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Because torture generally occurs in the absence of eyewitnesses willing to testify, medical evidence is important proof in substantiating a victim's torture claim.64 It is critical not only for holding accountable the abusive police officer but also for eventually excluding from evidence a confession that has been extracted under duress.

It is vital for the torture victim to be examined by a physician or forensic doctor as soon as possible after the ordeal. Immediately after the abuse, a doctor can often determine with a degree of certainty when the injury was sustained and what caused it. For example, scorch marks on the skin can be linked to electroshock, and long bruises to blows inflicted with a nightstick. In combination with documents on the date and time of arrest and on the detainee's condition upon arrival at the detention center, the abuse can sometimes be proven beyond a reasonable doubt. However, with every day that passes, the level of certainty with which a medical doctor can link the injuries to torture decreases, and within a month most medical evidence will have disappeared, unless injuries leave a scar or have become chronic.65

Authoritative international standards, such as the Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment (Principles on Detention), recognize the importance of prompt access to medical professionals. The Principles on Detention require that detainees have access to a medical examination "as promptly as possible after his admission to the place ofdetention or imprisonment."66 Further medical care or treatment should be provided whenever necessary, and detainees should in most cases have the right to request a second opinion.67 All medical examinations should be duly recorded.68 The U.N. Standard Minimum Rules for the Treatment of Prisoners require that untried detainees have the right to visits by their doctor.69

In Russia, however, torture victims are rarely able to obtain a prompt medical visit. Russian criminal procedure, physicians' reluctance to have anything to do with the police, and simple financial constraints combine to make it unlikely that the torture victim will obtain medical documentation of torture.

Access to a Forensic Expert

Law enforcement officials and courts regard conclusions of forensic experts from state-run forensic medical evidence centers as the most authoritative and often refuse to take into serious consideration other medical evidence. However, state forensic experts can examine people only at the request of certain law enforcement officials and judges, and only in the context of a criminal investigation. Thus, a forensic examination cannot generally be ordered as part of the initial, informal inquiry into a torture complaint. Torture victims and their lawyers cannot approach these forensic experts directly. They can, of course, request the investigator or judge in the case to order a forensic examination, but the latter can simply dismissthe request, claiming it is not germane to the criminal case.70 A vicious circle ensues: Investigators often refuse to institute a criminal investigation against alleged torturers for a lack of sufficient grounds, and without having opened a criminal investigation involving the alleged torturers, the medical examination, which could provide sufficient grounds, cannot be carried out.

Investigators may also order forensic medical examinations of injuries allegedly sustained as a result of police torture in the context of the criminal case against the torture victim. However, they do not usually do so and most requests from lawyers and defendants for such medical assessments are reportedly turned down. For example, in the case discussed above, Boris Botvinnik and his lawyer asked investigators, and later a judge, numerous times to order a forensic examination. Despite the fact that a hospital in Volgograd had diagnosed Botvinnik with head trauma, both investigators and judge refused these repeated requests.

Irkutsk lawyer Robert Sheptalin told Human Rights Watch that it is very difficult to have a forensic expert appointed to examine police torture victims, although deception of the police sometimes allows this:

The investigator...used physical force against the wife of Chernykh [Sheptalin's client], that is, they started to beat her up so that she would give testimony against her husband.... [After they let her go] I tricked the police officers.... She went to [another] police precinct and said: "I've been beaten up." She didn't say who beat her up. The police officer gave her the referral for a [forensic] examination.71

In a rare example, the procuracy investigator on Andrei Kol'tsov's case ordered a forensic examination when Kol'tsov requested one. Medical personnel at the IVS facilities both in Angarsk (September 26, 1996) and in Cheremkhovo (October 8, 1996) had recorded Andrei Kol'tsov's injuries. When Kol'tsov was able to contact his lawyer on October 8, the latter immediately demanded that the case investigator order a forensic examination. The investigator agreed, probably due to the still visible injuries and the examinations by IVS personnel, and a forensic expert examined Kol'tsov on October 23, 1996. Kol'tsov told Human Rights Watch:

I was called in, taken to the interrogation room [sic] and told: "What kind of complaints do you have. You did complain, right?" I said: "Ihave a broken rib." The forensic expert asks: "Where is it?" I showed him. He wrote it down after touching with his hands. We had requested that I be taken to the polyclinic of the city of Cheremkhovo and be examined completely there. The expert recorded only part of the bruises and left.72

