PART A – An overview of the Istanbul Protocol 9 II. THE IMPORTANCE OF MEDICAL PROFESSIONALS IN THE DOCUMENTATION OF TORTURE AND THE NEED FOR LAWYERS TO UNDERSTAND THE MEDICAL SYMPTOMS OF TORTURE Although the factors influencing the psychological responses to torture are not known exactly, several aspects can have an impact on the victim: are closely linked with the psychological meaning of the trauma to the person, which is socially, culturally and politically framed. • The social context before, during and after torture: such as community and peer resources and values and attitudes about traumatic experiences; political and cultural environment; traumatic conditions after torture; exposure to subsequent reactivating stressors – losses and changes in the individual’s life during the post trauma period also have a great impact on the psychological response. • The severity and duration of the traumatic events, the circumstances and the nature of the torture: It is difficult to make a hierarchical list of the severity of the atrocities on the individual and it is problematic to estimate objectively the degree of severity. Humiliation, threat to beloved ones or witnessing the torture of another person may have a more profound psychological effect on the victim than to suffer from electric shocks or falanga [beating the soles of the feet], though this may differ from person to person. • The developmental phase and age of the victim: although there is limited knowledge on factors that are related to torture symptoms, in a more general context of traumatic experiences, it has been determined that there is a relationship between the age of onset of the trauma, the nature of the traumatic experience, and the complexity of the clinical outcome. • The perception, interpretation and meaning of torture by the victim: Individuals react to extreme trauma like torture in accordance with what it means to them. The psychological reactions to trauma In other words, personal variables such as cultural and political background, gender, age, losses during and after the torture, etc., are all factors that may influence the severity of the symptoms produced by torture. In The Istanbul Protocol highlights the important role of medical professionals in the documentation of torture and sets out detailed guidelines on methodology for obtaining medical evidence, including the recommended content of medical reports. It is important for lawyers working with torture survivors to know how torture can be medically documented and how to recognise the physical and psychological symptoms of torture. This will not only help them to better understand their clients and assist them but equally, such insights are extremely important when lawyers lodge complaints of torture or other forms of ill-treatment on the survivors’ behalf. As recognised in the Istanbul Protocol, lawyers and doctors need to work closely together to effectively investigate and document acts of torture. Medical evidence will help prove that torture has occurred. It will also assist lawyers to determine victims’ claims for reparations (e.g., restitution, compensation and rehabilitation). Similarly, lawyers will need to assess whether the official investigation undertaken by the police or other competent body took into account proper medical evidence or whether they need to arrange for independent medical examinations to attest to the victim’s version of the events.