The role of forensic imaging in the allegations of torture in asylum seekers

Nowadays, according to the Istanbul Protocol, diagnostic tests are not an essential part of the clinical assessment of a person alleging torture or ill-treatment. In many cases, a medical history and physical examination are sufficient. However, literature evidence suggests a helpful role of diagnostic imaging in the allegation of evidence of torture, especially in the case of musculoskeletal injuries. The purpose of this narrative review is to highlight the role of imaging tests in suspected torture victims, emphasizing the role of these methods in establishing legal evidence of mistreatment. No specific imaging features are described in the literature, however, musculoskeletal imaging allows the detection of previous fractures, bone deformities, and tendon and ligament injuries. These are mainly due to blunt force injuries. MRI is the most helpful imaging tests to allegate evidence of Falaka. Imaging tests, particularly conventional X-rays and CT, are helpful in forensic investigations of when there is suspicion of retained foreign bodies, such as bullets or shrapnel, especially in cases where clinical examination is inconclusive. CT and MRI can show late sequelae of head trauma such as subdural hematomas, hygromas, old intracerebral bleeding, and hydrocephalus. The current literature highlights the importance of subjecting patients to imaging and specialists examinations to document evidence of torture and support the assessment of the degree of consistency with the reported history. These are second-level investigations that must be targeted to specific diagnostic questions and preceded by a thorough examination conducted by experts in the field using standardized methodologies, in line with the recommendations of the Istanbul Protocol. Imaging studies can bridge the gap between clinical examination and the patient's history.