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Cattaneo C, Franceschetti L. Commentary on: "Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany-results and insights of the in: Fo-project". Int J Legal Med 2023; 137:1939-1940. [PMID: 37460703 DOI: 10.1007/s00414-023-03063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Dipartimentale di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Lorenzo Franceschetti
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione Dipartimentale di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli 37, 20133, Milan, Italy.
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Sadana A, Gérard SE, Tang A, Pardee L, Sher O, Foote A, Ades V. Medical evidence in asylum applications: Medical versus legal approaches. J Forensic Leg Med 2023; 97:102553. [PMID: 37385206 DOI: 10.1016/j.jflm.2023.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
The purpose of this narrative review is to elucidate the ways the clinicians working on forensic medical evaluations can engage with asylum proceedings. We compare the legal and medical perspectives on different aspects of forensic medical evidence, asylum evaluations, and asylum applications. As asylum seekers must demonstrate a well-founded fear of persecution in order to receive asylee status, legal and medical professionals often need to collaborate in asylum cases. Although significant evidence has demonstrated that an objective expert medical opinion can support asylum claims, few studies have analyzed how the medical professional's role complements or is at odds with the goals of the legal system. This review summarizes and compares key aspects of the medical and legal perspectives on trauma, credibility, autobiographical memory, and medical evidence to better comprehend the role that medical professionals can play in writing medical affidavits for asylum applications. We dissect legal misconceptions surrounding trauma and the consequences of such misunderstandings and make recommendations for medical evaluators who are working in a forensic capacity.
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Affiliation(s)
- Annum Sadana
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Ashley Tang
- New York University College of Arts and Science, New York, NY, USA
| | - Lisa Pardee
- New York University College of Arts and Science, New York, NY, USA; New York University School of Global Public Health, New York, NY, USA
| | - Olivia Sher
- New York University School of Global Public Health, New York, NY, USA; Department of Obstetrics & Gynecology and Women's Health, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ali Foote
- New York University Center for Global Affairs, USA
| | - Veronica Ades
- Department of Obstetrics & Gynecology, Jacobi Medical Center, Bronx, NY, USA; Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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Franceschetti L, Magli F, Nava C, De Angelis D, Verzeletti A, Cattaneo C. Physical assessment of tortures: Interobserver analysis of medico-legal degrees of consistency based on the Istanbul protocol. Leg Med (Tokyo) 2023; 62:102248. [PMID: 36996735 DOI: 10.1016/j.legalmed.2023.102248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/25/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
The Istanbul Protocol section on medicolegal evaluation delineates the guidelines for the correct management of the physical examination and the methods of assigning the degrees of consistency. Considering that most cases exhibit highly heterogeneous lesions, the examiner is forced to rely on his own experience, and their evaluation may be very subjective. The purpose of this work is to understand how subjective such an evaluation may be and whether the "experience" factor, interpreted as years dedicated to this profession and the number of cases evaluated, is statistically significant. To this end, a survey containing eleven cases of pre-evaluated asylum seekers was sent to thirty Italian clinical forensic practitioners. The participants were invited to assign a degree of consistency to each case according to the Istanbul Protocol guidelines, besides answering a few questions regarding their professional record. The doctors were divided into groups based on the number of cases evaluated and the experience collected expressed in years, and then interobserver analysis was performed. Results showed that the Fleiss' Kappa coefficient acquired significant values when attention was turned to the sub-samples composed of more experienced participants. Therefore, the introduction of appropriately trained health professionals - "experts in migrations and torture" - could lower the risks of misinterpretation and make the assessment as reproducible as possible.
