Torture

Module 8 Answers

  1. Answer: B

    Police or other law enforcement officials should never be present in the examination room. This procedural safeguard may be precluded only when, in the opinion of the examining doctor, there is compelling evidence that the detainee poses a serious safety risk to health personnel. Under such circumstances, security personnel of the health facility, not the police or other law enforcement officials, should be available upon the medical examiner’s request. In such cases, security personnel should still remain out of earshot (i.e. be only within visual contact) of the patient. The presence of police officers, soldiers, prison officers or other law enforcement officials in the examination room, for whatever reason, should be noted in the physician’s official medical report. The presence of police officers, soldiers, prison officials or other law enforcement officials during the examination may be grounds for disregarding a negative medical report. The identity and titles of others who are present in the examination room during the medical evaluations should be indicated in the report.

  2. Answer: B

    Under no circumstances should a copy of the medical report be transferred to law enforcement officials or security personnel.

  3. Answer: B

    The routine use of restraints during medical consultation or treatment is contrary to medical ethics and international standards on treatment of prisoners. Health professionals must not accept such practises. Restraints not only interfere with the proper diagnosis, management and treatment of patients, but they also run contrary to the inherent dignity of all human beings. The only possible acceptable justification for use of restraints is as a last resort when there is substantiated reason to believe that this particular detainee presents an immediate and current violent threat to himself or others. Health professionals can and should question the use of restraints if they have reason to doubt such a risk exists. In the exceptional circumstances that restraints are used, they should be as minimal as possible.

  4. Answer: A

    It is important to obtain a complete medical history, including prior medical, surgical and/or psychiatric problems. Clinicians should document any history of injuries before the period of detention and any possible after-effects. Knowledge of prior injuries may help to differentiate physical findings related to torture from those that are not.

  5. Answer: B

    Mr. Adam’s psychosocial history contains information relevant to his psychological symptoms, or lack thereof, following the alleged torture and ill treatment. Mr. Adam’s political beliefs and activities have likely mitigated more severe psychological symptoms. His predominant reaction of anger is, in part, likely due to the killing of one of his brothers by security forces.

  6. Answer: C

    Mr. Adam’s history is significant for multiple lapses in consciousness. He was not blindfolded during the alleged torture, only during transport to the place where he was detained. Also, he does not demonstrate evidence of organic brain impairment or significant psychological sequelae.

  7. Answer: C

    Mr. Adam indicated that his multiple episodes of loss of consciousness were associated with asphyxia and electric shocks to his penis. Diagnostic imaging of the brain and EEG studies are not indicated in the absence of significant head trauma, seizure activity or a focal neurological deficit. Given minimal psychological symptoms and normal cognitive functioning, neuropsychological testing would not be indicated. A complete neurological examination would be adequate under the circumstances.

  8. Answer: B

    Sexual assault, including rape, is common among male detainees. Given the intense shame that is usually associated with sexual assault, additional information may not be spontaneously reported. It is important, therefore, to ask Mr. Adam something like: “Many men who are detained by police and security forces are assaulted sexually, including rape. Did anything like this happen to you?”

  9. Answer: A

    Mr. Adam’s difficulty having erections is most likely psychosomatic in origin since he indicated that he has noted normal erections upon waking from sleep.

  10. Answer: B

    Although Mr. Adam’s alleges being suspended from his hands tied behind his back, his acute symptoms of arm pain when lifting heavy objects and right arm numbness subsequently resolved. In the absence of any current complaint and/or numbness or weakness on physical examination, an EMG is not indicated.

  11. Answer: B

    Electric shock often does not result in acute lesions. When present, electric burns usually consist of a red brown circular lesion, 1 – 3 mm in diameter, usually without inflammation, and may result in a hyperpigmented scar. The absence of such changes should not be construed as an inconsistency.

  12. Answer: A, possibly C

    Survivors of torture who ascribe positive meaning to their suffering (e.g. World War II veterans and political activists) often have fewer and less severe psychological symptoms. Fear of police reprisals would likely increase Mr. Adam’s psychological symptoms. Although support from family member also may mitigate psychological symptoms, Mr. Adam’s parents expressed strong disapproval of his political activity and consider his action to be “foolish and dangerous.” This has resulted in considerable discord between them. He and his father have not spoken to one another in the past several weeks. Nonetheless, his parents’ concern may represent a longstanding source of support.

