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

allegations. 527 These investigations should include 632. While non-governmental health professionals
clinical assessments of both physical and psychological do not conduct evaluations on behalf of the
evidence in accordance with the Istanbul Protocol State, their evaluations should conform to the
and its Principles. Regardless of the type of legal minimum standards contained in the Istanbul
case (criminal, civil, administrative or other) or the Principles when they provide a medico-legal
setting in which torture is alleged (custodial or extra- opinion on torture or ill-treatment in legal cases.
custodial), the State should conduct timely assessments
by qualified experts. As stated in chapter IV (see 2. Clinical evaluations in non-legal contexts
paras. 354–355, 379 and 382 above) and annex I, the
Istanbul Principles suggest that health professionals 633. In non-legal contexts, health professionals may
should provide an interpretation of all findings and an observe injuries and psychological stress in the course
opinion on the possibility of torture or ill-treatment. of providing health-care services or assessing the
health status of victims. When this is the case, the
630. The provisions of the Istanbul Protocol allow for health professional should enquire about the cause
some flexibility with regard to the level of detail of such injuries or psychological stress and related
provided in a medico-legal report. This means that circumstances, including whether the individual has
the content of medico-legal evaluations can vary as been in the custody of any State officials, including law
long as the evaluations follow the Istanbul Principles. enforcement. Health professionals should always keep
States should establish policies and procedures for in mind that any person deprived of their liberty faces
State-employed health professionals’ use of the the risk of torture and other forms of ill-treatment.
Istanbul Protocol, including their obligation to
perform evaluations in accordance with the Istanbul 634. If the individual alleges or the health professional
Protocol and its Principles. This also includes, but suspects the possibility of torture or ill-treatment by or
is not limited to, requiring the use of standardized with the acquiescence of a State official, the clinician
evaluation formats to ensure quality, accuracy and should consider the following guidance in documenting
accountability that are consistent with the Istanbul and reporting the torture or ill-treatment (see annex I):
Protocol and its Principles. Non-governmental
health professionals, on the other hand, should not (a) Seek to obtain informed consent, as described
be required to use a standardized evaluation form in paragraphs 165–171 and 273 above, including
that may be required of State health professionals. disclosure of any mandatory reporting requirements,
before proceeding with an evaluation;
631. In all cases of alleged or suspected torture or
ill-treatment, it is the duty of the health professional (b) Exclude any third parties from the evaluation room
to carry out this work in accordance with the to ensure privacy. See paragraphs 312–315 above for
Istanbul Protocol and its Principles and not accept additional guidance on the presence of any third party
any limitation to this procedure, given for instance during an evaluation;
by prosecutors or judges. This means that the duty
to examine alleged victims in this way supersedes (c) Enquire about the cause of any injuries or
any limitations that may be imposed by statutory psychological distress;
considerations. It should be noted that clinicians
who conduct health assessments of persons deprived (d) Record and evaluate any physical and/or
of their liberty, for example in the case of routine psychological symptoms or disabilities that may be
health assessments of detainees, health-care delivery related to the alleged abuse;
of prisoners and detention monitoring visits,
should be trained and have the capacity to conduct (e) Conduct a directed physical examination of all
clinical evaluations in accordance with the Istanbul organ systems that may be related to the allegations
Protocol and its Principles given the possibility of abuse, including a brief mental status examination
of torture and ill-treatment in these settings. and a risk assessment for harm to self and to and
from others;

527 Convention against Torture, art. 12: “Each State Party shall ensure that its competent authorities proceed to a prompt and impartial investigation, wherever there is reasonable
ground to believe that an act of torture has been committed in any territory under its jurisdiction.”

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