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Jühling M, König LM, Gruber H, Wolf V, Ritz-Timme S, Mayer F. Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany-results and insights of the in:Fo-project. Int J Legal Med 2023; 137:863-873. [PMID: 36781444 PMCID: PMC10085958 DOI: 10.1007/s00414-023-02950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
As part of a third-party funded project, expert opinions according to the Istanbul Protocol (IP) standards were compiled in Germany on a larger scale for the first time. The assessment process was initiated for 130 project participants. Statistical analysis on numerous variables was performed to test the impact of the expert opinions, foremost of the forensic medical expert opinions, on the individuals' asylum proceedings. The variables were drawn from forensic medical expert opinions and reports of findings, questionnaires for the study participants' counsellors in the project and a query on the asylum status of the study participants. Regression analysis and bivariate analysis on two dependent variables-subjective impact on the asylum procedure from the counsellors' point of view and objective change in the asylum status-were performed to test for an influence on asylum procedures. No statistically significant results were obtained for the objective change of the study participants' asylum status. For the subjective dependent variable, a positive prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and highest IP grade; a negative prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and use of IP grading. Apart from the statistical analysis, a positive effect of the assessment on the psychosocial well-being of the study participants could be demonstrated. The results differed from other European studies which demonstrated a correlation between the objective outcome of an asylum procedure (asylum status) and, for example, specific types of violence or the number of documented injuries. Differences also occurred in the use of the plausibility grades proposed by the IP, which questions their use in cases in which the reported torture happened a relevant time ago. Therefore, compiling individually worded evaluations instead of using the IP grading system-if possible, by an experienced forensic physician-is recommended in this scenario. Still, the assessment of alleged torture experiences should follow the IP guidelines, since psychological assessments are of especially high importance in cases with healed physical injuries and since the results also demonstrated a positive effect on the psychosocial well-being of the study participants.
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Affiliation(s)
- M Jühling
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L M König
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - H Gruber
- Department of Psychology, University of Cologne, Cologne, Germany
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - V Wolf
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - St Ritz-Timme
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - F Mayer
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
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Hampton K, Mishori R. What constitutes a high-quality, comprehensive medico-legal asylum affidavit in the United States immigration context? A multi-sectoral consensus-building modified Delphi. J Forensic Leg Med 2023; 96:102513. [PMID: 37104900 DOI: 10.1016/j.jflm.2023.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
In the United States, clinicians are often called upon to provide their expertise to generate expert evidence in cases of individuals seeking asylum or other forms of international protection. Due to a lack of validated guidelines specific to the U.S. immigration context, clinical evaluations produced for immigration proceedings in the United States vary in their format, structure, and content, which can be confusing for practitioners and for adjudicators assessing the weight these evaluations should be afforded in asylum proceedings. We sought to review critical components of a medico-legal asylum evaluation from an interdisciplinary perspective of key stakeholders, by collecting and synthesizing expert opinions to reach consensus on what constitutes a high-quality, comprehensive medical or psychological affidavit for U.S. immigration cases. The consensus process incorporated a three-step modified Delphi method, which took place between September and December 2021 and consisted of two rounds of online questionnaires and a synchronous video conference meeting. The areas most experts agreed on included, by order of highest agreement (combining answers of "strongly agree" and "agree"): A narrative form or checklist is preferable to a predetermined template (95%); Primary care physicians should describe their qualifications to diagnose mental health conditions (81%); Use of citation is helpful, with caveats (77%); Clinicians should include an assessment of malingering (72%); Clinicians should include an executive summary/summary of conclusions at the top of the affidavit (72%); Clinicians should reference the Istanbul Protocol and explain its relevance (66%); It may be beneficial for clinicians to describe the anticipated process of healing (57%); Clinicians may include treatment recommendations (52%). Results of this and future consensus-building efforts and resulting guidance should be used to enhance overall quality of medico-legal reports and incorporated in training programs developed for clinicians, attorneys and adjudicators.
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Affiliation(s)
- Kathryn Hampton
- Asylum Network, Physicians for Human Rights, 256 W 38th Street, 9th Floor, New York, NY, 10018, USA.
| | - Ranit Mishori
- Asylum Network, Physicians for Human Rights, 256 W 38th Street, 9th Floor, New York, NY, 10018, USA; Physicians for Human Rights, Professor of Family Medicine, Georgetown University School of Medicine, Georgetown University, 3900, Reservoir Rd NW, Washington, DC, 20007, USA
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Oxford C. The Gory Details: Asylum, Sexual Assault, and Traumatic Memory. SEXES 2023. [DOI: 10.3390/sexes4020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
For asylum seekers to be granted asylum, they must convince immigration officials that they have been persecuted or that they fear they will be persecuted if returned to their home country. This article discusses the reluctance of asylum seekers to be forthcoming about sexual assault as a form of persecution and the ways in which traumatic memory can affect narratives of persecution for rape survivors. Many asylum seekers, particularly those who have been sexually assaulted, show symptoms consistent with trauma survivors. Consequently, their narratives of persecution are often shaped by partial and incomplete memory recall. The result is that how asylum seekers who have been sexually assaulted tell their stories of persecution is the antithesis of the expectations of credibility. This article is based on qualitative research in Los Angeles, California, and New York City, New York, in the United States. It includes interviews with asylum seekers, immigration attorneys, immigrant service providers, asylum officers, and immigration judges; observations of immigration court hearings; and content analysis of asylum applications. I use these sources to argue that the harm of rape and its long-lasting effects evidenced by symptoms of traumatic memory impacts how asylum seekers articulate stories of persecution. How these stories are told can have devastating effects for asylum seekers that may jeopardize their ability to gain asylum if immigration officials do not view them as credible applicants.
