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Intimate partner homicide-related deaths rare in Sri Lanka despite high IPV rate: Forensic academics 

04 Jan 2022

BY Ruwan Laknath Jayakody  The death of a young female as a result of chronic intimate partner violence (IPV) ending up as intimate partner homicide (IPH) is a rare occurrence in the Sri Lankan setup, according to a local case study.  This observation was made in a case report on “IPV leading to femicide: A case report” which was authored by N. Borukgama and S.R. Hulathduwa (both attached to the Sri Jayewardenepura University’s Medical Sciences Faculty’s Forensic Medicine Department) and published in the Medico-Legal Journal of Sri Lanka 9 (2) in December 2021.  IPV is defined in M. Breiding, K.C. Basile, S.G. Smith, M.C. Black and R.R. Mahendra’s “IPV surveillance: Uniform definitions and recommended data elements” as physical or sexual violence, stalking or psychological harm by a current or former partner or spouse. It is considered a serious public health problem. IPH or fatal IPV is, per “IPH of adolescents” by A. Adhia, M.A. Kernic, D. Hemenway, M.S. Vavilala and E.P. Rivara, an extreme form of IPV. Females are the commonest victims of IPH as they are, according to “IPH: Review and implications of research and policy” by J.C. Campbell, N. Glass, P.W. Sharps, K. Laughon and T. Bloom, four to five times more vulnerable to the same than males.  Femicide describes the death of a woman following IPV or the homicide of a female committed by any male. The term “uxoricide”, according to the Oxford English Dictionary, describes the killing of the wife or the girlfriend by her intimate partner. The major risk factor for IPH is identified by Campbell et al. as being prior domestic violence. Campbell et al. however noted that globally, the rates of IPH have reduced during the course of the last two decades.  With regard to the situation in Sri Lanka, S. Guruge, V. Jayasuriya-Illesinghe, N. Gunawardena and J. Perera’s “IPV in Sri Lanka: A scoping review”, although the overall prevalence of IPV in Sri Lanka is about 25-30%, the prevalence of the same in urban areas with poverty and compromised living standards such as in urban shanties located in the Western Province, is much higher than the average values, reaching approximately 60%. There are no Borukgama and Hulathduwa mentioned, official statistical data regarding IPH in Sri Lanka.  According to several quantitative analyses conducted in different parts of the world (Adhia et al. and “Fatal IPV against women in Portugal: A forensic medical national study” by A.R. Pereira, D.N. Vieira and T. Magalhães), the commoner modes of IPH include the use of firearms, causing sharp trauma and to a lesser degree, mechanical asphyxia by ligature strangulation or manual strangulation.  Borukgama and Hulathduwa described the investigation of the death of a young local female who succumbed to severe assaults by her husband.  Case report  A 30-year-old female, a mother of two children, was living with her lawfully married husband who was a drug addict. She was found dead in a storage area adjacent to her house. The body of the deceased was found by her mother who lived in a neighbouring house. After hearing her daughter screaming, she had gone to the victim’s house within several minutes.  There was a history of repeated episodes of IPV by the assailant husband prior to this event. They had a dispute on the day she was assaulted and murdered, as witnessed by her mother. The husband later confessed that he had committed the murder of the victim by hitting the sides of her neck with an iron rod, but denied strangulation or smothering.  The post-mortem examination of the woman was carried out subsequent to a Magisterial inquest.  The deceased was a small-built young female. There was an irregular, abraded, contusion of 10 centimetres (cm) into six cm in dimension, placed over the anterior aspect of the root of the neck and the superior part of the thorax, more towards the left side. There were multiple, linear, abrasions over the left forearm. Additionally, there were multiple, grazed, abrasions placed on the lateral aspect of the right thigh, on the left arm and on the posterior aspect of the right shoulder.  Further, there were several irregular abrasions on the face. There were petechial (tiny red, flat spots that are caused by bleeding) haemorrhages on the conjunctivae of the eyes, nasal bleeding and congestion above the neck of the body. There were no lip injuries or peri-oral injuries. No gagging material was found within the throat during the autopsy. There were no markings suggestive of a ligature mark around the neck or any tramline contusion elsewhere on the body.  Internal examination revealed extensive injuries to the front of the neck, face and chest. There was a displaced ante-mortem fracture of the body of the mandible (largest bone in the skull which holds the lower teeth in place) on the right side. Ante-mortem fractures of the bilateral greater horns of the hyoid bone (a horseshoe shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage) and bilateral, superior cornua (a horn shaped projection) of the thyroid cartilage were noted.  Furthermore, bilateral first rib fractures and bilateral haemothorax (a collection of blood within the pleural [thin membranes that line the lungs and the inside of the chest cavity] cavity) of approximately 300 millilitres (ml) on the right side and 400ml on the left side were noted. Additionally, extensive, strap muscle (a group of four pairs of muscles in the anterior part of the neck) contusions were observed.  Notably, the disruption of connective tissues surrounding the hollow viscera of the neck was noted, which usually results in increased mobility of the trachea and the oesophagus. Cervical spinal injuries or major vessel injuries of the neck were excluded. Musculoskeletal dissection of the posterior aspect of the body demonstrated a contusion over the inter scapular (shoulder blade) area of the back of the chest.  