Access to a Medical Doctor for Former Detainees

When they cannot be examined by a forensic expert, torture victims who have been released have other options to treat and document their injuries. Torture victims who have been released can turn to travmapunkty, or emergency rooms, or visit their general practitioner. Travmapunkty exist at the district level in every city or village and are equipped to provide first aid, run simple medical tests, and take X-rays. For more complicated examinations, the doctor at the emergency room can direct the individual to a specialist at a polyclinic. Victims can also call in the skoraia pomoshch, the ambulance service. If the individual indicates the nature of his injuries, ambulance personnel can bring portable equipment with them to run simple tests on the spot. As with emergency rooms, for more complicated tests the individual will be directed to a specialist at the polyclinic. Also, ambulances are usually manned by doctor's assistants (fel'dsher) who do not have a full medical education. Uchastkovye vrachi, or general practitioners, are not equipped to run any kind of tests more complicated than measuring blood pressure or checking reflexes and will direct the individual to a specialist if deemed necessary.

These non-forensic doctors are supposed to list the patient's complaints, describe the injuries in detail (including color, shape, length of bruises and wounds, etc.), and note the patient's story about their origin. Forensic doctors can later use these descriptions to establish the approximate time the injury was sustained, the object that caused the injury, and other factors that can play a key role in prosecuting abusers. However, medical examinations performed by emergency rooms, ambulance services, or general practitioners are often not sufficiently thorough or their diagnoses lack the necessary detail for forensic experts to draw categorical conclusions about the cause of injuries. There appears to be a tendency to focus on visible injuries, such as bruises, and ignore internal ones, unless there are specific and unsolicited complaints about organs or senses. For example, if the victim complains of pain resulting from blows to his heels with a club, the doctor may diagnose the heel as being bruised but not take an X-ray, which could confirm damage to the heel bone.

Two forensic experts told Human Rights Watch that the quality and level of detail of medical documents issued by non-forensic doctors are not always sufficient for categorical conclusions.

These medical documents are by far not always exhaustive in terms of the description [of the injury]. [Regular] doctors are concerned with treatment and their attitude toward description of details-the size of the injuries, their color, in other words the matters that interest us-is such that they often miss them.... Therefore, we can often not answer concrete questions about the time and manner [of the injury].73

An additional problem is that doctors become reluctant to examine a torture victim as soon as they learn how the patient sustained his injuries. Doctors are obliged to report any examination of injuries that may be related to a criminal offense to the police and, like most people in Russia, medical professionals prefer to avoid all contact with the police. Such examinations may lead to questioning by a prosecutor, having to testify in court, and possible unpleasant encounters with police officers, who could put the doctor under pressure to change his conclusions. Valerii Abramkin, of the Moscow Center for Prison Reform, told Human Rights Watch:

[T]hey are just afraid because they are unprotected. Nobody seems to take that into consideration and they say: "why do they [doctors] not issue [medical documents]? Aren't they independent of the police, these emergency rooms?" If you talk to him [a doctor], he will tell you: "Ok, and what will they do with me then, I [have to] live here!" Especially, if [they live] not in Moscow but in a small town.... In any case, it's much easier not to issue [a medical document].74

While most medical care is officially free of charge, any medical assistance beyond the most basic has to be paid for in today's Russia. Emergency rooms will still issue, free of charge, medical certificates superficially documenting the state of health of the individual, but they charge for in-depth examinations. This is a financial hardship for victims of police abuse, many of whom are poor.

Detainees' Access to Medical Doctors

The vast majority of victims of torture and ill-treatment remain in detention for many months after their ordeal and face overwhelming difficulties in obtaining medical documentation of torture and ill-treatment. Russian law does not grant untried detainees the right to be examined by their own doctors or a doctor of their own choice, as called for under international standards (see above). Detainees thus depend on the medical personnel at prison and detention centers.

As a rule, police stations and most IVS facilities do not have medical personnel on duty.75 This means that a detainee must first complain to the duty officer at the detention center or police station, who then decides whether to call an ambulance or provide the detainee with first aid using an emergency kit.

Ex-detainee German Il'in, from the village of Ikei in Irkutsk province, told Human Rights Watch that the duty officer refused him access to a medical professional after he was detained and beaten severely at his farm on November 20, 1995. When police brought him, his wife, his child, and his neighbor to the IVS at the Tulun police station, he demanded a medical examination:

They took us past the duty officer, kept us in his office and registered us, then they took Lida and myself to a cell. I asked them to record my injuries but they refused. I asked the duty officer, I asked our [local] policemen, Gurikov, Sveshnikov.... They answered: "What expert?! You will have an expert now! One more sound and we'll put you in the punishment cell."76

It took approximately one month of constantly demanding access to a doctor by both Il'in and his wife (who had been released) before the police and the procuracy finally agreed to call in a doctor to examine him. In contrast, a former policeinvestigator from Moscow asserted that duty officers do not obstruct access to physicians, "Duty officers have a strong incentive not to turn down requests for medical assistance: They will be held responsible if the detainee's condition further deteriorates or he dies."77 But in practice, access to medical attention in police custody appears to depend solely on the attitude of the officers in charge of the particular detention center.

