Use of medical reports

Cyprus

Country Report: Use of medical reports Last updated: 30/11/20

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The Refugee Law contains a number of provisions related to medical reports, which should be taken into consideration when assessing the credibility of statements, as well as past persecution or serious harm. First, according to the law, asylum applications are examined and decisions are taken individually, objectively and impartially taking into account, among others, the relevant statements and documents submitted by the applicant including information on whether the applicant has been or may be subject to persecution or serious harm.[1] Such documents include medical reports.

Other instances where the law refers to medical reports and how they should be taken into account for the assessment of credibility as well as past persecution or serious harm are the following:

  • As part of the initial medical examination to which the applicant is submitted, the examining physician, psychologist or other specialist prepares a report on the existence of any special reception needs and / or special procedural guarantees of the applicant and the nature of those needs;[2]

 

  • The personal interview may be omitted if the Asylum Service is of the opinion that the applicant is unfit or unable to be interviewed owing to enduring circumstances beyond his control. When in doubt, the Asylum Service shall consult a medical professional to establish whether the condition that makes the applicant unfit or unable to be interviewed is of a temporary or enduring nature;[3]

 

  • Where the examining officer considers it relevant for the evaluation of the application he or she shall, subject to the applicant’s consent, arrange for a medical examination of the applicant concerning signs that might indicate past persecution or serious harm, as well as symptoms and signs of torture or other serious acts of physical or psychological violence, including acts of sexual violence. The results of the medical examinations shall be assessed by the determining authority along with the other elements of the application;[4]

 

  • The personnel examining applications and taking decisions have the possibility to seek advice, whenever necessary, from experts on particular issues, such as medical, cultural, religious, child-related or gender issues.[5]

 

In practice, however, all the above may not be applied and overall there are inconsistencies in the way each officer / caseworker interprets medical reports and in the way these are evaluated. Specifically, medical reports provided by private doctors in Cyprus or from the country of origin of the asylum seeker are often viewed as non-credible and not taken into consideration by certain officers/caseworkers, whereas others may evaluate them and include them in the assessment. In addition, the costs for reports from private doctors are borne by the applicant. Medical reports from public hospital doctors are usually considered more credible, but even with such reports, there are discrepancies in the way they are assessed. Currently there are no NGOs providing medical reports. The only available report from an NGO is the one that may be provided under the specialised services for victims of torture implemented by the Cyprus Refugee Council,[6] which is a psychological report that may be drafted as part of the rehabilitation services offered to victims of torture.

 

Specifically regarding victims of torture, the law provides ‘Where the examining officer considers it relevant for the evaluation of the application, the officer shall, subject to the applicant’s consent, arrange for a medical examination of the applicant concerning signs that might indicate past persecution or serious harm, as well as symptoms and signs of torture or other serious acts of physical or psychological violence, including acts of sexual violence. The results of the medical examination shall be assessed by the determining authority along with the other elements of the application.’[7]

 

For this purpose, a state Medical Board has been appointed to evaluate torture claims within the asylum procedure. In the past the operation of this Board has been problematic with regards to the procedures / methodology followed, as well as in aspects of essential expertise. None of the members had sufficient training on issues of torture and did not follow a specific methodology or procedure, such as the Istanbul Protocol or other internationally accepted procedures. In addition, the examination itself took 20 minutes and there were no interpreters present during the examination, no psychological / psychiatric assessment and all reports issued concluded that “the Board is not in a position to determine the cause of the findings.”[8]

 

The UN Committee against Torture noted in its 2014 report the insufficient interpretation during the medical assessment, and referred to reports that children of victims of torture assumed the role of interpreters.[9] Following this criticism, the national Ombudsman carried out consultations in 2015 and 2016 with the responsible authorities to improve the procedures followed by the state Medical Board for the evaluation of victims of torture. In early 2017, the Ministry of Health in collaboration with EASO and the International Rehabilitation Council for Torture Victims (IRCT) organised trainings for all professionals that are part of the procedure, including a psychological assessment. The procedure currently being followed is closer to the training received and to that described under the Istanbul Protocol.

