3. Materials

Case Summary/Referral #01

(distribute to students who conduct the interviews)

(Weak physical evidence, strong psychological evidence and strong historical evidence; medical evaluation 4 months after alleged torture)

Note: This case example is written specifically for a female role-player. All names included in the narrative are fictitious.

Name: Mrs. Asha Ali Yousif
Date Reporting to the Center: dd/mm/yyyy (today’s date)
Date of Birth: dd/mm/yyyy (age 35)
Age: 35 years-old
Marital Status/Children: Married, widow, 13 year-old daughter
Religion: Muslim
Ethnic Group: Fur
Profession: Teacher
Political/Social Affiliation: None
Date and Place of Detention/Assault: dd/mm/yyyy (4 months prior to the exam date) in a field 2 Km east of Kalma Camp; dd/mm/yyyy (2 days following the alleged assault) at Nyala Wasat (Central) police station.
Period of Detention: Less than 2 hours on both occasions

Trauma History:

On dd/mm/yyyy (4 months prior to the exam date), at approximately 2:00pm, Mrs. Yousif, her 13 year-old daughter, and two other women were attacked by armed men in military uniforms whilst fetching firewood several miles from Kalma camp. They were all beaten and raped. One of the women, Fatima Ibrahim (22 yrs), was shot and killed while attempting to escape. Several days later, Mrs. Yousif reported the incident to police at Nyala Wasat (Central) Police Station. Police refused to file a case. One of the police officers, Omer Mohamed Suliman, beat and sexually assaulted her. She then went to Nyala Hospital, but was refused a medico-legal evaluation since she did not have Police Form 8 (medico-legal form for treatment of injuries caused by a criminal act), formerly a requirement under Sudanese Law. A friend in Kalma was worried about her and insisted that she get help. The friend also suggested that Mrs. Yousif and her daughter take legal action against their perpetrators.

Alleged Perpetrators:

Men in military uniform, also, police officer Omer Mohamed Suliman from Nyala Wasat (Central) Police Station.

Reasons for visit:

Mrs. Yousif indicated that she would like to get help for her daughter and herself, but she was not sure about taking legal action against their perpetrators.

Effects of Torture:

Insomnia, nightmares, inability to concentrate, profound sadness, frequent headaches and decreased appetite. She is also very troubled about her daughter’s health and future.

Case Narrative #01

(distribute to role-players only)


Note: This case example is written specifically for a female role-player. All names included in the narrative are fictitious.

Case Summary/Referral Information:

Name: Mrs. Asha Ali Yousif
Date Reporting to the Center: dd/mm/yyyy (today’s date)
Date of Birth: dd/mm/yyyy (age 35)
Age: 35 years-old
Marital Status/Children: Married, widow, 13 year-old daughter
Religion: Muslim
Ethnic Group: Fur
Profession: Teacher
Political/Social Affiliation: None
Date and Place of Detention/Assault: dd/mm/yyyy (4 months prior to the exam date) in a field 2 Km east of Kalma Camp; dd/mm/yyyy (2 days following the alleged assault) at Nyala Wasat (Central) police station.
Period of Detention: Less than 2 hours on both occasions

Trauma History:

On dd/mm/yyyy (4 months prior to the exam date), at approximately 2:00pm, Mrs. Yousif, her 13 year-old daughter, and two other women were attacked by armed men in military uniforms whilst fetching firewood several miles from Kalma camp. They were all beaten and raped. One of the women, Fatima Ibrahim (22 yrs), was shot and killed while attempting to escape. Several days later, Mrs. Yousif reported the incident to police at Nyala Wasat (Central) Police Station. Police refused to file a case. One of the police officers, Omer Mohamed Suliman, beat and sexually assaulted her. She then went to Nyala Hospital, but was refused a medico-legal evaluation since she did not have Police Form 8 (medico-legal form for treatment of injuries caused by a criminal act), formerly a requirement under Sudanese Law. A friend in Kalma was worried about her and insisted that she get help. The friend also suggested that Mrs. Yousif and her daughter take legal action against their perpetrators.

