Sexual violence against women in southern Tunisia: Epidemiology and risk factors.

INTRODUCTION: Sexual violence (SV) against women represents a public health problem. Despite, the promulgation of the new Act of 2017-58, SV remains frequent in Tunisia. In this paper, we propose to determine the socio-demographic characteristics of women victims of SV and to identify risk factors related to serious SV. MATERIAL AND METHODS: This is a retrospective, descriptive and analytical study including all women victims of SV, examined at the Forensic Department of Sfax Hospital, between 1st March 2018 and February 29th, 2020. We defined serious SV as any sexual violence associated with genital or anal lesions. RESULTS: We collected 269 cases of women victims of SV. This sexual violence was associated with extra-genital physical violence in 18.86 % of the cases. The average age of the victims was 21.23 years (+/-10.67 years). The consultation delay was relatively long. Only 11.52 % of victims consulted within 24 h. It was mainly an extra-family abuse. Vaginal examination revealed recent defloration in 9.29 % of the cases. The proctological examination was normal in most cases (61.63 %).Seven victims were pregnant. In the analytical study, we studied the risk factors of serious SV against women. A total of 150 cases were considered serious (55.8 %). Serious SV was statistically related to the age (over 18),the profession (housewives),the origin (urban),and the relationship with the aggressor (friend, neighbor, or family member).The risk of serious SV was greater when the victim didn't have any traumatic extra-genital injury. CONCLUSION: Sexual violence is a serious problem worldwide and in Tunisia. The Tunisian legislation repressing SV has been strengthened by the promulgation of the 2017-58 Act. However, much effort remains to be deployed to fight against this form of violence.

Physical violence against women in southern Tunisia: Epidemiology and risk factors.

INTRODUCTION: Violence against women is a widespread offense worldwide. It causes serious physical, psychological, and medico-legal repercussions. We aim to specify the socio-demographic characteristics of female victims of physical violence well as the medical consequences and risk factors related to serious physical violence against women in Tunisia. MATERIALS: This is a retrospective study including all women victims of physical violence, examined on judicial requisition at the Forensic Department of Habib Bourguiba University Hospital in Sfax, over two years (March 1st, 2018 to February 29th, 2020). Physical violence is considered serious whena forensic specialist predicts long term effects at the lesional stage (determining partial permanent disability: PPD). RESULTS: In our study, 2909 women were victims of physical violence. The average age of the victims was 34 ± 13 years (extremes:2 and94 years). The majority of victims were married (83.3%), jobless (52.5%), and of an urban origin (72.7%). Physical violence predominated in summer and autumn with a peak in frequency in July and at weekends. The consultation delay ranged between 1 and 30 days in two-thirds of the cases. The perpetrator was an intimate partner in 38.2% of cases, a stranger in 11.1% of cases, and a family member in 5.9% of cases. The weapon used was a blunt object in 82.8% of cases. Injuries were preferentially located in the upper limbs (52.6%) followed by the head and face (42.7%), consisting essentially of bruising and abrasions. The median duration of the total temporary disability (TTD) was 5 days (extremes: 0-60 days). The duration of TTD was statistically correlated to the type and the site of the most serious injuries. Moreover, there was a statistically significant correlation between the duration of TTD and the PPD prediction (p < 0.001). A 9-day TTD represented the threshold to expect PPD. A total of 198 cases (6.8%) were considered serious. Serious physical violence was statistically correlated to the origin of the victim (urban), the relationship with the aggressor (stranger, or thief), the type of weapon used (sharp or thermal force), the type of injury (contused wound, sharp wound, penetrating wound, fracture-dislocation, or head trauma) and thesite of the injury (head and face). CONCLUSION: Violence against women is a very widespread practice in our society. Despite legislative advances, Tunisian women remain victims of discrimination in several areas. A change in mentalities and an awareness of the need to respect women's rights are necessary and require collaboration between the various social, legal and medical stakeholders.