 

Regarding referrals to the Medical Board, as the law stipulates that referrals are at the discretion of the examining officer, it has been observed in recent years that practice varies. Caseworkers of the Asylum Service, if they have no doubt on the credibility of the applicant, will grant protection without referring to the Medical Board in many cases and tend to refer cases that are only considered to require further examination / evaluation. There have been no cases identified where the Asylum Service caseworkers have rejected an asylum application that includes torture claims without referring to the Board. On the contrary, EASO caseworkers examining asylum applications under the EASO-Cyprus support plan seem to be more reluctant to refer applicants to the Medical Board. [10] Indicatively, in 2018 and 2019 cases were identified which had been examined by EASO caseworkers that included a torture claim however the applicant was not referred to the Medical Board and was rejected as the applicant was found to be non-credible on the reasons for which the torture took place.

 

When an asylum seeker is referred to the Medical Board, the Board will arrange the appointment with the individual, in most cases several months after the referral has been made by the Asylum Service. Considering that the initial interview by the Asylum Service which leads to the referral is usually conducted one and a half to two years after the submission of the asylum application, this leads to a considerably delayed medical examination of victims of torture etc., which will inevitably affect the Board’s findings. Throughout 2018 and 2019 the procedure continues to be extremely slow with most cases reaching one to one and a half years to be concluded by the Medical Board alone. From then on, they will require approximately at least another year before the Asylum Service issues a first instance decision on the asylum claim.

 

The UN Committee against Torture in the latest report on Cyprus in December 2019 expressed its concern about ‘the lack of procedural safeguards to ensure a timely medical examination of alleged victims of torture and ill-treatment, including psychological or psychiatric assessments when signs of torture or trauma are detected during personal interviews of asylum seekers or irregular migrants. The Committee regrets that the requested information on the rehabilitation of identified victims of torture and ill-treatment, and on priority access to the asylum process for those who have been so identified, was not provided’. [11]

 

Regarding the quality of the reports issued by the Medical Board and the impact on the examination of the asylum applications, there have not been enough cases and reports to indicate a clear practice. A medical report reviewed at the end of 2018 in a case represented by the Cyprus Refugee Council stated the physical findings (scars) and that the applicant had symptoms that indicate PTSD. This confirms, at least, that a psychological assessment is now carried out. Furthermore, the report concluded that the findings could be the result of torture, also an improvement from the former procedure and medical report. However, in the subsequent decision on the asylum application issued by the Asylum Service based on a recommendation by an EASO caseworker, the applicant was found to be credible on the injuries sustained, noting that the medical report confirms these, but the applicant was found to be non-credible on the reasons for which the attack took place. As for the PTSD, it is stated that it was taken into consideration but that it is not adequate to excuse the non-satisfactory internal credibility of the applicant’s statements and the application was rejected.



[1] Article 18(3) Refugee Law.

[2] Article 9KΔ(3)(b) Refugee Law.

[3] Article 13A(2)(b) Refugee Law.

[4] Article 15 Refugee Law.

[5]Article 18(7A)(b)(ii) Refugee Law.

[6] For more information, see Cyprus Refugee Council, Our projects, available at: https://bit.ly/2DV3s9c.

[7] Article 15 Refugee Law.

[8] This is a standard phrase used in individual cases and this information is based on cases represented by the Cyprus Refugee Council.

[9] UNCAT, Concluding Observations on the Fourth Report of Cyprus, 21 May 2014.

[10]EASO, Special support plan to Cyprus – Amendment No 4, December 2017, Measure CY 8.1.

[11]UNCAT, Concluding Observations on the Fifth Report of Cyprus, December 2019.

 

Table of contents

  • Statistics
  • Overview of the legal framework
  • Overview of the main changes since the previous report update
  • Asylum Procedure
  • Reception Conditions
  • Detention of Asylum Seekers
  • Content of International Protection
  • ANNEX I – Transposition of the CEAS in national legislation