Alleged Perpetrators:

Men in military uniform, also, police officer Omer Mohamed Suliman from Nyala Wasat (Central) Police Station.

Reasons for visit:

Mrs. Yousif indicated that she would like to get help for her daughter and herself, but she was not sure about taking legal action against their perpetrators.

Effects of Torture:

Insomnia, nightmares, inability to concentrate, profound sadness, frequent headaches and decreased appetite. She is also very troubled about her daughter’s health and future.

1. Identification Information:

My name is Asha Ali Yousif, and I am 35 years-old.

Additional Information:
  • Date of Birth: dd/mm/yyyy (age 35)
  • Citizenship: Sudanese
  • Marital Status/Children: Married, widow, 13 year-old daughter
  • Place of Birth: A village east of Nyala
  • Place of Residence: Kalma IDP Camp, 17 Km. east of Nyala, southern Darfur state
  • Highest Level of Education: completed high school
  • Occupation: Former teacher, currently unemployed
  • Religion: Muslim
  • Identification Document Presented: None
  • Ethnic Group: Darfurian, Fur Tribe
  • Physician Examiner’s Name and License #: (To be fill out by the examining physician)
  • Individuals Present in the Examination Room and Reason for Presence: (To be fill out by the examining physician)
  • Language spoken: Fur
  • Name of Interpreter: None (To be fill out by the examining physician)
  • Restrictions Noted: (To be fill out by the examining physician)
  • Detainee Status: No (To be fill out by the examining physician)

2. Past Medical/Surgical History and Psychosocial History

Past Medical/Surgical History:

Before my encounters with soldiers and police, I had no medical problems, no major illnesses or injury, no surgery, broken bones or head injury. I am not on any medications, except aspirin for headaches and pains in my body. I have never used any illegal drugs and I do not drink alcohol. I do not smoke either.

Psychosocial History:

I never had any mental problems, nor has anyone in my family. I am the oldest of four children. Although my family was very poor, we were able survive with the money that my parents made working odd jobs. I was able to go to school and become a teacher. My husband was also a teacher, but he and my father were killed about a year ago, when the Sudanese Army and Janjaweed militia burned my village to the ground. After that, my daughter and I went to Kalma camp.

Prior Medical Evaluation:

I went to Nyala Hospital after my daughter and I were attacked by soldiers, but the doctors refused to examine me because I did not have official papers from the police. On the same day, I visited a clinic in Kalma, and they gave me some aspirin for my headaches. I was planning to tell them about what happened to me, but I was too afraid after my experience with the police.

3. Trauma History

NOTE: Provide information in parentheses only if specifically asked by the interviewer.

About a year ago, the army and militia came to our village and burned it to the ground. They accused us of supporting the SLA and shot some of the men including my husband and father right in front of us. My daughter and I have been living in Kalma for about one year. Since I lost my husband, my home and my job, we don’t have enough to survive. Sometimes we cut grass in nearby fields to sell. We also have go outside the camp to wash our clothes and collect firewood. We know this is dangerous, but we do not have a choice. My daughter and I have been through a lot. When they burned our village to the ground, they threatened to rape the women. This happened to some of the women in our village, but we were lucky that day. Since then, I thought it was safer for my daughter and me to be together. Now I know this is not true.

On dd/mm/yyyy (4 months prior to the exam date), I went to fetch firewood with my daughter and two other women from Kalma. We had done this many times without any problems, but on that day, we were attacked by 10 men in military uniforms. They had guns and threatened to kill us if we tried to run away. They started insulting us, calling us slaves and saying that this land did not belong to us. I pleaded with them not to hurt my daughter, Salwa. One of them said: “Don’t worry she will soon be the mother of an Arab child.” Salwa was very frightened and began to cry. They slapped her and told her to take off her clothes, but she did not. I tried to wrap my arms around her to protect her, but they pulled her away from me. I was stuck [above my left eye] with the butt of a gun and fell to the ground They continued to punch and kick me. One of the other women, Fatima Ibrahim, who was also from our village, tried to run away, but they shot her in the back. She was not moving. One of the men walked over to her and shot her in the head. “This is what happens when you do not obey your masters,” he said. One of the men started raping me while several others threatened me with their guns. I could hear my daughter screaming, but could do nothing. After the third one had raped me, he spit on me and kicked me very hard on the right side of my face. Later I noticed it was very swollen [in front of my right ear] and I was unable to move the right side of my face [or close my right eye] for about 2 weeks. They said nothing else and left us there naked. My daughter was badly bruised on her face and there was blood running down her legs. I tried to reassure her, but we both just wept for a long time.

