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

above and annex IV. The clinician’s opinion on has been beaten while suspended by handcuffs.
the possibility of torture or ill-treatment should be These findings can be distinguished from self-harm
expressed using the same levels of consistency as that injuries by their location on the bony aspects, and
used for interpreting findings: not consistent with, often relative symmetry, whereas self-harming
consistent with, highly consistent with, typical of and is more common on the non-dominant forearm.
diagnostic of. Ultimately, it is the overall evaluation Ligature injuries will depend on the tightness of
of all the clinical findings, and not the consistency the ligature, the nature of the ligature used, 427 and
of each lesion or symptom with a particular form the force applied, such as twisting of handcuffs or
of torture or ill-treatment, that is important in suspension and beating while handcuffed. 428
assessing allegations of torture or ill-treatment.
427. Acute abrasions resulting from superficial scraping
425. In addition to providing a conclusion on the lesions of the skin may appear as scratches, brush-
possibility of torture or ill-treatment, clinicians burn type lesions or larger scraped lesions. At times,
should reiterate current symptoms and disabilities acute abrasions may show a pattern that reflects the
and the likely effects on social functioning contours of the instrument or surface that inflicted
and provide any recommendations for further the injury. Repeated or deep abrasions may create
evaluations and care for the individual. areas of hypo or hyperpigmentation, depending on
skin type. This occurs on the inside of the wrists
if the hands have been tied together tightly.
E. Examination and evaluation
following specific forms of torture 428. Bruises are areas of haemorrhage into soft tissue due

to the rupture of blood vessels from blunt trauma. The
1. Beatings and other forms of blunt trauma extent and severity of a bruise depends not only on the
amount of force applied but also on the structure and
(a) Skin damage vascularity of the bruised tissue. Bruises occur more
readily in areas of thin skin overlying bone or in fatty
426. Acute lesions are often characteristic of torture and areas. Many medical conditions, including vitamin and
ill-treatment, because they show a pattern of inflicted other nutritional deficiencies, age and medication may
injury that differs from non-inflicted injuries in, for be associated with easy bruising or purpura. Bruises
example, their shape, size, distribution on the body and abrasions indicate that blunt force was applied to
and number. Since most lesions heal within a few a particular area. The absence of a bruise or abrasion,
weeks of torture or ill-treatment leaving no scars, or however, does not indicate that there was no blunt
non-specific scars, a characteristic history of the acute force to that area. Bruises may be patterned, reflecting
lesions and their development until healing might the shape of the inflicting instrument. For instance,
be the only support for an allegation of torture or “tramline” bruising may occur when an instrument,
ill-treatment. Permanent changes in the skin due to such as a truncheon or cane, has been used. The
blunt trauma are non-specific and usually without shape of the object may be inferred from the shape of
diagnostic significance. Prolonged application of the bruise. The colour of a bruise does not assist in
tight ligatures may result in characteristic findings, assessing age of injury. The perception of bruise colour
including a linear zone extending circularly around the varies according to skin tone and cannot be determined
arm or leg, usually at the wrist or ankle, containing accurately from images. In some skin types, bruising
few hairs or hair follicles, a form of cicatricial can lead to hyperpigmentation, which can last several
alopecia. These findings may be diagnostic of the years. Bruises that develop in deeper subcutaneous
alleged torture or ill-treatment as there are no other tissues may not appear until several days after injury,
skin diseases or injuries that could account for such when the extravasated blood has reached the surface.
findings. These findings are relatively rare, however; In cases of an allegation but an absence of a bruise,
it is more common to see short, linear, narrow scars the victim should be re-examined after several days.
over the bony sides of the wrists from handcuff It should be taken into consideration that the final
abrasions, especially in situations in which the person position and shape of bruises may bear no relationship

427 Muhammed Nabi Kantarci and others, “Evaluation of plastic and metal handcuff-related injuries under custody in medical examinations”, Turkiye Klinikleri Journal of
Medicine Sciences, vol. 33, No. 2 (2013), pp. 360–365 (in Turkish with summary in English).
428 Miriam Y. Neufeld and others, “Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol”, International Journal of
Legal Medicine, vol. 135, No. 2 (2021), pp. 583–590.

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