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

G. Assessment of functional disability facilities (e.g. X-rays and other imaging techniques),
haematological testing and further specialist advice
485. Assessment of functional disability is particularly as needed. In interpreting their findings, clinicians
useful in circumstances in which a compensation usually need to seek additional information from
claim is made, but is also helpful in planning children, young persons and their caregivers over and
individual rehabilitation strategies and goals. The above that available from non-medical interviews.
World Health Organization Disability Assessment
Schedule version 2.0 is a tool that can be used for 489. Children who have endured torture and other
this purpose to produce standardized disability forms of ill-treatment and human right violations
levels and profiles applicable across cultures. It is the must have access to trained, competent paediatric
operational tool for the International Classification examiners, wherever possible, who can provide
of Functioning, Disability and Health. 444 medical assessments and recommendations for care.
In children, part of the evaluation must include
486. The Schedule covers six domains of functioning, safeguarding for the prevention of further torture
namely: cognition (understanding and and ill-treatment, recommendations for recovery
communication); mobility (moving and getting and reintegration and reduction of exposure to
around); self-care (hygiene, dressing, eating and experiencing or witnessing violence. Access to
staying alone); getting along (interacting with other appropriate and confidential medical and psychological
people); life activities (domestic responsibilities, follow-up care is an entitlement 446 for children.
leisure, work and school); and participation (joining
in community activities and participating in society). 490. Genital examination of children should be performed
by clinicians experienced in documenting and
487. When scoring, the following numbers are assigned interpreting the findings. In settings in which video
to responses in each domain: 1 (“none”); 2 (“mild”); recording can be carried out, other experts can give
3 (“moderate”); 4 (“severe”); and 5 (“extreme opinions on the physical and genital findings without
or cannot do”). Item scores in each domain are the child having to be examined again. However, the
summed up and then the scores of all six domains clinician should be aware that an examination may
are added up. The summary score is then converted be reminiscent of the original assault and should
to a metric ranging from 0 to 100 (where 0 = therefore be carried out sensitively with appropriate
no disability; and 100 = full disability). 445 explanations to the child and the child’s caregiver.
Examination of the genital and anal areas under
general anaesthesia may result in changes to physical
H. Children findings and carries additional clinical risks; it should
not normally be carried out unless concurrent surgical
488. Medical examinations should be carried out in a child treatment to the area is being considered. Clinicians
friendly setting by trained clinicians with experience in should be aware that scar formation in children may
assessing and documenting physical injury (including be different from that in adults as wounds might heal
those resulting from sexual assault) in children and faster. Bony injuries, depending on their position
young persons. Consent for the examination should related to the growth plate, may not be apparent on
be obtained from children’s guardians and, where initial X-rays or months after a fracture has healed.
appropriate, from the children or young persons Radiological techniques should be used scrupulously
themselves (see paras. 165–171 and 285 above). Ideally in children given the anxiety that they may cause
clinicians should have access to additional diagnostic and potential after-effects of childhood radiation.

444 World Health Organization, How to Use the ICF: A Practical Manual for Using the International Classification of Functioning, Disability and Health – Exposure Draft for
Comment (Geneva, 2013).
445 Scoring templates can be obtained from: www.who.int/classifications/icf/more_whodas/en.
446 The Convention on the Rights of the Child, art. 39, stipulates that: “States Parties shall take all appropriate measures to promote physical and psychological recovery and
social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed
conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child.”

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