Module 5: Physical Evidence of Torture and Ill-Treatment

Objectives

  • To provide in-depth information on physical examination methods, factors to consider during examinations, and the interpretation of findings.
  • To be able to conduct a physical examination of each organ system and assess possible acute and chronic signs and symptoms of torture and ill-treatment
  • To understand basic mechanisms of injury
  • To be familiar with specific examination considerations for victims of sexual assault
  • To understand the effective use of medical photography and the appropriate use of diagnostic tests
  • Discuss the circumstances for the appropriate use of directed vs. comprehensive physical examinations
  • To be familiar with the differentiation of self-inflicted injuries and those caused by torture and ill-treatment

Content

  • Physical evidence of torture
  • Medical history
    • Acute symptoms
    • Chronic symptoms
  • The physical examination
    • Acute symptoms
    • Chronic symptoms
    • Dermatologic Evaluation
      • Abrasions
      • Contusions
      • Lacerations
      • Incisions
      • Burns and scalds
      • Complex Lesions
      • Scarring
    • Head and neck
    • Eyes
    • Ears
    • Nose
    • Jaw, Oropharynx and Teeth
    • Chest and Abdomen
    • Musculoskeletal System
      • Fractures
    • 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
      • Radiologic Imaging
      • X-Rays
      • Scintigraphy
      • Ultrasound
      • CT scans
      • MRI
      • Biopsy of Electric Shock Injury

Discussion Topics

  • Students should work in groups or individually to answer questions contained in Self-Assessment 5
  • Additional Discussion Topics:
    • Discuss relevant considerations to distinguish physical findings caused by torture and ill-treatment and those that may be self-inflicted or the result of other causes
    • Discuss the relative value of diagnostic tests and their limitations and develop a series of country-specific recommendations for indications of using diagnostic tests in various documentation settings
    • Discuss appropriate indications for a genital examination (women and men), how the examinations should, and should not, be performed, and any relevant country-specific considerations for the evaluation of allegations of sexual assault

Teaching Formats

  • Group Activity:
    • Divide the class into several groups and have each group work on answering questions contained in Self-Assessment 5
    • A facilitator should be identified to moderate the discussion and rapporteur should be identified to record the group’s findings and report them when the class reconvenes. 
    • After 20-30 minutes of group discussion, the entire class should reconvene
    • Rapporteurs should briefly report on their group’s findings
    • Open class discussion
    • Alternative Option:
    • Divide the class into several groups and assign each group with one or more (or all) of the Discussion Topics
    • Follow the usual sequence for conducting group activities as outlined above
  • Individual Research/Assignment: 
    • Individual students should answer all questions contained in Self-Assessment 5
  • Journal Entry: (Instructor to assign Write a few paragraphs -- no more than a page)
    • Respond to one or more of the Discussion Topics 

Primary Resources

  • The Istanbul Protocol, Chapter V
  • The Medical Documentation of Torture
  • Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
  • Medical Physical Examination of Alleged Torture Victims: A Practical Guide to the Istanbul Protocol for Medical Doctors
  • Examining Asylum Seekers
  • Dermatologic Findings after Alleged Torture (PowerPoint file). Lis Danielsen and Ole Vedel Rasmussen, IRCT 2004-2005.
  • Torture Methods (PowerPoint file). Ole Vedel Rasmussen, IRCT 2004-2005.
  • Işkence Atlaı: Işkencenin Tibbi Olarak Belgelendirilmesinde Muayene ve Tanısal Inceleme Sonuclarının Kullanılması
  • Trainers’ Guidelines for Health Professionals: Training of Users