Module 3: Interview Considerations

Ensuring procedural safeguards for detainees is essential for the safety and security of detainees, to earn the detainees trust, respect his or her privacy, and ensure confidentiality (See Procedural Safeguards for Detainees, Module 2). Disregard for certain procedural safeguards may not only result in inaccurate medical evaluation, but also the possibility of administrative and/or criminal santions against the medical expert responsible for forensic documentation of torture and ill-treatment. As described in Module 2, procedural safeguards for detainees can be summarised as follows:

• Forensic medical evaluation of detainees should be conducted in response to official written requests by public prosecutors or other appropriate officials.
• Detainees themselves, their lawyers or relatives have an independent right to request a medical evaluation to seek evidence of torture and ill-treatment.
• It is mandatory that detainees undergo a preliminary medical examination at the time of detention; a further examination and evaluation should be made upon their release.
• The detainee should be taken to the forensic medical examination by officials other than soldiers or police working in the unit where the detainee is held.
• The officials who supervise the transportation of the detainee should be responsible to the public prosecutors and not to other law enforcement officials.
• The detainee must be:
• independently and thoroughly examined by a qualified doctor, and, without any police officer being present.
• The presence of police, soldier, warden, or other law enforcement officers in the examination room, for whatever reason, should be noted in the physician’s official medical report. Notation of police, soldier, prison officer, or other law enforcement official’s presence during the examination may be grounds for disregarding a “negative” medical report.
• Medico-legal evaluations of detainees should include the use of a standardized medical report form.
• The report must include the story, details of injuries and psychological findings that may be attributable to torture or ill-treatment together with explanations of the patient and the opinion of the doctor.
• Under no circumstances should a copy of the medical report be transferred to law enforcement officials; instead it should be transmitted to the official requesting the report, generally the public prosecutor.
• If the forensic medical examination supports allegations of torture or ill-treatment, the detainee should not be returned to the place of detention, but should instead be presented to the competent prosecutor or judge for purposes of determining the detainee’s legal disposition.
• Access to the lawyer should be provided at the time of the medical examination.
• The medical examination should be free of charge.
• Forensic medical services should be under judicial or an independent authority and not under the same governmental authority as the police and prison system.
• Detainees have the right to obtain a second or alternative medical evaluation by a qualified physician also during his/her detention.

Ensuring procedural safeguards for detainees is essential for the safety and security of detainees, to earn the detainees trust, respect his or her privacy, and ensure confidentiality (See Procedural Safeguards for Detainees, Module 2). Disregard for certain procedural safeguards may … Continue reading →

The content of interviews varies among clinicians who conduct separate medical evaluations of physical and psychological evidence of torture. Additional interview considerations for these components of a medical evaluation are included in Modules 5 and 6.

The content of interviews varies among clinicians who conduct separate medical evaluations of physical and psychological evidence of torture. Additional interview considerations for these components of a medical evaluation are included in Modules 5 and 6.

Physical and psychological examinations by their very nature may re-traumatise an individual by provoking and/or exacerbating psychological distress and symptoms by eliciting painful memories. The interview must be structured so as to minimise the risk of re-traumatisation. According to the Istanbul Protocol:

Several basic rules must be respected (see chapter III, sect. C.2 (g). Information is certainly important, but the person being interviewed is even more so, and listening is more important than asking questions.

— (IP, §134)

The clinician needs to balance two important requirements which should be complementary, but may sometimes conflict: the need to obtain a useful account, and the importance of respecting the needs of the person being interviewed. The primary goal of documenting allegations of torture is to create an accurate, reliable, precise and detailed record of events by taking into account the personal situation and the psychological condition of the individual.

Interviewers should show sensitivity in their questioning and watch out for signs of tiredness or distress. A subjective assessment has to be made by the clinician about whether and to what extent pressing for details is necessary for the effectiveness of the report in court, especially if the interviewee demonstrates obvious signs of distress.

