Summary of Content

Module 1: International Legal Standards

The first Module [3] provides students with a foundation for understanding how torture is defined in international law, and the duties of States to prohibit torture and ill-treatment. It reviews common torture practises in the world today. As mentioned above, instructors should add country-specific information such as national norms and regional practise. A number of resources are suggested for this purpose. Module 1 also discusses international and regional monitoring mechanisms that health professionals should be aware of and specific safeguards for individuals deprived of their liberty. Module 1 should provide students with a foundation for understanding country-specific challenges to torture prevention and accountability and help them identify effective remedial measures.

Module 2: Istanbul Protocol Standards for Medical Documentation of Torture and Medical Ethics

Module 2 [2] introduces students to the Istanbul Protocol, its purpose, history, content, applications and limitations. It reviews procedural safeguards relevant to medico-legal evaluations of torture and ill-treatment. Module 2 also provides a review of medical ethics relevant to torture documentation and outlines the duties of clinicians working with alleged torture victims and detainees in general. Instructors should include additional information on country-specific rules and regulations regarding medical documentation of torture and ill-treatment. This will aid students in addressing country-specific challenges. Module 2 also reviews general guidelines for gathering evidence.

Module 3: Interview Considerations

Module 3 [1] provides a detailed review of interviewing considerations that is relevant not only for clinicians, but lawyers, adjudicators and human rights investigators/monitors. The Module first reviews a wide range of preliminary considerations (interview settings, trust, informed consent, privacy, empathy, safety and security, re-traumatisation, gender considerations, cultural and religious awareness, working with interpreters, and transference and counter-transference reactions, among others) and then discusses how to conduct interivews and the content of the interviews. Students will be asked to listen to an audiotape of a radio interview with a torture survivor and apply what they have learned in Module 3 to their experience of listening to a survivor. This practical exercise will help students to understand the emotions reactions of survivors (transference) and common reactions of clinicians (counter-transference).

Module 4: Torture Methods and their Medical Consequences

Module 4 [4] provides students with a detailed review of the relationship between specific methods of torture and their physical and psychological health consequences. It reviews specific torture methods and ill-treatment, how they are applied, and the possible acute and chronic physical findings associated with them. This information will help students to correlate medical findings and specific allegations of torture and ill-treatment. The Module also provides a review of common psychosocial consequences of torture and ill-treatment and factors that may affect the variability of psychological evidence.

Module 5: Physical Evidence of Torture and Ill Treatment

Module 5 [5] provides a detailed review of physical examination methods used to evaluate physical evidence of torture and ill-treatment. It begins with a review relevant questions for the medical history, then provides a systematic organ system review of physical evidence, and concludes with information on medical photography and relevant diagnostic tests. Module 5 will help students assimilate the information needed to evaluate and effectively document physical evidence of torture and ill-treatment. The Self-Assessment quizzes for Modules 4 and 5 will also help students to recognise common physical evidence of torture, provide accurate interpretations of their findings, and understand indications for diagnostic test.

Module 6: Psychological Evidence of Torture and Ill Treatment

Module 6 [8] addresses psychological evidence of torture. It provide clinicians with understanding of the central role of the psychological evaluation, how to conduct and psychological evaluation and how to interpret relevant findings. It reviews the value and limitations of using diagnostic classifications and the use of psychometric instruments. It also includes information on evaluating children who have been directly or indirectly exposed to torture. Case information for two Psychological Evaluations are included at the end of Module 6 to provide students an opportunity to formulate their own clinical impressions and review them with other students and the instructor.

Module 7 & 8: Case Examples

Modules 7 [7] and 8 [6] are designed to help students develop interview and examination skills that are essential to the effective documentation of torture and ill-treatment. Modules 7 and 8 each consist of a Case Example for a role-play interview of an alleged torture victim. Each Module contains Case Summary/Referral infomation that the students review prior to conducting an interview. Role-players act the part of an alleged torture victim using a Case Narrative file, which the students do not have access to. The physical examination findings are limited to photographic images. Each Module contains suggestions for instructors on how to implement the Case Examples and detailed guidelines for instructors to assist with the analysis of the cases.

Module 9: Writing Reports and Testifying in Court

Module 9 [9] provides information on how to write a medical report and provide court testimony. The Module reviews a number of general considerations for report writing, the content of medical reports, how to formulate appropriate interpretations and conclusions, and how to convey them to adjudicators. The Module also discusses how to address the problem of inconsistencies in an individual’s case. Students may be asked to bring their written reports from the Case Examples in Modules 7 and 8 and participate in a Mock Judicial Proceeding, wherein they have an opportunity to present their evidence in “court” and play the role of a cross-examining lawyer. Instructors should consider adding course evaluation component to the end of Module 9.