- Which of the following do you consider to be important considerations before interviewing Mrs. Asha Ali Yousif?
- A safe and comfortable location
- Privacy during the interview
- Understanding that she must answer all of the questions asked
- Understanding that she can take breaks if she wishes
- All of the above
- Which of the following must be addressed before beginning all interviews?
- Making sure that refreshments are available
- Obtaining informed consent
- Explaining the benefits and risks of the medical evaluation
- Ensuring that the translator and alleged victim are the same gender
- Who would you consider to be the most appropriate translator for your interview with Mrs. Yousif?
- Mrs. Yousif’s daughter
- A male village elder
- A stranger in Kalma Camp
- A stranger from outside Kalma Camp
- In the process of eliciting the trauma history from Mrs. Yousif, which of the following interviewing techniques do you think is most appropriate?
- Asking simple questions that require brief answers to ensure a coherent and reproducible narrative
- Asking questions about the most significant alleged trauma first
- Asking open-ended questions and minimize interruptions
- The evaluator should use whatever interviewing technique that he or she is most comfortable with
- What psychosocial information elicited from Mrs. Yousif’s is most likely to contribute to her to her psychological symptoms?
- The killing of her husband and burning of her home and village
- That she was poor
- Her occupation as a teacher
- That she had no prior history of mental problems
- Mrs. Yousif’s feelings of guilt are most likely related to?
- Not being able to support her family
- Failing to fight off her attackers
- Failing to protect her daughter’s sexual assault
- Exposing herself to further abuse by reporting the torture to the police
- In Mrs, Yousif’s case, which of the following factors may interfere with an accurate recounting of past events:
- Blindfolding
- Disorientation
- Lapses in consciousness
- Organic brain damage
- Psychological sequelae of abuse
- Fear of placing oneself or others at risk
- Lack of trust in the examining clinician
- It is important to document what the perpetrators reportedly said during the alleged abuse as it may help to establish the intent of their actions and provide insight into the meaning an individual assigns to his or her experience.
- True
- False
- If during the course of interviewing an alleged torture victim the individual acknowledges that he or she was sexually assaulted and does not feel comfortable discussing this further, which of the following would you consider appropriate?
- Move on with the interview
- Explain how common sexual assault is among torture survivors (women and men)
- Acknowledge relevant norms of social stigma associated sexual assault
- Offer to limit reporting of sexual assault information according to the alleged victim’s wishes, i.e. only to the judge
- All of the above
- Which of the following questions should you consider to indirectly assess allegations of sexual assault?
- What was said by the alleged perpetrators
- Removal of clothing of the alleged victim and perpetrator(s)
- Duration of the encounter/assault
- The use of weapons
- Any form of physical contact or touching
- Subsequent vaginal pain or bleeding
- The possibility of pregnancy or a sexually transmitted disease
- All of the Above
- Which of the following would you consider to be highly consistent with Mrs. Yousif’s allegations of torture?
- History of a right-sided facial droop after being kicked on the right side of her face
- Chronic headaches relieved by aspirin
- Bruises shaped in parallel lines, but clear in the middle of the lines
- No menstrual period since the assault
- All of the above
- If you examined Mrs. Yousif when she visited Nyala Hospital for medical care, what should have been done ideally?
- Conduct a thorough physical examination with particular attention to cutaneous lesions that could have resulted from an assault
- Conduct a pelvic examination and document any evidence of sexual assault
- Discuss the issues of pregnancy and emergency contraception
- Assess for sexually transmitted diseases (i.e. gonorrhoea, chlamydia, syphilis and trichomoniasis, Hepatitis B and HIV) and consider post-exposure prophylaxis
- Obtain wet vaginal swabs and dry them for subsequent DNA analysis
- All of the above
- Does Mrs. Yousif meet diagnostic criteria for PTSD?
- Yes
- No
- The presence of diagnostic criteria for PTSD has greater value for the adjudication of legal cases than understanding the meaning that individuals attach to experiences of torture and ill treatment.
- True
- False
- Which of the following factors may contribute to Mrs. Yousif’s psychological symptoms?
- Home and village burned
- Husband and father killed in front of her
- Difficulty surviving in Kalma Camp
- Rape of her daughter
- All of the above
- Which of the following can help to distinguish Mrs. Yousif psychological symptoms caused by sexual assault experiences versus other traumatic experiences or losses?
- The onset and trend in her psychological symptoms
- The content of her nightmares and intrusive recollections
- Triggers for intrusive recollection, reliving experiences, and avoidance reactions
- Feeling responsible for her daughter’s rape
- All of the above
- Mrs. Yousif should have a pelvic examination at the time of your evaluation to assess possible physical evidence of rape, even though the likelihood of such evidence decreases considerably after the first week of the assault.
