PART C – Other systems Haemoglobinuria may be mistaken for haematuria. Haemoglobinuria has been described in runners due to “footstrike” hemolysis (Eichner, 1985). The same mechanism might explain the “haematuria” in some torture victims. Falanga in particular (beating on the soles of the feet) is somewhat similar to the constant friction of the feet as they strike the ground in runners. Among 34 persons with acute renal failure admitted to hospital after alleged torture in police interrogation centres in Kashmir, only those who were beaten on the soles had evidence of haemoglobinuria (Malik, Reshi, Najar, Ahmad & Masood, 1995). To distinguish haemoglobinuria from haematuria, a centrifuge of the urine should be done. The erythrocyte will precipitate, which will not be the case with haemoglobinuria. 29 domyolysis, destruction of the muscle tissue, and may be caused by beating or electrical torture (Simpson, 1994). The urine is red or brownish and could be mistaken for blood. Myoglobinuria is a potentially dangerous condition as it causes damage to the kidneys, with serious risk of acute renal failure (Malik, Sirwal, Reshi, Najar, Tanvir & Altaf, 1993). Dysuria is as a frequent complaint among torture victims, probably caused by torture instruments in some cases and by cold and unhygienic conditions in the rest. Long-lasting bladder or kidney complaints, or both, have not been reported more frequently in torture survivors than in control groups. (See also § 185 and § 202 in the Istanbul Protocol.) Myoglobinuria occurs as a result of rhab- IV. OTORHINOLARYNGOLOGICAL Beating is the type of torture that carries a high risk of damaging the hearing functions, particularly in the form of “teléfono”, in which both ears are beaten simultaneously with the flat of the hand. “Teléfono” produced immediate, as well as long-lasting, symptoms in the ear (Rasmussen, 1990). It produces a shock wave against the eardrum, probably very similar to the one produced by explosions. Kerr (1978) describes the following clinical observations after blast injuries in Belfast: “Usually sensorineural deafness occurs accompanied by tinnitus. In mild cases this tinnitus and deafness may recover fully in a mat- ter of hours. Severe cases may never recover fully. Perforation of the tympanic membrane is common and occurs in pars tensa which is the lower five-sixths of the tympanic membrane. These perforations vary in appearance and may be linear tears, small holes or subtotal defects. From time to time, there is also damage to the ossicular chain. Especially high frequency sensorineural deafness occurs with preserved normal hearing for the speech frequencies. The hearing loss may recover up to six months after the explosion.” (See also §§ 179-181 in the Istanbul Protocol.)