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ISTANBUL PROTOCOL ANNEXES
C. Indicate the status of the individual in the XIV. Statement of truthfulness (for judicial testimony)
fluctuating course of trauma-related mental
disorders over time, that is what is the time For example: “I declare under penalty of perjury,
frame in relation to the torture events and where pursuant to the laws of [country], that the foregoing
in the course of recovery is the individual? is true and correct and that this affidavit was
D. Identify any coexisting stressors impinging executed on [date] at [city], [state or province].”
on the individual (e.g. ongoing persecution,
forced migration, exile, and loss of XV. Statement of restrictions on the clinical
family or social role) and the impact that evaluation/investigation (for subjects in custody)
these may have on the individual.
E. Mention physical conditions that may For example: “The undersigned clinicians personally
contribute to the clinical picture, especially certify that they were allowed to work freely and
with regard to possible evidence of head injury independently and permitted to speak with and
sustained during torture or detention. examine [the subject] in private, without any restriction
or reservation, and without any form of coercion
XIII. Conclusions and recommendations being used by the detaining authorities”; or “The
undersigned clinician(s) had to carry out his/her/their
1. Statement of opinion on the consistency between evaluation with the following restrictions: ...........”
all sources of evidence cited above (physical and
psychological findings, historical information, XVI. Clinician’s signature, date and place
photographic findings, diagnostic test results,
knowledge of regional practices of torture, consultation XVII. Relevant annexes
reports etc.) and allegations of torture or ill-treatment.
2. Reiterate the symptoms and disabilities A copy of the clinician’s curriculum vitae,
from which the individual continues to anatomical drawings for identification of torture
suffer as a result of the alleged abuse. and/or ill-treatment, photographs, consultations
3. Provide any recommendations for further and diagnostic test results, among others.
evaluation and care for the individual.
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