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Preliminary Considerations
Module 8 Presentation: Case Example #02
Toolkits > Istanbul Protocol Model Medical Curriculum > Module 8: Case Example #02 > Materials

Materials

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Case Summary/Referral #02

(distribute to students who conduct the interviews)

(Strong physical, moderate psychological and strong historical evidence; medical evaluation 7 days after alleged torture)

Note: This case example #02 is written for male role-player. All names included in the narrative are fictitious.

  • Name: Mr. Hassan Bashir Adam
  • Date Reporting to the Center: dd/mm/yyyy (today’s date)
  • Date of Birth: dd/mm/yyyy (age 25)
  • Age: 25 yrs
  • Marital Status/Children: Single, no children
  • Religion: Muslim
  • Ethnic Group: Darfurian, Zagawa tribe
  • Profession: Student, Khartoum University
  • Political/Social Affiliation: Member of Student Democratic Front (SDF)
  • Date of Detention: dd/mm/yyyy (7 months prior to the exam date)
  • Place of Detention: XXX police station
  • Period of Detention: 3 days
  • Trauma History: On dd/mm/yyyy (7 months prior to the exam date), Mr. Adam as arrested by four officers from the NSA. He was placed in a truck with blackened windows, blindfolded and taken to a police station. His mobile phone and ID card were confiscated. His hands were restrained and he was punched, kicked and beaten with black water hoses and electric wires. They suspended him by his wrists and applied electric shocks to his genitals.
  • Alleged Perpetrators: Security personnel from the NSA, including Abdel Salih, and Kaleel Rahim, also 2 perpetrators referred to as Rasoul and Mujahid.
  • Reasons for Visit: Treatment for problems related to torture and to take legal action against the perpetrators. The client has already met with SOAT legal advisors, and they have requested a medical evaluation of the client’s allegations of torture.
  • Effects of Torture: Musculoskeletal pain, multiple bruises and burns.

Case Narrative #02

(distribute to role-players only)

Note: Case example #02 is written for male role-players. All names included in the narrative are fictitious.

Case Summary/Referral Information

  • Name: Mr. Hassan Bashir Adam
  • Date Reporting to the Center: dd/mm/yyyy (today’s date)
  • Date of Birth: dd/mm/yyyy (age 25)
  • Age: 25 yrs
  • Marital Status/Children: Single, no children
  • Religion: Muslim
  • Ethnic Group: Darfurian, Zagawa tribe
  • Profession: Student, Khartoum University
  • Political/Social Affiliation: Member of Student Democratic Front (SDF)
  • Date of Detention: dd/mm/yyyy (7 months prior to the exam date)
  • Place of Detention: XXX police station
  • Period of Detention: 3 days
  • Trauma History: On dd/mm/yyyy (7 months prior to the exam date), Mr. Adam as arrested by four officers from the NSA. He was placed in a truck with blackened windows, blindfolded and taken to a police station. His mobile phone and ID card were confiscated. His hands were restrained and he was punched, kicked and beaten with black water hoses and electric wires. They suspended him by his wrists and applied electric shocks to his genitals.
  • Alleged Perpetrators: Security personnel from the NSA, including Abdel Salih, and Kaleel Rahim, also 2 perpetrators referred to as Rasoul and Mujahid.
  • Reasons for Visit: Treatment for problems related to torture and to take legal action against the perpetrators. The client has already met with SOAT legal advisors, and they have requested a medical evaluation of the client’s allegations of torture.
  • Effects of Torture: Musculoskeletal pain, multiple bruises and burns.

Identification

My name is Hassan Bashir Adam. I live in Khartoum, and I am 25 years-old.

Additional Information:

  • Date of Birth: dd/mm/yyyy (age 25)
  • Citizenship: Sudanese
  • Marital Status/Children: I am single, and I do not have children.
  • Place of Birth: Nyala
  • Place of Residence: Khartoum
  • Highest Level of Education: Currently a student at Khartoum University.
  • Occupation: Student
  • Religion: Muslim
  • Identification: ID confiscated
  • Ethnic Group: Darfurian, Zagawa tribe
  • Physician Examiner Name and License #: Fill out
  • Individuals Present in the Examination Room and Reason for Presence: Fill out
  • Language Spoken: Zagawa
  • Name of Interpreter: None
  • Restrictions Noted: This depends on the response of the interviewer.
  • Detainee Status: Detained by police and released

Past Medical/Surgical History and Psychosocial History

Past Medical/Surgical History

Before I was arrested, I had no medical problems, no major illnesses or injury, no surgery, broken bones or head injury. I never had any mental problems, nor has anyone in my family. I am not on any medications. I do not use any illegal drugs or drink alcohol. I smoke about one pack of cigarettes per day.

