An Analytical Study on the Medical Reports of Rape Survivors in Nepal

Introduction

The word rape is derived from Latin term “rapio” which means “to snatch” [1]. Absence of consent is the essential element in the crime of rape [2]. The victim’s body is forcibly seized by the perpetrator to fulfill the gratification of sex. Rape is a heinous crime criminalized by the law in Nepal [3]. The number of reported cases of sexual violence has increased by 256 percent in the past decade [4]. The Nepal Police report of October 2020 shows that there are 7 reported cases of sexual violence every day. The report adds on that 61.3% of women with sexual violence never shared the incident to anyone, thus suffer in silence. The consequence of rape is known to have immediate, short-term, and long-term physical, mental, and psychosomatic maladies [5]. Clinicians are the forefront for the medical management [6] as well as medico-legal documentation on the victim which carry a huge impact in the court of justice not only to come into final verdict, but also for justice for victim of crime, rehabilitation, and security against further abuse. This is a retrospective case law study on rape cases, retrieved from the Supreme Court website from the fiscal years 2012/13 to 2017/18 under the jurisdiction of High Court in Province Five in Nepal. The medical reports provided were studied on rape cases claimed and analyzed. 149 rape cases were analyzed for medical report. This research analyses the medical reports on the rape victim and the accused.

Methodology

This study is a retrospective descriptive focused analysis on the medical report on rape cases retrieved from the Supreme Court website under the jurisdiction of High Court in Province Five in Nepal registered from fiscal year 2012/13 to fiscal year 2017/18. The data were collected and processed with Microsoft Excel format for evaluation.

At the time of research, 149 cases under the jurisdiction of High Court in Province Five in fiscal year 2012/13 to 2017/18 were able to be retrieved from the Supreme Court website for analysis (Table 1 & Figure 1).

Results & Discussion

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The most vulnerable group was minor (less than 18 years of age) composing almost three quarters of survivors in this study. The younger the girls, the more violence they were found to suffer. More than one third of the rape survivors in this research were less than 10 years of age. The high incidence of children less than 10 years of age could be due society having less tolerance to violence that takes place in small children. The seriousness of the outcome, such as vaginal bleeding, tear, discharge etc., causes anger and draws emotion of retribution compelling parents to demand justice. Children less than 10 years of age are unlikely to distinguish sexual activities to any other activity; moreover, when involving someone trusted and known [7, 8, 9]. The perpetrators take the advantage of vulnerabilities and innocence of children. Another large group of victims were children aged between 11 and 16 years of age, where almost 40% survived the sexual violence. These groups of children are easy to coerce and threat and get involved in sex without much struggle. Girls aged 16 and 18 were relatively spared, mainly because they could voice out their refusal, retaliate or the perpetrator may have feared exposure and consequences of court appearances.

The mental health consequences of sexual violence can be just as serious and long lasting. Victims of child sexual abuse, for example, are more likely to experience depression, substance abuse, post-traumatic stress disorder (PTSD) and suicide in later life than their non-abused counterparts. Worldwide child sexual abuse is a major cause of PTSD, accounting for an estimated 33% of cases in females and 21% of cases in males [10]. Most of the survivors were female, however, there were 4 cases of male children who suffered unnatural sexual violence which was brought to trial for justice. There are likely to be several dormant cases of male rape victims that are never unveiled. This could possibly be due to stereotypes set on men and boys to act brave and to not to voice out their sufferings (Table 2 & Figure 2).

Conclusion

Medical examination on a rape survivor by a trained, dedicated, compassionate clinician is paramount not only for the immediate case management, medico-legal documentation, but also for the long-term possible holistic care for the optimum health of the survivor. Victims of sexual assault require comprehensive, gender-sensitive health services to cope with the physical and mental health consequences of their experience and to aid their recovery from an extremely distressing and traumatic event The World Health Organization’s definition of health is the “physical, mental and social wellbeing, and not merely absence of disease or infirmity”. Rape survivors suffer significant physical, mental, behavioral, and social maladies, gesturing towards the need for multidisciplinary medical teamwork up and plan of management. In Nepal at the time of this medical case law study, the medico-legal documentation needed to be filled in by doctors was inadequate. There is a need for amendment of medico-legal care for victims of rape in alignment with international standards. The government needs to prioritize these aspects in the care of rape victim survivors: in the setting of physical infrastructure facility structure, equipment, trained service-providers who work with ethical issues, and internationally standardized medico- legal documentation. In addition, a system of long-term holistic medical care, regular monitoring, and follow-up to identify shortcomings of these services and upgrade must be established.