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24-hour forensic examinations

  • Facility protocols should specify what medical forensic services are provided.   Key services following a sexual assault include: treatment of injuries, preservation of evidence, prevention of unwanted pregnancies and sexually transmitted infections, and psychosocial support (Welch and Mason, 2007).
  • Forensic services should have minimal wait times, be given priority services, have trained and accredited providers with a sufficient number of exams to maintain their level of proficiency in collecting evidence, documenting the assault, and addressing survivors’ emotional needs (Ledray, 1999).  Whenever possible, the exam should be conducted by a woman, as most survivors prefer to be examined by a woman (Welch and Mason, 2007).
  • Women may not choose to enter into a legal process right away, therefore, forensic exams should be made available with the option to keep forensic evidence on file in a sealed envelope should a woman decide to press charges at a later date.
  • Medical certificates should be made available free of charge. The WHO Guidelines recommend that medical certificates should be valid for up to 20 years, should a woman decide to claim compensation or make a criminal complaint at a later date.
  • Forensic examinations should follow guiding principles in providing health services to survivors.  In particular, women may fear reprisals if entering a legal process, therefore confidentiality surrounding forensic exams should be the paramount concern.  In the United States, anonymous rape tests are available nationwide to address this issue.   Testing for virginity should never be a part of the forensic examination, as it violates survivor’s rights and autonomy.
  • Studies done in the US showed that watching a video describing the forensic sexual assault exam may reduce survivors’ stress during the exam (Martin, 2007).
  • Survivors should also be provided written information in order to reinforce information given to them during their medical exam.  Some survivors may be in shock at the time of initial treatment and therefore may not fully absorb all the information shared orally by a forensic examiner.  Written information may include: 
    •  What is involved in a physical examination process;
    • Health risks after sexual assault and the need for testing and treatment;
    • HIV risks;
    • Treatment regimens and any side effects;
    • Prevention of pregnancy;
    • Psychological impact and coping strategies;
    • Further support after sexual assault through community services and/or telephone helplines

(Excerpted/adapted from: Jewkes, R., 2006. “Paper for Policy Guidance: Strengthening the Health Sector Response to Sexual Violence”, Unpublished.)

 

Illustrative Tools:

Guidelines for Medico-legal Care for Victims of Sexual Violence (World Health Organization, 2003); see “Forensic Specimens” (pp. 57-63).  Available in English.

 The Sexual  Assault Forensic Examiner Coordinator's Handbook (Carman, R., 2010).  Designed for Sexual Assault Forensic Examiner (SAFE) coordinators, examiners, and Emergency Department (ED) personnel such as nurses, social workers, and attendings, this Q & A handbook uses case studies and other practical tools to provide concrete guidance related to all aspects of SAFE programme operations. Available in English.

 Sexual assault nurse examiner (SANE) development & operations guide (Ledray, L. 1999). Washington DC: Office for Victims of Crime, U.S. Department of Justice. Available in English.

 Clinical Care for Sexual Assault Survivors (International Rescue Committee, 2009). Available in English.

A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents (United States Department of Justice Office on Violence Against Women, 2004). Available in English.

Additional Resources:

Forensic Evidence for Sexual Assault: A South African Perspective (Martin, L. 2001). International Journal of Gynecology and Obstetrics 78 (Supplement 1), pgs. S105-S110.

Rape and Sexual Assault (Welch, J. and Mason. F., 2007). BMJ; 334, pgs. Available in English.