Gestion des catastrophes de masse liées au naufrage de bateaux d'immigrés clandestins : expérience du service de médecine légale de Sfax (Tunisie)

Contexte: Le naufrage d’un bateau d’immigration clandestine constitue un événement imprévisible, responsable d’une catastrophe de masse pouvant générer une importante caisse de résonance médiatique. Cela constitue donc une urgence médico-sociale. Objectif: Dans ce travail, nous proposons de rapporter le bilan de l’activité du service de médecine légale de Sfax (Tunisie), de décrire la procédure de gestion des catastrophes de masse liées au naufrage de bateaux d’immigrés clandestins et d’étayer les principales difficultés rencontrées. Méthodes: Il s’agit d’une étude rétrospective et descriptive portant sur tous les cas de mort par submersion suite au naufrage de bateaux d’immigration clandestine, ayant fait l’objet d’une autopsie médico-légale au service de médecine légale de l’hôpital Habib Bourguiba de Sfax, durant une période de quatre ans allant d’octobre 2017 à septembre 2021. Résultats: Durant la période d’étude, nous avons colligé 539 décès par submersion à la suite de naufrages de bateaux d’immigration clandestine. La médiane des décès était de 93 cas par an. Nous avons remarqué un déclin important du nombre de victimes en 2019 (13 victimes) puis une remontée importante en 2020 (115) et surtout en 2021 (271). Nous avons noté deux pics de fréquence pendant les mois de juin et juillet (31,4 % et 20,8 % respectivement). Les victimes étaient essentiellement de sexe masculin (67,5 %) avec un sex ratio de 2,08. Nous avons noté la présence de mineurs âgés de moins de 18 ans dans 5,8 % des cas et de femmes enceintes dans 2,4 % des cas. La majorité des victimes étaient d’origine subsaharienne (63,1 %). Nous avons noté une augmentation du nombre de victimes de l’ethnie subsaharienne les deux dernières années. Des prélèvements ont été réalisés systématiquement pour une étude génétique. Le nombre de victimes identifiées était de 146, soit 27,1 % de tous les cadavres. Conclusion: Même si des avancées importantes ont pu être réalisées, différents défis et difficultés restent à surmonter pour pouvoir apporter une réponse rapide aux familles qui vivent dans l’incertitude quant au sort de leurs proches disparus.

Patterns of homicide in Sfax, Tunisia: A 9-year cohort study (2011-2019).

INTRODUCTION: In Tunisia, since the January 2011 revolution, there has been considerable media interest in violence, particularly homicides. A popular perspective is, aside from any politically motivated killings, of a rise in homicides from year to year. In the absence of Tunisian national homicide statistics, a more accurate picture may be obtainable from area pathologist records. AIMS: To examine annual homicide rates from post-mortem data for the second largest administrative area of Tunisia, Sfax, with a mixed urban-rural population of about one million people. METHODS: All victims of common law homicide for the region are taken to the forensic department of one hospital in Sfax. We conducted a retrospective and descriptive study of all such cases of homicide for the 9 year period from the date of the fall of the Tunisian government in 14 January 2011 to 31 December 2019 and linked these data to those from earlier studies in the same department. RESULTS: One hundred and nine victims of unlawful homicide were identified during this nine year period, with an average of 12 cases per year and a peak of 17 cases in 2016, yielding a broadly consistent rate of 1.2 homicides per 100,000 inhabitants and no consistent pattern in fluctuations. Just over two-thirds of the victims were men. Mean age of victims was 34.85 years (range 8-90 years). Just under half were married (45%); largest employment groups were of low-paid casual workers (40%) or unemployed (28%). One third of the killings had taken place in a private residence, with interpersonal conflict given as the largest explanatory category; over one quarter were intra-familial and 14% between intimate partners. There was some seasonal variation, with nearly two-thirds of homicides occurring in the spring and summer months. CONCLUSION: Contrary to press hype, we found no evidence of rising homicide rates in Southern Tunisia, although this does represent a different picture from that in the north of the country. The seasonal variation would merit further exploration as it raises questions around impact of fluctuations in mental health.