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Mayer F, Ahls F, Heyde C, Hochscheid CNM, Anders S, Jühling M, König L, Ritz-Timme S, Wolf V. Forensisch-medizinische Untersuchung von Menschen mit Foltererleben. Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Commentary on: "Tortures alleged by migrants in Italy: compatibility and other medicolegal challenges". Int J Legal Med 2021; 136:391-392. [PMID: 34779888 DOI: 10.1007/s00414-021-02744-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
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Jakobsen LS, Jacobsen C, Asmussen IH, Lynnerup N, Banner J. The legal impact of forensic medical life-threatening danger assessment conclusions in cases of violent offense. Forensic Sci Int 2021; 329:111034. [PMID: 34688185 DOI: 10.1016/j.forsciint.2021.111034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between the legal outcome for suspected perpetrators and the forensic life-threatening danger assessments conducted as part of the clinical forensic medical examinations of victims with penetrating injuries. METHOD From the Danish Central Crime Register, we retrieved the legal outcomes for suspected perpetrators linked to victims with penetrating injuries in a six-year period and compared the proportional distribution of forensic life-threatening danger assessment conclusions - no life-threatening danger (NLD), could have been in life-threatening danger (CLD), and life-threatening danger (LD) - with the legal outcomes. RESULTS 326 victims were related to at least one identified suspected perpetrator with a legal outcome. When the forensic life-threatening danger assessments were more severe, an increased proportion of cases resulted in formal charges and, subsequently, conviction, than when the forensic life-threatening danger assessments were less severe. The percentage point differences between NLD, CLD, and LD were almost equal. CONCLUSION Our results indicate that the forensic life-threatening danger assessments are associated with the legal outcome, as both the proportion of cases with formal charges and the proportion of cases with a conviction increased with the severity of the forensic life-threatening danger assessment conclusions.
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Affiliation(s)
- Lykke Schrøder Jakobsen
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark.
| | - Christina Jacobsen
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
| | - Ida Helene Asmussen
- University of Copenhagen, Faculty of Law, Center for Interdisciplinary Studies of Law, Karen Blixen Plads 16, 2300 Copenhagen South, Denmark
| | - Niels Lynnerup
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
| | - Jytte Banner
- University of Copenhagen, Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, Frederik V's Vej 11, 2100 Copenhagen East, Denmark
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Pogue M, Raker E, Hampton K, Saint Laurent ML, Mishori R. Conducting remote medical asylum evaluations in the United States during COVID-19: Clinicians' perspectives on acceptability, challenges and opportunities. J Forensic Leg Med 2021; 84:102255. [PMID: 34607249 PMCID: PMC8475638 DOI: 10.1016/j.jflm.2021.102255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/03/2022]
Abstract
Background Due to the COVID-19 pandemic, medical evaluations for asylum are being performed predominantly remotely. We sought to describe these evaluations and identify barriers. Methodology This study utilized an online survey to assess clinician perspectives and experiences regarding remote asylum evaluations. Results Clinicians reported positive experiences regarding remote interpretation (85%, 51/60), history taking (82.4%, 61/74), rapport building (81.3%, 61/75), and conducting the psychiatric exam (65.7%, 44/67). Concerns were more frequently reported with performing remote physical examinations (83.3%, 15/18). Although the majority denied challenges with technology (62.5%, 45/72), internet (60.8%, 45/74) or clients having difficulty acquiring technology (58.6%, 41/70) or finding private spaces (54.2%, 39/72), these aspects did represent barriers. Discussion Remote evaluations were relatively easy to perform and acceptable to clinicians. This may facilitate easier access for asylum seekers beyond the pandemic.