- True
- False
- Symptoms of sexual dysfunction following rape may be physical or psychological in origin or a combination of both and include:
- Aversion to members of the opposite sex or decreased interest in sexual activity
- Inability to trust a sexual partner
- Disturbance in sexual arousal and erectile dysfunction
- Dyspareunia (painful sexual intercourse in women) or infertility due to acquired sexually transmitted disease, direct trauma to reproductive organs or poorly performed abortions of pregnancies following rape
- All of the above
- On physical examination (see PPT Module 7, Slides 16-18) Mrs. Yousif is noted to have: 1) a 1 cm hyperpigmented, linear scar above the left eyebrow; and 2) a complex, atrophic scar, approximately 4 x 6 cm over the dorsum of the left hand associated with hypopigmentation and subcutaneous fibrosis. How would you describe the level of consistency between, Mrs. Yousif’s allegations of abuse and these physical examination findings?
- Not consistent
- Consistent with
- Highly consistent with
- Virtually diagnostic of
- How would you describe the level of consistency between, Mrs. Yousif’s allegations of abuse and psychological evaluation findings?
- Not consistent
- Consistent with
- Highly consistent with
- Virtually diagnostic of
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- Preface
- Introduction
- Module 1: International Legal Standards (Overview)
- Torture
- What is Torture
- Purpose of Torture
- History of Torture
- Other Definitions
- Cruel Inhuman & Degrading Treatment & Punishment (CID)
- Prohibition of Torture in International Law
- The United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 1984
- Torture in the World Today
- Country-Specific Legal Standards and Torture Practices
- The Perpetrators
- Common Situations for Torture Allegations
- Where Does Torture and Ill-treatment Occur?
- Obligation to Investigate and Bring Justice
- Formal Inspection of Detention Facilities
- Official Complaints to Human Rights Bodies and Other Organizations
- Recently Released Detainees
- NGO Information Gathering
- Late Allegations
- Prevention and Accountability
- International Supervisory Machinery and Complaints Procedures
- The Human Rights Committee
- The UN Committee against Torture
- Regional Mechanisms
- Other monitoring mechanisms
- The UN Special Rapporteur on Torture and other Cruel, Inhuman and Degrading Treatment or Punishment
- International criminal courts and tribunals
- The International Committee of the Red Cross (ICRC)
- Safeguards Against Torture for Those Deprived of Their Liberty
- Notifying people of their rights
- Use of officially recognized places of detention and the maintenance of effective custody records
- Avoiding incommunicado detention
- Humane conditions of detention
- Limits on interrogation
- Access to a lawyer and respect for the functions of a lawyer
- Access to a doctor
- The right to challenge the lawfulness of detention
- Safeguards for special categories of detainees
- Module 1 Presentation: International Legal Standards
- Self-Assessment and Quiz
- Torture
- Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
- The Istanbul Protocol
- An Overview of the Istanbul Protocol
- Medical Ethics
- Introduction
- Duties of the health professional
- International Codes
- Ethical rules directly prohibiting involvement in torture
- Primary loyalty to the patient
- Dual Obligations
- The treatment of prisoners and detainees
- Issues surrounding examinations of individuals in the presence of security forces
- Abusive medical treatment
- Consent and confidentiality
- Security
- Involvement of other health professionals in torture
- Seeking further information and support
- Country-specific legal responsibilities of health professionals for forensic documentation of torture and ill-treatment
- General Guidelines for Gathering Evidence and Documenting Findings
- Documenting the allegations
- Module 2 Presentation: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
- Self-Assessment and Quiz
- Module 3: Interview Considerations
- Preliminary Considerations
- Purpose of Medical Evaluations
- Interview Settings
- Trust
- Informed Consent
- Confidentiality
- Privacy
- Empathy
- Objectivity
- Safety and Security
- Procedural Safeguards for Detainees
- Risk of Re-traumatisation
- Gender Considerations
- Interviewing Children
- Cultural and Religious Awareness
- Working with Interpreters
- Transference and Counter-Transference Reactions
- Conducting Interviews
- Interview Content
- Identification and Introduction
- Psychosocial History (Pre-Arrest)
- Past Medical History
- Summary of Detention(s) and Abuse
- Circumstances of Detention(s)
- Prison/Detention Place Conditions
- Allegations of Torture and Ill-treatment
- Review of Symptoms
- Psychosocial History (post-arrest)
- Assessments of Physical and Psychological Evidence
- Physical Examination
- Closing
- Indications for Referral
- Module 3 Presentation: Interview Considerations
- Self-Assessment and Quiz
- Preliminary Considerations
- Module 4: Torture Methods and their Medical Consequences
- Introduction
- Torture Methods
- Beatings/Falanga
- Ear Trauma
- Eye Trauma
- Restraint, Shackling and Positional Torture
- Suspension
- Crushing and Stretching Injuries
- Burning
- Electrical injuries
- Asphyxiation
- Violent Shaking
- Sexual Assault
- Sexual Humiliation
- Prolonged Isolation and Sensory Deprivation
- Sleep Deprivation
- Temperature Manipulation
- Sensory Bombardment
- Threats of Harm
- Psychological Consequences of Torture
- Module 4 Presentation: Torture Methods and their Medical Consequences
- Self-Assessment and Quiz
- Module 5: Physical Evidence of Torture and Ill-Treatment
- Module 6: Psychological Evidence of Torture and Ill-Treatment
- Module 7: Case Example #01
- Module 8: Case Example #02
- Module 9: Report Writing and Testifying in Court