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

(c) Disruption of the rugal pattern may manifest as F. Specialized diagnostic tests
smooth fan-shaped scarring. When these scars are seen
out of midline (i.e. not at 12 or 6 o’clock), they can be 480. Diagnostic tests are not an essential part of the clinical
an indication of penetrating trauma; assessment of a person alleging torture or ill-treatment.
In many cases, a medical history and physical
(d) Skin tags, which can be the result of examination are sufficient. There are circumstances
healing trauma; in which such tests are valuable supporting evidence,
for example, in situations in which there is a legal
(e) Purulent discharge from the anus. Cultures should case against members of the authorities or a claim
be taken for gonorrhoea and chlamydia in all cases for compensation. However, it must be remembered
of alleged rectal penetration, regardless of whether a that any test will have a false negative rate and
discharge is noted. this is often higher the greater the interval between
performing the test and the time when the injury
479. Anal examinations are forcibly conducted in many occurred. If diagnostic tests are performed for clinical
countries in which consensual anal intercourse is rather than legal reasons, the results should be added
considered a criminal act. 442 They are conducted to the clinical report. It must be recognized that the
almost exclusively on males in an effort to “prove” absence of a positive diagnostic test result, as with
that they engage in “homosexual behaviour”. In a physical findings, must not be used to suggest that
statement made in 2016, the Independent Forensic torture or ill-treatment did not occur. There are many
Expert Group concluded that there was no clinical situations in which diagnostic tests are not available
validity in such a test. Such examinations are for technical reasons, but their absence should never
inherently discriminatory. In many circumstances in invalidate an otherwise properly written report.
which anal examinations are forcibly conducted, they
are accompanied by other forms of physical torture or 481. Diagnostic tests are being developed and evaluated
ill-treatment, such as beatings by police and demeaning all the time. For this reason, reference here to specific
remarks about the individual’s alleged homosexuality tests is limited, but when additional supporting
by police and medical personnel. Threats, coercion evidence is required, investigators should utilize
and physical force are often applied. The fact that the most up-to-date resources available to them.
an examination may be conducted with non-medical
personnel being present is an additional source of 482. In the acute phase of injury, various imaging
concern. In addition, the elements of forced nudity modalities may be useful in providing additional
and physical restraint, when used, amplify the sense documentation of skeletal and soft tissue injury.
of helplessness, fear, humiliation and degradation that Once the physical injuries of torture or ill-treatment
individuals experience. The Committee against Torture, have healed, however, the residual sequelae are
the Special Rapporteur on torture and the Working generally no longer detectable by the same imaging
Group on Arbitrary Detention have stated that the methods. This is often true even when survivors
practice of forced anal examinations contravenes continue to suffer significant pain or disability from
the prohibition against torture and ill-treatment. 443 their injuries. In addition, the more sophisticated
When anal examinations are forcibly conducted and expensive technology may not be universally
and involve anal penetration, the examination available or at least not to a person in custody.
should be considered a form of sexual assault and
rape. Involvement of health professionals in these 483. MRI may detect bone contusion and stress or
examinations violates the basic standards and ethics occult fractures before it can be imaged by either
of the relevant professions. Anal examinations carried routine radiographs, CT or scintigraphy.
out as body cavity checks should only be carried out
in accordance with the Bangkok Rules (rules 19–21), 484. Use of open scanners and sedation may
the Nelson Mandela Rules (rules 50–52) and the alleviate anxiety and claustrophobia, which
WMA statement on body searches of prisoners. are prevalent among torture survivors.

442 Independent Forensic Expert Group, “Statement on anal examinations” (see footnote 309), p. 85.
443 A/HRC/19/41, para. 37. See also A/HRC/22/53, para. 79.

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