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Affiliation(s)
- Megan Pogue
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA.
| | - Elsa Raker
- Physicians for Human Rights, 256 W 38th St 9th Floor, New York, NY 10018, USA.
| | - Kathryn Hampton
- Physicians for Human Rights, 256 W 38th St 9th Floor, New York, NY 10018, USA.
| | | | - Ranit Mishori
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA; Physicians for Human Rights, 256 W 38th St 9th Floor, New York, NY 10018, USA.
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Tortures alleged by migrants in Italy: compatibility and other medicolegal challenges. Int J Legal Med 2021; 135:2489-2499. [PMID: 34228193 PMCID: PMC8523510 DOI: 10.1007/s00414-021-02646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Background Illegal immigration to Europe is a well-known phenomenon whose numbers are being steadily increasing in recent years. Most of the immigrants in Italy come from war zones, and many of them submit an asylum application supported by the complaint to have been victims of persecutory acts in their home countries. Material and methods One hundred ninety-six medicolegal reports are analyzed considering the different country of origin, the type of the lesions claimed, tools used, evidenced effects, location of the perpetration of the physical abuses, and the possible motivation of the alleged torture. Results Greater than 80% of the assessed asylum seekers are over 18-year males coming from African countries. Fifty-eight percent of migrants were tortured or abused in countries of transit, 95% in Libya. Economic, familial, politic, and ethnic reasons prevail in some countries of origin, while tortures or abuses perpetrated in transit countries are mainly linked to forced labor and detention. In the 42.2% of cases, no physical evidence of tortures was detected. The Istanbul Protocol resulted to have been only partly applicable and about 40% of the medicolegal reports are “inconclusive” about the compatibility of physical evidence with the alleged tortures. Conclusions The medicolegal and forensic experts involved in torture and ill-treatment cases should seek specific education and training to lower the risks of underestimation and the rate of inconclusive reports. More extensive implementation of the Istanbul Protocol in daily practice should be pursued by the authorities in charge of asylum or protection releasement.
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Blandino A, Maggioni L, Chiaffarino F, Parazzini F, Capano D, Florio EM, Margherita M, Bertelle GM, Franceschetti L, Amadasi A, Vignali G, Ciprandi B, Crudele GDL, Merelli VG, Collini F, Muccino EA, Nicolò P, Barbara G, Kustermann A, Cattaneo C, Gentilomo A. Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations. PLoS One 2021; 16:e0253980. [PMID: 34185821 PMCID: PMC8241090 DOI: 10.1371/journal.pone.0253980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault. Methods It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor’s Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1st 2011 to 31st December 31st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge’s final judgment. Results Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim’s deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction. Conclusions Many factors seem able to influence the judge’s judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim’s statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.
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Affiliation(s)
- Alberto Blandino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
- * E-mail:
| | - Lidia Maggioni
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Francesca Chiaffarino
- Department of Woman, Newborn and Child, Gynaecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università Degli Studi, Milan, Italy
| | | | - Elena Maria Florio
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Manuela Margherita
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Gian Marco Bertelle
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Lorenzo Franceschetti
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Alberto Amadasi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Giulia Vignali
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Barbara Ciprandi
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Vera Gloria Merelli
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Federica Collini
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Enrico Angelo Muccino
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | | | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cattaneo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
| | - Andrea Gentilomo
- Department of Biomedical Science for Health, Institute of Legal Medicine, Università Degli Studi, Milan, Italy
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Bonnet AS, Gorio MCF, Magli F, Martrille L, Cattaneo C. Case study: Lesions due to forced ritual scarification in Cameroon - A warning from cultural anthropology to forensic medicine. Leg Med (Tokyo) 2021; 53:101913. [PMID: 34098410 DOI: 10.1016/j.legalmed.2021.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/20/2022]
Abstract
Asylum seekers and refugees are constantly increasing worldwide because of human rights' violations and political-related abuses. As a result, some of them show scars due to torture and other forms of maltreatments. In addition, they may also present scars due to ethnical practices, namely ritual scarifications. This case study presents a victim who did not give consent to perform such ethnical practices on her body. The authors aim to enlighten the difficulty to understand the origin and the purpose of these specific injuries and the importance to know how to distinguish them from other forms of abuse. Indeed, it appears that such lesions follow a cultural path, meaning that the lesions are performed methodically and may show macroscopic differences compared to others. The story narrated by the victim can be helpful for the experts' assessment, regardless, they may present memory-loss issues. This represents the value of a correct injuries' diagnosis and the importance of cultural anthropology-related analyses. The cultural and social background are relevant since the injuries have their own signification because of their symbolism. Therefore, a multidisciplinary approach with a cultural anthropologist may have the possibility to help the forensic experts in understanding and interpreting such stories fostering their ability to better assess asylum seekers stories and their reliability.