NOTE: Provide information in parentheses only if specifically asked by the interviewer.

Psychosocial History Pre-Arrest

I was born in Nyala and have two younger brothers. My father owns a small grocery store in Nyala and my mother helps him out at the store. I was good in school and decided to go to Khartoum University for business studies. I have had various part-time jobs, but I have never worked for my parents. My plan was to have a good job with a large company in the future. I have been an active member of the SDA (Student Democratic Front) for the past two years. Many of my friends and I were detained after the student elections last year. I was beaten, but not as bad as the others. One of my brothers was killed by security forces in Darfur about 9 months ago. My parents worry about me, because they know I am an active member of the SDF and they do not approve.

Trauma History

NOTE: At the time of arrest, there was no arrest warrant or subpoena order, search warrant, or resistance by the accused.

On dd/mm/yyyy (7 months prior to the exam date), at about 10:00 pm, four officers from the NSA came to the flat that I share with two other students. They told me that they needed to ask me some questions. I asked them if I was being charged with a crime. One of them, Abdel Salih, told me “Keep your mouth shut if you know what’s good for you.” Another one of them was named Kaleel Rahim.

I was placed in a truck with blackened windows and taken to XXX police station.

They took my mobile phone and ID card. When we arrived, they locked me in a room, about one meter by one meter and a half in size. The room was filthy and smelled of urine. There were no light and the ventilation in the room was very poor. During the time that I was detained, I had difficulty sleeping and was given only a small amount of poor quality food.

Later that night, they took me to an interrogation room and started asking questions about members of the SDF, who I knew and worked with and the nature of our work. I had made a speech recently on the situation in Darfur and they told me, “You may think you are free to criticize us, but we are free to do anything we like. We could kill you tonight and no one would care.” They tied my hands with rope and started beating me with punches, kicks, black water hoses and electric wires. This went on for more than an hour. One of them, “Rasoul,” put a plastic bag over my head and I was gasping for air. He repeated this 3 or 4 more times and I passed out.

When I woke up, they started beating me again (punches, kicks, and hoses). They forced me to take off all of my clothes. My hands were tied behind my back with a rope that was hanging from the ceiling. They lifted me off the ground; the pain was unbearable. They continued beating me while I was suspended. Then they sprayed cold water over me with a hose and forced it in my mouth and nose so I had trouble breathing. One of the agents attached a clip with some wires to my penis and my right foot. He said insulting things (Like “you won’t be needing this anymore.”). My whole body cramped violently when they shocked me. I lost consciousness after they shocked me about five or six times. When I woke up, I was on the floor. I felt several burning sensations on my right forearm. One of them had a lit cigarette in his hand. He burned my arm again and again. One of them told me, “You better stop making speeches or you will end up like your brother.” I was locked in a cell for two days before I was released. I am not guilty of anything, and no one should be treated this way. That is why I had the courage to take legal action against the people who tortured me.

Review of Torture Methods

The following history should be revealed only on further questioning, unless asked in the context of the trauma history:

  • The review of torture methods is negative for the all other torture methods, physical and psychological.

Symptoms (Acute and Chronic) and Disabilities

Acute Symptoms
  • Multiple bruises over my arms, legs and back, no injuries to the head. The bruises are red and swollen and still visible on my body. (No cuts or bleeding)
  • Pain in the shoulders, arms and wrists.
  • A number of burn marks on my right forearm, which took about 2-3 weeks to heal.
  • I did not observe any lesion on the penis where they shocked me.
  • Difficulty lifting objects due to pain in my arms and numbness in my right arm for a few months, but this resolved.
Chronic Symptoms
  • Scars noted on right forearm from cigarette burns.
  • Difficulty having erections, i.e. not able to perform sexually but has noted erections upon waking for sleep.
Disabilities
  • None noted

Psychological Evaluation and Mental Status

Mental Status

Mr. Adam was appropriately dressed and groomed and looked his stated age. He was alert, fully oriented, pleasant and cooperative throughout the evaluation. There were no gross abnormalities in movement or posture on observation. Sensory functions and motor functions appeared to be intact. He appeared to possess above average intellectual ability, with good insight and judgment. His speech was clear and fluent. There was no evidence of delusions, hallucinations or psychotic thought processes. Memory was intact. Attention and concentration appeared intact. His mood was apprehensive in the presence of the police officer who escorted him to my office, but then calm during the evaluation. There was no evidence of suicidal or homicidal ideation.

Psychological Findings

Mr. Adam did not admit to any symptoms of post-traumatic stress disorder or major depression. Though his affect was calm throughout most of the interview, he expressed considerable anger toward those who tortured him and the loss of his brother. Mr. Adam indicated that since being tortured, he is less sure of his future plans. He is now considering altering his career path to become more active politically. His parents have expressed strong disapproval, however; they consider his political activity 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.