Physical and psychological examinations by their very nature may re-traumatise an individual by provoking and/or exacerbating psychological distress and symptoms by eliciting painful memories. The interview must be structured so as to minimise the risk of re-traumatisation. According to the … Continue reading →

The physical examination, and any related photographs of physical findings, is usually conducted after all other interview components, including the psychological evaluation if the examiner is conducting both the physical and psychological assessments. Information on the physical examination is included … Continue reading →

Ideally, an investigation team should contain specialists of both genders, permitting the person who says that they have been tortured to choose the gender of the investigator and, where necessary, the interpreter. This is particularly important when a woman has been detained in a situation where rape is known to happen, even if she has not, so far, complained of it. Even if no sexual assault takes place, most torture has sexual aspects. The re-traumatisation can often be worse if she feels she has to describe what happened to a person who is physically similar to her torturers, who will inevitably have been mostly or entirely men. In some cultures, it would be impossible for a male investigator to question a female victim, and this must be respected. However, in most cultures, if there is only a male physician available, many women would prefer to talk to him rather than a female of another profession in order to gain the medical information and advice that she wants. In such a case, it is essential that the interpreter, if used, be female. Some interviewees may also prefer that the interpreter be from outside their immediate locality, both because of the danger of being reminded of their torture and because of the perceived threat to their confidentiality. If no interpreter is necessary, then a female member of the investigating team should be present as a chaperone throughout at least the physical examination and, if the patient wishes, throughout the entire interview.

When the individual is male and has been sexually abused, the situation is more complex because he too will have been sexually abused mostly or entirely by men. Some men would, therefore, prefer to describe their experiences to women because their fear of other men is so great, while others would not want to discuss such personal matters in front of a woman.

Ideally, an investigation team should contain specialists of both genders, permitting the person who says that they have been tortured to choose the gender of the investigator and, where necessary, the interpreter. This is particularly important when a woman has … Continue reading →

To conclude the medical evaluation, the clinician should review the next steps in the process of medical documentation, for example, that the clinician will forward a copy of his or her report to the individual’s attorney, or that the clinician is recommending additional tests or consultations. The clinician should consider acknowledging the emotional difficulty of the interview and thank the interviewee for his or her time and effort. During the psychological examination, the clinician may have reassured the individual that their symptoms are nomal reactions to extreme experiences. This is particularly helpful when the individual feels that their symptoms are a sign of “going crazy.” The clinician may consider reviewing this point with the individual at the end of the interview.

To conclude the medical evaluation, the clinician should review the next steps in the process of medical documentation, for example, that the clinician will forward a copy of his or her report to the individual’s attorney, or that the clinician … Continue reading →

Children have the rights to have their consent and confidentiality respected. Except in emergency they should not be given medical treatment without a parent or guardian present. Similarly, a detailed account of the cause of injuries should only be taken from a child in the presence of a parent or guardian or, if they are not available, someone else representing the child’s best interests.

Older children may be tortured to suppress political activity. They should be treated in the same way as young adults, and the approach needs to be very sympathetic. Torture of younger children is generally performed to put pressure on parents. Where possible, the family should be treated together and the child’s injuries should be documented and managed by pediatric specialists.

A child, in particular, needs to be in an environment in which he or she feels comfortable before being willing to disclose sensitive information. In discussing traumatic events, a child may prefer to draw a picture and then to explain it. Children’s attention spans can be quite short, so it may be necessary to break the interview frequently. See additional considerations in Module 6, Children and Torture.

Children have the rights to have their consent and confidentiality respected. Except in emergency they should not be given medical treatment without a parent or guardian present. Similarly, a detailed account of the cause of injuries should only be taken … Continue reading →

Wherever possible, examinations to document torture for medico-legal reasons should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local rehabilitation and support services. The clinician should not hesitate to insist on any consultation and examination that he or she considers necessary in a medical evaluation. In the course of documenting medical evidence of torture and ill-treatment, physicians are not absolved of their ethical obligations. Those who appear to be in need of further medical or psychological care should be referred to the appropriate services.

