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Role of forensic medicine in evaluating non-fatal physical violence against

women by their husbands in Jordan

Article  in  Journal of Forensic and Legal Medicine · May 2017

DOI: 10.1016/j.jflm.2017.05.004

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Contents lists available at ScienceDirect

Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Role of forensic medicine in evaluating non-fatal physical violence

against women by their husbands in Jordan
Hasan Abedr-Rahman, M.D, PhD forensic medicine a,
Hafsah Omar Salameh, M.D forensic medicine b, *,
Rakiz J. Salameh, M.D forensic medicine b, Laith I. Alabdallat Medical student a, b,
Imad M. Al-Abdallat Professor forensic medicine b
a
Forensic Pathology and Microbiology Department, The University of Jordan, Jordan
b
The University of Jordan, Jordan

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Intimate partner violence against women is a major health problem in most nations, but to
Received 9 October 2016 date, there has been little awareness of the extent or seriousness of this issue in Jordan. Forensic medical
Received in revised form practitioners play a significant role in diagnosing, evaluating and reporting these cases. The Jordanian
19 March 2017
judicial system is dependent on forensic reports. This study aims to assess the role of forensic medicine in
Accepted 1 May 2017
Available online 3 May 2017
evaluating the physical injuries sustained by women who are abused by their husbands.
Method: A retrospective review of 158 forensic reports of Jordanian women alleging assault by their
husbands and who were seen at Jordan University Hospital over the period 2010e2015.
Keywords:
Forensic
Results: Of the 158 women who presented, 87 had multiple injuries. The majority of injuries were soft
Women tissue injuries, but others included fractures, tympanic membrane perforation, burns and neck contu-
Intimate sions. Twelve women were pregnant at the time of the assessment. The period of incapacity caused by
Violence these injuries (an important factor for the Jordanian judicial system) was between 1 and 14 days.
Partners Conclusion: Intimate partner violence can present with a range of injuries from relatively minor to
Husbands potentially disabling or life threatening. Forensic medicine has a role in documenting and evaluating
these injuries and advising the judicial system in these cases. These are all key elements in increasing the
awareness of the nature and extent of this behavior and its impact on women (and men) and the wider
society.
© 2017 Published by Elsevier Ltd.

1. Introduction
A large proportion of women in Jordan have experienced inti-
mate partner violence at some point during their marriage;
thought to be in the order of 31.2% who have been subjected to
physical violence.1 Information regarding the incidence of wife
abuse is limited particularly in developing countries like Jordan,
due to the dominant culture that interprets violence against
women as a personal matter,2 rather than a criminal matter.
However, hurting or harming the individuals is not accepted in
Islam.2 Intimate partner violence (IPV) is a major detrimental factor
to women's health, welfare, social, and financial standing; and its
* Corresponding author.
E-mail address: hafsaomer@yahoo.com (H.O. Salameh).
most extreme form may result in the death of the woman.3
The Jordanian Ministry of Justice is currently providing a focus
to cases of family violence, such that cases of family conflict are
assigned to a special section of the court.4 In 2008 a law on family
protection was promulgated, which was intended to regulate the
handling of domestic abuse cases by medical workers and law
enforcement bodies.5
While there are some studies of intimate partner violence in
Jordan, (and in neighbouring countries). Those studies largely focus
on issues such as social, demographic, health and other aspects, but
there are few that explore the medico-legal consequences of
beating wives. It is the only form of intimate partner violence in
Jordan due to the cultural and religious norms which prevent other
forms of intimate relationship between a man and a woman. The
few studies which focused on the forensic issues mainly addressed
sustained injuries.6

http://dx.doi.org/10.1016/j.jflm.2017.05.004
1752-928X/© 2017 Published by Elsevier Ltd.
34 H. Abedr-Rahman et al. / Journal of Forensic and Legal Medicine 49 (2017) 33e36
Recently, IPV has become a more recognized public health issue
in Jordan due to the openness of the Jordanian community and a
more liberal view of the role of women in society. Moreover, family
protection law placed that it is a mandate for any health service
provider to report any incident of domestic violence have been
encountered to the responsible authority,7 in addition different
governmental organizations have played a role in increasing public
awareness of these issues.8 Forensic medical practitioners have also
contributed to national awareness raising initiatives.2
Evaluating the seriousness of physical injuries in beaten wives is
one of the critical roles of forensic medicine in Jordan. Forensic
medicine has much to contribute to fill the gaps between the health
service that victims need and the collection and documentation of
forensic evidence if wishing to pursue their case for criminal or civil
justice.9
One essential element of forensic reports for physical violence
cases is the estimation of the temporary period of incapacity
(inability of the person to perform daily tasks due to the injury, or
harm) which in turn will largely depend on the severity of the
injury and its impact on the individual's health.
According to the Jordanian Penal Code articles 333e334 & 344,10
the period of incapacity is divided into three categories:

Period of incapacity that doesn't exceed 10 days (part 2 of article
334).

