A/69/387 be fully informed, in words they can understand, about the risks and benefits of reporting allegations of torture and other ill-treatment to the relevant authorities and consent to it. The Association has consistently reiterated its policy on the responsibility of physicians to denounce acts of torture or cruel, inhuman or degrading treatment or punishment of which the y are aware. It urges national medical associations to speak out in support of these fundamental principles of medical ethics and to investigate any breach of these principles by their members. 30. The Special Rapporteur notes with concern that in cases where prison medical staff, including doctors under prison authorities, report allegations of torture to prison officials before reporting to the judiciary, there is inadequate protection of the alleged victim. In order to sufficiently guarantee confidential ity and protection, medical reports of detainees reporting possible cases of torture or other ill-treatment are the property of the detainee and should be addressed directly to the judge, prosecutors or other independent body according to national rules an d only with alleged victim’s prior and informed consent. C. 1. Forensic and medical documentation of allegations of torture and other ill-treatment Practical challenges 31. The Special Rapporteur has documented a number of practical challenges and obstacles to the effective investigation and documentation of torture and other ill-treatment. Torture may cause physical injury such as broken bones and wounds that heal slowly, or may leave no physical scars. Torture often takes place in secret, behind closed doors where there are no witnesses, and many torture methods used are becoming increasingly sophisticated and designed to be as painful as possible without leaving physical marks. These methods comprise, inter alia, asphyxiation; electric shocks; sleep deprivation; exposure to extreme temperatures; and stress positions. Making persons stand, kneel or crouch in an uncomfortable position for hours on end is unlikely to leave clearly identifiable traces. Even blows to the body may leave only slight physical marks, difficult to observe and quick to fade. The same applies when the torture is predominantly of a psychological nature, such as sexual humiliation and threats to the life or physical integrity of the person detained or of his or her family. Often torture will lead to psychological scars such as an inability to trust, social withdrawal, feelings of emptiness or hopelessness, a loss of core beliefs and values, alienation, shame and guilt, and a sense of being permanently damaged. Additionally, the victim may show psychophysiological consequences (intrusive and avoidance symptoms, hyper alertness) grouped under the concept of Post-Traumatic Stress Disorder. As such, torture methods that leave no traces do constitute an additional challenge to hold perp etrators accountable. Victims of such practices find it much more difficult to obtain recognition of their suffering and to initiate investigations. 32. During country visits, the Special Rapporteur observed that especially allegations of torture in police custody are extremely difficult for the victim to substantiate if he or she has been isolated from the outside world, without access to doctors, lawyers, family or friends who could provide support and assemble or access the necessary evidence. In a number of States there are no routine medical examinations by qualified medical doctors at the police investigation stage, by court 14-61535 9/23