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IV. GENERAL CONSIDERATIONS FOR INTERVIEWS ISTANBUL PROTOCOL

13. Addressing variability and inconsistencies individuals’ psychosocial history may also be an
indicator of internal consistency, as well as the
349. The reliability of clinical evidence is often based congruency between individuals’ emotions (both
on elements of internal and external consistency. reported and observed by the clinician) and their
Internal consistency refers to corroboration coping mechanisms. Some psychological symptoms
between elements of an individual case, whereas of PTSD may refer specifically to the alleged abuse
external consistency refers to consistency between rather than other traumatic experiences. For example,
individual case findings and knowledge of torture intrusive recollections and nightmares or triggers
and ill-treatment methods and practices within a for intrusive recollections, reliving experiences and
particular region or additional witness information. avoidance thoughts and behaviour that refer to the
alleged torture or ill-treatment are more likely to be
350. Internal consistency within the context of a clinical caused by the experience of torture or ill-treatment
evaluation may be supported by a wide range of rather than by other traumatic experiences.
general and specific observations. First and foremost,
the reliability of clinical evidence is reflected in the 353. Examples of external consistency may include
level of consistency between specific allegations descriptions of torture and ill-treatment methods or
of abuse and the documentation of physical and specific devices, body positions used in applying torture
psychological findings. Similarly, the degree of and ill-treatment methods, methods of restraint during
consistency between the description of physical torture and ill-treatment, and identifying information
injuries and reports of subsequent acute symptoms, about perpetrators and places of detention. In addition,
the healing process (taking into consideration relevant other external sources of corroboration of the alleged
mitigating factors) and chronic symptoms and events may be obtained from witnesses such as other
disabilities may also support the internal consistency detainees, family, friends, legal representatives, as well
of the clinical findings. Observations of congruency as medical reports, treatment records and photographs.
between an alleged victim’s observed affect (emotional
state) during the interview and the content of the
evaluation, for example, psychological distress in C. Content of interviews
relating painful experiences, may reflect internal
consistency of the clinical findings, bearing in mind 354. All clinical evaluations of alleged or suspected cases
that appropriate affect can vary widely due to an of torture or ill-treatment in medico-legal settings
individual’s circumstances and coping mechanisms. must be conducted in accordance with the Istanbul
Principles (see annex I) summarized as follows:
351. Inconsistencies are common in the accounts of events
by victims of torture and occur for many reasons. (a) Clinical evaluators should behave in conformity
Adequate explanation of such inconsistencies should with the highest ethical standards and obtain informed
be understood as an indication of the reliability of the consent before any examination is conducted;
clinical findings rather than a matter of untruthfulness.
It is important to note that without medical knowledge (b) Clinical evaluations must:
of human anatomy and pathophysiology, most
individuals would not be able to fabricate accurate (i) Be conducted promptly and in private;
historical information regarding the physical sequalae
of specific forms of torture or ill-treatment. (ii) Conform to established standards of
clinical practice;
352. Clinicians who conduct evaluations of psychological
evidence of torture or ill-treatment may consider a (iii) Be under the control of clinical experts, not
number of additional factors that may be relevant security personnel;
to the reliability of psychological findings – for
example, the temporal relationship between the (c) Written reports must be accurate and include the
alleged abuse and onset of psychological symptoms following:
as well as fluctuations in psychological symptoms
in relation to internal and external psychological (i) Identification of the alleged victim; time and
stressors and mitigating factors. The individual location of the interview, documentation of
meaning assigned to the alleged abuse in light of any physical restraint of the interviewee and/

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