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Medical Report and History
of Shin Dong-hyuk

As of July 9, 2007


Prepared by Dr. Gill Hinshelwood MB BS 1963
London University College Hospital Medical School

Dr. Hinshelwood was Senior Physician, Medical Foundation for the Care of Victims of Torture for 16 years, 1989-2005.

Dr. Hinshelwood has gained extensive experience (over 3,000 torture victims) of documenting torture and organized violence, and of the follow up treatment.

Dr. Hinshelwood examined Mr. Shin Dong-hyuk in London on 22 June 2007. Attached is her medical report of Shin Dong-hyuk.

Medical Report

Shin In-kun (N Korean name)
Shin Dong-hyuk (S Korean name)
D.O.B 19th November 1982
Citizen of S Korea

Introduction

Mr Shin is a twenty four year old citizen of S Korea. He has been in the UK for a few days as a guest of Christian Solidarity Worldwide who are documenting his history. He is a single man with no dependants. I have read the testimony taken by CSW. I have seen and examined Mr Shin with the help of a male interpreter on 22,6,07.

History

Mr Shin gave me the following history. He was born in a prison camp in N Korea where his parents were prisoners. He lived with his mother until he was aged 12 years, and thereafter was housed in men’s accommodation. His father was housed elsewhere and he saw very little of him. He had an older brother. He had schooling with other children of the camp. When he finished his education he worked on the machines in a garments factory, mainly making uniforms. Schoolchildren also had to labour from an early age. Mr Shin has made a very full statement about his life in the camp and I will not repeat it in this report.
Mr Shin has no memory of any tenderness from his mother. She worked long hours as a farmer and he supposes that he was left alone during that time, possibly tied to keep him out of the way.

He recalls a life of daily physical and mental cruelty from the guards, teachers, and other prisoners. These included being beaten, kicked, pushed and dragged, and having stones thrown at him. Living conditions were basic and food always scarce. His daily food consisted of corn and other vegetables heavily salted. The prison regime was harsh for all inmates and Mr Shin can recall countless injuries and deaths of prisoners through accidents and deliberate punishments. Mr Shin said his mother beat him severely once, for picking up a cucumber on their way back from the fields. There was always mistrust and Mr Shin made no close friendships. He said he knew no other life and had no curiosity.

Mr Shin has described a major incident when he was aged 14 years. His mother and older brother were arrested for trying to escape.

He says that on the morning of 6.4.96 he was handcuffed, blindfolded and driven to an unknown place. He learned about his mother and brother and was interrogated about his knowledge and part in the plot. He had no information to give.

He was left in a small cell overnight and the next day taken to another room. Here he was stripped and his hands and feet tied.

He was suspended from the ceiling by his arms and legs while being questioned. A fire was kindled on the floor under his back. The pain made him scream and writhe. When he did this a torturer forced a hook into the skin in his pubic area so that he could not struggle. He fainted.

Mr Shin does not know for how long he was unconscious. He regained consciousness in a cell. He was in great pain, and he had urinated and defaecated. His wounds became infected. He became weaker and feverish. He says that the guards refused to enter his cell because he smelled so bad. They just pushed food through the door. There were no toilet facilities. He was then moved into a cell with another prisoner, an older man who had been there a long rime.

Mr Shin has described how this older male prisoner helped him regain his strength and health and give him the will to live. He was in the cell for seven months. When he was taken from the cell he saw his father briefly and realised that he too had been tortured for the same reason. Mr Shin and his father were forced to watch his mother hanged and his brother killed by firing squad for attempting to escape.

Thereafter Mr Shin was routinely ill-treated by the camp authorities for being the relative of executed prisoners. He was given harder work and beaten more frequently by his teachers and camp officials. He became nervous and isolated.

After leaving school he was assigned to work in a garment factory, repairing machines. On one occasion he was carrying a machine and dropped it. He was grabbed by guards, and dragged to a table He was forced to kneel on the floor and his right hand was held on the table while a guard chopped the tip of his middle finger off. Mr Shin screamed. He did not faint.

When he looked the tip was hanging off, still attached with a bit of skin which he pulled. He then went to the camp clinic to have it cleaned and dressed.

Mr Shin described witnessing countless severe accidents involving gross injuries and loss of life. He has also seen others subjected to cruel punishments and killed. He says he knew of no other way of life. He did hear about individuals who committed suicide, but did not consider this himself.

Mr Shin has described how in 2004 he was working with a prisoner who had lived in the outside world and who described a different way of life. He says he resolved to escape with this man and together they watched for an opportunity.

