a. Are the physical and psychological findings consistent with the alleged report of torture? b. What physical conditions contribute to the clinical picture? c. Are the psychological findings expected or typical reactions to extreme stress within the cultural and social context of the individual? d. Given the fluctuating course of trauma-related mental disorders over time, what is the time frame in relation to the torture events? Where in the course of recovery is the individual? e. What other stressful factors are affecting the individual (e.g. ongoing persecution, forced migration, exile, loss of family, and social role, etc.)? What impact do these issues have on the victim? f. Does the clinical picture suggest a false allegation of torture? Acute symptoms Individuals should be asked to describe any symptoms and signs of injuries that may have resulted from the specific methods of alleged torture or ill-treatment. These can be, for example, bleeding, bruising, swelling, open wounds, lacerations, fractures, dislocations, joint pain, paralysis, haemoptysis, pneumothorax, visual disturbances, tympanic membrane perforation, genito-urinary system injuries as associated with red or dark urine, dysuria, incontinence, vaginal discharge and bleeding, burns (color, bulla or necrosis according to the degree of burn), electrical injuries (their color and surface characteristics), injuries from exposure to chemicals (color and signs of necrosis), pain, numbness, constipation, incontinence of feces or flatus, nausea and vomiting, impaired consciousness, seizures, or gaps in their memory. The intensity, chronology, frequency, and duration of each symptom should be noted. The development of any subsequent skin lesions should be described, indicating whether they left scars. Clinicians should ask about the health of individuals following the traumatic events: Were they able to walk or were they confined to bed? If they were confined, for how long? How long did the wounds take to heal? Were they infected? What treatment was received? Was it a physician or a traditional healer? Clinicians should be aware that the alleged victim’s ability to make such observations may have been compromised by the torture itself or its after-effects and should be documented. 19