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, 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, for a more detailed discussion of the interpretation of psychological evidence of torture.