After 2 days, I decided to go to the police station in Nyala to make a complaint. I waited a long time and then was placed in a room with a police officer. His name was, Omer Mohamed Suliman. I told him what happened and he laughed. “I find this hard to believe,” he said. Who were the men that you say did this?” he asked. I told him that I did not know, but that they were in military uniforms. He refused to believe me and said: “You know nothing and have no witnesses. If you were raped, then show your injuries. His tone began to change and insisted I take off my clothes. He slapped my face and called me a liar. He grabbed me and started pulling off my clothes. He touched my breasts and between my legs. I yelled for help. He stopped when another police officer peered in through the door. After that, be began beating me with a hose on my back and arms. He said, “If you tell anyone, your daughter will find you dead.”

From the police station, I went to Nyala Hospital. I told the doctor what happened in the field. I was too afraid to tell him about what happened at the police station. He said there was nothing he could do, since I did not have official papers from the police requesting an examination.

A few days later, I visited a clinic in Kalma and they gave me some aspirin for my headaches and a bandage for the cuts I had above my left eye and on the back of my left hand. I was planning to tell them about what happened to me, but I was afraid to after my experience with the police.

Recently, a friend in Kalma insisted that my daughter and I get some help. She can see that we are very troubled. She also suggested we take legal action against those who hurt us.

4. Review of Torture Methods

The following history should be revealed only on further questioning, unless asked in the context of the trauma history:
  • Sexual Assault:
    • Condoms were not used by any of the perpetrators.
    • No anal intercourse
    • No menstrual period for the past three months
    • [History of infibulation prior to marriage and reinfibulation after the birth of her child.]
  • Head trauma: handgun butt to the left side of her face, just above the left eyebrow, no loss of consciousness. There was blood on my face and a cut above my left eyebrow. The area was very tender and swollen for about one to two weeks.
  • Laceration injury to the dorsum (backside) of the left hand: I am not sure how or when this happened but I noticed that it had bled. The injury became infected, swollen and drained pus about a week later. I was treated as an outpatient with antibiotics. The doctors opened it and packed it with gauze. Eventually it healed.
  • The review of torture methods is negative for the all other torture methods, physical and psychological.

5. Physical Symptoms (Acute and Chronic) and Disabilities

Acute Symptoms:

  • Blood in the urine for about 3 days following the incident, then it resolved completely. No vaginal discharge, no menstrual period since the assault.
  • Unable to move the right side of my face [or close my right eye] for about 2 weeks.
  • Observed bruises where beaten, black and blue marks that resolve after about 2 weeks. [IF ASKED, RESPOND: Some of the bruises on the back and chest were long in shape, like the hose that was used to beat her. Each of the bruises had two parallel lines about 1-2 cm wide and a clear area in the middle of the lines.]

Chronic Symptoms:

  • Chronic headaches [IF ASKED, RESPOND: in the front of the head, throbbing, lasts a few hours, once to a few times per day, improved with acetaminophen, similar headaches in the past with stress, but only occasionally.]
  • Difficulty concentrating and irritable
  • Having problems sleeping (see psychological evaluation below)

Disabilities:

  • None noted

6. Psychological Evaluation and Mental Status

Mental Status:

Mrs. Yousif was appropriately dressed and groomed and looked her stated age. She was alert, fully oriented, pleasant and cooperative throughout the evaluation. There were no gross abnormalities in movement or posture on observation. She appeared to possess average intellectual ability, with good insight and judgment. Her speech was clear and fluent. There was no evidence of delusions, hallucinations or psychotic thought processes. Memory was intact. Attention and concentration appeared intact. Her mood and affect conveyed a watchfulness and some apprehension, and were congruent, but she was open enough to be able to describe her experiences willingly. At times, she wept when she was discussing emotionally painful aspects of her experience. There was no evidence of suicidal or homicidal ideation.

