A/HRC/22/56 11 cases, apparently designed to humiliate and to produce a powerful psychological response as well as severe physical discomfort and pain. Many described being suspended and restrained in stress positions while being beaten and otherwise tortured, as well as being interrogated. In some cases, restraint appears to have been designed to facilitate the administration of a particular form of torture, such as burning, electric shock, asphyxiation or sexual torture. A small number reported the use of asphyxiation techniques, including the repeated submersion of the head in water or contaminated water containing urine and faeces. One person was ‘water-boarded’ on at least five occasions. Three people were given medication by force, described as mind and mood altering and extremely distressing. 63. Given the high levels of shame and stigma attached to rape and sexual assault for men and for women, significant under-disclosure of sexual torture is highly likely among the cases in this sample. Despite this, 60% of men and women in the sample reported sexual torture including rape, molestation, violence to genitals and penetration with an instrument. Six of the 10 women experienced sexual torture. All were raped in the interrogation room or in their cell or both, all on more than one occasion, some many times and all by two or more people. Disclosure of rape in all cases was extremely problematic and clinicians recorded the intense psychological distress and flashback symptoms experienced by these women in talking about sexual torture. In some cases, disclosure was only possible after extensive counselling and in some the clinician reported being unable to facilitate a full disclosure due to the high risk of re-traumatisation. Four of the six women disclosed that they had also been subjected to sexual humiliation including forced nakedness (with clothing being violently removed), verbal abuse of an extreme sexual nature and molestation. All described being forcibly restrained while the rape and sexual assault was taking place and most were treated with extreme violence; at least four were rendered unconscious. 64. Of the twenty-four men who disclosed sexual torture, nine were subjected to rape and a further five to penetration with instruments. In some cases several perpetrators were present and participating, in the cell or in the interrogation room; all cases were forcibly restrained. Those cases who reported rape and anal penetration described brutal attacks during which they were penetrated, sometimes repeatedly, including with objects such as batons and bottles. Two other cases reported violent assault to their genitals, while a further eight described being sexually molested while being verbally abused and threatened with penetration or rape. In all cases clinicians recorded observing high levels of shame and ongoing psychological distress and significant difficulty in disclosure. Methods of psychological and environmental torture 65. Psychological and environmental forms of torture, which were highly prevalent in this case sample, included but were not limited to humiliation (40 cases), solitary confinement (34), verbal abuse (32), threat of death (22), threat to family (15), sleep deprivation (12), and mock executions (7). 66. Psychological forms of torture included the extensive and persistent use of humiliation in most cases, particularly verbal abuse and profanities directed towards the individual or members of their family (especially female family members). Being forced to perform humiliating acts (most but not all with a physical element causing pain and physical stress) and enforced nakedness or removal of clothing were also prevalent across the cases, with clinicians widely reporting the strong psychological impact of this treatment. 67. Threats, particularly of further or different forms of torture, of death and of violence to family members, were reported in 76% of cases and used to induce terror and enforce compliance, particularly to force a confession. Five people reported being given false information that their family members had died or were critically ill, or that they had been detained and tortured and had confessed to an alleged offence. Seven cases were subjected to a mock execution, where they believed that the threat of death would be imminently carried 40