Child torture victimization: Review of criminal statutes and medico-legal issues.

A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.

Profiles of posttraumatic stress disorder and negative world assumptions in treatment-seeking refugees.

Background: Refugees often suffer from trauma-related psychopathology, specifically posttraumatic stress disorder (PTSD). Negative world assumptions are strongly correlated with the development, course, and severity of PTSD.Objective: This study aimed to investigate whether there are distinct profiles of PTSD and negative world assumptions (NWA) and examine whether trauma load, torture, and gender differentially predict such symptom profiles.Method: In a sample of 225 treatment-seeking refugees who had resettled in the Netherlands, latent profile analysis was used to identify subgroups of patients sharing the same profile of PTSD and NWA symptoms. Predictors of profile membership were analyzed via multinomial logistic regression.Results: A three-profile solution yielded the best model fit: a low PTSD/low NWA profile (23.6%), a high PTSD/high NWA profile (41.8%), and a high PTSD/low NWA profile (34.7%). Participants who reported a higher trauma load, were more likely to be part of the high PTSD/high NWA profile or the high PTSD/low NWA profile in comparison to low PTSD/low NWA profile. Participants who reported having experienced torture were more likely to be part of the high PTSD/high NWA profile in comparison to low PTSD/low NWA profile. Gender did not differentiate between the profiles.Conclusions: This study reveals that among treatment-seeking refugees resettled in the Netherlands, there are distinct profiles of PTSD and NWA. These profiles indicate that PTSD and NWA are not uniformly experienced among refugees, emphasizing the diversity in their psychological responses to trauma. Among individuals experiencing severe PTSD symptoms, a subgroup was identified of individuals who additionally exhibited negative assumptions about themselves, others, and the world. Recognizing this heterogeneity is crucial in both research and clinical practice, particularly in the context of refugee mental health. Directions for future research are discussed.

Three profiles of PTSD and negative world assumptions were identified in a group of treatment-seeking refugees.Directions for future research and the importance of recognizing heterogeneity in psychological responses to traumatic experiences in refugees are discussed.

Manifestations of cruel, inhuman types of behavior and torture of Ukrainian military who died in captivity.

The given information and forensic medical characteristics of injuries found on the bodies of Ukrainian soldiers who were in Russian captivity and died as a result of cruel, inhuman treatment and torture in 2022-2023. According to their nature and morphological features, the damage could be the result of high temperature action using hot metal objects, but more likely, the result of the use of electric current conductors (bare end of the wire). In other cases, after the exhumation of the occupied territory of the Kharkiv region, the manifestations of torture were brain injuries and fractures of the bones of the body caused by blunt hard objects with a limited surface. All the injuries described by us correspond both to the list of physical evidence of torture of the "Istanbul Protocol" and to the list of war crimes of the "Rome Statute".

Long-term physical and psychological symptoms in Syrian men subjected to detention, conflict-related sexual violence and torture: cohort study of self-reported symptom evolution.

Background: Since March 2011, more than 1 million people, mostly men, have been arrested, detained, and tortured by the Assad regime. Published literature does not reflect the evolution of symptoms after male sexual and physical violence in detention. This cohort study examines the constellation and evolution of self-reported symptoms after male conflict-related sexual violence (CRSV) in Syrian state detention. Methods: Sexual, psychological, and physical symptoms and conditions experienced by a cohort of 106 male detainees after CRSV in Syrian regime detention were evaluated over a ten-year period (2012-2022). Men sought forensic medical expert evaluations (FMEs) to document torture and later consented to semi-structured interviews (SSIs), a median of 8.8 years after their detention. A standard data collection tool was used to assess symptoms and conditions during FMEs (Time 3), and at the time of the SSI (Time 4), during which men also reported symptoms experienced during detention (Time 1) and after detention release (Time 2). Findings: 30.2% of men spent more than 1 year in detention and 9.4% were detained >5 years. 90% reported being slapped, punched, kicked, hit with objects, 60.4% of men reported torture with multiple devices, and 48.1% reported being burned or electrocuted. Multiple sexual violence types were reported during detention: 97.2% forced nudity, 45.3% violence to genitals or anus, 30.2% collective sexual humiliation, and 9.4% rape. Men recalled nearly universal presence of acute pain, bleeding wounds, skin infections, sleep disturbances, fear, sadness, anxiety, and despair during detention. By Time 4, acute physical and psychological conditions were fading or absent, while scars, avoidance, intrusive memories, lack of trust, self-isolation, chronic pain, anger, and low self-esteem were reported by ≥50%. The most persistently reported symptoms following detention through the SSI included scars, pain, intrusive memories, and avoidance in ≥50% of men. At the SSI, 26.4% of men reported erectile dysfunction and 23.6% challenges with sexual relations. Interpretation: Men reported persistent symptoms and conditions years after CRSV, torture and detention. The unique constellation of findings and their evolution in male CRSV survivors, particularly increasing rates of anger, distrust, and self-isolation, must urgently inform design and delivery of support services and health care. Funding: This study was funded by the United Kingdom Foreign Commonwealth and Development Office and the Arts and Humanities Research Council through the project 'Understanding and Addressing the Impact of Invisibility on Conflict-Related Male Sexual Violence in Syria'.

