Page 147 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

or that they fear their interviewer will be unable to may be found by making a full review of symptoms,
accept hearing. Disclosure of sexual torture may be particularly of the genito-urinary and anorectal systems
difficult and delayed (see paras. 274–276 above). and a full examination. If injuries to an intimate part
of the body, such as the breasts, buttocks or thighs, are
456. There are some differences between sexual torture found, this may indicate that sexual violence occurred.
of men and sexual torture of women, but several It should be noted that absence of genital injury
issues apply to both. There may be verbal abuse of cannot be taken to indicate sexual violence did not
a sexual nature, physical torture of intimate body occur. Vulvovaginitis occurring as a result of repeated
areas, such as breasts and buttocks, and torture douching may be an indicator of past sexual violence.
targeted specifically at the genitals. Electricity and
blows are often aimed at the genitals in men, with or 458. Violent and repeated rape or sexual assault by anal
without additional anal torture. The physical trauma penetration with an object can cause significant
is enhanced by verbal abuse. Prisoners may be placed physical damage to the anal sphincter and rectum with
naked in cells with family members, friends or total long-lasting effects, including pain on defaecation,
strangers, breaking cultural taboos. This can be made chronic anal fissure and piles, and incontinence of
worse by the absence of privacy when using toilet faeces or flatus. Disclosure of these symptoms can
facilities. Additionally, prisoners may be forced to be difficult but, paradoxically, an enquiry about
sexually abuse each other, which can be particularly such symptoms as part of a body systems review
difficult to cope with emotionally. The fear of potential by the doctor can lead to a disclosure of the assault
rape, given the profound cultural stigma associated that caused them. Other clues may be an inability
with rape, can add to the trauma. For women, there to sit comfortably or for long, complaints about
is also the trauma of potential pregnancy, the fear lower back problems and high levels of anger and
of losing their virginity and the fear of not being irritability. 439 According to UNHCR guidance:
able to have children (even if the rape can be hidden “Many male survivors only report their experiences
from a potential husband and the rest of society). when they require urgent medical intervention.” 440
Rape is always associated with the risk of developing Another possible opening for disclosure is when
sexually transmitted infections, including HIV/AIDS. conducting a risk assessment for harm to self or others,
Currently, the only effective prophylaxis against HIV/ when a detailed exploration for thoughts triggering
AIDS must be taken within 72 hours of the incident, impulsive acts of violence may facilitate disclosure.
the earlier the more effective, and it is unlikely to
be available while the victim is still in detention. 459. If, in cases of sexual torture, the victim does not wish
the event to be known due to sociocultural pressures
457. A national study found that the most common effects or personal reasons, the physician who carries out the
suffered by victims of serious sexual assault are medical examination, investigative agencies and the
mental or emotional problems (63 per cent), followed courts have an obligation to cooperate in maintaining
by difficulty trusting people or difficulty in other the victim’s privacy. Establishing a rapport with
relationships (53 per cent). 436 In this study, only 27 per torture survivors who have recently been sexually
cent of victims had minor bruising or a black eye and assaulted requires special psychological education and
more serious injuries were rare. 437 However, the notion appropriate psychological support. Any treatment
that a victim who has not sustained physical injuries that would increase the psychological trauma of a
must have consented is still widely held. Fear of further torture survivor should be avoided. Before starting the
violence often limits the resistance of victims or they examination, specific consent must be obtained from
may simply “freeze”. In a global review of sexual the individual. The individual should be informed
assault cases, an average of 65 per cent of victims had about the importance of the examination and its
some kind of physical injury (namely, 35 per cent did possible findings in a clear and comprehensible manner.
not) and an average of 30 per cent had evidence of
anogenital trauma (namely, 70 per cent did not). 438
A previously undisclosed history of sexual violence

436 United Kingdom, Office for National Statistics, “Sexual offences in England and Wales” (see footnote 401).
437 Ibid.
438 Ibid.
439 UNHCR, “Working with men and boy survivors” (see footnote 402).
440 Ibid., p. 11.

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