72 Part III: Paths forward heavy bureaucracy and lack of interest or even suspicion from their superiors. On the other hand, there are unfortunately regular accounts of medical professionals compliant with or actively contributing to torture or knowingly producing poor or false reports because of fear or personal gain. There should be sanctions against those persons to hold them accountable. • A political environment conducive to the promotion of human rights. International pressure is crucial to this, both to promote the required reforms and to ensure protection of persons involved in torture documentation. However, international pressure should always build upon and support national initiatives, e.g. through human rights networks and independent media. A key challenge is that governments often perceive human rights activists with mistrust, not least when torture is the issue in question. In this respect a clear advantage of the Istanbul Protocol is that it represents a practical tool which provides an excellent platform for a constructive dialogue with governments and for assisting them in fulfilling their obligations. • Full implementation of obligations under international law. In order for any change to take place, a clear will to prioritise human rights issues must be present and the institutional framework created accordingly. Corruption amongst other factors remains a major impediment to such efforts. The value of documentation of torture is limited if torture is not criminalised in domestic law and/or if procedural regulations do not allow for independent medical evidence to be presented in court. For investigations to be effective, they must be carried out fully, promptly, impartially and thoroughly and the victims need to have access to information. Strategic advocacy and awareness raising efforts to promote the full implementation of the relevant international obligations into national law is therefore essential. To achieve real effect at the domestic level is a long-term process which requires constant follow-up and pressure and must address those underlying factors that lead to torture and ill-treatment. Further crucial ele-