Detainees' perception of the doctors and the medical institution in Spanish police stations: An impediment in the fight against torture and ill-treatment.

BACKGROUND: As part of a program by the Basque Government (Spain) and the University of the Basque Country, persons who have alleged exposure to torture and ill-treatment have been examined by psychologists and psychiatrists according to the Istanbul Protocol (IP). Medical examinations of detainees with the aim, inter alia, to document abuses is fundamental for torture prevention. The IP prescribes how this should be done to ensure data collection and prevent reprisals for having reported ill-treatment to the doctor.

OBJECTIVES: The objectives were to assess detainees' perception of the medical examinations which they underwent at different types of Spanish police institution and to compare practice between institutions; and, to compare information from the period 1969-1991 with that from 1992-2014.

METHODS: All information about medical examinations of incommunicado detainees from 202 extensive IP reports was analysed according to a 19-item tool developed for the purpose dealing with the doctors' professional performance, the confidence of the detainees in the doctors, reprisals and procedural safeguards (Annex 1). All information was classified as acceptable, unacceptable /insufficient or totally unacceptable.

FINDINGS: Very often the detainees perceived the doctors' professional performance as insufficient or totally unacceptable and the doctors did not instil their confidence. Threats of police reprisals and failure to observe procedural safeguards were often reported. There were no differences in the comparison between institutions. When comparing the two study periods an improvement was found over time. However, 64% of the scores came out as totally unacceptable or insufficient for the most recent period indicating that the medical institution in police stations where the detentions had taken place failed to constitute a preventive means against torture and ill-treatment.

LIMITATIONS: Only 57% of the 202 reports assessed contained relevant information; data was retrieved retrospectively; the interviews were done years after detention without a particular focus on medical examinations.