Chronic symptoms The clinician should elicit information on all of the physical ailments that the individual believes were associated with torture or ill-treatment and note the severity, frequency, and duration of each symptom and any associated disability or need for medical or psychological care, or treatment received. Importance of medical history Torture victims may have injuries that are substantially different from other forms of trauma. Although acute lesions may be characteristic of the injuries described, most lesions heal within weeks of torture, leaving no scars or, at the most, non-specific scars. This is often the case when torturers use techniques that prevent or limit detectable signs of injury. Blunt trauma is one of the most common modes of injury in torture and tends to cause mainly bruising and abrasions, which may heal without lasting physical evidence. Under such circumstances, the physical examination may be within normal limits, but this in no way negates allegations of torture. Physical examination Typically, the physical examination is conducted by a qualified physician at the end of the clinical evaluation and only with the alleged victim’s consent. Whenever possible, the alleged victim should be able to choose the gender of the physician and, where used, of the interpreter. If the physician is not of the same gender as the patient, a chaperone who is of the same gender as the alleged victim should be offered. Alleged victims must understand that they are in control and have the right to limit the examination or to stop it at any time. While it is important to examine the whole body, it should be done in sections, keeping as much of the body covered as possible at any one time. Exposing the body can be retraumatizing for the victim, since forced nakedness is a common form of torture. A complete examination should be made, as there may be findings of which victims are unaware (e.g. on their back) or which they forgot to mention when the history was taken. In cases of alleged recent torture or ill-treatment and when the clothes worn during torture or ill-treatment are still being worn by the alleged victim, they should be taken for examination without having been washed and a fresh set of clothes should be provided. 20