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General Considerations
Conclusions
Toolkits > Istanbul Protocol Model Medical Curriculum > Module 9: Report Writing and Testifying in Court > Written Reports > Content of Written Reports

Content of Written Reports

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The examiner should be prepared to address the following in his or her written report or affidavit:

  • Assess possible injury and abuse, even in the absence of specific allegations by individuals, law enforcement or judicial officials;
  • Document physical and psychological evidence of injury and abuse;
  • Correlate the degree of consistency between examination findings and specific allegations of abuse by the patient;
  • Correlate the degree of consistency between individual examination findings with the knowledge of torture methods used in a particular region and their common after-effects;
  • Render expert interpretation of the findings of medico-legal evaluations and provide expert opinion regarding possible causes of abuse in court hearings, criminal trials and civil proceedings;
  • Use information obtained in an appropriate manner to enhance fact finding and further documentation of torture.

First, the affidavit should recite the educational and professional qualifications of the medical professional. Prior experience examining survivors of torture and trauma should be highlighted, as should any experience working with individuals who suffer from common psychological symptoms such as PTSD and Major Depression. In addition, the professional’s participation in training (such as this Model Curriculum) and seminars relating to torture survivors should be included. If the professional is working in consultation with, or under the supervision of, other medical professionals or specialists, those professionals should also be listed. If the professional conducted the examination on a pro bono basis, or was referred to the case through a human rights organisation, these facts should be included. A copy of the medical professional’s resume or curriculum vitae (CV) should be attached to the affidavit. Some courts may require that the expert witness list the reason for the interview, who requested it, and a list of any background documents read beforehand.

Generally a written report contains the following components:

  • The account of the event(s) as described by the individual. As explained in Module 3 [1], this should detail events during arrest and conditions of any detention (e.g. prolonged solitary confinement) since these conditions in themselves may produce physical and psychological sequelae. The account should further detail specific events and methods of torture, both physical and psychological, during actual interrogation. If there are internal inconsistencies in the narrative, or if it contradicts testimony given elsewhere (for example, to a legal adviser), this must be explained.
  • A description by the individual of his or her physical and psychological symptoms and signs at the time of alleged ill-treatment, and an account of how these symptoms evolved with or without medical treatment.
  • A description of the individual’s physical and mental health at the time of the interview(s) and, if he or she has been seen over a period of time, how they have changed with treatment and as a consequence of concurrent events.
  • A note of any medical treatment in detention, or any treatment that was requested but denied.
  • An account of the physical and psychological findings from the interview(s). This should include the demeanour at different times of the process (including any contact before and after the interview(s)), the results of any psychological assessments, a detailed account of the physical examination, and the results of any investigations performed.
  • The professional opinion on the likely causes of these findings, discussing other relevant possible causes of those lesions attributed to torture. There should also be a summary, and the conclusions of the overall evaluation. (Note: it is advisable to separate the findings and the opinion into separate sections, as this makes it clear to any court which is which.)
  • Provide any relevant recommendations for additional tests, consultations, and/or the need for treatment services.

Depending on the intended forum, a summary of the findings of other team members could also be needed, or each might need to provide a separate report. Copies of x-rays, photographs or other reports also can be attached to the affidavit where appropriate and available.

Some trial attorneys and judges have objected to affidavits in which medical professionals recite information provided by the alleged torture victim to the professional. It is generally preferable for the medical professional to avoid a detailed recitation of every statement made to him/her by the individual. The individual’s own affidavit in the case will provide those details. Some statements will, of course, need to be included in order to explain the medical professional’s conclusions. To the extent that the professional needs to include this information to explain the basis for his/her conclusions, the professional should be careful to state only that the individual “states” or “reports” that a specific incident occurred. Such an approach is the safest, because, even if the professional believes the individual, the clinician is only reporting “hearsay” information. Failure to use such language has sometimes been used to undermine the credibility of medical affidavits.

When writing reports, health professionals should comment on the emotional state of the person during the interview, symptoms, history of detention and torture, and personal and family history prior to torture. Factors such as the onset of specific symptoms in relation to the trauma, the specificity of any particular psychological findings, as well as patterns of psychological functioning should be noted. Additional factors such as forced migration, resettlement, difficulties of acculturation, language problems, loss of home, family, social status, as well as unemployment should be described. If a formal psychiatric diagnosis is given, the reasons should be explained. See Clinical Interpretation, Module 6 [2], for a more detailed discussion of the interpretation of psychological evidence of torture.

Quelle

  • [1] http://phrtoolkits.org/toolkits/istanbul-protocol-model-medical-curriculum/module-3-interview-considerations/
  • [2] http://phrtoolkits.org/toolkits/istanbul-protocol-model-medical-curriculum/module-6-psychological-evidence-of-torture-and-ill-treatment/
General Considerations
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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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