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

examinations. If a camera is available, the clinician 2. Face
should obtain the best photographs possible and
supplement them with detailed descriptions and 405. The face should be palpated for evidence of fracture,
body diagrams, then follow up with professional crepitation, swelling or pain. All cranial nerves
photographs as soon as possible (see para. 234 above). should be examined. Appropriate radiological
Specific informed consent is needed for photographs, techniques should be used when possible to
including an explanation of their nature and purpose, confirm facial fractures, determine alignment
and protocols should be in place for intimate images and diagnose associated soft tissue injuries and
with regard to how they are stored and who may view complications. Intracranial and cervical spinal
them. Image quality may vary widely and a number injuries are often associated with facial trauma.
of practical guidelines are available. Images can be
taken on a variety of devices, including smartphones (a) Eyes
and tablets. Clinicians should always ensure that
rules and colour scales are included. Cross-polarized 406. Direct trauma to the eyes can present in many
light photography can also demonstrate some blunt ways, including conjunctival haemorrhage, lens
trauma injuries no longer visible on the skin. dislocation, subhyaloid haemorrhage, retrobulbar
haemorrhage, retinal haemorrhage, traumatic optic
403. It should be noted that if a lesion cannot be neuropathy, ruptured globe and visual field loss.
seen on a photograph it does not mean that it Specific injuries to the globe can cause scars from
was not there, especially if the clinician is not a choroidal haemorrhage or an irregular pupil from
trained forensic photographer with good quality injuries to the iris. Ophthalmologic consultation
equipment. When there are no skin lesions, bone should be obtained whenever there is a suspicion of
scintigraphy may be a useful method to detect ocular trauma or disease. Radiological techniques
non-fracture bone lesions following beatings, must be used to confirm orbital fractures and soft
particularly when torture has been prolonged. 419 tissue injuries to the bulbar and retrobulbar structures.
Forced solar gazing can cause eye damage, including
1. Skin burns to the retina. Retinal examination should also
be conducted to rule out retinal bleeding, which may
404. The examination should include the entire body be associated with whiplash/impact head trauma.
surface in order to detect signs of generalized skin
disease, including signs of vitamin A, B and C (b) Ears
deficiencies, pre-torture lesions or lesions inflicted
by torture, such as abrasions, bruises, pigmentation 407. Trauma to the ears, especially rupture of the tympanic
changes, lacerations, puncture wounds, burns from membrane, is a frequent consequence of harsh
cigarettes, chemicals, scalding liquids or heated beatings. The ear canals and tympanic membranes
instruments, electrical injuries, incised wounds, should be examined with an otoscope and injuries
alopecia and nail removal. Torture lesions should be described. A common form of torture, known in Latin
described by their localization, symmetry, shape, size, America as teléfono, is a hard slap of the palm to one
colour and surface (e.g. scaly, crusty or ulcerating), or both ears, rapidly increasing pressure in the ear
as well as their demarcation and level in relation canal, thus rupturing the tympanic membrane. This
to the surrounding skin. Clinicians should note if type of impact may also cause ipsilateral subdural
normal hair growth is absent or there are any areas bleeding, which may need to be explored by CT scan.
of numbness. Lesions may be described as fresh/acute Prompt examination is necessary to detect tympanic
or healed. Photography is recommended whenever membrane ruptures, which may heal within 10 days,
possible. For injury interpretation it is useful to although healing may be delayed. Fluid may be
consider if the lesion is a pigmented or depigmented observed in the middle or external ear. If haemotorrhea
lesion, a scar or contains areas of scarring. is confirmed by laboratory analysis, MRI or CT should
be performed to determine the fracture site. The
presence of hearing loss should be investigated, using
simple screening methods. If necessary, audiometric

419 Onder Ozkalipci and others, “A significant diagnostic method in torture investigation: bone scintigraphy”, Forensic Science International, vol. 226, No. 1–3 (2013), pp. 142–
145.

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