5:33am , Wednesday 20th January 2021

Culprits Cleared by Culture that Shames Autopsies

18 February 2014

Ramalah (Al Ayam Newspaper) – Over four hours have passed since the disappearance of the three cousins from the Abu Fakheida family home.

The family had searched for them all over the village of Ras Karkar, in the outskirts of Ramallah. Finally, the three, Omar 3, Muhannad 4, and Mohammad 6, were found dead in an old refrigerator in the lower levels of the family house – an area used for storage.

The story quickly swept throughout Ramallah; by the following day the district attorney had issued a burial order and the cause of death was attributed to “fate and divine decree” on the 20th of June 2012.

The family refused to permit an autopsy of the three.  According to Mohammad’s father, Mahmoud Abu Fakheida: “We accepted God’s fate so why should we ask for an autopsy, something we generally reject. An autopsy is uncalled for here since we have accepted their death!!”

The final outcome was that the refrigerator door had closed on the children while they were playing inside and they couldn’t open it. The file was closed.

In the village of Salfeet, a beleaguered family was about to bury a mother and her two children without carrying out an autopsy, as the prevailing cause of death was asphyxiation from methane gas. Minutes before the burial new evidence came to light that indicated possible criminal intent. It was verified later through autopsy that a member of the family had killed the mother and her children because she had discovered he was spying for Israeli intelligence. This was announced by the criminal investigation unit in Nablus, after the perpetrator’s confession.

When Palestinian president Yasser Arafat passed away, an autopsy of his body was not carried out. New information was revealed after nine years as to the possible cause of death. A special decree was issued to exhume the body and an autopsy revealed the existence of a poisonous substance.

In Palestine, local tradition forbids the carrying out of autopsies on dead bodies, despite the fact that the Ministry of Justice believes that autopsies are not only relevant in criminal cases but also for the study of pathology.  According to the ministry’s deputy minister, Khalil Karaja, the absence of forensic law in the Palestinian territories has allowed for a culture that rejects autopsies. This tradition strengthens the sanctity of the ‘martyr’ who dies while resisting Israeli occupation.

The absence of legislative authority in the Palestinian political system has augmented this rejectionist attitude. Also to blame is the lack of medical capabilities and institutions with expertise in forensic science. All this means that perpetrators often get away with committing crimes.

According to statistics from the Ministry of Health autopsies were carried out on only 162 dead bodies out of 10,733 in 2012.

The office of the district attorney relies on what prosecutors call ‘directives’ to be implemented at hospitals upon the arrival of a dead body suspected of foul play. The medical examiner is called in to carry out a routine check-up to verify if an autopsy is required.

However, in the story of the family in Salfeet, the medical examiner who carried out the examinations of the dead bodies told this reporter “the marks found on the neck of the mother were light and superficial wounds, and did not provide enough evidence that a crime had been committed. At the same time everyone was preparing for the burial.”

Salfeet Chief Prosecutor Tha’er Zuhair Khalil Thiyab, who worked on the case said: “suspicion arose at one o’clock in the middle of the night, after gathering evidence that indicated someone in the house had injury marks on their neck.”

The news quickly spread on the Internet; a family dies as a result of kitchen gas inhalation. Meanwhile discussions about the case were on-going between the medical examiner and the crime investigators.

The question that kept coming up in the argument of the crime investigator was: If the gas was the cause of death, why was the two-and-a- half- year old child spared?

Answers were not provided until an autopsy was carried out and the perpetrator confessed that he had suffocated the mother and her two children and then turned on the gas in the kitchen and cleared his fingerprints.

Luck might have played a part in the discovery of the Salfeet crime especially since no law stipulates the carrying out of autopsies at hospitals unless a crime is suspected. This is usually left in the hands of crime investigators and the district attorney’s office who often come across resistance from the family of the deceased.

Deputy Justice Minister Khalil Karaja confirms the existence of what he calls “a weakness in the system when it comes to dealing with forensic law in the Palestinian territories.” He adds: “There is a huge importance to the relevance of autopsies even in obvious homicide cases.”

The Palestinian Legislative Council has not been in session since 2006 due to differences between Fateh and Hamas. This has hampered the passing of laws to replace the General Health Law or the 1960 Jordanian Penal Law, which doesn’t enforce autopsies, used in the West Bank. (Jordan ruled the West Bank from 1950 until losing it to Israel in the 1967 War)

In contrast, Jordan has over the last two decades implemented a series of regulations forcing the district attorney to carry out autopsies on suspicious deaths, women and children included.  This was confirmed by forensic medicine expert, Dr. Mo’men Al Hadidi. The former chief of the National Centre for Forensic Medicine also said that Jordan currently carries out almost 3000 autopsies annually — nearly 10% of all deaths.

