Background: The use of psychological torture or torture methods that leave no visible marks (stealth torture) is on the increase in various contexts. However, the difficulties in the documentation of such methods should be recognized by lawyers and health professionals who may benefit from using research-based interdisciplinary instruments to improve their documentation for legal processes - in addition to the United Nations Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or DegradingTreatment or Punishment (1999) (Istanbul Protocol). Objective: With the aim to develop additional instruments for the documentation of various psychological torture methods, this article explains the recommended methodology for such research-based interdisciplinary instruments and the process of developing the first example of this approach relating to sleep deprivation. Development and pilot testing of the Sleep Deprivation Protocol: The pilot-testing of the Protocol by lawyers in the Public Committee Against Torture in Israel (PCATI) has already yielded positive results. Conclusion: Further advanced documentation instruments, using medical evidence in non-torture contexts and legal research, should be developed to effectively identify and record other psychological torture methods.

This Protocol originates from a joint projectregarding documentation of psychologicaltorture initiated by the Public Committeeagainst Torture in Israel (PCATI),REDRESS and DIGNITY - DanishInstitute against Torture (DIGNITY) in2015 after the Copenhagen Conferenceon Psychological Torture. The project is avehicle to establish a common understandingbetween health and legal professions asto how to best ensure the most accuratedocumentation of psychological torture.Historically, sleep deprivation has beenused for different objectives but, primarily,to cause stress and duress for the purposeof extracting information and confessions.Detention centers with poor conditions isanother context in which sleep deprivation,as a consequence of sleep disruption, takesplace. This is often due to overcrowding,insufficient or no mattresses, and poorconditions of transportation between thecourts and detention facilities.The aim of the Protocol is to improvedocumentation of sleep deprivationused in such settings (most often duringinterrogation) and therefore to clarify thefacts of the case so that stronger legal claimscan subsequently be submitted to local andinternational complaints mechanisms.The Protocol has been developed basedon a methodology involving: compilationand review of legal and health knowledgeon sleep deprivation, also in non-torturecontexts; drafting by first author; discussionin the group of international experts;1 pilot-1 The group includes the following experts andorganizations in addition to the authors of thisProtocol: Nora Sveaass, Nimisha Patel, BrockChisholm, Ahmed Benasr, REDRESS (RupertSkilbeck and Alejandra Vicente), Freedom fromTorture (Angela Burnett and Emily Rowe),testing by PCATI; and evaluation by thethree organizations and the group of experts.Despite generic elements of sleepdeprivation, the context in a specific countrywill determine many aspects of the factualsituation. Each context differs and as suchthis Protocol could serve as a guideline or achecklist of elements to be considered in aspecific context.We hope that this Protocol will assistin the discussions between the variousstakeholders and provide guidance on whatcan be documented and how to documentsleep deprivation.

On 26 of November 2018, Israel’s High Court of Justice decided that Mr Firas Tbeish, a Palestinian from the Hebron area in the West Bank, had not been tortured. This concluded of six-year legal battle undertaken by Mr Tbeish and the Public Committee Against Torture in Israel. The case summary outlines the context in which the decision was given, while paying particular attention to the (mis)conception of Istanbul Protocol reports in Israel’s legal system.