Documentation
One of the major preoccupations of our clients is their health - both mental and physical - and their fears that they have been irreparably damaged by their experiences of torture and persecution. The physical and psychological hallmarks of torture also form a core part of their identity as they are interviewed, re-interviewed, assessed and re-assessed as part of the process of claiming their right to protection as refugees.
The MF is not a medical treatment centre in that we do not prescribe drugs. However, we provide medical care, conduct initial assessments and produce medico-legal reports (MLRs) following a forensic examination of a client's injuries.
In producing MLRs, clients are asked to give a full history of their ill-treatment. Scars will be scrutinised, with doctors checking for other injuries such as badly healed fractures, scars, lacerations and burns, crushing to the soles of the feet from repeated beatings (falaka) damaged ligaments or chronic bone infection.
Only in rare cases can the doctor state categorically that a scar or other injury could not have been caused in any way other than torture. In line with the UN's Istanbul Protocol, the doctor indicates the degree of consistency between the injury when evaluated according to clinical criteria derived from the MF's experience in this area and the client's account of how it occurred.
All requests for MLR's go through the MF's Medico-Legal Reports team which determines whether the individual falls within the MF's remit, whether there are any physical signs or psychological symptoms and whether a report would make a material difference to the asylum claim. In any case where the facts are unclear, the individual will then be interviewed by one of the MF's legal volunteer caseworkers to establish the details before a clinical examination is arranged.
MLR's play an important role, for if an asylum seeker can show that he or she has been tortured in their country of origin, that may well indicate that they have good grounds for fearing further torture if returned there, and their lawyer will be able to argue that they therefore qualify for refugee status under the terms of the 1951 Convention Relating to the Status of Refugees.
Each report is scrutinised by an MF lawyer and a second doctor before being submitted. In recognition of our own high standards, the Home Office now insists that a senior officer is called in to endorse any negative decision over an asylum claim which includes an MF MLR.
The giving of testimony is also very much part of the healing process. In order to treat an individual who has been tortured, you must treat the whole person. Clients often find themselves telling their history for the first time to an attentive listener which in itself can be a validating experience.
The Istanbul Protocol
In compiling reports, doctors observe the UN Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, otherwise known as the Istanbul Protocol, endorsed by the UN in 1999.
The Protocol establishes clear guidelines for the impartial and objective documentation of torture. It notes that "a report supporting an application for political asylum in a third country need provide on a relatively low level of proof of torture".
It enables medical experts to gather reliable, accurate information on which to base conclusions of consistency between the survivor's account and medical findings.