Retrospective analysis of factors affecting rate of skeletonization within a tropical climate.

Estimating the post mortem interval (PMI) in skeletonized cases is an extremely challenging exercise. Sri Lanka lacks adequate taphonomic research which is a serious limitation when assessing PMI in forensic death investigations. Methods that have been proposed to estimate PMI using the total body score (TBS) and accumulated degree days (ADD) are mainly based on data from continental and temperate climates and have shown less reliability in tropical climates. With the intention of developing a region-specific, evidence-based guide which would be applicable to tropical climates like Sri Lanka, we selected thirteen skeletonized remains with known PMIs from forensic case records and analysed their taphonomy in relation to selected weather data. We also compared the ADD values within our dataset with reference ranges calculated using published formula. All except one were found from outdoor locations. The TBS ranged from 24 to 32 and had a weak positive correlation with the PMI. The earliest appearance of skeletonization was 15 days in a body found indoors. The highest rate of skeletonization was seen in a body with a TBS of 32 and a PMI of 23 days. The average daily temperature and relative humidity were similar across all the cases however, the amount of rainfall varied. Bodies exposed to monsoon rains (n = 6) had a lower mean rate of skeletonization compared to those that were not exposed (n = 4) suggesting lower rates of decomposition during periods of heavy rainfall. No correlation was found between ADD and TBS. In 9 (69.2%) cases, the actual ADD was much lower than reference ADD ranges for TBS values, indicating poor applicability of TBS and ADD based formulae in estimating PMI within the Sri Lankan climate. Our study shows a strong need for taphonomic and entomological research in tropical climates to further explore the impact of monsoons on biotic and abiotic factors affecting skeletonization.

Preventing ragging: outcome of an integrated programme in a medical faculty in Sri Lanka.

Ragging is prevalent in higher educational institutes in Sri Lanka and the deaths of some new entrants in the past have been directly linked to physical and emotional torture caused by cruel acts of ragging. Although there are general anti-ragging rules in place, the effectiveness of these measures is unknown. We developed an action plan to prevent ragging by integrating the views of the major stakeholders, implemented the plan and assessed its success. This article highlights the action plan and its success in a medical faculty in southern Sri Lanka.

Implementation of Istanbul Protocol for effective documentation of torture - review of Sri Lankan perspectives.

Documentation of torture is a multidisciplinary, multistage scientific procedure evolved over the past decades through the experience of various strata in medical and related fields. It plays a key role in effective corroboration of facts, providing redress to victims and also has a long term regulatory impact on prevention of torture in a society. The UN endorsed Istanbul protocol serves as the model for effective documentation of torture in the present context and there were many attempts in the recent years to create a systematic and uniform approach among professional bodies to document torture by adopting it to the local medico-legal and legal systems in some less resourced countries. The post independent Sri Lanka is widely known in international human rights forums for the prevalence of torture and its endemicity since 1970s. The long term struggle to ensure justice to torture victims in Sri Lanka has been greatly enhanced by the submission of detailed medico-legal reports on them to relevant courts. As strengthening of medico-legal and legal reporting strategies were more focused towards the end of twentieth century the medico-legal and legal professionals in consensus attempted to use Istanbul Protocol for documentation of torture since 2004. However Sri Lankan experience on application of Istanbul protocol for documentation of torture signifies that unless and until a political commitment is shown by the government to internalize Istanbul Protocol into legal and medico-legal systems locally the expected outcome of effective documentation would not be evident.

Guidelines for the effective conduct of mass burials following mass disasters: post-Asian tsunami disaster experience in retrospect.

The frequency of mass disasters is increasing, demanding actions that deal with these promptly and effectively to secure human interests. An undeniable and inevitable reality of any mass disaster is the massive number of fatalities, which will give rise to a further chain of events ranging from the recovery of the deceased, to their transport, storage, identification and, finally, disposal. Past experience has shown that traditional human disposal methods should be redesigned according to the requisites of mass fatality scenarios, and it has been proven that a proper mass burial is by far the most appropriate and standard method for disposal of the dead due to mass disasters as it takes all its practical issues into consideration. A mass burial can be defined as burying more than one deceased of a single or related incident in a single grave or multiple graves simultaneously or separately within a restricted time period in a single or multiple burial sites located within an identified geographical area. In the present context, it is an utmost necessity that we develop uniform detailed guidelines for the proper conduct of mass burials that provide the deceased with all due respect to human dignity, as this will enable these guidelines to be incorporated into future national mass disaster management schemes as an integral component.

Tsunami disaster victim identification in Sri Lanka: legal aspects.

Natural hazards amounting to disasters have almost become an endemic phenomenon during past decades throughout the globe, particularly affecting less resourced countries. The capabilities of the affected nations are stretched to the maximum in most of the disasters, thereby exposing deficiencies at various levels of the disaster mitigation mechanisms. A key factor identified through the human experience of all previous disaster scenarios is the requisite of effective and integrated local, national and regional disaster management mechanisms. The national and regional legal framework in this context can supplement disaster management enormously by drafting and implementing practical legislation which can be activated in disaster situations to co-ordinate the relief missions and minimize the damage. Thus, the existing legal systems and legislation at national and regional levels should be modified accordingly to yield proper disaster management policies. However, many less resourced countries are still lacking functional disaster management mechanisms in local legislation and are consequently highly vulnerable to heavy casualties in disasters. Sri Lanka is a typical example of a state which had an ineffective disaster management mechanism, not strengthened by legislation, when the Asian tsunami struck the country in December 2004, despite having frequently been affected by natural and man-made hazards during the past three decades. The net effect was total disarray in disaster victim identification, leading to drastic and irreparable consequences.

Review of initiatives adopted for effective documentation of torture in a developing country.

Effective documentation of torture is the key to successful interrogation and redress of torture victims. However the facilities available for such documentation to the forensic practitioners in less resourced countries are far from satisfactory. The emphasis on accurate and detailed documentation of examination findings of torture victims is currently necessary in Sri Lanka as the courts are relying heavily on medical reports for interrogation. In a situation where most of the torture victims are examined by unskilled medical officers who are not full time forensic practitioners, deficiencies of various degrees are commonly observed pertaining to depth of examination and documentation of examination findings. Therefore it was attempted in 2004, to introduce uniformity to existing documentation procedures by implementing Istanbul Protocol on island wide basis. However it was revealed that the adoption of the Istanbul Protocol could not be done as a whole in a short period due to variable degree of compliance from medical officers and further it need to be modified according to domestic requirements. The documentation of torture is a distinct multistage and multidisciplinary process. Therefore unless and until a cohesive collaboration is established between all disciplines concerned, a positive development on documentation process cannot be anticipated.

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Panel 2.16: forensic aspects of disaster fatality management.

This is a summary of the presentations and discussion of Panel 2.16, Forensic Aspects of Disaster Fatality Management of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to forensic aspects that pertain to the responses to the deaths created by the Earthquake and Tsunami. It is presented in the following major sections: (1) overview of victim identification; (2) resource factors in mass-fatality management; (3) mass-fatality management in protecting public health; and (4) reasons to use deoyxribose nucleic acid (DNA) to identify the deceased.