Ethical and Forensic Issues in the Medico-Legal and Psychological Assessment of Women Asylum Seekers.

Asylum-seeking migrants represent a vulnerable segment of the population, and among them, women constitute an even more vulnerable group. Most of these women and girls have been exposed to threats, coercion, and violence of many kinds, including rape, forced prostitution, harassment, sexual slavery, forced marriage and pregnancy, female genital mutilation/excision, and/or other violations of their rights (e.g., deprivation of education, prohibition to work, etc.). The perpetrators of the violence from which they flee are often their own families, partners, and even institutional figures who should be in charge of their protection (such as police officers). In the process for the acceptance/rejection of an asylum application, the forensic and psychological certification can make the difference between successful and unsuccessful applications, as it can support the credibility of the asylum seeker through an assessment of the degree of compatibility between the story told and the diagnostic and forensic evidence. This is why constant and renewed reflection on the ethical, forensic, and methodological issues surrounding medico-legal and psychological certification is essential. This article aims to propose some reflections on these issues, starting from the experience of the inward healthcare service dedicated to Migrant Victims of Maltreatment, Torture, and Female Genital Mutilation operating since 2018 at the Institute of Forensic Medicine of the University Hospital of Palermo.

Psychological torture: definitions, clinical sequelae and treatment principles.

Psychological torture, in its broadest sense, is the intentional infliction of suffering without resorting to direct physical violence, in what is known as 'no-touch' torture. While several other definitions of psychological torture have been suggested, there is no one precise definition. Given the rapidly evolving current global political climate and the intensification of conflict, war and asylum seeking, the need for better recognition of psychological torture among clinicians, followed by the provision of appropriate treatment support for victims, has become increasingly pertinent. This article raises awareness of the concept of psychological torture among clinicians, through an overview of its debated definitions, the modalities which constitute this form of torture, and its clinical sequelae and treatment approach.

Co-development of a clinical rehabilitation model with an evidence-based approach for torture survivors.

Torture is designed to silence, render powerless, oppress and terrify not just the individual torture survivor but the whole society where the act of torture occurs. The aftermath of torture can include trauma spectrum disorders such as post-traumatic stress disorder as well as other mental health problems, in addition to chronic pain and disability. Rehabilitation for torture survivors therefore needs to include empowerment at its heart. This is important to overturn the impact of torture on the survivor's sense of powerlessness and to address the silencing that begins with torture and is maintained by the psychological sequelae of surviving it. The organisation Freedom from Torture, together with survivors of torture, co-designed a new evidence-based clinical rehabilitation model by surveying service users and by carrying out a narrative review of the research literature and best practice guidelines. The resulting model incorporates co-delivery of therapeutic services by survivors.

What Are the Characteristics of Torture Victims in Recently Arrived Refugees? A Cross-Sectional Study of Newly Arrived Refugees in Aarhus, Denmark.