  13. Answer: C

    Cigarette burns typically result in 5 to 10 mm, circular, macular scars with a depigmented centre and a hyperpigmented, relatively indistinct periphery. The lack of a depigmented centre in Mr. Adam’s case may be related to the relative degree of heat applied. The characteristics of the lesions and location on one arm only, are highly consistent with his allegations of cigarette burns.

  14. Answer: B

    Mr. Adam was examined months after he was released from detention. The possibility of self-inflicted injuries cannot be fully excluded.

  15. Answer: C

    Mr. Adam’s physical examination findings of hyperpigmented, circumferential scars above both wrists are highly consistent with his allegations of “rope burns” from suspension torture.

  16. Answer: E

    All of the explanations listed indicate why these physical findings are not likely to be the result of self-inflicted injuries.

  17. Answer: D

    Striae distensae (stretch marks) are most common on the abdomen (especially after pregnancy), the lower back, the upper thighs, and around the axillae. They are hypopigmented lines in which the skin might be folded. They must not be confused with scars from whipping. In striae, the skin is intact. Axillary striae may not be noticed by individuals until after suspension torture.

  18. Answer: B

    Mr. Adam’s psychological findings may not be as extensive or severe as some might expect, but this can be adequately explained by symptom mitigation from his political beliefs and activities and possibly by support from family and friends. Effective coping mechanism also may help to explain his resilience, but this was not thoroughly assessed in Case Example #02. Mr. Adam’s allegations of abuse appear to be at least “consistent with” his psychological evaluation findings.

  19. Answer: B

    Psychological instruments may serve as a useful adjunct to the qualitative, psychological evaluation and may be particularly helpful if an individual has trouble expressing in words his or her experiences and symptoms. This is not the case for Mr. Adam, however. In addition, caution must be exercised in the interpretation of responses and scores of psychological instruments because established norms do not exist for many populations.

  20. Answer: E

    All of the considerations listed would support the credibility of Mr. Adam’s allegations of torture and ill treatment and, if relevant, may be included in the clinician’s written reports and oral testimony. Note that inconsistencies that are attributable to an individual’s torture experience may, in fact, support an individual’s allegations of abuse, rather than undermine it.

Answer: B Police or other law enforcement officials should never be present in the examination room. This procedural safeguard may be precluded only when, in the opinion of the examining doctor, there is compelling evidence that the detainee poses a … Continue reading

About the Istanbul Protocol

Istanbul Protocol thumbnailThe Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, commonly known as the Istanbul Protocol, outlines international, legal standards on protection against torture and sets out specific guidelines on how effective legal and medical investigations into allegations of torture should be conducted.

The Istanbul Protocol is an important source as it both reflects existing obligations of States under international treaty and customary international law and aids States to effectively implement relevant standards. It became a United Nations official document in 1999. The Istanbul Protocol is intended to serve as a set of international guidelines for the assessment of persons who allege torture and ill-treatment, for investigating cases of alleged torture, and for reporting such findings to the judiciary and any other investigative body. The investigation and documentation guidelines also apply to other contexts, including human rights investigations and monitoring, assessment of individuals seeking political asylum, the defence of individuals who “confess” to crimes during torture, and assessment of needs for the care of survivors of torture. In the case of health professionals who are coerced to neglect, misrepresent, or falsify evidence of torture, the manual also provides an international point of reference for health professionals and adjudicators alike.

The documentation guidelines apply to individuals who allege torture and ill-treatment, whether the individuals are in detention, applying for political asylum, refugees or internally displaced persons, or the subject of general human rights investigations. The guidelines provided cover a range of topics including:

  • Relevant international legal standards
  • Relevant Ethical Codes
  • Legal Investigation of Torture
  • General Considerations for Interviews
  • Physical Evidence of Torture
  • Psychological Evidence of Torture

Many procedures for a torture investigation are included in the manual, such as how to interview the alleged victim and other witnesses, selection of the investigator, safety of witnesses, how to collect alleged perpetrator’s statement, how to secure and obtain physical evidence, and detailed guidelines on how to establish a special independent commission of inquiry to investigate alleged torture and ill-treatment. The manual also includes comprehensive guidelines for clinical examinations to detect physical and psychological evidence of torture and ill-treatment.

The Istanbul Protocol also outlines minimum standards for state adherence to ensure the effective documentation of torture in its Principles on the Effective Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, or “Istanbul Principles” The guidelines contained in the Istanbul Protocol are not designed to be fixed, rather, they represent an elaboration of the minimum standards contained in the Istanbul Principles and should be applied in accordance with a reasonable assessment of available resources.