Physical Examination

NOTE: Images of “virtual physical examination” findings will be presented in a separate room using PPT slides.

  • Slide #1 and #2 (day of exam): Hyperpigmented, circumferential scars above both wrists, highly consistent with wrist abrasions from alleged restraint with rope and suspension
  • Slide #3 and #4 (day of exam): Multiple hyperpigmented circular scars (about 1 cm in diameter) with indistinct margins and no central palor or atrophy. The characteristics of the lesions and location on one arm only are highly consistent with the alleged cigarette burns.
  • Slides #5 and #6 (6 days following alleged torture): Linear “tram-track” lesions with peripheral echymosis and central palor, consistent with acute signs of beating to the back with a water hose.

Interpretation and Conclusion

Per trainee’s assessment

Preliminary Considerations
Module 8 Presentation: Case Example #02
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  • Istanbul Protocol Model Medical Curriculum

    • Preface
      • Copyright and Acknowledgements
      • Resources
      • Glossary
    • Introduction
      • Curriculum Materials
      • Summary of Content
      • How to Use These Educational Resources
    • 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
        • Prevention
        • Accountability
        • Reparation
      • 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
        • Module 1 Answers
    • Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
      • The Istanbul Protocol
        • About the Istanbul Protocol
        • Brief History
        • International Recognition of the Istanbul Protocol
      • An Overview of the Istanbul Protocol
        • Legal Investigation of Torture
        • General Considerations for Interviews
        • Physical Evidence of Torture
        • Psychological Evidence of Torture
        • Interpretation of Findings and Referrals
        • Misuse of the Istanbul Protocol
        • Procedural Safeguards for Detainees
      • 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
        • The aims and goals of investigation
        • Multidisciplinary approach to documentation
        • Role of the health professional in the team
        • Role of the lawyer in the team
        • Role of the NGO member in the team
        • Role of judges and prosecutors
      • Documenting the allegations
        • The aim of medical documentation
        • Types of evidence
        • Medical evidence
        • Gathering of evidence
        • Essential information
        • Quality of information
        • Comparing records
      • Module 2 Presentation: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics
      • Self-Assessment and Quiz
        • Module 2 Answers
    • 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
        • Types of questions
        • Cognitive Techniques
        • Summarising and clarifying
        • Difficulties Recalling and Recounting
        • Assessing Inconsistencies
      • 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
        • Module 3 Answers
    • 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
        • Introduction
        • The Paradox of Psychological Consequences of Torture
        • The Psychological Consequences of Torture
        • Social, Political and Cultural Context
        • Risk factors for Trauma and Torture-Related Disorders
        • Psychological Symptoms
      • Module 4 Presentation: Torture Methods and their Medical Consequences
      • Self-Assessment and Quiz
        • Module 4 Answers
    • Module 5: Physical Evidence of Torture and Ill-Treatment
      • Physical Evidence of Torture
        • Medical history
      • The Physical Examination
        • Dermatologic Evaluation
        • Head and Neck
        • 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
      • Module 5 Presentation: Physical Evidence of Torture and Ill-Treatment
      • Self-Assessment and Quiz
        • Module 5 Answers
    • Module 6: Psychological Evidence of Torture and Ill-Treatment
      • The Central Role of the Psychological Evaluation
        • Conducting the Psychological Evaluation
        • Psychological Findings and Diagnostic Considerations
        • Components of the Psychological/Psychiatric Evaluation
      • Children and Torture
        • Introduction
        • Developmental Considerations
        • Clinical Considerations
        • Role of the Family
      • Apendix I: Sample Psychological Evaluations
        • Psychological Evaluation #1
        • Psychological Evaluation #2
      • Apendix II: ICD-10
      • Module 6 Presentation: Psychological Evidence of Torture and Ill-Treatment
      • Self-Assessment and Quiz
        • Module 6 Answers
    • Module 7: Case Example #01
      • Introduction
      • Preliminary Considerations
      • Materials
      • Module 7 Presentation: Case Example #01
      • Self-Assessment and Quiz
        • Module 7 Answers
    • Module 8: Case Example #02
      • Introduction
      • Preliminary Considerations
      • Materials
      • Module 8 Presentation: Case Example #02
      • Self-Assessment and Quiz
        • Module 8 Answers
    • Module 9: Report Writing and Testifying in Court
      • Written Reports
        • General Considerations
        • Content of Written Reports
        • Conclusions
        • Inconsistencies
      • Providing Testimony in Court
      • Appendix: Court Testimony Guidelines and Maxims
      • Module 9 Presentation: Report Writing and Testifying in Court
      • Self-Assessment and Quiz
        • Module 9 Answers
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