Page 138 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

deficiencies or disease. Cognitive ability and mental (a) “Not consistent with”: the finding could not have
status must also be evaluated (see paras. 523–598 been caused by the alleged torture or ill-treatment;
below on the psychological/psychiatric evaluation).
In patients who report being suspended, special (b) “Consistent with”: the finding could have been
emphasis should be placed on examining for brachial caused by the alleged torture or ill-treatment, but it is
plexopathy (asymmetrical hand strength, wrist non-specific and there are many other possible causes;
drop, and arm weakness with variable sensory and
tendon reflexes) is necessary. Radiculopathies, other (c) “Highly consistent with”: the finding could have
neuropathies, cranial nerve deficits, hyperalgesia, been caused by the alleged torture or ill-treatment and
paraesthesia, hyperaesthesia, change in position there are few other possible causes;
sense, temperature sensation, motor function,
gait and coordination may all result from trauma (d) “Typical of”: the finding is usually observed with
associated with torture or ill-treatment. In patients this type of alleged torture or ill-treatment, but there
with a history of dizziness and vomiting, a vestibular are other possible causes;
examination should be conducted and evidence of
nystagmus noted. Radiological evaluation should (e) “Diagnostic of”: the finding could not have been
include MRI or CT. MRI is preferred over CT for caused in any way other than that described.
radiological evaluation of the brain and posterior
fossae. Seizures may occur as a result of head injury, 419. Consideration of the correlation of symptoms may
and require careful history and investigation to be of particular importance when methods of torture
distinguish from panic attacks and vasovagal episodes. or ill-treatment have been used that leave no lasting
physical evidence. This may apply, for example,
to experiences of asphyxia, head injury, electric
C. Interpretation of findings shocks, suspension and stress positions, sexual
torture and environmental torture. In the correlation
417. The Istanbul Principles require clinicians to provide of examination findings with knowledge of torture
an “interpretation as to the probable relationship effects used in a particular region, the changing
of the physical and psychological findings to pattern of torture and ill-treatment over time and
possible torture or ill-treatment” (see para. 379 from one location to another should be kept in mind.
above and annex I). In this sense, “physical and
psychological findings” can include symptoms, 420. In correlating the consistency between the findings of
signs, historical information, diagnostic test results, the physical examination and the alleged torture or
photographs and prior medical evaluations. ill-treatment, the clinician should indicate the level of
The clinician should correlate the following: consistency for each individual examination finding.
If the clinician considers there are clinical reasons for
(a) To what extent is the history of acute and chronic an inconsistent finding, this should be discussed (see
physical symptoms and disabilities consistent with the paras. 342–353 and 386 above). Sometimes a group
allegations of torture and/or ill-treatment? of similar lesions or lesions with the same attribution
can be considered together and a level of consistency
(b) To what extent are the findings of the physical applied to the group as a whole. The clinician should
examination consistent with the allegations of torture consider possible causes of the physical findings as
and/or ill-treatment? (Note: the absence of physical suggested by the evidence, for example, torture or
findings does not exclude the possibility that torture or other deliberate harm, accidental injury, skin disease,
ill-treatment was inflicted.) medical procedures, cultural medical care, ritual
scarification, self-harm and deliberate infliction to
(c) To what extent are the findings of the examination fabricate evidence of injury. It is common for there
consistent with known torture methods and their to be attribution of some physical findings on the
common after-effects used in a particular region? body to causes other than torture, such as accidental
injury, or for there to be physical findings for which
418. In conducting evaluations of physical evidence of the person cannot recall the cause. An individual may
alleged torture or ill-treatment, clinicians should innocently mistake a physical finding for torture (e.g.
consider the following terms for levels of consistency: striae distensae on the lower back) because they did
not notice it before the alleged torture or ill-treatment

99