Torture victims live with complex health conditions. It is essential for the rehabilitation of torture survivors that their traumas are recognized at an early stage. The aim of this study was to investigate (i) the prevalence of reported torture exposure, (ii) the association between demographic characteristics and exposure to torture, and (iii) the association between PTSD and exposure to torture among recently arrived refugees in Aarhus, Denmark. Data were extracted from health assessments of refugees arriving in Aarhus in the years 2017-2019, and 208 cases were included in the analysis. The prevalence of reported torture was 13.9% (29/208). Most torture victims were found among refugees arriving from Iran (17.0% (9/53)), Syria (9.3% (8/86)), and Afghanistan (25.0% (5/20)). Significant associations were found between reported torture exposure and male gender, Southeast Asian origin, and a diagnosis of PTSD. In the study, 24.5% (24/98) of males and 4.5% (5/110) of females had been subjected to torture. However, it is possible that the prevalence of female torture survivors is underestimated due to the taboos surrounding sexual assaults and fear of stigmatization. Nearly half of the torture victims in the study were diagnosed with PTSD (44.8% (13/29)). The results confirm that torture victims constitute a vulnerable group living with severe consequences, including mental illness such as PTSD. Furthermore, understanding the cultural perspectives of the distress among refugees is crucial in providing appropriate healthcare services. This study highlights the importance of addressing the mental health needs of torture survivors and tailoring interventions toward vulnerable refugee populations.

Associations between gender, torture, and health: A 5-year retrospective cohort analysis.

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war.

Reparation Policy in Gendered Political Violence: Gendered Torture During the Dictatorship and the Recent "Social Explosion" in Chile.

This study explores the gendered violence dimension present in the torture exerted in Chile and the problems that continue to affect the reparation policies. The analysis covers the cases of political prisoners during the Chilean dictatorship (1973-1990) and that of the people detained within the context of the social protest of October 18, 2019. The methodology used for this study includes desk research on secondary sources on gendered political violence and torture such as scholarly books, journalistic and academic articles, and non-governmental organization reports, analyzing their contents from a perspective based on human rights and gender. We argue that the crystallization of gender-based violence exerted by Chilean State agents is linked to the biases present in post-dictatorship reparation policy and reflect on the impact of these biases on the assurances of non-repetition of human rights violations.

Homicidal electrocution disguised as an accidental death.

Deaths due to electrocution are mostly accidental. Homicide by electrocution is rarely reported in the literature. However, the location and pattern of the electrocution wound can raise concern for a possible homicidal manner of death. We are reporting an unusual case wherein the dead body of a middle-aged man was found lying in a suspicious condition on the roadside of desolated area. There were circumferential, grooved electrocution lesions over the left and right second toes with oval electrocution lesions on the medial aspects of both the left and right third toes. There were split lacerations over the right high parietal region, right pinna, and forehead. There was avulsion of the nail of the left thumb. Pressure abrasion was consistent with a ligature mark on the lower part of the left leg. The locations and pattern of these injuries raised the possibility of torture infliction. Death was attributed to electrocution, which was confirmed by histopathology. Autopsy findings and possible inferences were furnished to the police. This case highlights the careful observation of different characterizations and locations of the wounds and deducing inferences about the possible manner of death. This information can be useful to investigating agencies.

The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System.

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (ß = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (ß = -0.345) and physical health problems of parents (ß = -0.305), and youth gender (ß = 0.126) and trauma exposure of youth (ß = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (ß = 0.449). Family type had an indirect effect on youth adjustment through youth gender (ß = 0.142), youth trauma exposure (ß = -0.165), parent physical health problems (ß = -0.202), and parent mental health (ß = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.

The effectiveness of psychoanalytic psychotherapy in individuals diagnosed with PTSD due to torture and severe human right violations.

