the HRQOL of this population by providing social, economic, and psychological support (28).

Ahmad Ali and his colleagues have discovered an increase in suspected cases of mental disorders among Iranian individuals over the age of 15 between the years 1999 and 2015 by examining the mental health status of Iranians. An interesting finding of this study was that in 1999, rural residents were more at risk of developing mental disorders, while in 2015, urban residents were more susceptible to such disorders. The likelihood of developing mental disorders increases with age and is higher in individuals over 65 years old, as well as in widows, divorced individuals, and those with low levels of education (29). The prevalence of common mental disorders in Iran has increased from 21% in 1999 to 32% in 2015. The authors have concluded that policymakers and health authorities must take urgent action to improve and maintain the mental health status of at-risk individuals in the country (29).

According to repressive policies in Iran, the prevalence of mental disorders among 180 prisoners in Kashan (with an average age of 32 to 39 years) has been 43%. The most common disorders were severe depression (28%), post-traumatic stress disorder (PTSD) (17%), and substance abuse disorder (17%). 52% of prisoners with mental disorders had a history of head trauma, with about half of the prisoners suffering from it (30). Therefore, in order to prevent such mental disorders, violence and torture against prisoners must be prevented.

In the following, we will discuss some of the indicators of psychological consequences of suppression in Iranian society.

Suicide.

It has been a long time since both personal and general levels of suicide have been attributed to cultural, social, economic, and political factors of society. Another study shows that the main cause of suicide is family conflicts (32%). Other factors such as marital problems (26%), economic difficulties (12%), and educational failures (5%) have also been identified as reasons for suicide. In studies on suicide in Iran, social factors such as family conflicts and marital problems have been seen more than other factors (31%).

From this perspective, it seems that the phenomenon of suicide has caused increasing concern in recent years in society. According to another report, Iran ranks third among Islamic countries (32). Based on statistics, more than 13 people in Iran commit suicide every day, with most of them being between 15 and 35 years old. Economic hardships, mental illnesses, cultural constraints, political issues, and social pressures are the most important factors contributing to suicide in the country (32).

B – Children and Adolescents.

The prevalence of mental disorders in children and adolescents in Iran and other countries is different. The prevalence rate of obsessive-compulsive disorder among Iranian children and adolescents is between 1% to 11.9%, while this rate has been reported to be between 0.03% to 2.6% in other countries in the region. The prevalence rate of social anxiety disorder (8% to 23.5%) among Iranian children and adolescents is significantly higher compared to non-Iranian children and adolescents from four other studied communities (0.08% to 0.9%) (33).

Children who are facing execution, having gone through a legal process that is contrary to accepted international principles, are under immense pressure, including fear of imminent execution and lack of knowledge about the date of their execution. The expectation of imminent death causes even more suffering for these children and their families.

Addiction.

The consumption of illegal drugs in Iran has increased in the past decades. According to officials, the number of addicts has doubled in the past six years (34). Alcohol, opium, and marijuana are the most commonly used illegal substances. However, the growing use of anabolic steroids (synthetic testosterone), ecstasy, and psychotropic drugs has created new problems. Long-term use of opium in different regions of the country ranges from 1.2% to 8.6% (35). It is highly likely that the significant increase in drug addiction is a result of social, economic, cultural, and political imbalances in society. The Ministry of Health, Treatment, and Medical Education of Iran has reported the existence of 800,000 registered addicts in the country, with a 100% increase in just 9 years (36). According to estimates by the United Nations, the rate of use of opium-derived drugs in Iran is between 1.7% and 2.

A high percentage of Iranian prisoners are addicted to drugs and even their suicide rate is significantly higher than the overall suicide rate in Iran (42% compared to 35%) (35).

The mental difficulties of journalists.

Journalists are another group who suffer from constant political oppression and suppression. Iran ranks 173 out of 180 countries in terms of press freedom. Recently, the psychological harassment of Iranian journalists, 65.8% of whom have left the country, has been studied. These factors include arrest (41.3%), torture (19.3%), assault (10.5%), intimidation (51.4%), and threats to families (43.1%). We associate these factors with mental disorders such as PTSD and related symptoms of depression. Approximately one-third of Iranian journalists regularly use sedatives (38%).

Final review.

Medical personnel inside and outside the borders can play a valuable role in supporting the human rights of prisoners. In this regard, and according to the Istanbul Protocol, along with treating injuries, medical personnel can collect evidence of possible torture (12); which can also pose serious risks for medical personnel within the borders. The medical organization must report threats to all relevant authorities as well as to the international medical community and Amnesty International. Other forms of physical punishment such as amputation and flogging (cruel and unusual punishments prohibited by Article 5 of the Universal Declaration of Human Rights – adopted in 1948) are carried out publicly (39). Since the Iranian government prevents UN special rapporteurs from traveling to the country, all evidence of deliberate physical harm must be collected and reported to organizations such as the international medical community and the United Nations.

Result.

Due to obstacles in conducting empirical research in Iran, there is limited access to scientific reports from Iran. However, available reports and studies indicate an increase in mental health issues such as suicide, drug abuse even among young people, and violence against women. Furthermore, there is credible evidence of widespread use of torture, execution of juveniles, and continuous violation of human rights and failure to sign international conventions. As a result, political suppression can be a major factor in increasing physical and mental health problems in Iran. In conclusion, we hope that with increasing public awareness and pressure from both internal and international sources, we will see the establishment of citizen safety and justice in Iran.

A research based on the “Social Medicine” system, Volume 14, Issue 1, January to April 2021, procedures 37 to 43 (www.socialmedicine.info).

To study the 39 references mentioned in the text, please refer to the link below:

The text is a link to an article titled “The Role of Social Medicine in Promoting Health Equity”.

Explanation:

This is a research article by Cyrus Mirzaei, Homayoun Alizadeh, Seyed Zarei, and Reem Alkaseiri.