Page 143 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

minutes or less, but may be repeated many times (a) Compartment syndrome. This is the most severe
over a period of days or weeks. Radiological complication. Oedema in a closed compartment results
and retinal examinations are recommended. in vascular obstruction and muscle necrosis, which
may result in fibrosis, contracture or gangrene in the
(d) Chest and abdominal trauma distal foot or toes. It is usually diagnosed by measuring
pressure in the compartment;
439. Rib fractures are a frequent consequence of beatings
to the chest. If displaced, they can be associated with (b) Crushed heel and anterior footpads. The elastic
lacerations of the lung and possible pneumothorax. pads under the calcaneus and proximal phalanxes are
Fractures of the vertebral pedicles may result from crushed during falanga, either directly or as a result
direct use of blunt force. When rib fracture is of oedema associated with the trauma. Also, the
suspected, plain radiographs should be obtained. connective tissue bands that extend through adipose
tissue and connect bone to the skin are torn. Adipose
440. In cases of acute abdominal trauma, the physical tissue is deprived of its blood supply and atrophies.
examination should seek evidence of abdominal organ The cushioning effect is lost and the feet no longer
and urinary tract injury. However, the examination absorb the stresses produced by walking;
is often negative. Gross haematuria is the most
significant indication of kidney contusion. Peritoneal (c) Rigid and irregular scars involving the skin and
lavage may detect occult abdominal haemorrhage. Free subcutaneous tissues of the foot. In a normal foot,
abdominal fluid detected by radiological investigation the dermal and subdermal tissues are connected to
after peritoneal lavage may be from the lavage or the planter aponeurosis through tight connective
haemorrhage, thus invalidating the finding. Organ tissue bands. However, these bands can be partially
injury may be present as free air, extraluminal fluid or completely destroyed due to the oedema, which
or areas of low attenuation, which may represent ruptures the bands after exposure to falanga;
oedema, contusion, haemorrhage or a laceration.
Peripancreatic oedema is one of the signs of acute (d) Rupture of the plantar aponeurosis and tendons
traumatic and non-traumatic pancreatitis. Ultrasound of the foot. Oedema in the post-falanga period may
is particularly useful in detecting subcapsular rupture these structures. When the aponeurosis cannot
haematomas of the spleen. Renal failure due to crush tighten normally, the supportive function necessary
syndrome may be acute after severe beatings. Renal for the arch of the foot disappears, the act of walking
hypertension can be a late complication of renal injury. becomes more difficult and foot muscles, especially the
quadratus plantaris longus, are excessively forced and
2. Beating of the feet become fatigued. Passive extension of the big toe may
reveal whether the aponeurosis has been torn;
441. Falanga, or falaka, are the common terms for repeated
application of blunt trauma to the feet (or more (e) Plantar fasciitis. This may occur as a further
rarely to the hands or hips), usually applied with complication of foot beatings. In cases of falanga,
a truncheon, a length of pipe or similar weapon. irritation is often present throughout the whole
Victims may describe the pain going right through to aponeurosis, causing chronic aponeurositis. Studies
their head. Because the injuries are usually confined on the subject have shown that, in prisoners released
to soft tissue, CT or MRI are the preferred methods after 15 years of detention who claimed to have been
for radiological documentation of the injury, but it subjected to falanga when first arrested, positive
must be emphasized that physical examination in bone scans of hyperactive points in the calcaneus or
the acute phase should be diagnostic. Falanga may metatarsal bones were observed; 433
produce chronic disability. Walking may be painful
and difficult. Squeezing the plantar (sole) of the foot (f) Permanent deformities of the feet. Such deformities
and dorsiflexion of the great toe may produce pain. are uncommon but do occur, as do fractures of the
tarsal bones, metatarsals and phalanges. Tarsal bones
442. Numerous complications and syndromes can occur: 432 may be fixed or have increased motion;

432 Kristine Amris, Søren Torp-Pedersen and Ole Vedel Rasmussen, “Long term consequences of falanga torture – what do we know and what do we need to know”, Torture,
vol. 19, No. 1 (2009), pp. 33–40.
433 Veli Lök and others, “Bone scintigraphy as clue to previous torture”, Lancet, vol. 337, No. 8745 (1991), pp. 846–847. See also Mehmet Tunca and Veli Lök, “Bone
scintigraphy in screening of torture survivors”, Lancet, vol. 352, No. 9143 (1998), p. 1859.

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