Weighing Punjab’s medico-legal services

Actionaid arranged a conference with lawyers on the medico-legal system in Punjab. The conference was organized in partnership with Sahil and in collaboration with SPO, SAP-PK, Shirkat Gah, Aurat Foundation and Homenet Pakistan. A number of senior lawyers and representatives of the civil society organizations attended the consultation.
Women in Pakistan visage horrifyingly high rates of rape, sexual assault and domestic violence while the perpetrators go unpunished owing to widespread incompetence, corruption, and bias against women throughout the societal institutions particularly in the criminal justice system. The study aimed to explore the facilities and equipment available for examining the survivors of violence and also to asses the practices and challenges faced by medico-legal officers.
The objective is to bring about improvements in the medico-legal system in Pakistan through working in collaboration with relevant line department and stakeholders. The research includes interviews of medico legal surgeon (Punjab), medico legal officers in the district hospitals of Lahore, Jhelum, Sargodha, Multan and Muzaffargarh districts. In addition to these, the MLOs appointed at the tehsil hospitals and rural health centers in the above mentioned districts were also interviewed.

CONCLUSIONS
MLO’s status: MLOs had not taken extensive pre or in-service training on gender sanitization; on understanding violence against women and had only studied medical jurisprudence.
Case incidence: Domestic violence cases were the highest reported in a month coming for the ML examination. Rape survivors were next in the category followed by poisoning and sexual assault cases.
Separate examination room: Majority of women were mentally prepared for an ML examination and hesitated if a female MLO was not available. At the tehsil hospitals and rural health centers, separate examination rooms for females were not available and a common room was used, whereas at some places the doctors’ and MLOs rooms were used for examination. Only at district hospitals, separate examination rooms were available, ensuring privacy of the women/victim.
Record maintenance: ML records and registers have been well maintained at district hospitals and in rural health centers. However, mostly at the rural health centers, there was no record rooms, yet the records were maintained by the MLOs in their personal capacity.
Security: The district hospitals in routine have enough security to handle violent situation between parties coming for ML examination. At the tehsil hospitals and rural health centers, the security was found week.
Charges: An examination fee of Rs 200 is charged for ML examination
at all levels in Punjab.
Healthcare: The women seeking medical care after ML examination were given only first aid at rural health centers, while serious cases were referred to the district hospitals. This results in distortion of evidence and delay in providing medical care.
Available/unavailable facilities: The DNA testing/Forensic analysis facility and rape kits were not available in any surveyed district. Screening facilities were available in Jhelum, Multan, Lahore and Sargodha. Emergency contraceptive measures were taken at district hospitals to avoid forced pregnancies. At the tehsil hospitals and RHCs, MLOs had still to adopt these practices.
Evidence treatment: Forensic evidence was transported for chemical examination mostly on the same day from the tehsil hospitals to district hospitals. However, from the rural health centers it took more than 24 hours resulting in distortion of evidence.
Counseling: MLOs had not received comprehensive training on providing counseling services to the women.

RECOMMENDATIONS
ML examination availability: The ML examination services should be available round the clock so as to detect and record the evidences quickly. ML examination should be made free, so that it is accessible to the poor and encourages women to come forward for examination.
MLOs training: Training courses be offered to the MLOs by the Ministry of Health. The training could be arranged on counseling strategies for women in stress and trauma, investigation and communication skills, gender sensitization and women psychology. Comprehensive trainings should also be provided on the conduct of ML and postmortem examinations based on the modules developed by the government of Punjab (2007).
Provision of report copy: MLOs must be given awareness that it is compulsory to give one copy of the ML report to the victim. Efforts should also be undertaken both by the government and civil society organizations (CSOs) to aware community about their rights. No one else should tamper with the report, if the victim has a copy.
Budget separation: The budget of the ML sector should be separated from the hospitals budget. This would help in improving the quality of ML services.
Provision of separate examination room: Separate examination rooms for both males and females at all levels should be ensured.
Female officers: The number of female medico legal officers should be increased.
Facilities’ availability: The ML centers must have a rape kit containing all the equipment required to conduct a through rape examination. Basic forensic equipment must be provided for chemical analysis.
Evidence treatment: Transportation of forensic evidence to the chemical examiner’s office on the same day when it is collected is required. In this regard, the 2005 Memorandum Order to chemical examiners should be strictly enforced and written explanations must be asked from MLOs in case of delay.
Awareness: Women must be given awareness about their rights including importance of ML examination in case of violence. In rural and semi-urban areas, lady health workers can also be involved in disseminating information about ML services.
Monitoring: The Ministry of Health must develop mechanisms for regular monitoring and evaluation of the ML sector personnel.