As is already recognized by the authorities in South Africa, the current system for provision of medico-legal services is deficient in many respects - not only as it relates to violence against women - and urgently in need of reform. The reform proposals that have been made, however, have for the most part not considered the system as a whole, nor have the individual initiatives that have been taken to improve the system been well coordinated between government departments or between government and the nongovernmental sector. Although this is changing at the national level, at the provincial level - responsible for delivery of health care, including medico-legal services - the different departments still often act at odds from each other and without consultation with nongovernmental organizations.
The improvement of the response of South Africa's medico-legal services in cases of violence against women must consider the experience of women from the time they first report an assault to the time they appear in court. It depends not only on improving the district surgeon system, but also on improving the manner in which the police and courts use that system and ensuring proper cooperation between the different branches of the criminal justice system. Attention must be paid to the better training of police, prosecutors and magistrates with respect to issues of gender violence in general, and to the understanding and use of medical evidence in particular. This training must be acquired before police, prosecutors, and magistrates begin work in the field. In the case of district surgeons, the existing system is inaccessible to many women. The service provided varies hugely in quality and at its worst may compound the trauma already experienced by a woman who has been raped. Lack of training in the field of violenceagainst women manifests itself in failures to collect and record all the necessary medical evidence, reluctance to take a full history from the woman who is being examined, and racist or sexist attitudes more generally.
Human Rights Watch believes that the current proposals for reform go some way toward addressing the deficiencies of the existing system, in particular the effort to develop standardized guidelines for the handling of sexual offenses by all within the criminal justice system. Yet the proposals at the national level relating to the medico-legal system have concentrated on the examination of the dead rather than the living, and they fail to address adequately the specific issues of violence against women. While some provinces have independently moved forward to improve the service for women who have been sexually assaulted, others are still failing to grapple effectively with the changes needed. Most importantly, the reforms should address the need of the district surgeon - or district medical officer responsible for medico-legal work, if that is the new terminology - for training before appointment and for back-up from the state health sector more generally; for example, by the development of protocols, provision of referral information or a requirement for regular in-service training. If medico-legal services are to be provided at primary health care facilities, specialized training is equally needed for those responsible. Furthermore, if the results of medico-legal examinations are to be useful in obtaining convictions of the perpetrators of sexual assault, police, magistrates and especially prosecutors also need to be thoroughly trained in the interpretation and presentation of medical evidence.
In the area of violence against women, as with other violations of bodily integrity, the government has responsibilities in international and national law to prevent, investigate and prosecute such abuse. A key part of the criminal investigation of cases of sexual violence is the collection and use of medical evidence. An effective medico-legal system is needed if South Africa is to fulfil its responsibilities under international law to protect the human rights of women in South Africa.