The assessment of Refugees for Singn of Torture: an Italian glimpse

Assessment of torture allegations is one of the most recent fields of application of clinical forensic pathology, which is often affected by specific diagnostic limits, especially for what concerns the assessment of scars and the reconstruction of their origin. In Italy specific committees actually exist for the recognition of the status of refugee, which only in the last year have begun to include forensic pathologists. This presentation aims at exposing the first experiences concerning the assessment of signs of torture in an initial sample of refugees visited at the Institute of Legal Medicine of Milan, in order to show the difficulties which are encountered in establishing a correct coordination between the different professionals involved in the specific committees, and the pitfalls in the interpretation of lesions and scars. Twenty-six cases have so far been assessed between 2008 and 2012: each alleged victim was interviewed and examined. Every scar and lesion was analysed especially for what concerns morphology and size, and photographed. In several cases special examination, such as X-rays for a better understanding of bone calluses, was performed. The final report concerning the consistency between lesions and the given history was performed according to the indications of the Istanbul protocol. In most cases the subjects came from African countries, and a high number of them went through Libya during the civil riots. Almost all the subjects are male, and in 56% they are aged between 20 and 30 years. Only in 32% of cases the history revealed torture for political reasons, whereas in 28% of cases a history of random military aggression is given. Blunt and thermal lesions were most frequently reported (respectively 49% and 23%). Blunt lesions were most frequently performed by truncheons and wooden sticks (respectively 26% and 24%), and were observed on the limbs and the torso; thermal injuries were performed by torches (45%) and cigarettes (30%), and highly affected the limbs. Sharp force injuries were produced by knives in 70% of cases and were observed most frequently on the trunk. Gunshot lesions, dogbites, chemical and blast lesions were residual. One of the most relevant results concerns the correlation between scars and the origin of the lesions reported by the refugee; in almost all cases the analysis led to a general concordance with the presumed history, although other origins could not be excluded. In few cases the scars were highly suggestive for the reported history according to the existing literature, and concerned specific modalities such as thermal and sharp force lesions. This presentation highlights the lack of information in literature concerning the correct assessment of scars and the need for further studies in this relatively recent and sensitive field. Another important point of discussion concerns the need for a correct coordination between the different professional figures involved in such committees, in order to produce a useful and clear report of the alleged tortures.