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April 22, 2004
Missing evidence
Medico-legal departments do not provide relief to rape and sexual abuse victims, nor do they have sufficient examination forms to note down valuable evidence, reports Zainab Mahmood
Medico-legal officers (MLOs) work in one of the most sensitive areas of the medical profession. They deal with victims of violence (accidental or intended) and rape as well as unnatural deaths. They are usually the second port of call for these victims, in some cases, even the first, and the medical examination they conduct is of grave importance, not only for health but also for legal reasons. For rape victims, this examination and the reported information form the most essential evidence for their case against the accused. The validity of their case, and the outcome, largely depend upon what is reported by the medical examiners in the medico-legal form.
Open-ended interviews were conducted at three major hospitals in Karachi (Jinnah Postgraduate Medical Centre, Civil Hospital and Abbasi Shaheed Hospital) where the medico-legal departments are actively functioning. Each department consists of an MLO, and additional MLOs, as well as two to three female doctors and male doctors depending on their availability.
The lady doctors are responsible for conducting the first medical examination on female victims of violence, and the male doctors conduct the examination on all male victims, as well as accused rapists, murderers, etc. The doctors’ duties include gaining the trust of the victims, treating them with care and respect, conducting a thorough examination and reporting their findings accurately, as well as attending to the victims’ immediate health needs either directly or by referral.
The first and foremost problem faced by all three hospitals is the lack of necessary items needed to conduct the examinations such as examination table, gloves, slides, swabs and weighing machines. This greatly reduces the accuracy of the examination and can adversely affect the victim’s case. Due to the shortage of stationery and a dearth of forms, which are provided by the medical authorities, most of the doctors print their own forms to meet the demand.
The MLOs as well as the female doctors admitted that they feel the forms are inadequate. The form requires personal information as well as details of the examination to be entered into the specified columns. The doctors felt that certain vital information is left out, such as prior history of sexual abuse, rape and abortion. They also suggested that the vocabulary used to complete these forms is inappropriate, and there are not enough instruction manuals and guidelines to provide them with useful information.
Certain doctors suggested that proper training workshops and seminars must be organized by the medical authorities in order to equip them with vital information and techniques for a thorough medical examination, as well as how to provide comprehensive care for rape victims, such as psychological and medical support. Another startling fact is that all the doctors admitted that there is no arrangement for follow-up sessions or regular referrals to psychiatrists. Rape victims require long-term care, which is not provided by our state hospitals.
There is no cooperation between the medico-legal department and the departments of psychiatry or gynaecology, both of which are required to play a vital role in the care of a rape victim. Very few victims return for a check-up after the initial examination and none are sent to psychiatrists to receive counselling to deal with the trauma they have suffered.
The victims are mostly from impoverished backgrounds and are uneducated, and therefore are unaware of their rights and needs. This greatly limits the help they receive, and as a resultant their cases are weakened. Often they do not know what to do in the event of a rape, and they end up compromising their evidence and their health through delay and carelessness.
Due to dishonesty, apathy and disregard on the part of the medical authorities, as well as certain health professionals, this department is functioning with limited resources and untrained personnel, which is greatly minimizing its effectiveness.
The rights of an ordinary citizen should be protected with dignity and respect, and they are meant to receive the assistance they require in a situation as serious as rape. The psychological as well as physical consequences of this crime can be greatly mitigated if the state and the medical authorities provide proper care.
The NGO War Against Rape (WAR) has taken the initiative to redesign the medical examination form, and with the approval of the MLOs, health department officials and lawyers. The new form will be introduced as the standardized form at all medico-legal departments in Karachi. It will be accompanied by a booklet highlighting the details of an effective medical examination, encompassing the victim's physical as well as psychological needs.
The medico-legal departments must get the attention it deserves, and the problems mentioned above must be addressed, otherwise we are condemning all victims of violence to severe maltreatment and injustice.
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