The Istanbul Protocol is a non-binding document. However, international law obliges governments to investigate and document incidents of torture and other forms of ill-treatment and to punish those responsible in a comprehensive, effective, prompt and impartial manner. The Istanbul Protocol is a tool for doing this.

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The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, commonly known as the Istanbul Protocol, outlines international, legal standards on protection against torture and sets out specific guidelines on how effective … Continue reading

Module 9 Answers

  1. Answer: A, B, C, E, F

    Expert medical reports and testimony can be of value in all of the contexts listed with the exception of D. As the Istanbul Protocol makes clear, a medical evaluation does not exclude the possibility that the alleged torture took place. Medical evaluations should not be used to “prove” that law enforcement officials, or any other alleged perpetrator, is innocent of alleged acts or torture and ill treatment.

  2. Answer: A

    The purpose of written reports and oral testimony is to assess claims, document evidence of torture and ill-treatment, and effectively communicate this evidence to adjudicators. Clinical evaluations are often critical in enabling adjudicators to make accurate and just decisions in medico-legal cases by providing an assessment of the degree of consistency between allegations of torture and ill treatment and physical and psychological evidence.

  3. Answer: F

    All of the items listed may represent relevant qualifications.

  4. Answer: A

    Qualifying as a medical expert depends on relevant knowledge and skills for both physical and psychological evidence of torture. Physicians who are not psychiatrists may qualify as experts on psychological evidence of torture and ill treatment as symptoms of depression and anxiety are common in general populations and many primary care physicians can acquire the knowledge and skills to diagnose these conditions and initiate appropriate care. The diagnosis of trauma-related disorders such as PTSD requires more specific training and experience for all clinicians, including psychiatrists, psychologists and clinical social workers.

  5. Answer: B

    The evaluating clinician should review the alleged victim’s affidavit (declaration) and any relevant medical or legal materials that the alleged torture victim has presented to the court, as it generally includes information that may be compared with the clinician’s evaluation. Any discrepancies that may arise should be pursued with the individual and/or the individual’s attorney to a point of clarity. Adjudicators often interpret inconsistent testimony as a lack of credibility on behalf of the alleged torture victim, when, in fact, such inconsistencies are often related to the presence of psychological, cultural, linguistic or other factors.

  6. Answer: E

    All of the items listed are true.

  7. Answer: E

    All sources of information listed above can and should be used to corroborate allegations of torture and ill treatment as long as the medical evaluator deems them to be relevant and credible.

  8. Answer: A

    Adjudicators are often unaware of the complexities of effective documentation of torture and ill treatment and their decisions may be influenced by pre-existing prejudice. Clinicians can and should take the opportunity to educate adjudicators on physical and psychological evidence of torture and ill treatment, i.e. explaining likely causes of inconsistencies, the sensitivity and specificity of physical findings and diagnostic tests, the utility and limitations of psychological instruments and diagnoses, the significance of historical evidence, etc.

  9. Answer: A

    First evaluations may be less convincing in a court of law than those conducted by clinicians with extensive experience. It is therefore advisable to conduct one’s first evaluation(s) under the supervision or of a more experienced evaluator.

  10. Answer: A

    Historical information may be very useful in corroborating an individual’s allegations of torture because it indicates first-hand knowledge of the alleged experience.

  11. Answer: B

    Istanbul Protocol guidelines include recommendations for care when they are clinically indicated. This is a professional duty independent of the immediate objectives of the legal team.

  12. Answer: A

    The clinician’s interpretation of findings and conclusions on the possibility of torture and ill treatment should be based on all categories of corroborating evidence, including physical and psychological evidence, historical information, and any other relevant resource materials.

  13. Answer: F

    All of the considerations listed support the credibility of an individual’s allegations or torture and ill treatment and, if relevant, may be included in the clinician’s written reports and oral testimony. Note that inconsistencies that are attributable to an individual’s torture experience may, in fact, support an individual’s allegations of abuse, rather than undermine it.

  14. Answer: B

    Credibility is not an all-or-nothing concept – there is a continuum between the absolute truth and the complete fabrication of events, with at least three points in-between: a) a mixture of falsehood and truth; b) conscious or subconscious exaggeration – saying that the ill-treatment was more frequent and more severe than actually happened; and c) genuine errors arising from mistakes and misunderstandings. Clinicians should try to identify potential reasons for exaggeration or fabrication, keeping in mind that fabrications may require detailed knowledge about trauma-related symptoms and findings that individuals rarely possess.

  15. Answer: H

    Inconsistencies may result from a number of factors that may be directly related to the torture and ill treatment or to the psychological and/or neurological symptoms that result from torture and ill treatment. Interview conditions and cross cultural factors may be significant factors as well. Clinicians should be familiar with such factors to effectively explain any inconsistencies observed.

