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ANNEXES ISTANBUL PROTOCOL

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of caregivers. For children under the age of 3 who in order to preserve cohesion in the family, a
have experienced or witnessed torture, the protective child may be overly protected or important
and reassuring role of their caregivers is crucial. facts about the trauma may be hidden.
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Children older than 3 but less than 8 often tend to
withdraw and find it impossible to speak directly E. Ethical issues
about traumatic experiences. The ability for verbal
expression increases during development with a 1. Safeguarding children and duty of care
marked increase around 8 to 9 years old. At this time
and even before, concrete operations and temporal and When working with children and young persons it is
spatial capacities develop. Adolescence is a volatile important to remember that: “Organisations have a
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developmental period when the effects of torture and duty of care to children with whom they work, are
ill-treatment can vary widely and may cause profound in contact with, or who are affected by their work
behavioural changes, including erratic reactions similar and operations.” The principle of safeguarding
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to those seen in younger children as well as those seen children includes ensuring that children are protected
in adults, for example anger, depression and painful from harm and that any risk of harm is identified
memories (see paras. 575 and 584–594 above). and addressed immediately. Safeguarding includes
the prevention of further torture or ill-treatment,
Children’s ages and development – as well as the recommendations for recovery and reintegration,
repeated traumas that they experience, separation reduction of exposure to experiencing or witnessing
from the family at a young age or the family’s attitude violence, and access to appropriate and confidential
about sharing the experiences, mental health and medical and psychological follow-up care. If the
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pre-existing difficulties, such as learning disabilities – assessment is recorded, particular caution should
can affect children’s understanding of events and their be given to keeping the recording confidential, with
ability to recall events and communicate experiences. limited access given only to the assessment team, and
to protecting the child’s identity. Local legal data
D. Family considerations protection requirements should be adhered to.

It is important to consider factors that affect the 2. Informed consent
family and the child (e.g. physical separation
between family members, threats to family members, Children should be provided in advance with
bereavement, witnessing the torture or death of full information about any assessment or
family members, loss of social and economic status, procedure. Information on procedures needs to be
discrimination, forced displacement, racism, and tailored to children and their developmental stages
experiences and beliefs related to seeking support) and communicated in ways that they can understand.
and the social and political contexts. Parents who are Children should be given the opportunity to consent
torture survivors may experience shame and guilt, or assent to any evaluation or procedure. In younger
fearing that the intensity of their own feelings about children, this process will also normally involve
their trauma could overwhelm their children. 8 seeking consent from their parents or legal guardians;
however, in all cases, consideration for safeguarding
Parents of children who were tortured may also the child’s best interests should be paramount and
experience guilt over their inability to protect their include deliberation on the possibility of harm by
children, and their parenting may be affected by family members. The age at which children can provide
feelings of helplessness, which can be reinforced independent consent without the need to inform their
in violent and oppressive environments. Such parents or legal guardians varies across countries and
environments may also damage adolescents’ jurisdictions and so local legal and ethical guidelines
perception of their parents’ authority. Furthermore, should be considered before seeking independent

5 Saskia von Overbeck Ottino, “Familles victimes de violences collectives et en exil: quelle urgence, quel modèle de soins? Le point de vue d’une pédopsychiatre”, Revue
française de psychiatrie et de psychologie médicale, vol. 14 (1998), pp. 35–39.
6 Michel Grappe, “La guerre en ex-Yougoslavie: un regard sur les enfants réfugiés”, in Psychiatrie humanitaire en ex-Yougoslavie et en Arménie: face au traumatisme, Marie
Rose Moro and Serge Lebovici, eds. (Paris, Presses universitaires de France, 1995), pp. 89–106.
7 Jean Piaget, La naissance de l’intelligence chez l’enfant, 9th ed. (Neuchâtel, Delachaux et Niestlé, 1977).
8 Center for Victims of Torture, Healing the Hurt: A Guide for Developing Services for Torture Survivors (Minneapolis, 2005), chap. 2.
9 Keeping Children Safe, Child Safeguarding Standards and How to Implement Them (2014), p. 10.
10 Convention on the Rights of the Child, art. 39.

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