Psychological Findings:

1. Symptoms of Post-traumatic Stress Disorder:
  • Persistent Re-experiencing of Traumatic Events and Avoidance Behaviour: Mrs. Yousif reported frequent nightmares from which she awakens in a sweat with her heart pounding. The nightmares usually refer to a grave threat to herself and her daughter. The content of her dreams includes trauma-related material to varying degrees but usually not precise repetitions of actual events. For example, the night prior to the examination she dreamt that thieves had entered her domicile carrying knives, beating her with sticks, and threatened her and her daughter. She awakens from her nightmares gripped with fear and finds it difficult to fall asleep again. She often experiences intrusive recollections of the sexual assault that she experienced. Mrs. Yousif indicated that she has a profound sense of guilt over what happened to her daughter and is often preoccupied with thoughts of what she should have done differently. Sometimes when she sees police or security forces, she feels anxious and starts thinking about what happened to them. She tries to avoid intrusive recollections through prayer. Also, she avoids talking to her daughter and others about what happened to them as it often precipitates recollections of her abuse and makes it difficult to fall asleep.
  • Persistent Symptoms of Increased Arousal: As mentioned above, Mrs. Yousif suffers from difficulties falling asleep and from poor sleep throughout the night, often waking up hourly throughout the night. In the morning, she often feels exhausted. She also startles easily, feeling very jumpy in response to any kind of sudden noise. She indicated that: “Sometimes when I am in a room like this, I feel that someone may just storm in.” She feels that her concentration is impaired since being raped. For example, she used to like to read and talk to friends, but now has difficulty following conversations and reading. Often she forgets that she has already taken her headache medicine and subsequently takes a second dose. She misplaces things and sometimes takes days to find them. She is no longer good with directions and indicated that she cannot find her way even after a second time. “I have trouble following what is said in conversation and forget names of people I know, or what I had eaten the previous night,” she said. She sometimes feels irritable and has outbursts of anger without a clear reason. Her daughter has been unable to speak since the rapes; she spends hours alone staring straight ahead and she seems to be unaware of her surroundings. Mrs. Yousif is worried that her daughter is losing her mind. She tries to coax her daughter to eat and talk with her and she tries hard to keep her own despair secret in order to reassure her daughter. Nevertheless, Mrs. Yuosif finds that she has outbursts of anger and crying that she cannot prevent. Somatic Complaints: Mrs. Yousif suffers from frequent headaches that respond well to aspirin.
2. Major Depression: Mrs. Yousif demonstrated symptoms of major depression, including depressed mood, diminished interest or pleasure in activities, decreased appetite resulting in weight loss [IF ASKED, RESPOND: about 4 Kilos], insomnia, fatigue and loss of energy, frequent crying and difficulty concentrating. She denied suicidal ideation and suicide attempts. Mrs. Yousif explained that her sadness stems largely from her inability to protect her daughter and what this means for her future. Though she wants justice for what has been done to them, she is afraid to take legal action.  In the days after she had been raped, she spent hours bathing herself to cleanse herself of the shame she felt. Mrs. Yousif blames herself for what happened. She regrets not insisting that her daughter stay in the camp. She also expressed considerable anger over the camp-related security issues. She asked, “Why do we have to go where it is dangerous to get what we need?”

7. Physical Examination (All photos taken on the day of examination)

NOTE: Images of “virtual physical examination” findings will be presented in a separate room using PPT slides

Slide #1: Note 1 cm hyperpigmented, linear scar above left eyebrow consistent with an old laceration injury.

Slide #2: Note complex, atrophic scar, approximately 4 x 6 cm over the dorsum of the left hand associated with hypopigmentation and subcutaneous fibrosis.

8. Interpretation and Conclusion

Per trainee’s assessment
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