  16. Answer: A

    Adjudicators and cross-examining attorneys may dismiss the medical expert’s findings on the basis of “hear-say” evidence, i.e. that the medical expert is stating a fact that was simply reported to him or her. A statement qualifying the veracity of testimony is therefore advisable.

  17. Answer: B

    While PTSD and MDD are common among survivors of torture, the diagnosis of either one is not cause-specific. Experiences other than torture and ill treatment also may be the cause of these diagnoses or sub-threshold symptoms.

  18. Answer: E

    All of the guidelines listed are relevant considerations for oral testimony by medical experts.

  19. Answer: E

    It is common in medico-legal contexts for the clinician to be asked whether psychological symptoms were caused by the alleged torture and ill-treatment or other traumatic experiences that may have occurred before or after the alleged events. Clinicians should note temporal relationships between the onset of symptoms and the alleged torture and ill-treatment and subsequent trends in psychological symptoms in relation to external stressors. They should also consider content-specific symptoms that may relate to the alleged torture and ill-treatment such as: the content of nightmares, triggers for intrusive recollection, reliving experiences, and avoidance reactions.

  20. Answer: B

    In court, the finding of credibility is a legal matter that is the responsibility of the judge. The expert witness is one resource that the judge draws upon to make that determination. The clinician need not feel the compulsion to make that determination for the judge, and, indeed, judges may resent an expert who tries to do so. What the clinician can do is address any observed inconsistencies and answer the questions of the attorneys and the judge as thoroughly and professionally as possible, along with his/her opinion about credibility, and let the judge arrive at his/her own conclusion.

Answer: A, B, C, E, F Expert medical reports and testimony can be of value in all of the contexts listed with the exception of D. As the Istanbul Protocol makes clear, a medical evaluation does not exclude the possibility … Continue reading

Curriculum Materials

Model Curriculum

Consisting of 9 Modules (see Summary of Content below). The Modules serve as the overall knowledge base for the Model Curriculum.

Istanbul Protocol

Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

PowerPoint (PPT) Presentations

There is a PPT Presentation to accompany each of the 9 Modules. The Presentations were designed primarily for instructors who prefer to use a lecture format. The content of the PPT presentations closely parallels that of the Modules.

Case Examples #01 and #02

Two case examples have been incorporated into Modules 7 and 8. They are designed to give students practical experience interviewing alleged victims of torture and documenting physical and psychological evidence. The medical evaluations that students develop from these case examples should be applied to Mock Court Proceedings in Module 9.

Psychological Evaluations 1 and 2

Two Psychological Evaluations are included in Module 6 to provide students with an opportunity to develop clinical impression from information contained in actual asylum cases.

Self-Assessments (quizzes)

For each Module, there is a related Self-Assessment that is designed specifically for individual student users to assess their knowledge of curriculum content. The Self-Assessments may be applied to other teaching formats as well.

Audio File

In Module 3, students will listen to an audiotape of an interview with a torture survivor, Sr Diana Ortiz, to better understand the challenges of interviewing survivors, particularly the emotional reactions of survivors and clinicians.

Model Curriculum Consisting of 9 Modules (see Summary of Content below). The Modules serve as the overall knowledge base for the Model Curriculum. Istanbul Protocol Model Medical Curriculum (pdf) Istanbul Protocol Manual on the Effective Investigation and Documentation of Torture … Continue reading

The aim of medical documentation

Medical documentation may be critical to legal investigations of torture through the following means:

  • Producing a contemporaneous record (a record as close in time as possible to the event) of signs and symptoms of ill-treatment when an individual presents to any health professional for treatment after the event – the examining health professional may not be called upon to produce a report, but in the future an expert may be asked to use this record to form an opinion of events at the time
  • Providing detailed understanding of the case so that the person can be referred for the appropriate treatment and rehabilitation in a specialised centre or by other specialists
  • The production of a medico-legal report for submission to a judicial or administrative body:
    • for judicial enquiries or court cases aimed at the prosecution of perpetrators
    • for a judicial process which decides on the responsibility of the state
    • for a judicial process which decides upon compensation/reparations for survivors
    • in individual cases where a medico-legal report may be used as part of a court application to end on-going abuse while the person is still in detention
    • for the case of asylum seekers when medical evidence may be used as part of the evidence (e.g. in hearings) to show a history of ill-treatment in another country and the physical and psychological consequences thereof.
  • The documentation of patterns of widespread abuse. Courts, NGOs, and inter-governmental mechanisms, can all have need for knowledge of the existence of widespread abuse. Assessment of the prevalence of torture and other ill-treatment, relies upon well-documented individual allegations
  • The production of supporting material during visits to places of detention. Medical documentation may not necessarily lead to the production of a medico-legal report on specific cases, but the medical findings can be used more generally to support allegations of conditions and treatment amounting to torture or other ill-treatment.

