A/59/324 may be, in quite a number of instances, the death of the victim, be it intentional or not. 44. In the opinion of the Special Rapporteur, it is crucial to identify the many aspects of the impact of torture on its victims in order to better appraise and address their needs, in particular from a medico-psychosocial point of view, and to make recommendations that would ensure the most adequate and effective reparation. Most, if not all, torture survivors say that they will never forget what they have been through, but can only learn to live with it.14 45. The first Special Rapporteur on torture, Peter Kooijmans, described, in his first report to the Commission on Human Rights (E/CN.4/1986/15), how the victim’s personality, which constitutes man’s inherent dignity, could be destroyed through torture. As he pointed out, “[t]orture is the violation par excellence of the physical and mental integrity — in their indissoluble interdependence — of the individual being. Often a distinction is made between physical and mental torture. This distinction, however, seems to have more relevance for the means by which torture is practised than for its character. Almost invariably the effect of torture, by whatever means it may have been practised, is physical and psychological. Even when the most brutal physical means are used, the long-term effects may be mainly psychological, even when the most refined psychological means are resorted to, there is nearly always the accompanying effect of severe physical pain. A common effect is the disintegration of the personality (para. 4).” Indeed, in addition to the physical injuries, infliction of physical pain creates fear, anxiety, frustration and humiliation. According to the information received, infliction of pain is also frequently accompanied by mental pressure, such as verbal abuse, mocking, degrading treatment, threats or sham executions. Whether it is accompanied by mental pressure or not, the infliction of physical pain invariably leads to mental suffering as well. Thus, treating only the physical signs of torture cannot be sufficient. 46. Poor detention conditions, such as overcrowding, inadequate sanitation and hygiene, lack of food and medical assistance, not only may put at risk the physical integrity of detainees, but have far-reaching consequences on their mental integrity. The Special Rapporteur has observed that in some cases detainees are deliberately subjected to poor conditions while in pre-trial detention in order to break their will and to elicit confessions and information, or to be able to present them before the court as unwholesome and dangerous, which would erode any sympathy they might have received from the judge.15 The Special Rapporteur also notes that prolonged solitary confinement in conditions of severe material deprivation and with no or little activity may have a serious impact on the psychological and moral integrity of the prisoner.16 47. Torture and other forms of ill-treatment may take such a wide variety of forms that the whole range of their physical sequelae can hardly be exhaustively described. However, amongst the most common sequelae are loss of hearing or sight, skin lesions, fractures, sexual dysfunction, cardiopulmonary, gastrointestinal, musculoskeletal and neurological problems, and infectious diseases.17 It must be noted that victims are often subjected to multiple forms of torture and ill-treatment, which may result in overlapping injuries. While some of the physical sequelae of torture may be medically treated and may eventually disappear with time, others will remain a visible stigma, sometimes still painful, that victims will have to bear 13