Period of incapacity that doesn't exceed 20 days (part 1 of article
334).

Period of incapacity that exceeds 20 days (article 333 and part 1
of article 334).10
The final judicial judgment depends greatly on this period, and
the penalty increases with the increase in the period of temporary
incapacity as follows:

If the period does not exceed 10 days, legal action can only be
taken based on a written or oral complaint by the victim, in such
a case the complainant has the right to drop the complaint as
long as no final judgment is issued.

If the period of temporary incapacity is more than 10 days but
less than 20, then the perpetrator shall be punished by impris-
onment for a period not to exceed one year.

If the period estimated is more than 20 days, then the assailant
shall be punished by imprisonment from three months to three
years.10
Due to its importance to the judicial system in Jordan, the period
of temporary incapacity is estimated by forensic physicians in Jor-
dan depending on many factors including:

The severity of injuries documented in the preliminary report
written by the treating physician in the emergency department
just after or at the time of the assault.

The nature of the primary and the follow-up medical
management.

The period of hospitalization if needed.

The nature of injuries at the time of forensic medical
assessment.

The type of work or lifestyle of the victim.

The dependency for the victim on that particular injured part of
the body.
These factors apply to all victims of assault crimes including our
group of study; wives assaulted by their husbands. Similar legis-
lation applies in countries such as Syria,11 and the French
Republic.12
In Jordan forensic medicine has two roles, the first is an
assessment of deceased persons, and the other role is examining
the living victims of assault, some of whom are women who have
been physically abused by their husbands. The main role of forensic
physicians in these cases is describing the injuries and their
possible mechanism, estimating the temporary period of incapacity
for the victim and clarifying this to the judicial system in a medico-
legal report.
In clinical practice, there is much misuse and confusion among
health professionals of common forensic terms such as bruising and
ecchymosis and differences between lacerations and cuts.13 This
exhibits the importance of forensic medicine reports in cases of
IPV; using proper forensic terms to describe injuries and providing
opinions on the circumstances in which the injuries may have been
sustained. There is limited literature talking about a role of forensic
medicine in cases of wife abuse as a form of intimate partner
violence.
The aim of this study is to contribute to a better understanding
of the role of forensic medicine in the evaluation of physical injuries
which are sustained by women allegedly abused by their male
partners and in the collection of evidence in such cases.
2. Materials and methods
A total of 234 forensic medical reports were reviewed for a six
year period (2010e2015). The reports were prepared by the
Forensic Department of Jordan University Hospital, which provides
forensic services to people living in the north of Amman; a popu-
lation of about 1 million inhabitants, the majority are Muslims.
These reports were specifically about women who alleged they had
been physically assaulted by a male family member. Out of the
original number, 158 forensic reports (67.5%) concerned Jordanian
women who reported physical assaults from their husbands; the
religious and cultural norms dictate that husbands are the only
accepted form of intimate partners in Jordan. In the remainder of
the cases (32%), the alleged assault was perpetrated by another
male family member; a father or a brother.
This study is confined to cases of physical assault on women
allegedly committed by their husbands and who were referred to
the forensic department following a judicial request from the court
or the police. The purpose of the referral was to document the in-
juries sustained and provide an opinion on the possible mechanism
and the estimation of the period of temporary or permanent in-
capacity, an original signed copy of the forensic report is sent to the
court file, and a copy is saved in forensic department archives.
The following data in both reports (the preliminary report and
the forensic report) was retrieved, including the age, the place of
residence, and type of injuries. Also the anatomical distribution of
injuries, their severity, and medical management, in addition to the
possible mechanism of the injury, the weapon involved and the
period of incapacity e temporary or permanent. These reports did
not mention the religion of the victim or the socioeconomic status.
Moreover, no information was given from the judicial authorities
about drug problems the victim or the assailant might have, and no
other data about the assailant could be retrieved.
If the victim wishes to sue the offender, then a judicial request
from the court or the police is given to the victim with a copy of the
preliminary medico-legal report to contact the forensic depart-
ment. This request usually asks the forensic medical practitioner to
reexamine the victim and provide the court with a medical opinion
about the injuries sustained, and their severity represented by the
period temporary incapacity or permanent disability. Moreover,
clarifying the possible tool and mechanism. A forensic medico-legal
report is generated following the consent of the subject. Forensic
physicians depend on the primary medical treatment, the
 H. Abedr-Rahman et al. / Journal of Forensic and Legal Medicine 49 (2017) 33e36 35