Dr. Hadidi,  founder of Abu Qrat Centre and professor at the judicial institute said: “ In Jordan, autopsies are carried out in cases of deaths resulting from injury and accidents (fights, asphyxiation and others), or when there is enough evidence to indicate that a crime had been committed: a single pregnant female (honour crimes) and multiple injuries in traffic accidents.”

In the last twenty years the police have relied on evidence more than witnesses and information, especially if suspicious circumstances are in play.

Autopsies have been used as a means to discover the cause of death or to confirm the identity of the deceased, especially in cases of armed conflict when the identity of the victim is very important.

Jordan relies on the Penal Law issued in 1960, which is also used in the West Bank, as are other laws, despite the fact that judicial and administrative ties between the two areas were severed in July 1988.

The law includes a decree that “in the case of death, the district attorney should seek assistance from a doctor and others to find out the cause of death.” 

Al Hadidi also said that “ in some cases crimes were discovered in incidents where death followed an unexplained illness, as in the case of a female whose spinal cord was damaged as a result of poisoning.

Karaja adds, “ autopsies should also be carried out on deaths resulting from shooting by the occupation forces; injuries and wounds should be noted as should the type of bullets used, even if family members refuse to permit this. This is very important for legal cases against the occupation currently taking place in international law courts.”

According to Karaja, the Palestinian Ministry of Justice is currently working on a forensic law and training the necessary team members to implement this law. He also says “a team headed by myself is currently in negotiations with the Portuguese Ministry of Justice, where autopsies are enforced even in cases of traffic accidents, in order to issue a modern Forensic Law.”

There are only seven medical examiners working in the West Bank, an area with an approximate population of 2.5 million. There are two forensic labs in the West Bank, one at the AnNajah National University and the other in Abu Dees. The Ministry of Justice is in the process of building another. In September 2013, the Ministry of Justice signed a deal with Canada to train eight medical examiners in Jordan over a period of four years at a cost of $100.000 for each doctor.

Karaja confirms “the absence of forensic law in the Palestinian territories and the prevailing culture have weakened the case against forensics.” The biggest hurdle however, is the culture,  as many believe that autopsies denigrate the dead.

Ahmad Shobash, the Mufti of Nablus, has added his views on the subject: “Autopsies of dead bodies are against Islamic Sharia as they are considered a denigration of the deceased. The procedure involves the cutting open of the dead body and examining the organs, all of which are not in adherence with Islamic Sharia laws.”

The Mufti, however, does interject by saying: “there are exceptions to these rules especially if the cause of death is not obvious or it appears that a crime had been committed, and an investigation is necessary.” He adds “necessity permits what is not allowed; this means that the importance of finding out how the crime was committed and the cause of death, all of which can be discovered through an autopsy, which might also lead to the discovery of the criminal is enough to allow one to be carried out.”

With this view in mind, the Mufti of the Palestinian territories Sheikh Mohammad Hussein permitted the exhuming of the body of the late president Yasser Arafat after evidence came that he passed away in the autumn of 2004 due to poisoning. The Palestinian Authority would not permit an autopsy until the Mufti had issued a decree.

According to information gathered from chief prosecutors and crime investigators, when a doctor notices any possible criminal intent on dead bodies he/she immediately informs the office of the district attorney who in turn calls the medical examiner to the hospital to perform an autopsy.

On many occasions the medical examiner calls for an autopsy only to be met with refusal from the deceased’s family. In some instances the body was stolen from the morgue by family members who were worried that an autopsy would be “disrespectful to the soul of the dead and torment it.”

In 2003 a number of youths broke into the morgue at Ramallah governmental hospital and stole the body of young man that was due for an autopsy. The ME had ruled that death had happened under suspicious circumstances. According to a hospital official who asked to remain anonymous, the young men said that the youth had died as a result of inhaling tear gas fired by the occupation forces.

The official added: “The youths were adamant that a Martyr’s body could not be defiled with an autopsy.”

An ambulance driver tells the story of the family of a deceased young woman, in her 30’s, who attacked the ambulance car while on its way to Abu Dees laboratory for an autopsy, and stole the body and buried it.

According to Nablus District Attorney Baha’a Al Ahmad “ an autopsy is carried out when suspicions of a crime exist.”

Al Ahmad believes that is necessary to make autopsies mandatory on any deaths between the ages of 10 and 50 no matter the cause of death.

According to Al Ahmad “the scale of criminal intent is usually agreed upon by criminal investigators depending on the evidence gathered at the crime scene. If there is no indication of a crime and the death is of natural causes than there are no suspicions.”

He adds: autopsies do not necessarily reveal the perpetrator, however they do provide definitive answers as to the cause of death.

Legislators and men of law refer to autopsies as “the doctor’s investigation with the victim to discover the criminal.”

A spokesperson for the Ministry of Health points out that the majority of deaths in the West Bank do not undergo an autopsy. Many deaths are not reported and the true cause of death is not registered.