Medical documentation may be critical to legal investigations of torture through the following means: Producing a contemporaneous record (a record as close in time as possible to the event) of signs and symptoms of ill-treatment when an individual presents to … Continue reading

Introduction

Effective medical investigation and documentation of torture and ill-treatment require clinicians to have a detailed understanding of torture methods and their physical and psychological sequelae. This Module provides a review of common torture methods and their medical consequences. It is important to keep in mind that it is difficult to separate physical from psychological torture, as each has a component of the other; for example, hooding not only impedes normal breathing, but also produces disorientation and fear. In addition, physical forms of torture and ill treatment will generally produce both physical and psychological sequelae, and psychological forms of torture and ill-treatment often result in psychological sequelae, but may also produce physical sequelae as well.

The methods of torture and ill-treatment included in this module are not exhaustive. The actual methods that a survivor experiences are only limited by the imagination and cruelty of his or her torturers. As mentioned in Module 1, it is important to realize that, although there is much similarity of torture methods around the world, there can be regional and country-specific variations. Instructors and students who use this Model Curriculum should be aware of regional, country-specific, and local practises and adapt them to the Model Curriculum materials accordingly with relable and current human rights reports.

Although physical torture as practised around the world has many features in common, almost invariably including beating, slapping and kicking, more sophisticated techniques have been developed in many areas. In countries whose authorities wish to disguise the fact that torture takes place, methods are devised, sometimes with the help of doctors, that produce maximum pain with minimum external evidence. This must be recognised by the examiner if the after-effects of these techniques are not to be missed, especially after the passage of time. Documentation of special methods of torture alleged by an individual requires that the examiner has a detailed knowledge of torture techniques used in the country where the torture was alleged to have taken place. With this knowledge the interviewer can take an informed and detailed history (taking care to avoid using leading questions). This helps to give a precise picture of such details of torture as the victim’s posture, clothing, blindfolding or hooding, the implements used, duration of assault and his or her condition at the end of the session – whether he or she could walk or whether there were any bleeding wounds. It cannot be emphasised too strongly that such a detailed history is essential to ensure that, during the subsequent physical examination, signs in the relevant areas of the body are not missed and that a correct differentiation from accidental or self-inflicted injury is made. For this reason it is necessary to review, at length, some of the techniques employed in different countries before outlining the symptoms and signs to be expected during history-taking and physical examination. Of particular value in assessing the severity of the attack is a history of loss of consciousness, though this should be elaborated by questions aimed at finding out whether unconsciousness was caused by blows to the head, asphyxiation, unbearable pain or exhaustion.

As discussed in Module 3, survivors may be unable to describe exactly what happened to them because they may have been blindfolded, lost consciousness, sustained head injury, or have difficulty recalling or revealing the especially traumatic components of their experience. It is important to realize that torturers often attempt to conceal their deeds. For example, physical evidence of beating may be limited when a wide, blunt objects are used for beatings. Similarly, victims are sometimes covered by a rug, or shoes in the case of falaka, to distribute the force of individual blows. For the same reason, wet towels may be used with electric shocks. In other cases, torturers use methods with the intent of producing maximal pain and suffering with minimal evidence, for example, forced positioning, near asphyxiation, mock executions, temperature manipulation, sensory deprivation, prolonged isolation, threats of harm to the individual and his or her family, and sexual humiliations, among many others.

It is important to understand that some methods on their own may amount to torture; in other cases significance is attached to the use of a combination of methods, which may collectively amount to torture. Also, the length of time over which the individual is subjected to the methods may be decisive. Again, for this reason, it is important to document as accurately and completely as possible all the events to which an individual was exposed and their consequences.

The Subjective Element of Suffering

It is important to keep in mind that, when assessing the degree of suffering involved, one should take into account the identity and background of the alleged victim. For example, certain situations that might be relatively bearable for some people could be degrading and humiliating to those of a particular gender, culture or religious faith. Torture and other ill-treatment can also often go hand-in-hand with discrimination, based on race, religion, gender or other factors, which may exacerbate the distress. In addition, physical and mental suffering can differ amongst categories of victims, for example some tortures may exacerbate pre-existing health problems, and children may experience a higher degree of suffering than adults undergoing similar ill-treatment. All these factors should be taken into account in documenting the alleged victim’s experience.

