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

they left scars. Clinicians should ask about the health B. Physical examination
of individuals following the traumatic events: Were
they able to walk or were they confined to bed? If 400. Typically, the physical examination is conducted
they were confined, for how long? How long did by a qualified physician at the end of the clinical
the wounds take to heal? Were they infected? What evaluation and only with the alleged victim’s consent.
treatment was received? Was it a physician or a Whenever possible, the alleged victim should be able
traditional healer? Clinicians should be aware that to choose the gender of the physician and, where used,
the alleged victim’s ability to make such observations of the interpreter. If the physician is not of the same
may have been compromised by the torture itself gender as the patient, a chaperone who is of the same
or its after-effects and should be documented. gender as the alleged victim should be offered (see
para. 283 above). Alleged victims must understand
2. Chronic symptoms that they are in control and have the right to limit
the examination or to stop it at any time. While it is
398. The clinician should elicit information on all of the important to examine the whole body, it should be
physical ailments that the individual believes were done in sections, keeping as much of the body covered
associated with torture or ill-treatment and note the as possible at any one time. Exposing the body can be
severity, frequency and duration of each symptom retraumatizing for the victim, since forced nakedness
and any associated disability or need for medical is a common form of torture. A complete examination
or psychological care, or treatment received. Even should be made, as there may be findings of which
if the after-effects of acute lesions cannot be seen victims are unaware (e.g. on their back) or which
months or years later, some physical findings may they forgot to mention when the history was taken.
still remain, such as scars, increased or reduced
pigmentation, skeletal deformities, bone abnormalities 401. Clinical evaluations of physical evidence of torture
associated with fractures, dental injuries, loss of or ill-treatment may require specialist referral and
hair and myofibrosis. Common symptoms include further investigation. Unless the alleged victim is in
headache, back and joint pain, gastrointestinal detention, it is important for physicians to have access
discomfort, sexual dysfunction and muscle pain. to physical and psychological treatment facilities, so
Common psychological symptoms include depressive that any identified need can be followed up. In many
affect, anxiety, insomnia, nightmares, flashbacks and situations, certain diagnostic test techniques will not
memory difficulties (see paras. 499–522 below). be available and their absence must not invalidate the
report. For many investigations, while a positive result
3. Importance of medical history may support the account of torture, a negative result
does not necessarily mean that torture did not occur.
399. Torture victims may have injuries that are substantially
different from other forms of trauma. Although 402. In cases of alleged recent torture or ill-treatment and
acute lesions may be characteristic of the injuries when the clothes worn during torture or ill-treatment
described, most lesions heal within weeks of torture, are still being worn by the alleged victim, they should
leaving no scars or, at the most, non-specific scars. be taken for examination without having been washed
This is often the case when torturers use techniques and a fresh set of clothes should be provided. Local
that prevent or limit detectable signs of injury. Blunt procedures for ensuring chain of evidence should be
trauma is one of the most common modes of injury followed. Wherever possible, the examination room
in torture and tends to cause mainly bruising and should be equipped with sufficient light and medical
abrasions, which may heal without lasting physical equipment for the examination. Any deficiencies
evidence. Under such circumstances, the physical should be noted in the report. The examiner should
examination may be within normal limits, but this note all pertinent positive and negative findings,
in no way negates allegations of torture. A detailed using body diagrams to record the location and
account of the person’s observations of acute lesions nature of all injuries (see annex III). Some forms
and the subsequent healing process often represents of torture, such as electric shock or blunt trauma,
an important source of evidence in corroborating may be initially undetectable, but may be detected
specific allegations of torture or ill-treatment. during a follow-up examination. Although it may
be unusual to be able to record photographically
lesions of prisoners while they are in the custody of
their torturers, photography is a useful component of

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