The poor state of Egypt's medico-legal authority

conference room at the medico-legal authority in Cairo

I took part in a training workshop for the medico-legal authority (forensic authority) in December in Cairo and last month in Assiut.

My part in the training was on the psychological consequences of torture. This was part of a training on the Istanbul Protocol, an internationally recognised guideline for medical and legal documentation of cases of torture. The IRCT managed to convince the director of the authority (chief forensic examiner) Dr. Ehsan Gorgy to provide such training, in exchange the authority will get them several digital cameras to help improve their documentation.

The authority was established in 1931 and is part of the Justice Ministry. It works within the legal framework of laws passed in 1952. A year before the structure of DNA was discovered and before many of the current advances in radiology and other fields of medicine. Currently the authority has an office in every governerate and a workforce of about 70+ doctors.

The authority was under intense scrutiny by the public following the Khaled Said case. It was accused of being complicit with the regime. This case is still a sore issue for forensic doctors and the public still carry lots of mistrust.

While exchanging contacts with one of the doctors at the end of a training day. One told me he has a Facebook account and is quite active on it but no longer writes his occupation as a forensic doctor fearing insults and shaming from his Facebook friends.

One of the older doctors in the authority had a session at the end of each training. Half of what she spoke about was outside the topic and the other half was marginally related. The first half was what could be described as intense brain washing, moral boosting or anything of that sorts. She went on how the 70+ doctors in the authority are the best. That any shortcomings from the authority is due to lack of equipment. From her high horse she went at lengths to describe examples of how the doctors of the authority are pure gold but didn't find what she said later self-contradictory when she described the poor state of reports, lack of supervision and the need for training opportunities that will be available in this 'new-era' for the authority.

The second half she discussed the independence of the authority from the ministry of justice, other specifics about dealing with the prosecution, poor pay (she mentioned striking), health insurance which isn't as extensive as judges and the security concerns of doctors.

During breakfast, the same doctor sat with me for 90 minutes or more. I had to endure at that time her version of the history of the authority in the past 10 years. And how the subsequent directors loved their positions and did anything to secure it. While doing so they lost many of their powers to the justice ministry and the government. For example, since around 2000 the director became appointed (or mandated انتداب) to the position without the standard official hiring procedure. This limited his/her (it has always been his) financial authorities over the institution and gave the justice ministry more say on what can or can't be done.

This form of mandating the director is the way the state decides to pick and choose who would run the institution and ignore the seniority of the older doctors.

The director of the authority as soon as he assumed power he would then wage a war against his more eligible colleagues, she says. Basically a standard story within almost all of Egypt's bureaucratic institutions.

She did admit that some doctors cooperated with the state and that this was up to each doctor and his own conscience. Dr. el-Seba'ay was a tool for the state. He received phone calls from the minster of interior Habib El-Adly and his expertise was questionable.

She added that all previous directors persecuted her or tried to avoid direct confrontation because of what she could do. Her scientific status (one of the few who carry a Phd), being well known and loved within the institution and not shying away from going directly to the minister of justice to complain, made her immune to such attacks.

The entire 90 minutes or so were like suddenly the planets changed path and the entire universe was starting to revolve around her.

El-Seba'ay was sacked following a TV interview after admitting, following the revolution, with pride that he was chosen by the patriotic institution of the State Security Investigations. Dr. Gorgy, the current director, apart from being a very amusing man with a very heavy Upper Egyptian accent appears to be someone who is more open minded, more willing to collaborate with human rights organisations and to try to change the situation, within what's possible, as he would say. Making it clear to angry doctors that he won't support any radical undertaking, such as striking. He is actually the most senior but refuses to get his full powers in the position.

UPDATE: Dr. Gorgy resigned yesterday 7/3/2012, saying it is due to family reasons.

Currently the situation of the authority is quite bad. They are operating with outdated laws, lack independence and autonomy, are poorly equipped, poorly paid and understaffed (with many leave to gulf countries after 3 or 4 years of work).

One striking example was when one of the attendees explained that they don't have sterile swabs for rape victims. Something that is absolutely necessary for rape victims and needs prompt response. They instead have to send the victim to a maternity hospital to have the swab taken. Losing valuable time and adding to the burden of such examination.

They don't have the necessary lighting conditions for autopsy during the night. Needed for sun like exposure of colours. Outside Cairo there aren't even dedicated places for autopsy. Only after this training that they are going to get enough digital cameras to improve their documentation.

Doctors aren't allowed to have another appointment with anyone which usually means that they don't have time to establish rapport with traumatised individuals and people who may need psychiatric examination. And any request to examine a victim by a psychiatrist is seldom taken seriously.

There are no academic links with the forensic departments in different universities. Which limits their access to new research, information and participation in conferences locally or abroad. This isolation is also bilateral, the forensic specialists at universities rarely do autopsies.

Perhaps the training, which just touched the surfaces of the Istanbul Protocol guidelines, will at least marginally improve their reports. If we are trying to get the perpetrators of torture behind bars and are looking for establishing a society governed by the rule of law, this institution shouldn't be overlooked.