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ISTANBUL PROTOCOL V. PHYSICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

393. Clinical evaluations of alleged torture or ill-treatment perpetrators and places of detention. However,
should be conducted in accordance with chapters practices may change over time and vary from
IV, V and VI. The present chapter provides specific one location to another, so caution should be
information on the clinical evaluation of physical exercised when reviewing other source information.
evidence of torture or ill-treatment and, therefore, All complaints made by an alleged torture victim
should be understood as an integral component are significant. Although there may be no direct
of clinical evaluation. To the extent that physical correlation with the physical findings, they should be
evidence of torture or ill-treatment exists, it provides reported. Acute and chronic symptoms and disabilities
important confirmatory evidence that a person associated with specific forms of abuse and the
has been tortured or ill-treated. However, the subsequent healing processes should be documented.
absence of such physical evidence should not be
construed to suggest that torture or ill-treatment 396. In those seeking asylum, medical records and reports
did not occur, since such acts of violence against from the country of origin may sometimes be available
persons frequently leave no permanent marks. and may corroborate the account of past treatment of
injuries or mental health conditions due to the torture
or ill-treatment. In some cases, they may not be an
A. Medical history accurate record of the torture as they may deliberately
omit mention of torture or assault, for example in
394. The clinician should obtain a complete medical history, cases in which this requires a mandatory report that
including information about prior medical, surgical might draw the attention of the authorities. Medical
or psychiatric problems and be sure to document any records in general may only contain brief notes on a
history of injuries before each period of alleged torture condition and treatment and are typically prepared
or other ill-treatment and any possible after-effects. to convey clinically relevant information from one
Leading questions should be avoided and inquiries clinician to another or to their patient. They cannot
structured to elicit an open-ended, chronological be reviewed in the same light as a medico-legal report
account of the events experienced. If the individual is prepared by a qualified clinician and may not contain
not able to do this, clinicians should remember that an opinion about the cause of the clinical findings.
some people may have difficulty both due to the effects
of the torture or ill-treatment on them and because 1. Acute symptoms
they may come from a culture in which giving an
account of one’s own individual experiences is not 397. Individuals should be asked to describe any symptoms
prioritized. The clinician should enquire specifically and signs of injuries that may have resulted from the
about physical punishment in childhood, domestic specific methods of alleged torture or ill-treatment.
abuse and injuries from living in a conflict zone or These can be, for example, bleeding, bruising, swelling,
from military service, as these might most closely open wounds, lacerations, fractures, dislocations, joint
resemble physical signs of torture and need to be pain, paralysis, haemoptysis, pneumothorax, visual
distinguished from them. A full review of symptoms is disturbances, tympanic membrane perforation, genito-
important as it may reveal effects of torture that were urinary system injuries as associated with red or dark
not disclosed during the examination phase dealing urine, dysuria, incontinence, vaginal discharge and
with medical history, particularly, but not exclusively, bleeding, burns (colour, bulla or necrosis according
in relation to the possibility of sexual torture. to the degree of burn), electrical injuries (their colour
and surface characteristics), injuries from exposure
395. Specific historical information may be useful in to chemicals (colour and signs of necrosis), pain,
correlating regional practices of torture with numbness, constipation, incontinence of faeces or
individual allegations of torture or ill-treatment. flatus, nausea and vomiting, impaired consciousness,
Examples of useful information include descriptions seizures or gaps in their memory. The intensity,
of torture devices, body positions, methods of chronology, frequency and duration of each symptom
restraint, descriptions of acute or chronic wounds should be noted. The development of any subsequent
and disabilities and identifying information about skin lesions 418 should be described, indicating whether

418 A lesion is any physical finding in an examination or investigation. In terms of the skin, healed or healing lesions include wounds, scars and areas of altered pigmentation.
Some skin lesions may contain areas of both scarring and altered pigmentation. Inflammatory processes after injury may lead to increased or reduced pigmentation in the
affected skin. Lesions also include bony injury, neurological deficits and impaired joint function.

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