Technical Guidance

Recognising Sequelae and Impact of Torture


Sleep Deprivation

There are many ways sleep deprivation is created in detention or as part of an intentional pattern of torture and ill-treatment.

Electrical Injury and Torture

Electrical injury is a physiological reaction caused by electric current passing through the body. The injury depends on the density of the current, tissue resistance and duration of contact.

Stress Positional Torture

Victims may be placed in painful and degrading positions during interrogations or while detained.

Cigarette Burns

Cigarettes do not always leave the same scar appearance. The typical appearance of an intentionally inflicted cigarette burn is a sharply defined lesion of about 1 cm, circular, and can be hypopigmented or hyperpigmented (darker or lighter than skin color).

Self-Harm: Physical

Self-harm may also be described as self-injury, self-poisoning, self-mutilation and suicide attempts. It is a repetitive pattern of behavior in response to stress, pain, ambiguity, or emotional trauma.

Self-Harm: Psychological

Most people engaging in self-harm behaviors are doing so to manage and cope with intense psychological and emotional pain from torture, sexual violence, forced displacement, and other traumatic events.

Whipping/Blunt Trauma

The highest prevalence injuries related to torture and ill-treatment are blunt impact trauma which may be caused by elongated rigid or semi-rigid implements such as whips (wires, cords, leather, sticks), rods, hoses, cables, tubing and rods.

Gunshot Wounds

The appearance of healed gunshot wounds can range from round to circular scars which are typically flesh-colored, with raised borders and depressed centers. Their size and shape vary. Details regarding the mechanism of injury are essential to develop conclusions about the correlation between the history of the events and the physical findings, often years later.

LGBTQI Patterns of Injuries

Persecution based on sexual orientation and gender identity is not new; there is a long history of hate-motivated violence. Discrimination and human rights violations against LGBTQI persons appear in a variety of egregious ways.

Women in Detention

High risk settings include those where women and men are detained in the same center, where guards are mostly men, when women remain in police custody, when they are detained in the pre-trial custody, are in transit, are in solitary confinement or restrained, and those who are detained without charges or with the pretense of protecting them.

Solitary Confinement

The mental, physical, and social effects of solitary confinement are impacted by the duration, degree of isolation, purpose, pre-existing health problems, and physical conditions of the space including light, sound, food, water and medical care.

Sexual Dysfunction After Torture

Sexual dysfunction ranges from aversion to touch and lack of interest in consensual sexual acts, to body image distortions and shame, to acute and chronic pain, and finally, the inability to experience satisfaction from healthy sexual activity.

Forensic Medical Evaluations of Torture & Sexual Violence


Preparing for the Medical Evaluation

Follow this checklist to ensure that you are ready and you have everything you need to complete the evaluation.

Informed Consent

It is the patient's right and the patient's choice to document. Be sure to obtain informed consent first.

Building Rapport with Patients

Doctors do these evaluations all the time. But for the patient, it may be their only time. Prepare to put the patient at ease and build rapport.

Documenting the Patient Narrative

Preparing, writing, and ensuring quality control of written documentation is important. Typos, poor grammar, and other mistakes reflect poorly on the expert.

Trauma-Informed Evaluation & Interviewing

People respond differently to medical evaluations, and special accommodations should be made for those with prior trauma.

Best Practices for Defensible Forensic Interviewing

Getting the history in a manner that is usable for court and avoids doing harm.

Photographic Evidence

A picture is worth 1000 words - if it's well done. Follow these guidelines to improve the quality of photographic evidence.

Collecting and Preserving Evidence for Court

You should not not collect anything if you cannot safely store it. Learn what to do and what not to do.

Concluding the Patient Interview and Evaluation

Finishing evaluations properly and with warmth and clarity is essential.

Post-Evaluation Checklist

Doctors will start to forget details immediately no matter how experienced they are. Follow this checklist to ensure you have taken all the proper steps.

Writing the Conclusion Section of the Report

The report alone might be relied upon by the judge, without your testimony or explanation, so the report must stand on its own.

Expert Qualifications

Highlighting and making the most of your professional experience and qualifications to demonstrate credibility is important.

Preparing for Court


Role of the Expert Witness

The overriding duty of an expert witness is to provide independent, impartial, and unbiased evidence to the court or tribunal.

Preparing to Testify in Court

Preparation is essential. Your court testimony may occur years after the evaluation occurred.

Overview of Direct and Cross Examination

Understanding the order of witnesses and ways attorneys may question expert witnesses. Learn what to expect in court.

Tips for Testifying in Court

Prepare in advance, tell the truth, and stay calm. Testimony can last for many hours or even days.