To medical and health professionals: • Provide training to all medical and health professionals to improve the quality of MLRs so that they meet the standards outlined in the Istanbul Protocol. For example, the examination and documentation of torture should be included in the national university curriculum, and peer-to-peer training support should be encouraged amongst medical and health professionals. In addition, general practitioners must be trained to recognise symptoms and signs of torture and trauma, so that they are able to make a referral to a relevant medical or psychological expert for an MLR if required. • Encourage collaboration with state authorities, to develop training programmes to be provided to state officials to aid the early identification of VoTs and improve the quality of decision-making where MLRs are relied on. Barriers in communication and a lack of trust towards state authorities also need to be broken down if collaboration on training programmes is to be successful.151 • Research is essential to build on the current understanding of the health effects that the asylum process has on VoTs. Additional research on the cost/benefits to states that provide for the early identification of VoTs is also needed to demonstrate that early identification not only benefits the individual but also the state. To legal professionals: • Clarify the relevant guidelines to the use of MLRs in procedures, including when payment should be covered by the state. • Provide training to legal professionals involved in asylum proceedings: • Immigration judges involved in asylum tribunal and court proceedings must receive training on the recognition of the signs and symptoms of torture and trauma and on the standards and guidelines in the Istanbul Protocol. Research shows that the treatment of MLRs by tribunal and court judges can be varied, suggesting that more training is required. This can be the case even where there are specific guidelines in place on procedures with respect to vulnerable persons appearing before the immigration tribunal or court.152 • Legal representatives who advise asylum applicants must receive training from medical professionals on recognising the signs and symptoms of torture or trauma, so that they are able to make referrals to relevant medical and/or psychological experts if they think that a client may have suffered past torture or trauma, or that an MLR should be submitted as evidence. This is particularly important as many VoTs will first come into contact with a legal representative. • Improve collaboration between legal and medical professionals to provide good quality training on the recognition of signs and symptoms of torture or trauma and the use of MLRs as an evidential tool, in compliance with the Istanbul Protocol standards. 74 / Recognising victims of torture in national asylum procedures