A/HRC/22/56 out and the same number reported being forced to witness violence or harm to others in detention, including rape. Many cases (34%) described being exposed to the sounds of others being tortured or in distress in detention. While many cases reported the use of threats as well as torture to induce them to give information about others, in most cases they had no information or refused to give it. Four people said that they were eventually forced to give limited information about or name family members and associates. 68. The most prevalent form of environmental torture was the use of solitary confinement (68% of cases), in small cells, mostly throughout the entire detention. While the duration of solitary confinement was between a week and a month in the majority of cases, some were detained in this condition for several months and at least two cases for more than a year. Twelve people reported that they were prevented from sleeping or that their sleep was deliberately interrupted throughout the detention by guards banging on their cell doors, dousing them in cold water or taking them for interrogation as soon as they fell asleep. Others were kept awake by constant bright light in their cell. Forensic evidence and psychological impact of torture Forensic evidence of torture 69. Forty-one of cases (82%) had forensic evidence of physical trauma documented in their MLRs in the form of lesions (including scars) 2 arising from torture in detention in 2009-2011. MLRs for the other nine cases specifically focused on the psychological signs and symptoms of torture and in four cases were prepared by the person’s treating clinician as examination by an independent doctor was not deemed clinically appropriate. Chronic pain symptoms, mostly attributed to blunt force, positional and sexual tortures, were also reported in 48% of cases and nine cases documented fractures resulting from torture as described. Of the 50 cases sampled 17 (34%) had up to five lesions attributed to torture, while 11 cases had significantly more. Four people had a very large number of lesions (more than 20) or groups of numerous individual lesions assessed together in relation to their consistency with common attributed causes of torture. In all cases where a physical examination was conducted and lesions as well as other signs and symptoms of physical trauma were documented, those attributed to torture were clearly differentiated by clinicians and the individuals themselves, from those with a non-torture attribution. 70. The form of torture that produced the largest number of lesions overall was blunt force trauma; more than 60% of cases had some or numerous lesions attributed to this cause. Freedom from Torture clinicians, using Istanbul Protocol guidelines to describe the level of consistency of the physical findings with the attributed cause of torture, found that in 26 cases there were lesions assessed to be ‘diagnostic’, ‘typical’ or ‘highly consistent’ of blunt force trauma as described by the individual (with no other possible cause, few or a few other possible causes). It should be noted that although used in all cases in this sample, blunt force trauma very often does not produce enduring physical evidence, depending on factors including the force of the blow, the part of the body hit, the length of time since infliction, whether the skin was broken and the healing process. It is also routinely observed by clinicians that while individual scars and groups of scars are assessed for their ‘level’ of consistency with the attributed cause in line with the Istanbul Protocol, ‘...Ultimately, it is the overall evaluation of all lesions and not the consistency of each lesion with a particular form of torture that is important in assessing the torture story...” 71. All seven cases that reported being burned had lesions assessed by the clinicians as being ‘diagnostic’, ‘typical’ or ‘highly consistent’ of this form of torture. Similarly most of the sharp force trauma scars were assessed as having this high level of consistency with the ascribed cause of torture. Physical evidence assessed as ‘typical’ or ‘highly consistent’ of positional torture was documented in seven cases and consisted of ligature or shackle scars 41