Another former detainee Human Rights Watch interviewed, Valerii Shapochnikov, complained that when a medical doctor visited him in the IVS in Irkutsk province on November 25, 1997, two days after he was detained and beaten, the examination was only cursory:

They brought him to me in the KPZ, he examined me in the cell. I undressed to my waist, where everything was swollen, it hurt, my jaw was swollen, I showed him, he looked and says: "Well, you don't have anything there!" I showed him that I urinated with blood and that everything hurt. He said: "No, maybe you have a small internal blood blister and that's it." He turned around and left.78

Within three days of the moment of detention, detainees must be transferred to SIZOs from police stations and IVSs.79 SIZOs have permanent medical staff and every new detainee is examined. Detainees are routinely checked for a series of illnesses, including HIV infection and syphilis. According to the head doctor at the Arkhangel'sk SIZO No. 1, Dr. Alexander Mazanov, other aspects of the detainee's health are checked if he or she has complaints or if there is another reason to do so. He also said that any complaints about beatings or other forms of ill-treatment are entered on the inmate's medical card, including details on the identity of the perpetrator(s), the place, time, and method of ill-treatment. He further said that when a detainee does not have any visible injuries but complains about headachesor pain in the kidneys, doctors can run only elementary tests to establish possible internal damage.80

While access to medical personnel at SIZOs is better than at IVSs or police stations, detainees may mistrust prison doctors. Until September 1998, SIZOs were under the authority of the same ministry as the police. Although they are now part of the Ministry of Justice, many inmates see prison authorities, investigators, and police as belonging to one and the same system.81 Inmates may therefore decide not to ask for a doctor or not to inform him or her of the real origin of their injuries for fear of repercussions.

Death in Custody or Permanent Physical Damage

Torture causes lasting emotional and physical harm to the victim. It sometimes leads to the death of the suspect, during or subsequent to this treatment. Some deaths in custody have resulted in legal proceedings in Russia and received publicity in the local media, but these cases may represent only a small minority of the total. Public exposure of torture, and prosecutions in turn, seem to be limited largely to cases in which the detainee dies in custody-or is seriously injured-in circumstances that cannot entirely be concealed.

Oleg Igonin from the city of Saransk in the Republic of Mordovia died in 1995 after police tortured him by asphyxiation (see above, "Slonik"). On July 25, 1995, three police detectives from the Lenin police precinct in Saransk detained a minor, A. Lavrent'ev, on suspicion of a robbery. They asphyxiated and beat him, and demanded that he confess to armed robbery and name his accomplices. Lavrent'ev named Oleg Igonin as his alleged co-offender, after which the Saransk precinct chiefs instructed their subordinates to detain Igonin. The three detectives and a colleague detained Igonin at his home at 2:00 a.m., brought him to the police station, did not register him with the duty officer or write a detention report, and forced him to write a confession. Police asphyxiated Igonin on various occasions, until Igonin died at around 4:00 a.m. at the station. All four police officers were found guilty of torture and sentenced to prison terms ranging from three to nine and a half years.

During a hearing at a Nizhnii Novgorod court, it was established that several years earlier Nizhnii Novgorod police had beaten and bound a detainee, who died as a consequence. An officer had beaten Chistiakov and thrown him in a punishment cell, apparently as a form of punishment for demanding that policerelease him. The officer reportedly took Chistiakov out of the cell, beat him and, after tying him up in the "konvertik" position, threw him in a punishment cell, where he died. A forensic expert examination found forty bruises from night sticks on his body.82 Two police officers were found guilty of this crime but received suspended sentences.