INTRODUCTION: Various psychotherapies have been applied to individuals who have been subjected to torture and severe human rights violations. However, studies assessing the ef-fectiveness of such therapies are limited. Psy-choanalytic psychotherapy is said to be used frequently in practice for these patient groups. Yet, there are scarcely any studies assessing its efficacy. In this study, we aim to assess the effectiveness of psychoanalytic psychotherapy in patients with PTSD associated with torture and severe human rights violations. METHODS: 70 patients who were diagnosed with PTSD due to being tortured and severe human rights violations in accordance with DSM-IV-TR and who applied to the Human Rights Foundation of Turkey were given psy-choanalytic psychotherapy. CGI-S and CGI-I scales were applied to the patients (in Months 1, 3, 6, 9, and 12); and the patients' continu-ity of therapy and the changes in their recov-ery during the one-year psychotherapy period were assessed. RESULTS: 38 (54.3%) of the patients were female. Their mean age was 37.7 years (SD= 12.25), while their mean baseline CGI-S score was 4.67. The drop-out rate was 34%. The mean length of treatment was 21.9 ses-sions (SD = 20.30). Mean scores for CGI-I scale were 3.46, 2.95, 2.23, 2.00, and 1.54 for months 1, 3, 6, 9 and 12 respectively. As the number of sessions increased, the final CGI-I scores of the patients improved significantly towards recovery.75.4% of the pa-tients benefited from the treatment in general according to their final CGI-I score. CONCLUSIONS: Considering the limited liter-ature in the field, this study has provided sig-nificant data on the effectiveness of the use of psychoanalytic psychotherapy in individuals diagnosed with PTSD related to torture and severe human rights violations, despite its lim-itations such as not involving a control group, not having been conducted blindly and ran-domized and being based on a single scale.

"The Darkness": Deprivation of sunlight as a form of torture.

INTRODUCTION: Deprivation of sunlight (DoS) should be considered independently as a method of torture. We review the definition and the spectrum of DoS, and the harms it causes that may rise to the level of torture. METHOD: We review relevant international case law, and highlight how the harms of DoS have historically not been fully considered in torture cases, possibly legitimizing its use. CONCLUSION: A standardized definition of deprivation of sunlight be developed and in-cluded in the Torturing Environment Scale, we call for an explicit international prohibi-tion of DoS.

What constitutes a high-quality, comprehensive medico-legal asylum affidavit in the United States immigration context? A multi-sectoral consensus-building modified Delphi.

In the United States, clinicians are often called upon to provide their expertise to generate expert evidence in cases of individuals seeking asylum or other forms of international protection. Due to a lack of validated guidelines specific to the U.S. immigration context, clinical evaluations produced for immigration proceedings in the United States vary in their format, structure, and content, which can be confusing for practitioners and for adjudicators assessing the weight these evaluations should be afforded in asylum proceedings. We sought to review critical components of a medico-legal asylum evaluation from an interdisciplinary perspective of key stakeholders, by collecting and synthesizing expert opinions to reach consensus on what constitutes a high-quality, comprehensive medical or psychological affidavit for U.S. immigration cases. The consensus process incorporated a three-step modified Delphi method, which took place between September and December 2021 and consisted of two rounds of online questionnaires and a synchronous video conference meeting. The areas most experts agreed on included, by order of highest agreement (combining answers of "strongly agree" and "agree"): A narrative form or checklist is preferable to a predetermined template (95%); Primary care physicians should describe their qualifications to diagnose mental health conditions (81%); Use of citation is helpful, with caveats (77%); Clinicians should include an assessment of malingering (72%); Clinicians should include an executive summary/summary of conclusions at the top of the affidavit (72%); Clinicians should reference the Istanbul Protocol and explain its relevance (66%); It may be beneficial for clinicians to describe the anticipated process of healing (57%); Clinicians may include treatment recommendations (52%). Results of this and future consensus-building efforts and resulting guidance should be used to enhance overall quality of medico-legal reports and incorporated in training programs developed for clinicians, attorneys and adjudicators.

Enforced Disappearances and Torture Today: A View from Analytical Psychology 2. Torture Survivors and the Unthinkable: A Hyper-Present Body in the Therapeutic Process: 2. Torture Survivors and the Unthinkable: A Hyper-Present Body in the Therapeutic Process1.

In very rare cases, individuals survive the atrocities of abduction, imprisonment and torture that are part of the hallmark of enforced disappearances. Cases of people who survive torture and seek asylum in a third country help us understand some important aspects related to the crime of enforced disappearance. In the psychotherapy of torture survivors, at an early stage and for a long time, words often do not convey the core of the patient's experience. Survivors usually have tormented bodies in which individual and collective violence, hatred, anger, guilt and shame are painfully inscribed. Corporeal countertransference becomes the only possible way for a therapist to get in touch with a survivor's experience through a kind of body-to-body communication. The centrality of the body in these therapies suggests that the body is the involuntary recipient and container of mass political atrocities and, for this reason, the place where, in the case of horrific social violence, the possibility of social "knowing" is stored and can be retrieved. Thus, when it comes to forced disappearance, the determination of the relatives to get to the truth through the discovery of the remains of their disappeared demonstrates the importance of the body as the final witness of what happened, beyond any possible manipulation.

