Before considering the applicable legal frameworks and some key recurring issues for victims of terrorist attacks, it is important to identify some of the effects that the resultant violations and trauma may have on the victims themselves. Sometimes, in the counter terrorism context, such factors are not always as prominent as they should be, even though, ultimately, a primary objective of rule of law based counter-terrorism efforts is to prevent victimization. In order to fully provide access to justice for victims, however, an understanding of the harm they have suffered, and the needs that arise because of that harm, is essential.
Notably, the impacts identified in this section are not intended to represent the specific experiences of all survivors of terrorist acts, but rather are descriptive of a range of responses which survivors might experience. Traumatic responses will differ between individuals and may be influenced by several factors, including the age and gender of the survivor, together with any political, religious or cultural affiliations which they hold (Baker, 1992, p. 83; Spiric et al., 2010, pp. 411-412). In addition, the socio-political-cultural context within which the trauma occurs will inform the way in which survivors interpret and respond to their experiences (Aroche and Coello, 2004, p. 56). These factors are discussed further in the context of the interrelationship between individual and societal trauma and are demonstrated through a case study example of the use of torture.
The potential effects on victims of terrorism can be devastating and multiple; it may be experienced at many interrelated levels - individually, collectively and societally. From a victimological perspective, there are three circles of 'personal victimization' which are determined in accordance with their proximity to the direct victim: " primary or first order victimization, experienced by those who suffer harm directly, whether it is injury, loss or death; secondary or second order victimization, experienced by family members, relatives or friends of primary victims; and tertiary or third order victimization, experienced by those who observe the victimization, are exposed to it through TV or radio coverage of the victimization, or help and attend to victims" (Erez, 2006, p. 20). (Italics added).
Unlike the effects of accidental injury or disease, research on the effects of crime has stressed mental, psychological and social effects, in contrast to physical or financial effects. This is attributable to the fact that crime is "qualitatively different from being the victim of an accident or disease, because it includes someone deliberately or recklessly harming you" (Shapland and Hall, 2007, p. 178). For the sake of completeness, both the potential physical and psychological consequences of terrorism are highlighted here. (See e.g. General Assembly, Human Rights Council report 19/38, para. 4).
The physical consequences of terrorism-related acts and violations can include broken bones, soft tissue injuries, disability, long-term, chronic pain and sensory disturbance. Victims may experience visceral symptoms, including cardiovascular and respiratory difficulties, intestinal and urological problems and genital complaints (IRCT, 2009(a), Part C, sects. I, II and VI). They may also suffer somatic symptoms, including headaches and back pain (Hoge, 2007). Where abuses have included rape or other forms of sexual violence, survivors may also experience gynaecological, rectal and internal haemorrhaging (Tompkins, 1995, p. 857). Medical consequences can include the contraction of sexually transmitted disease including HIV and other chronic infections, cervical cancer (directly linked to HPV, or Genital Human Papilloma Virus infection, see Ghoborah, Huth and Russet, pp. 198-199), fistula, pregnancy, miscarriage, throat agitation and reproduction problems, together with somatic symptoms such as chronic pelvic pain and hormone dysfunction (Ingeborg, 2005, pp. 73-75; Bell, 2005, p. 117; Clifford, 2008).
At a psychological level, trauma can engender "a metamorphosis of the psyche… mental decomposition and collapse" (Vinar, 2005, p. 313). This in turn can affect a survivor's sense of self (Kira, 2002, p. 54), producing identity disorientation and essentially eliciting "the devastation of one's core identity" (Rauchfleisch, 1996, cited in Hárdi and Kroó, 2011, p. 133). Man-made trauma, such as that associated with terrorism, can shatter core beliefs, including belief in the world as a just place ('the existential dilemma') (Herlihy and Turner, 2006, p. 84; Ramsay, Grost-Unsworth and Turner, 1993, p. 55), in others as kind and trustworthy individuals, and in the inviolability of the self (IRCT, 2009(b), pp. 6-7; Agger, 1992, p. 13). Survivors of terrorist acts - such as hostage taking, hijacking or kidnapping - may experience fear, shock, anxiety, shame, guilt and self-blame, anger, hostility, rage and resentment (Schmid, 2006, p. 7), together with a sense of disempowerment and helplessness. Survivors may also suffer grief for the loss of others and the self, anxiety, depression (including suicidal ideation), emotional numbness and difficulties in recollection (Brewin, 2007, pp. 227-228; Duke et al., 2008, pp. 310-320; Smith and Patel, 2008). Some victims may also experience post-traumatic stress disorder (PTSD) which, in addition to depressive symptoms, may also include intrusive phenomena such as flashbacks and nightmares, and which may persist for months or years (Shapland and Hall, 2007, p. 178).