In 1997, the Voronezh Province Court sentenced three police officers to eight, nine, and ten years of imprisonment for torturing to death a criminal suspect and burning his body. The officers tortured the detainee and his brother for several hours, beating and asphyxiating him. When they realized one of them had died, they tried to dispose of the body by burning it and dumping it in a sewer.83

Boris Botvinnik, whose treatment has already been noted, lost most of his eyesight after police beat and asphyxiated him at his Moscow apartment in September 1996. About ten days after his detention Botvinnik, noticed that his vision, which had previously not given him any problems, was deteriorating, at first very rapidly, later more gradually. Approximately three weeks after his detention, Botvinnik requested in writing to see a doctor. It took another several weeks before Botvinnik was examined by an eye specialist, who concluded that only about 10 percent of Botrinnik's eyesight remained and recommended a more thorough examination at an eye clinic. In mid-December, specialists of the Gel'mgol'ts Institute, Russia's leading eye clinic, found that he had suffered from descending atrophy. On the basis of this diagnosis, Botvinnik was released from pretrial detention on January 17, 1997. A medical examination conducted after his release at a Volgograd hospital diagnosed Botvinnik with post-traumatic basal arachnoiditis-a low-grade chronic inflammation of a layer of membranes covering the brain and spinal cord. This chronic inflammation was said to have caused the damage to Botvinnik's eyesight. According to a British neurologist, who was unable to examine Botvinnik in person, Botvinnik condition as diagnosed by Russian medical doctors may have been caused by beatings to the head.84

Human Rights Watch learned of four cases of detainees in three different Russian cities (including Arkhangel'sk, Ekaterinburg, and Nizhnii Novgorod), who jumped out of high police interrogation room windows to escape torture-too many to be a coincidence. Two of the detainees sustained severe permanent injury, and one died. While torture did not directly cause these injuries, the terror,disorientation, and despair in each case prompted suicidal leaps that were a consequence of the torture.

Twenty-four-year-old Dmitrii Ivanov, from a town in Central Russia, leapt from the window of an investigation room in August 1997 and was crippled for life. Police detained Ivanov on August 5, 1997 at a car park where he was waiting for a friend. Ivanov, who had had his jaw broken by police officers during an arrest several years earlier, tried to run but was apprehended. At the police station, Ivanov was taken to the third floor and ordered to confess to being among a group of people who robbed a computer firm. Police officers announced they would "play soccer" with him until he would "remember" how everything happened.

Police subsequently beat Ivanov and subjected him to electroshock. In his words, he "flew through the room, like a soccer ball." The detectives in the meantime told Ivanov to confess to a series of crimes, including robbery and dealing in stolen goods. Police suggested people he should name as his "clients." Unable to stand the pain any longer, Ivanov noticed the open window and jumped.

He fell fifteen meters and landed on his back on a parked car. Police phoned an ambulance and apparently removed his handcuffs before the ambulance arrived. At the hospital, doctors determined that Ivanov's spine had been fractured in four places and operated on August 7. According to Ivanov, a police officer named Zhenia (who had participated in his torture) visited him before the operation and suggested that since Ivanov would possibly not survive the operation, he might as well write a confession. Police did not inform Ivanov's family of his arrest or injury, although on August 10 a nurse at the hospital phoned at Ivanov's request. Investigators changed Ivanov's status from suspect to "witness" after the accident.

Ivanov was discharged from the hospital in late September 1997, disabled for life. When Human Rights Watch representatives visited Ivanov in October 1997, he was not able even to sit up. The life of his family has been turned upside down, as he needs constant outside care and a variety of expensive drugs, on which his mother spends the majority of her income.85

On November 21, 1996 in Ekaterinburg, then fifteen-year-old Oleg Fetisov jumped out of a window of the Verkh Isetskii police station, where three police officers questioned, beat, and asphyxiated him. Fetisov noticed an open window and jumped. Fetisov was taken to the hospital with a fractured skull, pelvic bone, and arm, a small cerebral hemorrhage, a damaged knee, and a concussion. Fetisov spent twenty-one days in the hospital and several more months at home recovering.

In 1996 a twenty-year-old man from Arkhangel'sk threw himself out of a police precinct window and fell to his death on the street in front of the precinct building. Blood stains in the office where he was questioned and reported injuries on the man's body that apparently were not caused by the fall gave reason to believe that he may have been tortured. Criminal proceedings against the officers in charge were initially instituted but dropped three months later.86

A representative of the Nizhnii Novgorod Society for Human Rights recently reported another such case: twenty-three year old Aleksei Mikheev reportedly jumped out of a police station's upper window after he was tortured with electroshock, landing on a parked motorcycle. He is currently described as paralyzed from the waist down and recovery prospects are uncertain.87