Dans de très rares cas, des personnes survivent aux atrocités de l'enlèvement, de l'emprisonnement et de la torture qui caractérisent les disparitions forcées. Les cas de personnes qui survivent à la torture et demandent l'asile dans un pays tiers nous aident à comprendre certains aspects importants liés au crime de disparition forcée. Dans la psychothérapie des survivants de la torture, à un stade précoce et pendant longtemps, les mots ne transmettent souvent pas le cœur de l'expérience du patient. Les survivants ont généralement des corps tourmentés dans lesquels la violence individuelle et collective, la haine, la colère, le sentiment de culpabilité et la honte sont douloureusement inscrites. Le contre-transfert corporel devient le seul moyen possible pour un thérapeute d'entrer en contact avec l'expérience d'un survivant par une sorte de communication de corps à corps. La centralité du corps dans ces thérapies suggère que le corps est le destinataire involontaire et le conteneur des atrocités politiques de masse et, pour cette raison, le lieu où, dans le cas d'une violence sociale horrible, la possibilité d'un "savoir" social est stockée et peut être récupérée. Ainsi, lorsqu'il s'agit de disparitions forcées, la détermination des des membres de la famille à accéder à la vérité en retrouvant les restes de la personne disparue montre l'importance du corps en tant que dernier témoin de ce qui a eu lieu, au-delà de toute manipulation.

En casos muy raros, las personas sobreviven a las atrocidades del secuestro, el encarcelamiento y la tortura que forman parte del sello distintivo de las desapariciones forzadas. Los casos de personas que sobreviven a la tortura y buscan asilo en un tercer país nos ayudan a comprender algunos aspectos importantes relacionados con el delito de desaparición forzada. En la psicoterapia de supervivientes de tortura, en una fase temprana y durante mucho tiempo, las palabras no suelen transmitir el núcleo de la experiencia del paciente. Los supervivientes suelen tener cuerpos atormentados en los que se inscriben dolorosamente la violencia individual y colectiva, el odio, la ira, el sentimiento de culpa y la vergüenza. La contratransferencia corporal se convierte en la única vía posible para que un terapeuta entre en contacto con la experiencia de un superviviente a través de una especie de comunicación cuerpo a cuerpo. La centralidad del cuerpo en estas terapias sugiere que el cuerpo es el receptor involuntario y el contenedor de las atrocidades políticas masivas y, por esta razón, el lugar donde, en el caso de la violencia social horrorosa, se almacena y puede recuperarse la posibilidad del "conocimiento" social. Así, cuando se trata de desapariciones forzadas, la determinación de los familiares por llegar a la verdad a través del hallazgo de los restos de sus desaparecidos demuestra la importancia del cuerpo como testigo final de lo sucedido, más allá de cualquier posible manipulación.

Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.

RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.

Physical assessment of tortures: Interobserver analysis of medico-legal degrees of consistency based on the Istanbul protocol.

The Istanbul Protocol section on medicolegal evaluation delineates the guidelines for the correct management of the physical examination and the methods of assigning the degrees of consistency. Considering that most cases exhibit highly heterogeneous lesions, the examiner is forced to rely on his own experience, and their evaluation may be very subjective. The purpose of this work is to understand how subjective such an evaluation may be and whether the "experience" factor, interpreted as years dedicated to this profession and the number of cases evaluated, is statistically significant. To this end, a survey containing eleven cases of pre-evaluated asylum seekers was sent to thirty Italian clinical forensic practitioners. The participants were invited to assign a degree of consistency to each case according to the Istanbul Protocol guidelines, besides answering a few questions regarding their professional record. The doctors were divided into groups based on the number of cases evaluated and the experience collected expressed in years, and then interobserver analysis was performed. Results showed that the Fleiss' Kappa coefficient acquired significant values when attention was turned to the sub-samples composed of more experienced participants. Therefore, the introduction of appropriately trained health professionals - "experts in migrations and torture" - could lower the risks of misinterpretation and make the assessment as reproducible as possible.