On 2,1,05 they were working near the perimeter barbed and electrified wire fence. They saw an opportunity and made a dash for it. His fellow prisoner died on the wire. He sustained burns and deep cuts to both legs, and received an electric shock, but somehow managed to keep going and ran.

The wounds on his legs became infected and took many months to heal. He found a way of surviving in N Korea for about 20 days until he was able to escape to China and eventually to S Korea, where he now lives.

Past Health

Mr Shin says that he was always thin and hungry as a child, and added that he presumes that if he had had serious health problems he would not have survived childhood. He does not recall ever seeing a doctor. There was a clinic at the camp which dispensed first aid. He had wounds dressed on a number of occasions, the most serious being when his finger was deliberately cut. When he had severe burns as described above his injuries were dressed by his fellow cell mate, and took many months to heal. He did not receive any medical assistance for these from the camp officials.

He says he was in a deplorable condition when he first arrived in China. He was under-nourished, his leg wounds became grossly infected, and he was fearful all the time.

Nevertheless he was able to do physical work in a logging camp in China. With the money he earned he was able to eat well and treat his wounds. By the time he had spent a year in China his weight was 76 kg, and scars healed and he spoke basic Chinese. In S Korea when he was no longer compelled to work, he had time to think and this was when his most severe mental symptoms began to appear, some of which are present to date.

Present Health

Mr Shin’s main complaint is of insomnia. He can only get to sleep if he is really exhausted with physical activity. Up to a month ago he was suffering nightmares. In these bad dreams he was always back in the prison camp with its terrifying regime and all powerful guards chasing him. There was much fear and he would awaken in a panic, screaming, thinking he was really back in the camp. His mouth and jaw were in pain, his teeth felt as if they were being pulled and his heart was pounding fiercely.

These nightmares became so frightening that he tried not to sleep, and was consequently very fatigued during the day. Mr Shin has received some medication for these in S Korea and they have lessened in frequency and severity. He is no longer taking medication.

He finds it hard to get to sleep even when he is tired, because as soon as he lies down his mind seems to become overactive, memories of all he has been through going round and round in his head.

Since he left China and has been in S Korea his weight has fallen to 61kg. Mr Shin has no appetite. He will eat what is put in front of him, but has no anticipation or desire for a meal. He has no symptoms of gastrointestinal disease. He has had some dental treatment and his teeth are satisfactory. His bowels are normal.

Mr Shin has no urinary tract problems, no respiratory complaints and does not complain of any musculo-skeletal disorder.

Mr Shin mentioned his mental state many times. He suffers frequent flashbacks of frightening events in the camp. During these episodes he finds his heart beating fast and he feels great fear. He needs to look around for a familiar object in his new life to reassure himself. He sometimes feels blank in the head. His interpreter who knows him well reported that Mr Shin often gazes blankly ahead, appearing oblivious to his surroundings, deaf to conversation around him.

He says he becomes filled with anger at what has happened to him and has a great hunger for what he has now learned that he has missed out on. He describes very up-and-down mood swings, with tearfulness, despair, anger and relief taking him over in ways which make him feel out of control.

On Examination

Mr Shin is a lean man, weighing 61kg. His cardiovascular and respiratory systems are normal. He has no abdominal masses. His vision and hearing are normal. His teeth are satisfactory and his skin is clear.

He has no evidence of neurological damage or deficit.

I did not test his urine but he reports no problems with his genitourinary system.

He has full movements of his musculoskeletal system.

Both arms show a curious abnormality. When they are fully extended laterally from the shoulder, the lower arms bend downwards from the elbow about 20 degrees from the horizontal. Mr Shin says he was unaware of this being different, until one day after he had escaped he and his interpreter met a former prison guard, who recognised him. ‘Look at his arms’ he pointed out. ‘It is not that uncommon in the camps. We think it is caused by the extremes of hard physical labour.’ It is symmetrical, painless, and does not interfere with his strength or dexterity. I have not seen this before and an orthopaedic opinion would be interesting, but not essential for his wellbeing.

It may be congenital, or related to vitamin and mineral deficiencies in early childhood, coupled with physical hardship.

Mr Shin has a concave area at the back of his head. He has never been aware of it. There are no scars on this area and his hair grows just as well in this part. It is most likely to be congenital. He says he was hit on his head countless times during his life in the camp. In my opinion the types of beatings he describes are not likely to be the cause of this skull variation.

Scars

Mr Shin has a number of scars resulting from his injuries sustained in the camp.

1. He has a 1.5cm diagonal linear scar at the outer aspect of his left eye. He says he was hit with a stone when he was aged 11 years. The appearance is consistent with this history.