64 Although physical signs of torture may disappear fairly quickly, psychological damage may last for many years. A study by Danish torture specialist Ole Vedel Rasmussen concluded that long-lasting symptoms were present in approximately two-thirds of the torture victims examined. The most frequently recorded symptoms were sleep disturbances, irritability, anxiety, and depression. Psychological examinations of torture victims could provide important evidence of torture. However, during our research in Russia, we did not find a single case in which the procuracy had appointed a psychological expert to provide an assessment. See, Ole Vedel Rasmussen, "Medical Aspects of Torture," Danish Medical Bulletin, vol. 37, supplement 1, January 1990, pp. 28-33. 65 It is often not easy to link scars (from kicks, blows, or burning cigarette butts), damage to the nervous system (which may result from suspension and blows to the head), loss of eyesight (which may result from blows to the head) or brain damage (which may result from asphyxiation) to torture because similar injuries can be sustained otherwise as well. Medical doctors can positively link them to torture only in exceptional cases. 66 Principle 24 states: A proper medical examination shall be offered to a detained or imprisoned person as promptly as possible after his admission to the place of detention or imprisonment, and thereafter medical care and treatment shall be provided whenever necessary. This care and treatment shall be provided free of charge. 67 Principle 25 states: A detained or imprisoned person or his counsel shall, subject only to reasonable conditions to ensure security and good order in the place of detention or imprisonment, have the right to request or petition a judicial or other authority for a second medical examination or opinion. 68 Principle 26 states: The fact that a detained or imprisoned person underwent a medical examination, the name of the physician and the results of such an examination shall be duly recorded. Access to such records shall be ensured. Modalities therefore shall be in accordance with relevant rules of domestic law. 69 Rule 91 of the U.N. Standard Minimum Rules for the Treatment of Prisoners reads: "An untried prisoner shall be allowed to be visited and treated by his own doctor or dentist if there is reasonable ground for his application and he is able to pay any expenses incurred." 70 Article 184 of the criminal procedure code states that the investigator can decide to order an expert examination if he "recognizes the necessity of carrying out an expert assessment." 71 Human Rights Watch interview with Robert Sheptalin, Irkutsk, April 1, 1998. 72 Human Rights Watch interview with Andrei Kol'tsov, Cheremkhovo, Irkutsk province, April 2, 1998 73 Human Rights Watch interview with Larisa Romanova and Yuri Solntsev, Moscow, February 11, 1999. 74 Human Rights Watch interview with Valerii Abramkin, July 15, 1998, Moscow. 75 There appear to be several exceptions to the rule that IVS do not have medical personnel on duty. One torture victim told Human Rights Watch that the IVS in Angarsk and Cheremkhovo (both Irkutsk province) do have medical personnel. Also, the deputy head of Irkutsk province police, Vitalii Bartoshevich, told Human Rights Watch that a nurse is present in the IVS twenty-four hours per day and it is her duty to "record the status [detainees'] health" and possible injuries (Human Rights Watch interview with Vitalii Bartoshevich, Irkutsk, April 9, 1998). On the other hand, the acting head of IVS No. 1 in Novgorod, Mr. Isachenko, told Human Rights Watch that there are no medical personnel at that IVS (Human Rights Watch interview, Novgorod, July 17, 1998). 76 Human Rights Watch interview with German Il'in, Okei, Tulun district, Irkutsk province, April 3, 1998. 77 Human Rights Watch interview with Vladimir Federov., Moscow, June 8, 1999. "Vladimir Federov" is not the man's real name. 78 Human Rights Watch interview with Valerii Shapochnikov, Tulun, Irkutsk province, April 4, 1998. 79 Article 96-2 of the criminal procedure code prohibits police from keeping suspects in IVSs for more than three days. Under presidential decree 1226 of 1994, police could hold criminal suspects believed to be linked to organized crime for thirty days in IVSs. However, this decree was rescinded in 1997. 80 Human Rights Watch interview with Dr. Alexander Mazanov, chief doctor of SIZO No. 1 in Arkhangel'sk, July 24, 1998. 81 IVSs, by contrast, continue to be under the MVD's control. 82 Nizhnii Novgorod Society for Human Rights, "The Use of Torture on the Territory of the Nizhnii Novgorod Province, 1997," p. 13. 83 Gennadii Litvintsev, "Samosud v militseiskom zastenke," Rossiiskaia gazeta, April 8, 1997, p. 8 84 Human Rights Watch interview with Dr. Christopher Hawkes, October 6, 1999. 85 Human Rights Watch interview with Dmitrii Ivanov. "Dmitrii Ivanov" is not the man's real name, and at his request we do not reveal his home town. 86 Igor Lymar', "Chelovekopad," Pravda severa [Truth of the North] (Arkhangel'sk), February 22, 1996, p. 1; Igor Lymar', "Pytka smert'iu syna," Pravda severa, May 28, 1996, p. 6. 87 Human Rights Watch telephone interview with Igor Koliapin, Moscow, August 1, 1999.

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