preliminary medical report in addition to the current manifesta- Table 2

tions in giving their opinions. The judicial authorities rely heavily Obvious physical injuries sustained in the 139 cases of abused women.

on the result of these reports in making a final judicial judgment Physical injuries Number Rate %
about the assault allegations. Bruises, abrasions
Scalp 52 22%
3. Results Neck 19 8%
Nose 8 3%
Black eye 29 12%
Over the period of this review (2010e2015) there were an Ear 2 1%
average of 26 cases each year. Tympanic membrane perforation 2 1%
Table 1 shows the distribution of the 158 women who were Upper limbs 65 27%
assaulted by their partners. All of the women were between 18 Lower limbs 37 15%
Back 8 3%
years and 59 years old; nearly 90% were below 40 years of age.
Chest 4 1.7%
Of 158 reported cases, 139 (88%) had obvious injuries, and 19 Cut wounds in different sites 6 2.3%
(12%) had no obvious injuries. Of those with injuries, 63% had Total soft tissue injuries 232 96%
multiple injuries including different anatomical sites and/or Fractures:
Upper limbs 4 2%
various types of trauma. Table 2 shows the injuries in these 139
Nasal 2 1%
cases. Total fractures 6 3%
During the original assessment, it was found that twelve women Burns:
(7.6%) were pregnant at the time of the assault. In these cases the Scald 1 0.33%
history given by pregnant women included being struck in the Chemical 1 0.33%
Cigarette 1 0.33%
abdomen, suffering from abdominal pain, vaginal bleeding or both.
Total burns 3 1%
Only one abortion documented and that was in the first trimester of Total injuries 241 100%
pregnancy.
There was a lack of recorded data in most of the reports about
One case was with permanent disability, and according to article
the mechanism of injury and the weapon used. Only in 29 cases
335 if the harm causes bodily disfigurement which is permanent or
(18.4%) the following details were retrieved: blunt object e 7 cases,
has a permanent appearance, the perpetrator shall be punished by
sharp object e 2 cases, kicking e 7 cases, biting e 4 cases, hair
temporary imprisonment with hard labor for a period not to exceed
pulling- 4 cases, scalding e 1 case, chemical burn e 1 case, cigarette
ten years.10
burn e 1 case and strangulation attempt e 2 cases.
Injuries were most commonly on the head, neck and face (47%)
In 15 cases (9.5%) women reported that they were beaten
followed by upper limbs (27%), Again these findings are similar to
repeatedly.
other studies that showed head and neck and face injuries were
The period of temporary incapacity was judged to be in the
most frequent ranging from 40 to 50%.14e16 Upper limbs may be
range of 1e14 days with an average of 3 days.
injured when the individuals attempt to defend themselves.17
In 39 cases (24.68%) there were no period of incapacity esti-
In 87 cases (63%) there were multiple injuries at different sites of
mation due to the absence of apparent physical injuries at the time
the body. This finding might indicate a sustained assault, multiple
of examination as well as in the preliminary medical report from
assaults or the aggressor's desire to leave visible injuries.18
the emergency room.
There were 19 cases (8%) of neck injuries, in the form of abra-
One case was identified as sustaining permanent disability;
sions and contusions. It is unclear if these occurred in the setting of
facial disfiguration due to chemical burns.
attempted strangulation or if they were sustained randomly as part
of a general assault or after strangulation attempt, this could not be
4. Discussion
retrieved from the reports although some studies have shown that
the prevalence of strangulation in IPV ranged from 15% to 68%.13
In this selected group of women, IPV mainly presented with
In many cases of medico-legal evaluation, the history of events
minor and non-serious injuries (most commonly soft tissue in-
may be absent or incorrect. Experienced forensic medical practi-
juries), this is in line with other studies.13 These injuries were
tioners may be able to assist the court with a better understanding
mainly caused by a blunt object even though the exact implement
of what happened or what did not happen and most frequently, a
could not be identified in the majority of cases. The period of
range of scenarios that are feasible. It is important to note that
temporary incapacity was between 1 and up to 14 days; all were
forensic practitioners should only work with facts (e.g. the injury)
estimated less than 20 days, putting them in the cell of article 333
and their opinions should be able to withstand close scrutiny.13
of Jordanian penalty code, meaning lower penalty. Most cases had
With respect to the few number of cases (an average of 26 cases
been treated as an outpatient or in the Emergency Department
per year) of abused wives that referred to the forensic department
before coming to the forensic department and none needed
in Jordan University, it might be explained with the following
admission to hospital, which is in line with the low physical seri-
related to the situation in Jordan:
ousness of the observed injuries, the psychological state of the
victim is not usually addressed by the forensic physician.

