What is falanga?
Falanga is the most common term for repeated application of blunt trauma to the feet or, rarely, to the palm(s) of the hand or the hips. Synonyms for falanga are falaka, falaqa, karma, arma, bastinad, and basinado (2).
Falanga is recognized as a method of torture in the Istanbul Protocol and should be considered an unacceptable form of treatment under any circumstance.
A Danish study from 2008 shows 40% of torture survivors among asylum seekers had been subjected to falanga (4). A Swedish study from 2009 found that 45% of torture survivors among asylum seekers had been subjected to falanga (5). Both studies show a higher frequency of falanga in men.
The use of falanga has been documented in the last two decades in Afghanistan, Algeria, Argentina, Azerbaijan, Bangladesh, Cameroon, Chile, Egypt, Eritrea, Ethiopia, Greece, India, Iran, Iraq, Israel, Jordan, Kenya, Lebanon, Libya, Mauritius, Nepal, Palestine, Peru, Spain, Somalia, South Korea, Syria, Chechnya, Turkey and Uganda (2).
There are two variations of falanga. In the first one, the victim lies on their stomach with the legs bent, the soles of the feet facing upwards. In the second one, the victim lies on their back with their feet bound by the ankles tightly to a pole. The pole may be suspended or held by two men, with the soles of the feet exposed outward. Some victims are forced to walk around in between or after the blows to increase the impact of the mistreatment (2).
Health consequences of falanga
Victims of falanga often report impaired walking, including alterations in gait pattern and reduced stride and walking speed potentially leading to chronic disability (3,7). Fractures of the tarsal, metatarsal, and phalanx bones are uncommon, but do occur (1).
Two types of pain are usually described:
1. A deep, dull cramping pain in the feet, which becomes more intense with weight bearing and muscle activity spreading up to the lower leg.
2. A superficial burning, stinging pain in the foot soles, often accompanied by sensory disturbance. Both can seriously affect daily activities (3).
Closed compartment syndrome is the most severe complication of falanga. It can lead to necrosis (irreversible muscle damage) due to vascular obstruction (blockage of a blood vessel). This can further develop into gangrene (a serious bacterial infection) of the distal portion of the foot or toes potentially leading to amputation (1).
Crushed heel and footpads which lead to loss of the cushioning effect and loss of the feet’s ability to absorb the stresses produced by walking (1).
Rupture of the plantar aponeurosis which is the connective tissue located beneath the skin of the soles of the feet (1).
Plantar fasciitis, i.e. inflammation of tissue that runs across the bottom of the foot, may occur as a future complication of falanga (1).
- There is need for treatment protocols for falanga survivors derived from a systematic study of treatment and outcome of treatment.
- There is a need for more awareness of the serious health consequences of falanga among health care personnel dealing with torture victims.
- There is a need for more collaboration between health professionals, researchers and those working with torture victims to build understanding and to evaluate and improve management.
- UN (2004). Istanbul Protocol: manual on the effective investigation and documentation of torture and other cruel, inhuman, or degrading treatment or punishment. Rev. 1. New York: United Nations; 2004. 76 p. (Professional training series).
- Rejali DM (2007). Torture and democracy. Princeton: Princeton University Press; 2007. 849 p.
- Amris K, Torp-Pedersen S, Rasmussen OV (2009). Long-term consequences of falanga torture -what do we know and what do we need to know? Torture Q J Rehabil Torture Vict Prev Torture. 2009;19(1):33–40.
- Masmas TN et al (2008). Asylum seekers in Denmark--a study of health status and grade of traumatization of newly arrived asylum seekers. Torture Q J Rehabil Torture Vict Prev Torture. 2008;18(2):77–86.
- Edston E (2009). The epidemiology of falanga--incidence among Swedish asylum seekers. Torture Q J Rehabil Torture Vict Prev Torture. 2009;19(1):27–32.
- Amris K, Prip K, Tived L (2003). Diagnostic Considerations and Treatment after Falanga Torture. RCT and IRCT; 2003.
- Prip K (2014). Disability among tortured refugees in relation to pain and sensory function in their feet: PhD thesis. Odense: Institute of Public Health, University of Southern Denmark; 2014.
- Amris K, Williams AC de C (2015). Managing chronic pain in survivors of torture. Pain Manag. 2015;5(1):5–12.
Written by: Marie My Warborg Larsen and Andreas Moses Appel
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