CAT/C/39/2 page 36 continuously insulted and threatened. The physical examination of the detainee revealed motor and sensorial neuropathy of the lower limbs with alteration of the motor function, that is, pathology compatible with what he reported. 146. Hence, the medical expert observed that some of the physical injuries could be related to trauma, while other injuries were absolutely diagnostic of mistreatment. These latter signs clearly and unequivocally proved the existence of situations of repeated mistreatment. 147. All detainees examined denied they had experienced other types of torture, namely asphyxiation by wet and dry methods, injuries by penetration, crushing, exposure to chemicals, burns or pharmacological torture. They also denied they had experienced humiliation by verbal abuse or the carrying out of humiliating acts, threats to them or their families, systematic psychological techniques of personal humiliation or coerced behaviour. 148. Eleven of the detainees examined showed psychological alteration well above what was expected within their cultural and social context, resulting from the stress of their current situation as detainees. The medical expert observed elements suggesting depression and post-traumatic stress, requiring a deeper neuropsychological and psychiatric assessment, which was impossible to carry out in the context of these examinations. Besides the depressive states, amongst the most frequent psychological symptoms, the medical expert found lack of pleasure, anxiety, insomnia, emotional liability, sense of uselessness (very often related to the boredom resulting from having nothing to do), lack of self-confidence, dissociation and depersonalization. The psychosomatic complaints, of diverse intensity, consisted mainly in chronic headaches, back pain, muscular or skeletal pain and gastro-intestinal symptoms. 149. The medical expert noted that the detention system is inefficient in terms of provision of medical, psychiatric and dental care and assistance to the detainees, and that in some cases these services were unavailable to detainees. A large number of detainees had skin diseases (scabies, psoriasis, infections etc) that in the majority of the cases were not being medically treated. There were no adequate and separate facilities for detainees with infectious contagious diseases, namely tuberculosis, who live side by side with others. The non-existence of regular and satisfactory medical care both in the case of general medical care, as well as dental health care, was also observed. 150. The Committee members and the medical expert were provided with a videotape containing images collected during surprise visits carried out by prosecutors from the Children’s and Minors Court of São Paulo to juvenile detention centres under the responsibility of FEBEM in São Paulo. The videotape contained, inter alia, images where the medical expert observed the existence of significant and intense injuries of a traumatic nature produced by blunt instruments in many juveniles. These were essentially ecchymosis, haematomas and grazing, in the majority of cases located in the dorsal and lumbar region, but also in other parts of the body, namely the back of the hands and forearms, buttocks and thighs. A few of them have been produced by rubber bullets. In general, they were injuries whose location and typology (and in some cases they clearly looked like defence wounds) allowed him to conclude unequivocally that they were the result of violent aggression. The fact that recent and not so recent injuries were simultaneously observed, led him to believe that there is a situation of repeated aggression and not just a case of a sporadic episode of aggression.