Effective medical investigation and documentation of torture and ill-treatment require clinicians to have a detailed understanding of torture methods and their physical and psychological sequelae. This Module provides a review of common torture methods and their medical consequences. It is … Continue reading

The Central Role of the Psychological Evaluation

Psychological evaluations can provide critical evidence of abuse among torture victims. It has a central role in the medical investigation and documentation of torture allegations. All medical investigations and documentation of torture should include a detailed psychological evaluation because:

  • One of the main aims of torture is to destroy the psychological, social integrity and functioning of the victim.

    Perpetrators often attempt to justify their acts of torture and ill-treatment by the need to gather information. Such conceptualisations obscure the purpose of torture and its intended consequences. One of the central aims of torture is to reduce an individual to a position of extreme helplessness and distress that can lead to a deterioration of cognitive, emotional and behavioural functions. Torture is a means of attacking the individual’s fundamental modes of psychological and social functioning. The torturer strives not only to incapacitate a victim physically, but also to disintegrate the individual’s personality: The torturer attempts to destroy a victim’s sense of being grounded in a family and society as a human being with dreams, hopes and aspirations for the future.

    — (IP, §235)

    Internationally accepted definitions of torture acknowledge that provoking mental suffering is often the intention of the torturer.

  • All kinds of torture inevitably comprise psychological processes.
  • Torture often causes psychological/psychiatric symptoms at various levels.
  • Torture methods are often designed not to leave physical lesions, and physical methods of torture may result in physical findings that either disappear quickly or lack specificity.

    The improvement in the methods of detecting and providing evidence of physical torture has paradoxically led to more sophisticated methods of torture that do not to leave visible evidence on the victim’s body. Most physical symptoms and signs of torture, if there are any, rapidly disappear.

    It is important to realise that torturers may attempt to conceal their acts. To avoid physical evidence of torture, precautions are taken with the intention of producing maximal pain and suffering with minimal evidence. Especially under conditions of raised awareness in society, torture applied with these precautions and sophisticated methods may leave almost no physical signs.

    Torturers know that by not leaving permanent physical scars, they help their cause and make the work of their counterparts in the human rights arena more difficult. For this reason, in the Istanbul Protocol it is underscored that, “the absence of such physical evidence should not be construed to suggest that torture did not occur.”

  • Psychological symptoms are often more prevalent and long-lasting than physical symptoms.

    Contrary to the physical effects of torture, the psychological consequences of torture are often more persistent and troublesome than physical disability. Several aspects of psychological functioning may continue to be impaired long-term. If not treated, victims may still suffer from the psychological consequences of torture even months or years following the event, sometimes for life, with varying degrees of severity.

Psychological evaluations can provide critical evidence of abuse among torture victims. It has a central role in the medical investigation and documentation of torture allegations. All medical investigations and documentation of torture should include a detailed psychological evaluation because: One … Continue reading

Module 1 Answers

  1. Answer: A, B, D

    Torture as defined by CAT, involves the intentional infliction of severe mental or physical pain or suffering, by or with the consent or acquiescence of the state authorities, for a specific purpose, such as gaining information, punishment or intimidation or for any other reason. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

  2. Answer: B, C, D

    Ill-treatment does not have to be inflicted for a specific purpose, but there does have to be an intent to expose individuals to the conditions which amount to or result in the ill-treatment. Like torture, ill-treatment is perpetrated by or with the consent or acquiescence of the state authorities.

  3. Answer: C

    Amnesty International documented cases of torture and other cruel, inhuman or degrading treatment in 81 countries in 2007.

  4. Answer: B

    Torture has been practiced throughout history, but universal prohibition against torture was codified in international law only in the aftermath of WWII in 1948. The UN Convention on Torture Against Torture was adopted by the UN General Assembly considerably later in 1984.

  5. Answer: E

    Torture commonly serves the purpose of suppressing and punishing political opponents and alleged criminals and to achieve social control by inducing a sense of terror in a population, but it is also frequently used in interrogations to force confessions. Moreover, torture can occur where there is no obvious purpose.

  6. Answer: D

    The prohibition of torture and ill-treatment is absolute; such acts cannot be justified under any circumstances including, national security, states of emergency, the need to counter terrorism, or following orders from one’s superiors.