Head injuries, thoracic or abdominal organ injuries were not noted during the macroscopic examination during the autopsy. Additionally, there were no obvious organ pathology or anatomical abnormalities suggestive of any natural disease condition. No evidence of poisoning was found during the dissection. Samples were collected for routine toxicology and histopathology and the toxicology reports were negative.  “The major injuries noted on the body were confined to the neck, the superior part of the thorax and the lower part of the face. Several minor abrasions noted on the other parts of the body were mainly suggestive of defence injuries and injuries due to dragging on an irregular surface. All the injuries were compatible with those caused due to blunt force. Stabs, cuts, other forms of perforating injuries, burns and firearm injuries as well as previous tell tale marks of such incidences were not found.  “Even though some injuries were compatible with the given history of assaulting with a heavy metal object, there were no obvious injuries such as gross cranio cerebral injuries, cervical spinal injuries or severe internal organ damage that would have caused a rapid death. Furthermore, the abraded contusion on the anterior aspect of the chest was more suggestive of a friction abrasion that had resulted due to contact with a smooth, broad surface than being caused due to impact with a metal pole. The contusion noted over the back of the chest was also suggestive of blunt force trauma.  “When the above two injuries are considered collectively, with the internal findings of the neck; it is suggestive of fixation and compression of the neck, with the possible compression of the body against the ground by the assailant while getting onto the upper chest from the front as a plausible reconstruction of the event. The presence of classical signs of asphyxia such as petechial hemorrhages, overt hemorrhages (scleral [the white outer layer of the eye balls at the front of the eyes} hemorrhage, and nasal bleeding] and facial congestion is, to a certain extent, non-specific in this case.  “Yet, such features, per ‘Knight’s forensic pathology: Fourth edition’ by P.J. Saukko and B. Knight, are suggestive of the sustained obstruction of the venous drainage of the head. There was no evidence suggestive of poisoning or aggravation of a pre-existing natural illness. Considering the above findings with the available history and circumstantial evidence, the cause of death could be formulated as ‘fatal pressure on the neck’,” Borukgama and Hulathduwa explained. Deciding upon the exact method of asphyxia is, Borukgama and Hulathduwa elaborated, difficult in this case due to the complexity of the injuries and their non-specific nature.  “Manual strangulation and compression of the neck by the metal rod are possible modes though the presence of a component of traumatic asphyxia cannot be completely excluded. Burking, as described in D. Prasad’s ‘Burking: A case report’, is a method of homicide conducted by smothering, combined with traumatic asphyxia exerted by the assailant’s body weight by getting onto the chest of the victim. In this case, there were no injuries suggestive of smothering by hand, yet smothering cannot be completely excluded as it could occur without any injuries,” Borukgama and Hulathduwa further explained. “Therefore, the probable operating mechanisms of death in this case could be considered as venous obstruction resulting in cerebral hypoxia (oxygen is not available in sufficient amounts at the tissue level in order to maintain adequate homeostasis) as it could explain the occurrence of classical asphyxial signs. Vagal inhibition is another mechanism that could occur due to neck trauma, which can result in rapid death even without sustained compression, though it is unlikely in this case, as, per Saukko and Knight, sudden cardiac arrest will result in a pale face rather than features of congestion and other established features of asphyxia. Hence, an asphyxia mode of homicide had been employed using a heavy, elongated, metal object to exert external pressure on the neck region,” Borukgama and Hulathduwa concluded. IPH, as mentioned earlier, is the most extreme form of IPV. Adhia et al. and Campbell et al. reiterated that the greatest risk factor for IPH is the history of repeated IPV. Many other risk factors have however been identified as contributing to both IPV and IPH. Studies (“Partner killing by men in cohabiting and marital relationships: A comparative, cross national analysis of data from Australia and the United States” by T.K. Shackelford and J. Mouzos, and “Spousal homicide risk and estrangement” by M. Wilson and M. Daly) have noted the relationship between cohabitation, the increased age difference between the two partners and estrangement with the increased risk of uxoricide.  Substance abuse and being under the influence of abusive substances at the time of the event (“A comparison of IPH with IPH-suicide: Evidence from a Norwegian national 22-year cohort” by S.K.B. Vatnar, C. Friestad and S. Bjorkly) are found to have a strong relationship with IPV and the increased risk of IPH. IPV also has many adverse impacts on the physical, mental and social well being of children. This, as described by Borukgama and Hulathduwa, takes on the most heinous form with IPH, as children lose one parent forever while the other parent may be incarcerated, thus depriving the children of the support of both the parents.  If you feel that you or someone you know may be affected by this content or may require help the following institutions would assist you:  The National Institute of Mental Health: 1926  Sri Lanka Sumithrayo: 0112 682 535  Shanthi Maargam: 0717 639 898  Police Child and Women Bureau: 011 2444444  Courage Compassion Commitment (CCC) Foundation: 1333  Women In Need (WIN) 24-hour hotline: 077 567 6555

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