NOTE: Online course available on “Caring for Torture Survivors” offered by the Boston Center for Refugee Health and Human Rights. See http://www.bcrhhr.org/pro/course/course_index.html [1]

Wherever possible, examinations to document torture for medico-legal reasons should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local … Continue reading →

The clinician should attempt to understand mental suffering in the context of the interviewee’s circumstances, beliefs, and cultural norms rather than rush to diagnose and classify. Awareness of culture specific syndromes and native language-bound idioms of distress is of paramount … Continue reading →

Good interpreters, particularly those from the same background as the individual, are able not only to interpret the words, but also to identify and explain relevant cultural, historical and social factors as well as linguistic idioms to the interviewer. Beware, however, of over-reliance on interpreters, as they are not experts in areas outside their own field.

Interpreters are an important part of the inquiry team. They need to be trained to work with survivors of torture and other ill-treatment even if they have considerable experience of interpreting in other contexts. Most professional interpreters have their own code of ethics. If not, they must be advised that what they hear and interpret in interviews is strictly confidential.

Professionals working with interpreters need to remind themselves that, if they do not share a language with the individual, the quality of the interpreter used will impact on all aspects of their interview, examination and report.

Second and third languages

In situations where the health professional is seeing the individual in their routine practise, they will usually speak the same language. In situations where there are several ethnic groups within a country, there may be language barriers within the population. Sometimes the one will speak some of the other’s language, or they may share a third language. The danger is that if one person’s command of this second or third language is weak, this may lead to inaccuracies and inconsistencies in the report. There may also be difficulties associated with interpreters of a different ethnicity or from a different region from that of the individual. The accent and vocabulary might differ.

Gender and age of interpreters

In many cases, it is necessary to use an interpreter for some, or all, of the interview. The issues of gender may be even more important in this situation as the interviewee may relate more to the interpreter than to the interviewer. Some individuals are less concerned about the gender of the interviewer than they are about that of the interpreter. Age may also be relevant. A young male individual may be able to discuss sexual torture with an older woman to whom he may relate as to an aunt, but not to a woman of his own age. Similarly, a young female individual may find an older man easier to talk to than one who is of a similar age to her torturer. Bear in mind, however, for women, having a female interviewer and interpreter is the best practise.

Local and international interpreters

When an international team makes a visit to a country it might include interpreters, or it may choose to employ local interpreters. There are two issues to keep in mind in such cases. Firstly it must be made clear to the local interpreter that he or she may be putting him- or herself into danger by working with visiting interviewers when documenting torture. Secondly, the individual may not trust a local interpreter and not give a complete account of what happened.

Using an interpreter

Interviewers should remember to talk to the individual and to keep eye contact with him or her even though there is a natural tendency to speak to the interpreter. It helps to pose questions directly to the first person, for example: ‘What did you do then?’ rather than indirectly through the interpreter, for example: ‘Ask him what happened next.’ Observing body language, gestures and facial expressions, as well as non-verbal communication, is essential both to enhance the amount of information gained and to give the individual confidence that the health professional is interested in what is being said. Above all, it helps the individual to understand that he or she has been heard. When the individual is providing a long, unbroken account, the health professional should pause the interview regularly to note the information. This helps the interpreter not to forget key points and allows the health professional to clarify points when they are still fresh in the individual’s mind.

Family members

As a rule, family members and friends must not be used for interpretation for two reasons. First, the quality of interpreting is generally inadequate, and second, there may be topics that the individual will not discuss in front of a family member, and therefore the risk of a failure to disclose torture is greatly increased. Many parents, for example, will not reveal details of their torture in front of their child. Furthermore, revealing such details in their presence may even lead to psychological harm for the child.

Good interpreters, particularly those from the same background as the individual, are able not only to interpret the words, but also to identify and explain relevant cultural, historical and social factors as well as linguistic idioms to the interviewer. Beware, … Continue reading →