Module 5: Physical Evidence of Torture and Ill-Treatment
Objectives
- To provide in-depth information on physical examination methods, factors to consider during examinations, and the interpretation of findings.
- To be able to conduct a physical examination of each organ system and assess possible acute and chronic signs and symptoms of torture and ill-treatment
- To understand basic mechanisms of injury
- To be familiar with specific examination considerations for victims of sexual assault
- To understand the effective use of medical photography and the appropriate use of diagnostic tests
- Discuss the circumstances for the appropriate use of directed vs. comprehensive physical examinations
- To be familiar with the differentiation of self-inflicted injuries and those caused by torture and ill-treatment
Content
- Physical evidence of torture
- Medical history
- Acute symptoms
- Chronic symptoms
- The physical examination
- Acute symptoms
- Chronic symptoms
- Dermatologic Evaluation
- Abrasions
- Contusions
- Lacerations
- Incisions
- Burns and scalds
- Complex Lesions
- Scarring
- Head and neck
- Eyes
- Ears
- Nose
- Jaw, Oropharynx and Teeth
- Chest and Abdomen
- Musculoskeletal System
- Neurological Examination
- Head Trauma and Post-traumatic Epilepsy
- Nerve damage
- Examination of Women
- Examination Following a Recent Assault
- Examination After the Immediate Phase
- Follow-up
- Genital Examination of Women
- Genital Examination of Men
- Perianal Examination
- Medical Photography
- Assessment for Referral
- Diagnostic Tests
- Radiologic Imaging
- X-Rays
- Scintigraphy
- Ultrasound
- CT scans
- MRI
- Biopsy of Electric Shock Injury
Discussion Topics
- Students should work in groups or individually to answer questions contained in Self-Assessment 5
- Additional Discussion Topics:
- Discuss relevant considerations to distinguish physical findings caused by torture and ill-treatment and those that may be self-inflicted or the result of other causes
- Discuss the relative value of diagnostic tests and their limitations and develop a series of country-specific recommendations for indications of using diagnostic tests in various documentation settings
- Discuss appropriate indications for a genital examination (women and men), how the examinations should, and should not, be performed, and any relevant country-specific considerations for the evaluation of allegations of sexual assault
Teaching Formats
- Group Activity:
- Divide the class into several groups and have each group work on answering questions contained in Self-Assessment 5
- A facilitator should be identified to moderate the discussion and rapporteur should be identified to record the group’s findings and report them when the class reconvenes.
- After 20-30 minutes of group discussion, the entire class should reconvene
- Rapporteurs should briefly report on their group’s findings
- Open class discussion
- Alternative Option:
- Divide the class into several groups and assign each group with one or more (or all) of the Discussion Topics
- Follow the usual sequence for conducting group activities as outlined above
- Individual Research/Assignment:
- Individual students should answer all questions contained in Self-Assessment 5
- Journal Entry: (Instructor to assign Write a few paragraphs — no more than a page)
- Respond to one or more of the Discussion Topics
Primary Resources
- The Istanbul Protocol, Chapter V
- The Medical Documentation of Torture
- Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
- Medical Physical Examination of Alleged Torture Victims: A Practical Guide to the Istanbul Protocol for Medical Doctors
- Examining Asylum Seekers
- Dermatologic Findings after Alleged Torture (PowerPoint file). Lis Danielsen and Ole Vedel Rasmussen, IRCT 2004-2005.
- Torture Methods (PowerPoint file). Ole Vedel Rasmussen, IRCT 2004-2005.
- Işkence Atlaı: Işkencenin Tibbi Olarak Belgelendirilmesinde Muayene ve Tanısal Inceleme Sonuclarının Kullanılması
- Trainers’ Guidelines for Health Professionals: Training of Users