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ISTANBUL PROTOCOL VIII. IMPLEMENTATION OF THE ISTANBUL PROTOCOL

their obligation to effectively investigate allegations of all health personnel who evaluate or may encounter
torture or ill-treatment, forensic and clinical services alleged victims of torture or ill-treatment.
must be independent of law enforcement, prosecution
and/or military authority. While this may require 670. State forensic institutions and health agencies
significant administrative changes, the importance should respect and facilitate the right of individuals
of clinical independence cannot be overstated. to be evaluated by one or more non-governmental
health professional(s) of their choosing anytime
667. Independent State forensic institutions and health during or after being in custody. States must
agencies should be vested with the authority and inform an alleged victim of this right and provide
funds to train and oversee provision of medico-legal referral information to other health professionals
and other relevant clinical evaluations and have if requested to do so by the alleged victim.
adequate financial and human resources to conduct
effective medico-legal evaluations of alleged torture 671. States should provide training on the effective
or ill-treatment, including: qualified personnel/ investigation and documentation of torture and
consultants; professional interpreters; medical ill-treatment. State forensic institutions and health
and photographic equipment; access to diagnostic agencies should ensure that all relevant personnel
imaging and laboratory tests; and adequate time to receive training on the Istanbul Protocol and its
conduct their evaluations. States should not prohibit Principles. This not only includes State forensic
or obstruct the establishment of non-governmental experts, but all clinicians who may encounter alleged
forensic or medico-legal services; nor should they victims of torture or ill-treatment. As noted in chapters
have the authority to qualify or disqualify non- IV and VII, health professionals may encounter victims
governmental forensic experts or clinicians. of torture or ill-treatment in non-medico-legal contexts
in which the primary purpose of the evaluation is
668. State forensic institutions and health agencies should related to health status or health care. Training on
ensure that medico-legal evaluations of alleged torture the Istanbul Protocol for health professionals should
and ill-treatment are conducted promptly (immediately be comprehensive and include all aspects of clinical
and not later than 48 hours from the time that torture evaluations, in particular: essential interview conditions
or ill-treatment is alleged or documented in an initial and skills; clinical qualifications; procedural safeguards
clinical evaluation) 537 and objectively by qualified, for such evaluations; the content of a complete
independent governmental experts to assess physical evaluation, including physical and psychological
and psychological evidence in accordance with Istanbul evidence; guidance on the interpretation of findings
Protocol standards. They should require their forensic and conclusions; and limitations of the Istanbul
experts and health professionals to investigate all Protocol and potential misuse. In addition, forensic
allegations of torture or ill-treatment and cases in experts and clinicians should receive specific training
which torture or ill-treatment is suspected, even in on relevant ethical obligations, including resisting
the absence of a specific legal complaint or request. institutional pressures that conflict with their ethical
State forensic institutions and health agencies should obligations to patients and alleged victims of torture
ensure that forensic and clinical evaluations of alleged or ill-treatment. State institutions should also ensure
victims of torture or ill-treatment are conducted support systems for clinicians to follow their ethical
in accordance with the Istanbul Protocol and its obligations and pathways for them to report concerns.
Principles. In order to ensure compliance with Istanbul
Protocol standards, States should consider requiring 672. Effective training of health professional groups can
the use of standardized evaluation report forms that be achieved through interactive classroom training,
are based on the Istanbul Protocol and its Principles. usually under the leadership of highly experienced,
independent national or international trainers,
669. State forensic agencies and health agencies should followed by individual mentoring and supervision
ensure that procedural safeguards for the effective of forensic experts and clinicians in real-life settings.
medico-legal documentation of alleged torture and This approach is typically enhanced by implementing
ill-treatment are included in domestic law, relevant extended “training of trainers” courses to amplify
regulations and standard operating procedures for the initial training efforts. The effectiveness of
training on the Istanbul Protocol is also enhanced by

537 This time frame is based on the necessity of identifying and preserving clinical evidence of torture or ill-treatment, particularly physical evidence, which may resolve over time.

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