“In many cases of death, the cause is unclear. For example, if it is reported that death was due to a haemorrhaging heart or the beating of a face, the cause of the beating is not revealed.” He added: “Even in cases of traffic accidents, it is only the type of injury that is listed and the diagnosis is usually not precise.”

And “when we receive a death by strangling case we have no indication of knowing if the person hung himself/herself or was hanged.”

Salfeet Chief Prosecutor Tha’er Khalil confirms that there have been many dead bodies that were buried without knowing the cause of death and the truth disappears with the body. The situation turns problematic when evidence comes to light that a crime has been committed after the burial. Khalil was unable to provide numbers of such instances, however.

According to district attorney files in Ramallah which were examined by this reporter,  a young woman was buried in a West Bank village after registering the cause of death as a sudden heart attack. After the burial, information was received that the young woman’s brothers had purchased some poison from a pharmacy a few days prior to her death. After investigations were carried out it turned out that the brothers had poisoned their sister after discovering that she was having an illicit relationship with a young man from a nearby village. An order to exhume the body was issued and an autopsy revealed that the death was as a result of poisoning and the victim was two months pregnant. This was all revealed only after the autopsy was carried out!

Bitar complains that in drowning cases “we don’t know if it was intentional or by accident. I usually receive the files, which have already been closed and signed off by the medical examiner and district attorney.

He points to the death certificate form which includes a paragraph where the doctor is required to put down clearly the cause of death. “I do not know the reasons behind the absence of such information; all I can say is that in many cases we do not receive sufficient information as to the cause of death.”

According to Dr. Na’el Bani Fadel, lecturer in law at the Law Institute in AnNajah National University, the Public Attorney’s office is the area in charge of investigating causes of death. However, certain social and cultural factors come into play that may prevent an investigation especially if the perpetrator and victim are from the same family.

Bani Fadel also says “ the public is afraid of autopsies, but there should be a law that enforces them.”

Dean of Arts and lecturer in sociology and social sciences at the AnNajah National University, Dr. Maher Abu Zant says, “from the point of view of sociology, societal traditions and norms play an important part in influencing the behaviour of people. Holding off a burial and permitting an autopsy is not normal for them and their main concern is immediate burial.”

He adds: “the prevailing culture believes that death is final and it is the end of everything, which means there is no need for further explanations, despite the possibility of a crime behind the demise, which may involve murder or blackmail. Death is regarded as a private matter.”

Dr. Abu Zant also says “there should be a law that enforces the carrying out of autopsies so that the truth is discovered.”

Za’noon states that people often rely on religious decrees that ban such acts on the body. He believes this is uneducated and uninformed.

During work on this investigative report, stories monitored from local media archives showed several cases of burial without autopsy. The refusal was due to social and cultural reasons and the cause of death registered was attributed to fate and divine decree.

Many of those who adhere to the idea of enforcing autopsies cite the exhuming of the body of President Yasser Arafat after nine years as an example. His body never underwent an autopsy in the Palestinian territories.

In 2001, the official in charge of the Jerusalem portfolio at the Palestine Liberation Organization, Faisal Al Husseini passed away in Kuwait. No autopsy was carried out when his body arrived in the Palestinian territories, under the pretext that the martyr’s body should be respected.

Former Palestinian Chief Prosecutor Ahmad Al Mughani announced during a workshop that a body was buried after the cause of death was listed as electrocution. It was later discovered that the real cause had been poisoning and this was only found out after the body had been exhumed and an autopsy carried out.

(A.A.) refuses to talk about the details surrounding the death of his son who fell from a high building while working in construction. When asked why he didn’t ask for an autopsy to verify that the death was caused from the fall he responded: “No matter what the details, I have lost a son and the most respectful thing is to immediately bury the body, there is nothing more important.”

A security officer who was being held in custody for investigation died at the end of 2012. No autopsy was carried out and the cause of death was registered as heart attack.

Around the same time, a detainee being held by the security forces also passed away. Cause of death was listed as a result of a fall from the third floor of the building with no autopsy.

In 2001, the cold body of a man in his twenties was transferred to Ramallah hospital; the people carrying the body said he had died as a result of tear gas being fired by the Israeli Army. Doctors and hospital officials registered the cause of death as unknown and an autopsy was scheduled, but the family members refused this and removed the body from the morgue after a high level intervention.

In the same year, a young man sitting with his friends suddenly passed away; this necessitated an autopsy. However a number of officials intervened and his body was taken out of the morgue. His death was hailed as that of a martyr’s and photos of him were plastered on electricity poles in the village.

From a scientific and judicial point of view, autopsies serve a purpose in the community, not only to reveal the perpetrator of a crime, but also to identify unknown diseases and to further science and medicine.

Will a new law be issued or amendments made to the current laws in order to open the door for forensic medicine and victim investigation?

This investigative report was implemented with support from  Arab Reporters for Investigative Journalism (ARIJ) and coached by Hossam Izzedine.


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