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Affiliation(s)
- Anne-Sophie Bonnet
- LABANOF, Laboratorio di Antropologia ed Odontologia Forense, Istituto di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy.
| | - Maria Carlotta F Gorio
- LABANOF, Laboratorio di Antropologia ed Odontologia Forense, Istituto di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy
| | - Francesca Magli
- LABANOF, Laboratorio di Antropologia ed Odontologia Forense, Istituto di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy
| | - Laurent Martrille
- CHU Nancy, Pôle URM, Service de Médecine Légale, Rue du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, Lorraine, France
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia ed Odontologia Forense, Istituto di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milan, Italy
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Mishori R, Hampton K, Habbach H, Raker E, Niyogi A, Murphey D. "Better than having no evaluation done": a pilot project to conduct remote asylum evaluations for clients in a migrant encampment in Mexico. BMC Health Serv Res 2021; 21:508. [PMID: 34039345 PMCID: PMC8150148 DOI: 10.1186/s12913-021-06539-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Asylum evaluations are highly specialized medico-legal encounters to collect physical or mental health evidence for use in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for those in United States immigration detention or other forms of custody, such as under the U.S. Migrant Protection Protocols or “Remain in Mexico” policy. Given advances in telehealth in recent years and growing evidence of similar outcomes with in-person management, it seems prudent to examine whether remote modalities may also be effective for conducting mental health asylum evaluations in hard-to-reach populations. Methods We analyzed the responses of 12 U.S. clinicians who conducted 25 cross-border remote mental health evaluations with clients in Mexico prior to the COVID-19 pandemic, and completed a post-evaluation survey regarding their impressions and experiences of the remote encounter. Data were coded through a process of thematic analysis. Results The average evaluation time was 2.3 h, slightly shorter than might be expected from an in-person encounter. Five themes emerged from the coding process: rapport building, achieving overall goal, comparison of in-person vs. remote, technical issues, and coordination. Clinicians encountered a number of challenges including technical difficulties and a decreased ability to establish rapport. Nearly uniformly, however, clinicians noted that despite difficulties, they were able achieve the goals of the evaluation, including rapport building and diagnosis. Conclusion Remote evaluations appear to achieve their intended goal and may be useful in expanding legal options for hard-to-reach asylum seekers.
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Affiliation(s)
- Ranit Mishori
- Global Health Initiatives, Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, 20007, USA. .,Physicians for Human Rights, New York, NY, USA.
| | | | | | - Elsa Raker
- Physicians for Human Rights, New York, NY, USA
| | - Anjali Niyogi
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Dona Murphey
- Medical Initiatives, Project Lifeline, Houston, TX, USA
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Margherita M, Franceschetti L, Maggioni L, Vignali G, Kustermann A, Cattaneo C. Male victims of sexual abuse and domestic violence: A steadily increasing phenomenon. MEDICINE, SCIENCE, AND THE LAW 2021; 61:54-61. [PMID: 33591863 DOI: 10.1177/0025802420947003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Violence perpetrated on male victims is a phenomenon that is currently underestimated by both national and international scientific communities, since males are historically (and stereotypically) considered the perpetrators rather than the victims of violence. As a consequence, the available literature lacks data which would allow a better understanding of this issue and its presenting features. We undertook a retrospective analysis of 231 medical files of male victims of violence over a five-year-period (2014-2018) at the Soccorso Violenza Sessuale e Domestica Centre in Milan, Italy. The sample included 112 victims of sexual violence and 119 victims of domestic violence, most of whom were younger than 18 years of age. The main aim of this study was to describe the presentations of male victims of violence in order to understand the phenomenon better, increase awareness of the issue and enable improved health-care management. The need to pay more attention to this vulnerable part of the population is mandatory in health-care services, and it includes: the provision of management guidelines, training to attending physicians and a supportive service to male survivors. Understanding which risk factors are related to male abuse can help with the development of programmes that identify, prevent and minimise violence - this being especially useful for primary-care clinicians. This is the first Italian study to deal with domestic and sexual violence involving male victims.
