In addition to the general recommendations in its 1995 report, Violence Against Women in South Africa: The State Response to Domestic Violence and Rape, Human Rights Watch makes the following recommendations to the South African government specifically relating to the medico-legal system and its response to violence against women. Some of these recommendations are already being implemented in some provinces, others have received less attention. We believe that all are necessary.
General:
· Women who have been sexually assaulted and report to a police station should be taken by the police to be examined by a specialist medico-legal practitioner as soon as possible, to ensure that forensic evidence is not lost and to allow the complainant to wash herself and change as soon as possible. There is no need for a full statement to be taken by the police at the time of initial reporting.
· Women who have been sexually assaulted and report to a public health facility should wherever possible be examined for medico-legal purposes at that facility, if necessary after calling a specialist fromelsewhere to carry out the examination. The woman should be informed of her right to lay a charge and, with her consent, police should be called to the facility for the crime to be reported.
· Following medico-legal examination, government policy should pay greater attention to the need for women to receive appropriate treatment for injuries, infections, or other related trauma. Women should be informed in writing and orally in their own language (if possible), or in a language they understand, about governmental and nongovernmental support services available and referred for counseling. Special care should be taken to ensure that a woman who decides to lay a charge against her assailant and who therefore requires a medico-legal examination (a purely diagnostic procedure) is not effectively deterred or prevented from also obtaining treatment for her injuries.
· Private practitioners who treat women who have been sexually assaulted should have sufficient training and information at their disposal to be able to advise their patients of the desirability of a medico-legal examination by a specialist and refer them to the nearest facility where that is possible.
· Government departments should ensure through training and distribution of information that all those who have contact with victims of sexual assault in an official capacity, whether in the health or criminal justice system, are able to refer them to appropriate governmental and nongovernmental support services and to inform them of their rights.
· Efforts should be made to increase the number of women practicing in the medico-legal field and to ensure that a woman who has been assaulted is examined by other women where possible, or that another woman health worker is present while the examination is conducted.
· In developing policy initiatives, the problems faced by women and children and the solutions suggested should be disaggregated and addressed as separate issues.
District surgeons/medico-legal practitioners:
· In reforming district surgeon services, attention should be paid to the urgent need to ensure adequate expertise in medico-legal matters among those doctors providing medico-legal services. Although the integration of medico-legal services with general primary health care responsibilities would be a welcome step toward making those services more accessible, an examination carried out by an inexperienced and untrained doctor may be useless. As accessibility improves, every effort must be made to ensure that quality is maintained by requiring thorough and appropriate training for all medico-legal practitioners.
· Training programs should be developed for those appointed to carry out medico-legal work, both as a requirement before appointment and as annual in-service training. These programs should include information on the technical aspects of medico-legal practice and education on the psychological impact of sexual assault on the victim.
· Manuals should be developed for newly appointed district surgeons (or district medical officers, as they are now to be known) which outline the relevant laws for their work, review the necessary specialized medical information (for example, ways of determining the time of injury), and provide detailed descriptions of injuries specific to sexual assault in both adult and child victims.
· Standardized protocols for the examination and treatment of survivors of rape and sexual assault and the collection of biological samples should be developed and distributed to all those engaged in medico-legal work.
· Specialized curricula in clinical forensic medicine for medical students should be developed by the universities offering medical training and made compulsory for all medical students, with practical expertise in a medico-legal clinic a requirement of such courses; a qualification in clinical forensic medicine, similar to that for forensic pathologists, should also be developed and made available to those doctors who wish to specialize in this area of work.
· Specialized curricula in clinical forensic medicine for nurses should be developed, and a qualification in clinical forensic practice made available to nurses who wish to specialize in this area. The possibility of specialized nurses carrying out medico-legal examinations should be investigated.
· The Medical Association of South Africa, which publishes a journal of continuing medical education, should arrange for a special edition of this publication dealing with medico-legal aspects of violence against women.
Police:
· Police investigating officers handling sexual assault and rape cases should specialize in such investigations and be trained in the issues surrounding gender violence and the use of medical and other forensic evidence.
The courts:
· Specialized curricula in clinical forensic medicine for law students should be developed and successful completion of such a course made compulsory for lawyers applying to become prosecutors or magistrates.
· Justice College, in Pretoria, where prosecutors and magistrates are trained, should include courses on the use of medical evidence within its syllabi.
· As is already the trend, each regional magistrates court should identify specialized prosecutors to handle cases of sexual abuse and rape, who should receive additional training in the issues surrounding such violence.
· Where appropriate, the use of doctors as lay assessors to sit with magistrates to judge sexual assault cases should be encouraged.
· The Department of Justice should make available specialized training in medico-legal vocabulary to court interpreters.
· Legislation should be introduced to abolish the use of the "cautionary rule" in rape cases, which requires courts to exercise additional care in assessing the credibility of a rape survivor. The cautionary rule in rape cases places a particular premium on corroborative evidence if a woman is to win her case.
The collection and analysis of medico-legal evidence:
· The J88 form, used to record the findings of a medico-legal examination, should be redesigned along the lines set out in the body of this report.
· The Pretoria forensic biology laboratory, and forensic services in general, should be taken out of control of the police and placed under the Department of Health, with an independent status, similar for example to that of the attorneys general.
Collection and dissemination of information on violence against women:
· All health facilities should have information on display and available to be taken away on the medico-legal and other services available to women who have been subjected to sexual assault or domestic violence.
· A national directory of governmental and nongovernmental services available to women should be developed, and information should be distributed to police stations and magistrates courts, as well as to district surgeons, hospitals and other health care facilities about locally available referral services for women who have been assaulted.
· In designing data collection models, the specific issues of violence against women should be addressed (for example, the means of collecting statistics from the health services on both rape and domestic violence, or the possibility of making rape a reportable occurrence as child abuse already is).