2. He has a 3 cm well-defined vertical linear scar with 6 suture marks on his left shoulder. This was an injury sustained during childhood but he cannot recall the incident.

3. Across his lower back he has an extensive diamond shaped area of scarring, measuring 40 cm horizontally by 20 cm vertically. Within this scarred area are patches of much more severe skin damage. The scarring is highly consistent with Mr Shin’s history of being suspended over a fire by his arms and legs. It is also consistent with the length of time the burns took to heal, and the development of secondary infection of his burns.

4. Mr Shin has an oval scar 6 cm by 4 cm on his right side which he attributes to a burn sustained in the same incident. The scar is consistent with this history.

5. Within his pubic hairline Mr Shin has two small round raised keloid scars, 0.75 cm in diameter, about 5 cm apart horizontally. These have been attributed to injuries caused by a hook which was inserted into Mr Shin’s flesh and held rigidly in place. This was to stop him moving his body to avoid being burned by the fire in the incident cited above. These scars are consistent with this history.

6. His right middle finger is very slightly shorter than the left one. The nail is absent, apart from a small, 0.5cm bit of nail growing from a bed on the palmar surface of his finger tip. There is also scarring at the tip. This is consistent with his history of the tip of his finger being cut off.

7. On his right shin there is an area of severe scarring, 15 cm vertically by 9 cm across. This is related to wounds sustained when Mr Shin broke through the barbed and electrified wire surrounding the camp, during his escape. Mr Shin says that the original wounds were smaller, but they became infected and further damaged by his rough living and lack of medical treatment. They took many months to heal.

8. On his left shin is an area of scarring 9 cm by 6 cm. This was sustained at the same time and in the same way as above. These two areas of scarring are consistent with Mr Shin’s history of escape, and his way of life in his first year of freedom, as described in his statement.

9. Mr Shin has 3 small irregular discreet areas of scarring around his right ankle. At the medial aspect the scar is 2.5cm by 1cm. Laterally he has 2 smaller, slightly keloid 1 cm scars.

10. Mr Shin has similar but smaller scars around his left ankle. He relates both sets of ankle scars to the chains used to suspend him over the fire when he was aged 14 years. The scars are highly consistent with this history.

11. On his right instep he has a diagonal well-defined 2 cm linear scar. He relates this to a wound caused by the barbed wire when he escaped, and this is possible.

Mental State

Mr Shin was alert and responsive throughout our meeting. He answered appropriately and there was no evidence of thought disorder. He was orientated in time and space, He understood the purpose of the consultation. He made eye contact with both the interpreter and myself. He did not volunteer information except when we were looking at his scars, and then he was more forthcoming and was able to give a very clear picture of how he was assaulted and tortured. About other aspects of his health he preferred to be questioned so I endeavoured to make questions as open ended as possible.

The emotion he spoke about the most was fear of ever being recaptured. He fears all men in uniform and as he spoke about this he looked around fearfully. There were a few flashes of anger about his deprived life. He showed no grief when he spoke about the killing of his mother and brother, or the death of his fellow prisoner when he escaped.

Mr Shin showed very little curiosity, and in conversation about this he volunteered that wanting to know is a dangerous mindset in the prison camp. He does not have any ideas about the rest of his life. He did not express thoughts or ideas that would suggest a clinical depression. He had an air of passivity about him.

Summary

Mr Shin is a 26 year old man, who was born in a prison camp in N Korea and who lived under harsh prison conditions until he was aged 24 years. He was emotionally physically and materially deprived from birth. He was physically abused all his prison life and tortured on at least three occasions. He made a successful escape and is now a citizen of S Korea. He has scars which are consistent with his history of torture and escape. He has suffered many of the symptoms of post traumatic stress disorder, especially panic attacks, nightmares and flashbacks.

He has had treatment for this in Seoul, and these are lessening but still dominate his day-to-day existence. He is frequently in the grip of the emotions of fear and anger. He has a flat and a small allowance. He is in touch with a Human Rights Institute caring for defectors from N Korea. This is a research organisation and Mr Shin assists and spends much of his time in the company of a colleague there. He does not like to be alone for long periods because his thoughts trouble him.

Mr Shin did not give a history of sexual abuse, but it is unusual for this to be volunteered. This is something I would have liked to have explored in a second interview. He says that he has had no relationships with women, and when I wondered if he had them with men the subject was changed with a non-sequitur which I decided not to challenge, in a one-off interview using an interpreter with whom I had not discussed the issue before.

Mr Shin has no plans for the future. He is concerned primarily about safety.

Gill Hinshelwood MB BS
9 July 2007