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Affiliation(s)
- Manuela Margherita
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Lorenzo Franceschetti
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Lidia Maggioni
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Giulia Vignali
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
| | - Alessandra Kustermann
- Service for Sexual and Domestic Violence (SVSeD), Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - Cristina Cattaneo
- LABANOF (Laboratorio di Antropologia e Odontologia Forense), Istituto di Medicina Legale, Dipartimento di Scienze Biochimiche per la Salute, Università degli Studi di Milano, Italy
- Service for Sexual and Domestic Violence (SVSeD), Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
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Patterns and evidence of human rights violations among US asylum seekers. Int J Legal Med 2020; 135:693-699. [PMID: 32875395 DOI: 10.1007/s00414-020-02405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Asylum seekers report exposure to human rights violations associated with a range of psychological and medical sequelae. Clinical evaluators can provide forensic evaluations that document evidence associated with their reports of persecution. The aim of this study was to characterize the forms of abuse experienced by asylum seekers, the psychological consequences of abuse, and the frequency with which clinician-evaluators found evidence that corroborated asylum seekers' reports. METHOD We completed a retrospective chart review of 121 asylum seekers who received pro bono medical-legal evaluations through a human rights program and analyzed data using the constant comparative method. RESULTS Eighty-eight percent of the clients reported experiencing multiple human rights abuses. Ninety-one percent of the clients who received psychological evaluations presented with symptoms associated with depression, anxiety, or trauma and stressor-related disorders. Clinician-evaluators found physical or psychological evidence consistent with the clients' reports in 97% of cases. Forms, perpetrators, and psychological consequences of abuse varied significantly by gender and geographic region. DISCUSSION Asylum seekers report diverse forms of persecution in their countries of origin that differ by gender and geographic region. Clinician-evaluators overwhelmingly found physical and psychological evidence consistent with the asylum seekers' accounts of persecution.
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Evaluation of medical examination of forensic medicine specialists during / after detention within the scope of Istanbul Protocol. J Forensic Leg Med 2020; 71:101921. [PMID: 32094109 DOI: 10.1016/j.jflm.2020.101921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/30/2020] [Accepted: 02/09/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Istanbul Protocol is a document prepared by many scientists from different countries and accepted by the United Nations thematising the medical reporting of torture. Normally, forensic specialists are responsible for medical examinations of torture victims, but this study looks at forensic specialists who were themselves subject to torture and mistreatment. It aims to analyze and evaluate, especially with regard to the Istanbul Protocol, the medical examinations performed on them while they were in detention. MATERIAL/METHOD This study includes experts in forensic science who were detained during and after the state of emergency that was declared in 2016 in Turkey. Participants were asked questions regarding the examination steps specified in the Istanbul protocol. The Google Forms system (Google Inc., CA/USA) was used for the surveys, sent to the participants via text message. RESULTS Twenty-two forensic scientists who were detained during and after the state of emergency in Turkey participated in this study. 45.5% of the participants were not asked for identification before their medical examination in detention. 36.4% of the participants stated that police were present in the examination room. Only 13.6% of participants found the privacy conditions during the examination appropriate. 90.9% stated that the time allocated for the examination was insufficient. The medical examinations lasted from 10 s to 10 min. Most participants were examined in less than 5 min. When asked if they were abused, 22.7% stated that they were not tortured, and 77.3% stated that they were subjected to torture or mistreatment practices, such as beatings, inappropriate use of handcuffs, being forced to wait or being rushed unnecessarily, being abandoned in isolating or hostile environments. In addition, the questions required to assess the psychological indications of torture and maltreatment were never asked in 40.9% of the cases. DISCUSSION AND CONCLUSION Although torture is prohibited by international and humanitarian law, it has not completely disappeared. Medical personnel play an important role in torture assesment and prevention. The testimony of the forensic experts, who were fired and detained, revealed that the medical examinations during and after the State of Emergency in Turkey did not comply with the Istanbul Protocol and ethical rules. Medical examinations not carried out in accordance with the Istanbul Protocol lead to the denial of many rights and health problems. A worldwide awareness and sensitivity is needed to solve this problem.
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