Notably, while PTSD is one of the most commonly diagnosed mental health disorders in survivors of atrocities, the diagnosis itself is controversial amongst some clinical experts and there is disagreement as to its cross-cultural applicability (Hárdi and Kroó, 2011, p. 136; Becker, 2003; OHCHR Professional Training Series No. 8/Rev.1, para. 237). Others criticize the diagnosis because it does not reflect the political, societal or cultural context of abuse suffered by victims (Herman, 1997, pp. 118-120; Aroche and Coello, 2004), the limited list of symptoms which the diagnosis encompasses and its perceived inability to encapsulate and reflect the full symptomology of the survivor (Silove, 1999, p. 201; Hárdi and Kroó, 2011). For others still, PTSD is the 'medicalization' of what they understand to be a natural response to a deeply traumatic experience (Becker, 2003).
Research conducted on the effect of terrorist attacks on victims has revealed that acts of terrorist violence often produce high proportions of significantly affected victims, i.e. that they tend to be at the higher end on the scale of effects. For example, "[a] longitudinal psychiatric evaluation of 32 victims of a bomb attack in a Paris subway in December 1996 found 39% were rated as having PTSD after six months, with 25% still having PTSD at 32 months" (Shapland and Hall, 2007, p. 200, citing Jehel, 2003). Similarly, a study conducted by Bleich et al. concerning responses of victims of terrorism in Israel, reported that of those who responded to questions about emotional harm, over three quarters (77%) had at least some traumatic stress symptoms and almost one-tenth (9.4%) had acute stress, with over half (59%) reporting feelings of depression. It was found that the level of exposure and objective risk of an attack were not related to stress (Erez, 2006, p. 93). One explanation for this is that any victim of crime may suffer consequential effects as a response, which includes "changes in perceived risk of future victimisation" (Shapland and Hall, 2007, p. 178). As Schmid has observed, "[t]he degree of terror as well as the resilience of the individual survivor play a role [in the degree of symptoms experienced as a result of terrorist attacks." (Schmid, 2006, p. 7).
Where abuse has included forms of sexual violence, survivors may also experience sexual dysfunction, fear of intimacy, self-loathing and rejection of their body, which in turn can engender self-injurious behaviour (Yohani and Hagen, 2010, pp. 208-209).
Where injuries and abuses are perpetrated within an ongoing conflict setting, or where there is otherwise insecurity and/or destruction of the healthcare infrastructure, physical and psychological symptoms may be exacerbated by prevailing unsanitary conditions and a lack of access to clinical services or necessary medication. In the case of survivors of rape, clinical needs may go unreported due to shame and fears of social stigmatisation (Andrews, Qian and Valentine, 2002, reported in Bogner, Herlihy and Brewin, 2007), leaving survivors at risk of further injury and/or death because of unsafe, non-sterile abortion practices, infection, and suicidal ideation.
In addition to the psychological impact of terrorism-related violations experienced at an individual level, affected societies may suffer collective trauma which is particularly the case where attacks are targeted against a particular group or community. (See Alexander, 2012, who explores the development of social and cultural trauma; see also Weine, 1998, p. 1721). In such a situation, the sense of group identity and allegiance is heightened (Aroche and Coello, 2004, p. 56), producing collective solidarity, identity and mutual support (Modvig and Jaranson, 2004, p. 37). Because of that heightened allegiance, when the group, or members of it, are attacked, it may collectively experience symptoms of psychological trauma (De Jong, 2004, p. 165 and 168).
Manifestations of trauma at a societal level can include varying forms of community dysfunction. Abuses such as torture or ethnically-targeted violence may create "an order based on imminent pervasive threat, fear, terror, and inhibition,… a state of generalized insecurity, terror, lack of confidence, and rupture of the social fabric" (Lecic and Bakalic, 2004, p. 97; Kira, 2002; IRCT, 2009(a)). Societies that witness the perpetration of atrocities such as war rape and other forms of violence against community and family members may experience severe trauma (Hagen and Yohani, 2010, p. 19). Collectively, communities enter into shock, which is compounded by grief for the loss of the victim through either death, the debilitating physical and psychological impact of the violation, or, in the case of rape, familial and community rejection (Yohani and Hagen, 2010, pp. 208 and 214; Hagen and Yohani, 2010, p. 19).
