INTRODUCTION: Torture has been consistently prohibited in international human rights and humanitarian law for more than half a century and has been condemned in a number of international conventions.* The prohibition is absolute and no exceptions, including situations of public emergency and war, may be evoked to legitimise the use of torture. Despite this, occurrences of torture and other forms of ill-treatment are still widespread and continue to be practiced in over 100 countries.
International law obliges states to investigate allegations of torture and to punish those responsible. It also requires that victims of acts of torture are able to obtain reparation and have an enforceable remedy to fair and adequate compensation, restitution of their rights and as full a rehabilitation as possible. Nevertheless, torturers are seldom brought to court and torture survivors rarely receive any kind of redress as compensation for their suffering. One of the major challenges in fighting impunity is to obtain sufficient evidence in cases against alleged perpetrators.

Medical examination of alleged victims and documentation of torture can play a crucial role in bringing evidence of torture and ill-treatment to light.

In order to support investigations into torture allegations, forensic examination teams often have to travel abroad and may have to work in sometimes politically sensitive climates, or in conflict or post-conflict situations. The missions may contribute to legal investigations into allegations of torture, investigations of human rights violations, the work of international commissions and ‘truth commissions’, and assessments of needs for treatment.

During the missions, teams may face challenges related to local rules and regulations, the availability of diagnostic equipment and facilities, safety and security, language, and confidentiality issues. The teams should consist of resourceful people used to finding solutions; however, finding solutions on the spot is time-consuming and may compromise the quality of the investigation and the time spent with the alleged torture victim.

The Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment – known as the Istanbul Protocol – provides internationally recognised standards on how to identify, document and report symptoms of physical and psychological torture.

The ‘Model Curriculum on the Effective Medical Documentation of Torture and Ill Treatment’ is a comprehensive Istanbul Protocol training resource that was developed to enable health professionals to effectively investigate and document torture and ill-treatment (see http:// istanbulprotocolmodelcurriculum.org).

The present manual is designed to provide practical information for agencies and individuals involved in planning and carrying out medical examination missions. It is based on lessons learned from past medical examination missions and on the challenges met during those missions. The manual is meant as a tool to be used in conjunction with the Istanbul Protocol. It does not replace the Istanbul Protocol, nor does it seek to replace the many other existing manuals and guidelines available on the medical examination and documentation of torture, on the reporting on torture, on human rights monitoring and on visiting places of detention5. It does not provide detailed information on how to carry out an examination or how to prepare a report.

It is an operational tool to facilitate the preparation and operational aspects of a mission for the examination and documentation of alleged torture, particularly relating to the survivors of torture. It includes suggestions on the team composition and obligations of team members and the contracting organization, ethical codes, practical information related to the preparation for the mission, security and safety measures, and some basic recommendations for the medical examination. Some sections may also be useful for examinations into extra-legal, arbitrary and summary executions. However, the perspective and purpose of an examination in these instances is different and require that primarily the Minnesota Protocol6 is taken into consideration…