In less than 2.5% of cases where women were assaulted, was an
attempt made to call police or a lawyer, this was mostly driven
Table 1 by a desire to avoid disclosure of her private life and to prevent
Age groups of assaulted women. the adverse impact of social stigma.2
Age number rate

The unemployment rate among females in Jordan in the first
quarter of 2015 reached 22.1% compared to 11.0% of males for
18-28 years 73 46%
the period.19 Women may choose to stay in an abusive rela-
29-39 years 68 43%
40-49 years 14 9% tionship for financial and social reasons and out of concern for
50-59 years 3 2% their children, stigma or fear of losing custody of children
Total 158 100% associated with divorce.20
36 H. Abedr-Rahman et al. / Journal of Forensic and Legal Medicine 49 (2017) 33e36

Divorce is one of the worst nightmares for women in Jordan. An
abused woman cannot request a divorce, because she will be
socially ostracized and accused of being rebellious and not car-
ing about her family and children.2 Divorced women, the elderly
and widows are most likely to experience poverty and depri-
vation, and they are often forced to depend on relatives, friend,
or welfare support.5
4.1. Role of forensic medicine reports in cases of IPV
Women seek judicial intervention (and hence forensic reports)
for reasons such as an application for divorce, ensure that the
perpetrator will be brought to justice and to protect herself and her
children. The medico-legal reports written by forensic physicians
can provide a clear, unambiguous and objective assessment of the
findings following an allegation of IPV. The report answers specific
judicial questions about the period of temporary or permanent
incapacity, and about the possible mechanism of injuries and the
tool that might cause these injuries and if this victim needs further
medical evaluation or treatment from her treating doctor. This is
beneficial for police and prosecutors who are investigating an
offense and for the courts who are obliged to deliberate on issues of
innocence or guilt and any associated penalties. The objectivity of
these reports assists in removing decisions based on prejudices,
bias, or personal feelings.
Minor injuries, although harder to detect and assess, are
important from a criminal justice standpoint.17 The description and
documentation of physical injury in a medico-legal report may be
supportive to the woman's allegations. The severity of these in-
juries can be assessed by the doctor and so give the court a clue
about the seriousness of these injuries through the period of
temporary incapacity to perform daily tasks. Sometimes testimony
in court about this report is needed, and the doctor can explain the
possible mechanism of these injuries.
It is important for society to understand the seriousness of
physical abuse and its personal, social and legal consequences.21
Forensic medico-legal reports should provide a comprehensive
capture of the spoken word. The examination findings and the
collection of evidence, this will allow for an objective assessment of
the mechanism and circumstances in which the injuries were
sustained and the implications of those injuries. If required, these
reports will be the basis of evidence provided to the courts.22 Such
evidence will provide the wider community some knowledge about
the consequences of this behavior.21
5. Conclusion
Violence against women is an endemic public health and human
rights issue. Forensic medicine is an important tool that attempts to
respond to questions raised by the legal system when it addresses
such cases. The forensic involvement should incorporate accepted
scientific methodology and norms to analyze events or physical
items. The forensic report may be able to clarify the mechanism or
weapon used by the offender. It might also assist in the delivery of
social and follow-up services. Women should be aware of their
rights to access a forensic service when they face any form of
violence. Forensic medicine is a small but important component of
the program to reduce the incidence and impact of intimate
violence in the Jordanian society.
Conflicts of interest
All authors declares that they have no conflict of interest.
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Acknowledgement
We thank David Wells, (Associate Professor, Depts. of Forensic
Medicine & Pediatrics, Monash University, Victorian Institute of
Forensic Medicine) for assistance in reviewing the paper and for
comments that greatly improved the manuscript although he may
not agree with all of the interpretations/conclusions of this paper.
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