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ISTANBUL PROTOCOL IV. GENERAL CONSIDERATIONS FOR INTERVIEWS

(r) Solitary confinement and other forms of isolation; includes: (a) methods of assessment; (b) current
psychological complaints; (c) pre-torture history;
(s) Sensory overload, such as loud music, bright lights (d) post-torture history; (e) past psychological/
and prolonged interrogations; psychiatric history; (f) substance abuse history; (g) a
mental status examination; (h) an assessment of social
(t) Exhaustion from prolonged, forced exercise often in functioning; (i) psychological testing, if indicated;
combination with sleep deprivation; and (j) neuropsychological testing, if indicated.

(u) Humiliation, guilt and shame, often resulting from 374. In assessing the health consequences of torture
verbal abuse and the performance of humiliating acts and ill-treatment, it is important to consider and
on the basis of one’s identity, gender and/or (actual or to probe into the interrelationship between the
presumed) sexual orientation; physical, psychological and social consequences
of ill-treatment. For example, beatings may
(v) Threats of death, harm to family, further torture, result in chronic musculoskeletal pain, which
imprisonment and mock executions; or attacks by in turn can trigger terrifying memories, which
animals, such as dogs, cats, rats or scorpions; in turn results in social isolation. Such probing
can provide a more complete picture of the ill-
(w) Psychological techniques to break down the effects of torture or ill-treatment suffered.
individual, including forced betrayals, amplifying
feelings of helplessness, exposure to ambiguous 7. Closing and indications for referral
situations or contradictory messages and violation
of taboos; 375. To conclude an evaluation, clinicians should
review the next steps in the process of medico-legal
(x) Behavioural coercion, such as forced engagement documentation, for example forwarding a copy of their
in practices against the religion of the victim (e.g. reports to an individual’s lawyer or recommending
forcing Muslims to eat pork), forced harm to others additional tests or consultations. Clinicians should
through torture or other abuses, forced destruction of consider acknowledging the emotional difficulty
property, and forced betrayal of someone placing them of the interview, thank interviewees for their time
at risk of harm; and effort, and address any ongoing concerns or
disabilities by making appropriate referrals. The
(y) Manipulation of affect and emotions; emotional state of the interviewee should be assessed
and clinicians should take steps to mitigate signs of
(z) Forcing victims to witness torture or atrocities being stress. Clinicians have an ethical obligation to make
inflicted on others, including members of their families. appropriate referrals for medical and psychological
services if needed, particularly if there is a risk of
6. Assessments of physical and psychological self-harm or suicide. During psychological evaluations,
evidence clinicians may have reassured individuals that their
symptoms are normal reactions to extreme experiences.
373. When the evaluation of an alleged victim is conducted This is particularly helpful when individuals feel
by more than one clinician, for example one for that their symptoms are a sign of “going crazy”.
physical evidence and another for psychological Clinicians may consider reviewing this point with
evidence, the content of the interview should focus the individual at the end of the interview. Clinicians
on the information most relevant to the clinician’s should also discuss how the interview and examination
expertise. Chapters V and VI provide detailed process may exacerbate psychological symptoms.
guidance on these evaluations. In summary, the
evaluation of physical evidence includes: (a) a review 376. When clinicians detect evidence of torture or
of acute and chronic symptoms and disabilities; (b) ill-treatment, they have legal and ethical obligations
a thorough physical examination; (c) diagnostic to report such evidence to the appropriate authorities.
studies and clinical consultations, if indicated; (d) As discussed in chapter II (see paras. 174–182
the use of anatomical diagrams (see annex III) and above), the decision to report clinical evidence of
photographic documentation to describe physical torture or ill-treatment ultimately should rest on the
findings; and (e) an assessment of functional informed consent of the alleged victim. Statutory
disability. The psychological evaluation typically law may require clinicians to report evidence of

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