  7. Answer: B

    Non-refoulment in the Convention against Torture refers to the forcible return or extradition of a person to another country where he or she is at risk of torture.

  8. Answer: True

    States are responsible for safeguarding the rights of everyone within their jurisdiction and may under some circumstances be held accountable for acts carried out by private individuals if it supports or tolerates them, or fails in other ways to provide effective protection in law and in practice against them.

  9. Answer: True

    Torture and ill treatment are often perpetrated in the process of criminal investigations in order to obtain false confessions to alleged crimes and in the context of claims of national security.

  10. Answer: False

    The prohibition of torture is not limited to a negative obligation to refrain from causing suffering, but also contains wider obligations: including the obligation to investigate allegations, even if there has not been a formal complaint about it, and to bring the perpetrators to justice. The UN Convention Against Torture states clearly in article 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.”

  11. Answer: D

    The ICRC’s findings are communicated and discussed on a confidential basis with the concerned authorities and are not made available to the public. The ICRC undertakes visits under nonnegotiable modalities which include: access to all places of detention and all people detained and to make a register of all those who wish to have their details recorded; the possibility to select individual detainees to talk with in private, and the possibility to repeat the visits as often as is deemed necessary. During visits, the ICRC takes the humane treatment of detainees to encompass not only freedom from torture and other ill-treatment, but also general conditions of detention that maintain both the physical and mental integrity of the individuals.

  12. Answer: False

    The prohibition of torture is the concern not only of those countries which have ratified particular treaties, but is also a rule of general or customary international law, which binds all states even in the absence of treaty ratification. In fact, the prohibition of torture is generally regarded as having the special status of a ‘peremptory norm’ of international law, and states cannot choose to disregard or derogate from it.

  13. Answer: True

    The Convention Against Torture (Article 14) indicates that victims of torture have a right to redress and adequate compensation.

  14. Answer: E

    People are particularly at risk when they are deprived of their liberty, held in pre-trial detention or subject to interrogation. The greatest risk is in the first phase of arrest and detention, before the person has access to a lawyer or court. People being held in incommunicado detention – without access to anyone in the outside world – are particularly vulnerable.

  15. Answer: True

    Optional Protocol to the UN Convention Against Torture established a complementary dual system of regular visits by independent international and national bodies to places of detention in order to prevent torture and ill-treatment.

  16. Answer: E

    The Human Rights Committee has stated that the protection of detainees requires that each person detained be afforded prompt and regular access to doctors. The Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment state that ‘a proper medical examination shall be offered to a detained or imprisoned person as promptly as possible after his admission to the place of detention or imprisonment, and thereafter medical care and treatment shall be provided whenever necessary. This care and treatment shall be provided free of charge. Detainees have the right to request a second medical opinion by a doctor of their choice, and to have access to their medical records.

  17. Answer: True

    Rule 22(2) of the UN Standard Minimum Rules for the Treatment of Prisoners states that detainees or prisoners needing special treatment must be transferred to specialised institutions or civil hospitals for that treatment.

  18. Answer: E

    All of the measures listed above are important in the prevention of torture and ill treatment. Additional prevention measures include non-refoulement or no transfer to a country where torture is likely, providing detainees access to family members and friends, and the training of state officials, including medical personnel, on torture prohibition.

  19. Answer: A, C, D

    Effective investigation of alleged torture and ill treatment and criminal prosecution of alleged perpetrators are essential for accountability. Adequate victim and witness protection is a critical component of such prosecutions. Allowing torture to be prosecuted as a lesser crime such as “abuse of police duty” would likely have a permissive effect on torture and ill treatment practices.

  20. Answer: False

    All detained people have the right to equal treatment without discrimination on the grounds of race, colour, sex, sexual orientation, language, religion, political or other opinion, national or social origin, property, birth or other status. Particular allowances should, however, be made for the rights and needs of special categories of detainees including women, juveniles, elderly people, foreigners, ethnic minorities, people with different sexual orientation, people who are sick, people with mental health problems or learning disabilities, and other groups or individuals who may be particularly vulnerable during detention.

Answer: A, B, D Torture as defined by CAT, involves the intentional infliction of severe mental or physical pain or suffering, by or with the consent or acquiescence of the state authorities, for a specific purpose, such as gaining information, … Continue reading

Legal Investigation of Torture

According to the Istanbul Protocol, investigations into torture should seek to establish the facts of alleged incidents in an effort to identify and facilitate the prosecution of perpetrators and/or secure redress for the victims. When possible, forensic experts should obtain detailed information on the following topics: 1) the circumstances leading up to the torture; 2) the approximate dates and times when the torture occurred; 3) detailed physical descriptions about the people involved in the arrest, detention and torture; 4) the contents of what was asked of or told to the victim; 5) a description of the usual routine in the place of detention; 6) details about the methods of torture and/or ill-treatment used; 7) any instances of sexual assault; 8 ) resulting physical injuries; 9) weapons or physical objects used; and 10) the identity of any witnesses.

