Istanbul Protocol Model Medical Curriculum

Wherever possible, examinations to document torture for medico-legal reasons should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local rehabilitation and support services. The clinician should not hesitate to insist on any consultation and examination that he or she considers necessary in a medical evaluation. In the course of documenting medical evidence of torture and ill-treatment, physicians are not absolved of their ethical obligations. Those who appear to be in need of further medical or psychological care should be referred to the appropriate services.

NOTE: Online course available on “Caring for Torture Survivors” offered by the Boston Center for Refugee Health and Human Rights. See http://www.bcrhhr.org/pro/course/course_index.html [1]

Wherever possible, examinations to document torture for medico-legal reasons should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local … Continue reading →

Children have the rights to have their consent and confidentiality respected. Except in emergency they should not be given medical treatment without a parent or guardian present. Similarly, a detailed account of the cause of injuries should only be taken from a child in the presence of a parent or guardian or, if they are not available, someone else representing the child’s best interests.

Older children may be tortured to suppress political activity. They should be treated in the same way as young adults, and the approach needs to be very sympathetic. Torture of younger children is generally performed to put pressure on parents. Where possible, the family should be treated together and the child’s injuries should be documented and managed by pediatric specialists.

A child, in particular, needs to be in an environment in which he or she feels comfortable before being willing to disclose sensitive information. In discussing traumatic events, a child may prefer to draw a picture and then to explain it. Children’s attention spans can be quite short, so it may be necessary to break the interview frequently. See additional considerations in Module 6, Children and Torture.

Children have the rights to have their consent and confidentiality respected. Except in emergency they should not be given medical treatment without a parent or guardian present. Similarly, a detailed account of the cause of injuries should only be taken … Continue reading →

The clinician should attempt to understand mental suffering in the context of the interviewee’s circumstances, beliefs, and cultural norms rather than rush to diagnose and classify. Awareness of culture specific syndromes and native language-bound idioms of distress is of paramount … Continue reading →

Good interpreters, particularly those from the same background as the individual, are able not only to interpret the words, but also to identify and explain relevant cultural, historical and social factors as well as linguistic idioms to the interviewer. Beware, however, of over-reliance on interpreters, as they are not experts in areas outside their own field.

Interpreters are an important part of the inquiry team. They need to be trained to work with survivors of torture and other ill-treatment even if they have considerable experience of interpreting in other contexts. Most professional interpreters have their own code of ethics. If not, they must be advised that what they hear and interpret in interviews is strictly confidential.

Professionals working with interpreters need to remind themselves that, if they do not share a language with the individual, the quality of the interpreter used will impact on all aspects of their interview, examination and report.

Second and third languages

In situations where the health professional is seeing the individual in their routine practise, they will usually speak the same language. In situations where there are several ethnic groups within a country, there may be language barriers within the population. Sometimes the one will speak some of the other’s language, or they may share a third language. The danger is that if one person’s command of this second or third language is weak, this may lead to inaccuracies and inconsistencies in the report. There may also be difficulties associated with interpreters of a different ethnicity or from a different region from that of the individual. The accent and vocabulary might differ.

Gender and age of interpreters

In many cases, it is necessary to use an interpreter for some, or all, of the interview. The issues of gender may be even more important in this situation as the interviewee may relate more to the interpreter than to the interviewer. Some individuals are less concerned about the gender of the interviewer than they are about that of the interpreter. Age may also be relevant. A young male individual may be able to discuss sexual torture with an older woman to whom he may relate as to an aunt, but not to a woman of his own age. Similarly, a young female individual may find an older man easier to talk to than one who is of a similar age to her torturer. Bear in mind, however, for women, having a female interviewer and interpreter is the best practise.

Local and international interpreters

When an international team makes a visit to a country it might include interpreters, or it may choose to employ local interpreters. There are two issues to keep in mind in such cases. Firstly it must be made clear to the local interpreter that he or she may be putting him- or herself into danger by working with visiting interviewers when documenting torture. Secondly, the individual may not trust a local interpreter and not give a complete account of what happened.

Using an interpreter

Interviewers should remember to talk to the individual and to keep eye contact with him or her even though there is a natural tendency to speak to the interpreter. It helps to pose questions directly to the first person, for example: ‘What did you do then?’ rather than indirectly through the interpreter, for example: ‘Ask him what happened next.’ Observing body language, gestures and facial expressions, as well as non-verbal communication, is essential both to enhance the amount of information gained and to give the individual confidence that the health professional is interested in what is being said. Above all, it helps the individual to understand that he or she has been heard. When the individual is providing a long, unbroken account, the health professional should pause the interview regularly to note the information. This helps the interpreter not to forget key points and allows the health professional to clarify points when they are still fresh in the individual’s mind.

Family members

As a rule, family members and friends must not be used for interpretation for two reasons. First, the quality of interpreting is generally inadequate, and second, there may be topics that the individual will not discuss in front of a family member, and therefore the risk of a failure to disclose torture is greatly increased. Many parents, for example, will not reveal details of their torture in front of their child. Furthermore, revealing such details in their presence may even lead to psychological harm for the child.

Good interpreters, particularly those from the same background as the individual, are able not only to interpret the words, but also to identify and explain relevant cultural, historical and social factors as well as linguistic idioms to the interviewer. Beware, … Continue reading →