Page 184 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL VII. HEALTH PROFESSIONALS DOCUMENTING TORTURE AND ILL-TREATMENT

given their vulnerability and the increased risk challenges. These challenges include, but are
of torture and ill-treatment in such settings. not limited to, the issues mentioned below.

608. Mandatory health examinations include 1. Fear of reprisals
examinations upon detention, periodically during
detention, and before transfer to other facilities 611. As mentioned previously, since torture is a crime
or release from custody. The purpose of such committed by or with the consent or acquiescence of
examinations is both to assess health conditions State officials, health professionals may fear reprisals
and to prevent torture and ill-treatment. for conducting a clinical evaluation and/or making
interpretations that imply that a crime was committed
by a State official. Health professionals working under
C. Challenges such conditions should understand that they have a
professional duty to document and report torture and
609. Health professionals who evaluate alleged victims ill-treatment whenever informed consent is provided
of violence, whether as a result of torture, domestic and that failing to do so is a form of complicity in
violence, child abuse or other forms of ill-treatment, such abuses. It should be kept in mind that contexts
may experience significant challenges in conducting in which health professionals face the risk of reprisal
such evaluations effectively. In order to fulfil their may be at the same time contexts in which torture
obligation to document and report torture and and ill-treatment practices are widespread. Therefore,
ill-treatment, health professionals should understand clinical evaluation and documentation is of vital
and mitigate such challenges. State-employed health importance. They should be aware of procedural
professionals need to understand and mitigate the safeguards in conducting their clinical evaluations
challenges associated with effective documentation to minimize the risk of reprisals (see paras. 312–315
of torture and ill-treatment in order to fulfil their above). Also, as discussed in paragraph 179 above,
torture prevention and accountability obligations. health professionals should seek to work with
These challenges are discussed in detail in paragraphs independent monitoring and investigation bodies,
269–302 above and include essential conditions and as well as national and international professional
interview skills (e.g. safety, security, trust, empathy organizations, to mitigate any fear of reprisal.
and privacy), the risk of retraumatization of the
interviewee, specific considerations regarding gender 612. In case the clinical examination is conducted outside
and children and the emotional reactions of the clinical facilities, for instance inside a prison or
interviewee and the health professional that may even a prison cell, there may be increased risks with
adversely affect the clinical evaluation and individuals regard to security, privacy, reprisals and different
involved in the evaluation. In conducting clinical forms of pressure that the health professional
evaluations of cases in which torture or ill-treatment must be aware of. There is also the risk of false
is alleged or suspected, health professionals should be negative reports after such examinations.
aware of: procedural safeguards to ensure safe, ethical
and effective evaluations that are independent of undue 2. Lack of training
influence (see paras. 312–315 above); communication
barriers and the skills and techniques to address them 613. Health professionals should seek to obtain the
as discussed in paragraph 325 above, including the use necessary training on Istanbul Protocol documentation
of interpreters (see paras. 296–298 above); and how standards, including reading and understanding the
to assess inconsistencies that may result from trauma- Istanbul Protocol and its Principles, participating in
related difficulty in recalling and recounting traumatic training courses and learning from colleagues, when
experiences (see paras. 342–353 above). Chapter possible in supervised mentoring settings. States should
IV also provides guidance on how clinicians should provide such training for their health professionals,
interpret their clinical findings and the limitations of and academic institutions should include relevant
such interpretations (see paras. 379–389 above). training on professional curricula, as well as continuing
education courses. Such courses and curricula should
610. Health professionals who encounter alleged include relevant topics in the Istanbul Protocol.
victims of torture or ill-treatment in the
above-mentioned contexts, particularly non- 614. Health professionals should be aware of their
legal contexts, may experience additional professional ethical obligation to document and

146