MODULE 7
Prevention through Documentation Torture Project
Case Example #1
CONTRIBUTORS:
Vincent Iacopino, MD, PhD, Physicians for Human Rights
Önder Özkalıpçı MD, International Rehabilitation Council for Torture Victims
Alejandro Moreno, MD, JD, Boston Center for Refugee Health and Human Rights
PtD Project (IRCT, HRFT,
REDRESS, PHR)
Case #1 Outline for
Demonstration
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Role-play interview
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Interview divided into 8 components
– Learning objectives for each component
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Time-outs: A break in the interview
action used to make teaching points
PtD Project (IRCT, HRFT, REDRESS, PHR)
Interview Components
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Introduction
– Conditions of interview
– Identification information
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Past history
– Medical, surgical, psychosocial (Pre-Arrest)
Trauma history
 Review of torture methods
 Physical symptoms (acute & chronic) and disabilities
 Psychological assessment and mental status
examination
 Physical examination
 Interpretation of findings & conclusions
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PtD Project (IRCT, HRFT, REDRESS, PHR)
Case Summary/Referral #1
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Name Name: Mrs. Asha Ali Yousif
Date Reporting to the Center: dd/mm/yyyy
Date of Birth: dd/mm/yyyy
Age: 35 years-old
Marital Status/Children: Married, widow, 13 year-old
daughter
Religion: Muslim
Ethnic Group: Fur
Profession: Teacher
Political/Social Affiliation: None
Date and Place of Detention/Assault: dd/mm/yyyy in a field
2 Km east of Kalma Camp; dd/mm/yyyy at Nyala Wasat
(Central) police station.
Period of Detention: Less than 2 hours on both occasions
PtD Project (IRCT, HRFT, REDRESS, PHR)
Case Summary/Referral #01
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Trauma History:
– On dd/mm/yyyy 2:00pm
– Mrs. Yousif, her 13 year-old daughter, and two other women
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fetching firewood
Attacked by armed men in military uniforms
All beaten and raped
One woman, Fatima Ibrahim (22 yrs), shot and killed
Days later, Mrs. Yousif reported incident to police. Police
refused to file case
One police officer, Omer Mohamed Suliman, beat and sexually
assaulted her
Mrs. Yousif went to went to Nyala Hospital, but was refused a
medico-legal evaluation since she did not have Police Form 8
Friend in Kalma worried about her and insisted that she get
help. The friend also suggested that Mrs. Yousif and her
daughter take legal action against their perpetrators.
PtD Project (IRCT, HRFT, REDRESS, PHR)
Case Summary/Referral #1
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Alleged Perpetrators: Men in military uniform, also,
police officer Omer Mohamed Suliman from Nyala
Wasat (Central) Police Station.
Reasons for visit: Mrs. Yousif indicated that she would
like to get help for her daughter and herself, but she
was not sure about taking legal action against their
perpetrators.
Effects of Torture: Insomnia, nightmares, inability to
concentrate, profound sadness, frequent headaches and
decreased appetite. She is also very troubled about her
daughter’s health and future.
PtD Project (IRCT, HRFT, REDRESS, PHR)
Begin Interview
PtD Project (IRCT, HRFT, REDRESS, PHR)
1. Introduction/Conditions of
Interview & Identification
Information
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Learning Objectives
– Provide clear and effective introduction: identity of examiner,
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purpose of interview, who medical evaluation will be sent to and
limitations on confidentiality
Explain nature of evaluation and simultaneous need for detail
and accuracy. Uncertainties should be discussed due to likely
adverse effect on credibility.
Obtain informed consent on Standard Evaluation Form (#1-3)
Ensure comfortable stetting, respectful interaction
Earn trust, establish alleged victim’s control over interview
process
Ability to accurately record relevant case information
Develop appropriate responses to police coercion
PtD Project (IRCT, HRFT, REDRESS, PHR)
2. Past Medical and Surgical
History & Psychosocial History –
Pre-Arrest
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Learning Objectives
– Obtain a complete medical history, including prior medical,
surgical and/or psychiatric problems
– Document any history of injuries before period of detention and
any possible after-effects. Knowledge of prior injuries may help
differentiate scars, or other physical evidence, related to
torture from those that are not
– Summarise any previous forensic evaluation related to
allegations of torture and/or ill treatment
PtD Project (IRCT, HRFT, REDRESS, PHR)
3. Trauma History
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Learning Objectives
– Understand various techniques of questioning and apply them
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appropriately
Elicit a coherent and accurate account of alleged torture/ill
treatment
Structure inquiries to elicit a chronological account of events
experienced
Understand sources of variability and effect of such variability
on history taking
Pursue and clarify possible inconsistencies in the trauma history
Take note of non-verbal (process) information and links between
emotional affect and content of trauma history
PtD Project (IRCT, HRFT, REDRESS, PHR)
4. Review of Torture Methods
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Learning Objectives
– Understand advantages and disadvantages of direct questions
about specific methods of torture/ill treatment
– Assess a wider range of possible physical and psychological
methods of torture
PtD Project (IRCT, HRFT, REDRESS, PHR)
5. Physical Symptoms (acute
and chronic) and Disabilities
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Learning Objectives
– Assess relevant physical symptoms (acute and chronic) and
disabilities experienced after alleged torture/ill treatment
– Anticipate physical symptoms and/or disabilities for specific
methods of alleged torture
– Correlate reported physical symptoms (acute and chronic) and
disabilities with specific allegations of abuse
PtD Project (IRCT, HRFT, REDRESS, PHR)
6. Psychological Assessment
and Mental Status Examination
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Learning Objectives
– Conduct a mental status examination
– Be aware of factors that may contribute to psychological
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outcomes
Assess symptoms of common psychological conditions associated
with torture and ill treatment.
Recognise signs and symptoms of possible organic brain
dysfunction
Recognise and respond effectively to transference and
countertransference reactions
Recognise and respond effectively in court when asked
qualifications of physician to conduct a psychological evaluation
PtD Project (IRCT, HRFT, REDRESS, PHR)
7. Physical Examination
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Learning Objectives
– Recognise physical signs of torture/ill treatment in acute and
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chronic settings and understand sensitivity and specificity of
common findings
Anticipate pertinent positive and negative findings based on
specific allegations of torture and/or descriptions of
acute/chronic symptoms or disabilities following torture or ill
treatment
Understand the advantages and disadvantages of conducting
complete vs. directed physical examinations
Understand how mitigating factors may affect physical sequelae
of torture and ill treatment
Document photographic evidence where appropriate and make
effective use of anatomical drawings
PtD Project (IRCT, HRFT, REDRESS, PHR)
Virtual Physical Examination
Cases #1
Cases Developed by
Vincent Iacopino, MD, PhD,
Alejandro Moreno, MD, JD, and
Önder Özkalıpçı, MD
Case #1
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35 year-old female alleging:
– Sexual Assault
– Head trauma
– Laceration injury to the dorsum (backside)
of the left hand
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The following photographs were taken at the
time of the current evaluation.
Case #01
8. Interpretation of Findings
and Conclusions
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Learning Objectives:
– Provide interpretations on physical, psychological and, if
relevant, historical evidence of torture/ill treatment
– State unequivocally in the conclusion the student’s opinion on
possibility of torture and/or ill treatment, and indicate degree
of certainty. Consider recommendations in Istanbul Protocol
– Provide appropriate recommendations for further evaluations
and treatment
PtD Project (IRCT, HRFT, REDRESS, PHR)
Debriefing
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Role-players provide feedback on student
performances and process issues
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Consider relevant transference and
countertransference issues
PtD Project (IRCT, HRFT, REDRESS, PHR)