How can signs of torture be documented accurately and what is the aim of doing so?
The Istanbul Protocol (1999) is a tool for accurate and detailed documentation of torture prepared to international standards. The medico-legal reports produced using this guidance are used as expert opinion to compare the testimony of an individual with psychological and physical evidence. They can be used to support asylum procedures, hold perpetrators accountable, establish an understanding of regional practices of torture and are used collectively for monitoring and advocacy campaigns by human rights organisations.
The Istanbul Protocol contains detailed information about the interview and examination needed to complete a medico-legal report. Briefly, this includes a complete medical history, a detailed history of the alleged trauma, what happened, physical and psychological examination, photographic documentation of any injuries and appropriate investigations. The clinician then provides an interpretation of the relationship between the alleged torture and physical and psychological findings, varying between “not consistent”, “consistent”, “highly consistent” and “diagnostic”. Sometimes doctors can do harm by overstating the case, for example by asserting that scars could only have been caused by torture, instead of taking an objective approach. Therefore whilst empathy is hugely important for the interview, the subsequent report produced must be analytical and objective. The clinician should also provide recommendations for any medical and psychosocial interventions required.
Access the Istanbul Protocol and see how the document is structured. Click on the link below for further medical guidelines.
The protocol was written to cover numerous different situations:
- patients in custody who have already suffered torture and may be at risk of more
- asylum seekers citing torture as grounds for humanitarian protection
- compensation and prosecution of perpetrators It is also intended to guide doctors, lawyers, psychologists, police officers, the courts and governments.
Reflection point: Which parts of the protocol may apply to your patients?