Preventing Torture An Operational Guide for National Human Rights Institutions - Updated Edition • a medical examination of the victim at the time, or shortly after, the torture is alleged to have taken place • a physical examination of the victim at the time s/he made the complaint • a psychological examination of the victim • a post-mortem examination (autopsy). Medical evidence should be treated with caution as a medical examination alone cannot prove an allegation of torture. However, it may be consistent with the allegation and can therefore provide important corroborating information. It is recommended that any medical evidence is gathered and compiled by a physician with proper forensic skills. NHRIs might face difficulties in finding appropriately qualified medical personnel. Indeed, some NHRIs may face a situation where there are no skilled forensic medical personnel in the country. In this case, one possible solution may be to seek outside assistance to train medical personnel in forensic skills. In other countries, there might be a lack of independent forensic medical personnel, particularly if they all work for government agencies and/or provide forensic expertise for the police or public prosecutor. NHRIs will then have to assess whether they, and the victim, can trust the independence and professionalism of these personnel. There are physical signs of torture Medical examination of victims of torture must be left to medical professionals. However, with experience, a human rights investigator can come to recognize some of the most common signs of torture. It is often useful to take photographs of the physical signs of torture, if the victim gives their consent. However, such photographs should not identify the person (for example, by showing the face). Several pictures should be taken to record all aspects of these physical signs. Clear colour photographs, taken in good lights, can form part of the corroborating evidence and be provided to medical personnel for professional evaluation. It is important to take close-up photographs of the injuries and wide-angle photographs showing the location of the injuries on specific parts of the body. Some of the common types of torture, and the physical signs that result from this, include: • beating and other blunt violence, which can cause broken bones, bruises, scars and tramline stripes (from beatings with a cane or stick) • beatings on the sole of the feet, which can result in intermittent pain in the feet and legs, tingling and “pins and needles” in the legs and feet, as well as hard, rough scars on the soles • burning, which can leave scars of varying shapes and sizes • suspension, which causes a burning sensation and sharp pains in the arms and legs • electrical torture, which can cause changes to the skin and splintering or loss of teeth • partial suffocation with water, which can lead to chronic bronchitis • sexual torture, which can result in injuries to the genital area, irregular periods, spontaneous abortions, testicular pain, anal itching, sexually transmitted disease and sexual dysfunction. It may be appropriate to apply a presumption of ill-treatment, when an individual who was in good health at the time of detention is found to be injured at the time of release.84 The absence of physical signs of torture does not mean that torture has not taken place. Some methods of torture do not leave any physical signs, such as sensory deprivation and other forms of psychological torture. 84 58 See ECtHR, Eren v. Turkey, no. 36617/07, Judgment of 20 October 2015, para. 30