When designing commissions of inquiry, states or organisations should be very clear in defining the scope of the investigation. By framing the inquiries in a neutral manner (without predetermined outcomes), allowing for flexibility, and being clear about which events and/or issues are under investigation, the proceedings can achieve greater legitimacy among both commission members and the general public.

Commissions should be given the authority to obtain information by compelling testimonies under legal sanction, ordering the production of State documents, including medical records, and protecting witnesses. In addition, the commissions should be granted the power to conduct on-site visits and issue a public report.

Perhaps most crucial to the legitimacy of any medico-legal investigation is their impartiality. According to the Istanbul Protocol, “…[c]ommission members should not be closely associated with any individual, State entity, political party or other organisation potentially implicated in the torture. They should not be too closely connected to an organisation or group of which the victim is a member, as this may damage the commission’s credibility.”

In addition, commissions should, whenever possible, rely on their own investigators and expert advisers, especially when examining misconduct by members of the government.

Following the inquiry, the commission should issue a public report, with minority members filing a dissenting opinion. These reports should include: the scope of inquiry and terms of reference, as described above; the procedures and methods of evaluation; a list of all testifying witnesses—except for those whose identities are protected—with their age and gender; the time and place that each sitting occurred; all relevant political, social and economic conditions that may have influenced the inquiry; the specific events that occurred and supporting evidence; the commissions’ conclusions; and finally, a set of recommendations. In response to these reports, the State should issue a public statement describing how it plans to heed the commission’s recommendations.

The Istanbul Protocol also includes obligations of governments to ensure minimum standards for the effective investigation and documentation of torture and ill-treatment as stipulated in the Istanbul Principles as mentioned above.

According to the Istanbul Protocol, investigations into torture should seek to establish the facts of alleged incidents in an effort to identify and facilitate the prosecution of perpetrators and/or secure redress for the victims. When possible, forensic experts should obtain … Continue reading

Safety and Security

Clinicians should carefully consider the context in which they are working, take necessary precautions and provide safeguards accordingly. If interviewing people who are still imprisoned or in similar situations in which reprisals are possible, all precautions should be taken to ensure that they do not place the detainee in danger (or in additional difficulty). Promises must not be made, for example, to provide security for the witness or for relatives who might be at risk, unless the interviewer is certain that they can be fulfilled. Witnesses might believe that international organisations or others investigating allegations of torture have more power to protect them than is the case. It is part of the informed consent process that individuals are aware of all the issues before they agree for a clinician to make a formal report. If the risk of harm from reprisals is a virtual certainty, conducting a medical evaluation may be considered unethical even if informed consent is obtained. This may be the case in the context of documenting human rights violations in places of ongoing conflict.

Whether or not certain questions can be asked safely will vary considerably and depends on the degree to which confidentiality and security can be ensured. When necessary, questions about forbidden activities should be avoided.

If the forensic medical examination supports allegations of torture, the detainee should not be returned to the place of detention, but rather should appear before the prosecutor or judge to determine the detainee’s legal disposition (see Procedural Safeguards below).

An interviewer will make notes of the interview, and may use other recording devices. The reasons for this should be explained to the interviewee who should be reassured as to how the notes and other records will be used and asked for consent. The way in which any records of such interviews are stored can be important in protecting the security of the interviewer and the interviewee. In many countries where torture is prevalent, the police have been known to raid clinics and search or confiscate medical records. In order to protect patients, therefore, in such conditions records should have no obvious identifying information on any document inside (such as initials or date of birth), and the files themselves being numbered with a register kept in a secure place elsewhere. Patients can be given cards with the identifying number so that treatment can be continued even if the register is not available. In some circumstances it may be necessary to hold records at a different location or even in a third country to ensure their security.

If information about an individual needs to be transmitted to another body, fax transmission is generally safer than e-mail as a copy of the latter may be stored on the sending computer or held on the server of the internet service provider. In some countries the authorities routinely screen all outgoing messages.

Clinicians should carefully consider the context in which they are working, take necessary precautions and provide safeguards accordingly. If interviewing people who are still imprisoned or in similar situations in which reprisals are possible, all precautions should be taken to … Continue reading