Whilst the perpetration of atrocities can generate trauma at the individual and societal levels, the respective nature of individual and collective trauma may differ. Individual and collective trauma reactions can be influenced by factors such as the specific targeting of abuse and the duration or intensity of the stressor. These factors in turn affect the degree of life threat - i.e. the assessed risk of surviving the event - and hence the resulting trauma response. In particular, individually-targeted violations are more likely to represent a threat of imminent death than a repressive, longer-term and chronic stressor targeted at a specific community (Modvig and Jaranson, 2004, p. 37). Notably, while mass conflict or a prevailing threat of terrorist attack is recognized as having a widespread, psychological impact upon society, its effects will not necessarily be uniform, but will be dependent upon the extent to which specific groups were affected (Aroche and Coello, 2004, p. 57).
Far from being conceptualized discretely, however, individual and societal forms of trauma are understood as interlinked and interdependent trauma responses. Gross violations of human rights can affect the individual not only as an individual per se, but also as a member of a community or of society more generally. In particular, community or societal allegiance or affiliation, as aspects of social and cultural identity, form part of the individual's personal identity system. Clinical literature describes a 'layering' of trauma, reflecting to some extent the 'victimization circles' referred to above, such that an individual, as a member of a particular group or of society more broadly, may experience the first phase of the traumatisation process with the onset or increase in group repression or persecution (which may include elements of social and political change). The period during which the individual personally becomes a victim of serious human rights violations marks the second phase in the traumatisation process. A third phase - characterized by dislocation and exile - arises where the victim is forced to flee their home to avoid the threat of harm (van der Veer, 1998, p. 5). Moreover, the societal response to individual and collective trauma has a significant impact on the rehabilitation of individual survivors.
The combined impact of these elements can be illustrated by the example of torture. The issue of conflict-related sexual violence is discussed separately, later in this Module, and illustrates the interrelationship between individual and collective aspects of trauma.
Torture and its societal trauma
While torture is an act perpetrated against an individual, its effects are experienced on a wider social level, such that, whether implicitly or explicitly, torture represents a threat to the broader community and its value systems.
The Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, OHCHR, 1999 (the "Istanbul Protocol")*, for example, notes that:
By dehumanising and breaking the will of their victims, torturers set horrific examples for those who later come into contact with the victim. In this way, torture can break or damage the will and coherence of entire communities. (para. 235).
This broad affect is recognized and reflected in legal definitions of the term, which include third party intimidation and coercion as an underlying, purposive feature of the act. Torture against individuals is therefore employed to exercise control over communities, social groups and societies more generally, to effect responses of fear, inhibition, impotence and conformity within the affected society or community. (See Module 9 on torture more generally).
* United Nations, OHCHR (2004). Istanbul Protocol Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment . Professional Training Series No. 8/Rev.1. Geneva.
Victims, whether directly or indirectly affected, may suffer social effects, "involving changes to the victim's lifestyle, normally to avoid the situation or context in which the offence occurred. Social effects are very disruptive to the victim's lifestyle and may affect earning potential" (Shapland and Hall, 2007, p. 178). Trauma can also "impact upon the roles of parent, spouse, employee, employer, citizen etc." (Baker, 1992, p. 86), engendering a deterioration in social, educational and occupational functioning (IRCT, 2009(a), p. 7), leading to social withdrawal and isolation, as well as impacting upon societal and cultural aspects of personal identity (Kira, 2002).
In addition, there are often financial costs of terrorism that are directly associated with individuals wanting to take additional crime preventive measures. There can also be wider socio-economic effects associated with terrorism, such as businesses closing and, therefore, an increase in poverty and unemployment. In turn, as result of increased levels of poverty and unemployment in one study this was linked to an increase in property crime. An atmosphere of political violence as underpins terrorism, may also lead to an increase of violence within the affected society (Erez, 2006, p. 93). Research has further documented the powerful anxiety-inducing effect of the media when reporting on traumatic events such as terrorist attacks which, in turn, may have an adverse negative psychological effect on members of the wider population. Severe circumstances such as an active threat of terrorism "tend to increase the prevalence, and possibly also change the impact, of victimisation" (Shapland and Hall, 2007, p. 199).
Furthermore, there are several other ways in which terrorist activities and threats may have a wider impact on a person's life and community which impairs or prevents their enjoyment of other economic, social and cultural rights. Some of the primary ones are examined in below.