Physical evidence of torture organized violence and assault on removal
General points:
a) Report should
- give history of injury and nature of trauma
- describe lesion(s)
- consider alternative explanations for findings
- give attribution and degree of certainty about same, according to Istanbul Protocol: (URL = see below)
Overall evaluation of patient: multiple independent lesions make torture more likely. b) A plausible description of treatment of serious injuries may support claim, as may contemporaneous medical notes (rare) or subsequent investigations. c) Read the “reasons for refusal” from IO or “determination and reasons” by IJ. Have they made unwarranted medical assumptions? d) If appropriate, give prognosis and make recommendations for referral or treatment.
Specific issues (torture and similar):
a) Cigarette burns - Circular or ovoid; 0.6-1.2 cm diameter. Often but not always pale centre, hyper-pigmented edge. b) Lacerations: Signs of infection (eg wide, irregular scarring). Were they sutured? (Are other lesions sutured?) Eg does absence of stitch marks suggest they were inflicted in circumstances (such as detention) where medical assistance unavailable. c) Head injury: Scalp scars? History of unconsciousness. Persisting neurological damage (esp grand mal and partial seizures). How does this intersect with psychiatric issues? d) Maxillo-facial: Missing teeth, zygomatic fractures, infraorbital nerve (Vb) impairment, TM joint damage. e) Falaka: typical history of swelling up to 3+/52, residual patchy hyper-pigmentation of sole of foot, tender over MT heads or heel, possible pain on weight-bearing or walking limitations (similar to claudication), collapse of plantar arch, lymphoedema f) Gun shot and shrapnel: entry and exit wounds/ high and low velocity injuries. g) Rape: Late disclosure common>Only ≈ 5% of cases have vaginal or other persisting genital injury. Human bites/ stab wounds to thighs etc more common. Anal rape commonly creates persisting fissure. h) FGM: varying grades; sometimes not disclosed. i) Post-inflammatory hyper-pigmentation. Common in dark skinned people. Follows blunt trauma without break in epithelium; ? due to over-stimulation of melanocytes by products of resorbing haematoma. j) Electrocution: rarely leaves signs, esp on genitals; occ. tiny burns, but may also have scars from crocodile clips. k) Ears and eyes: barotrauma can → perforated eardrums
photo-trauma can → epiphora in bright light. l) Suspension: (Palestinian hanging) rotator cuff > brachial plexus injuries m) Restraint injuries: (old or new) partial annular abrasions, hyperpigmentation or scars, Tinnel’s sign, cervical pain and nerve signs.
Example Opinions:“Lesion E2 is typical of a cigarette burn.” “ Lesion E3 is highly consistent with a stab wound inflicted by a bayonet; the fact that it displays no evidence of surgical repair supports the contention that it was inflicted under conditions such as detention, where medical assistance as not available.” “My overall assessment is that - from the evidence available to me - there is a reasonable likelihood that this person has suffered torture.” Nb standard of proof for asylum cases = reasonable likelihood.
Useful references:
From the Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, P35
“…(b) Consistent with: the lesion could have been caused by the trauma described, but it is non-specific and there are many other possible causes;
(c) Highly consistent: the lesion could have been caused by the trauma described, and there are few other possible causes;
(d) Typical of: this is an appearance that is usually found with this type of trauma, but there are other possible causes;
(e) Diagnostic of: this appearance could not have been caused in any way other than that described…..
187. Ultimately, it is the overall evaluation of all lesions and not the consistency of each lesion with a particular form of torture that is important in assessing the torture story.”
http://www.phrusa.org/research/istanbul_protocol/ist_prot.pdf
ICD-10 diagnostic criteria for PTSD and panic disorder at:
http://www.who.int/classifications/apps/icd/icd10online/
Harm on Removal: Excessive Force against Failed Asylum Seekers
by Dr Charlotte Granville-Chapman, Ellie Smith and Neil Moloney
Medical Foundation for the care of Victims of Torture
Cohen J. Errors of Recall and Credibility: Can Omissions and Discrepancies in Successive Statements Reasonably be Said to Undermine Credibility of Testimony? Medico- Legal Journal, 69 (1): 25-34, 2001
Bögner D, Herlihy J and Brewin CR Impact of sexual violence on disclosure during Home Office interviews. British Journal of Psychiatry 191, 75-81: 2007.
Peel M et al. Postinflammatory hyperpigmentation following torture.
Journal of Clinical Forensic Medicine 2003; 10: 193-6.
Peel M (ed). Rape as a form of Torture
Medical Foundation for the care of Victims of Torture. London, 2004.
http://www.torturecare.org.uk/UserFiles/File/publications/rape_singles2.pdf
Get the determination: has the IJ misused the medical evidence?
Related topics ; "Blank" statement used by a Medical Justice doctor as a template Expert Reports - Practice Direction |
