An insufficient medico-legal system for the city with the highest crime rate

Only three medico-legal centres are operational across Karachi

KARACHI: With only three medico-legal centres operational in a city that has a population of more than 20 million and the highest crime rate in the country, there is a dire need to strengthen the medico-legal system in Karachi.

The annual budget of the entire medico-legal section of the health department stands at not more than Rs0.7 million, while no medical equipment is being provided to officers to perform their daily services.

In Karachi alone, more than 25,000 cases are handled by medico-legal officers (MLOs) in a year in the three major healthcare facilities of the city. The health department is responsible for providing medico-legal facilities in nine sub-stations established at all the general hospitals in Sindh. However, due to a lack of infrastructure, trained doctors and staff, the patients seeking medico-legal certificates only have the option to visit Civil Hospital, Karachi, Jinnah Postgraduate Medical Centre (JPMC) or Abbasi Shaheed Hospital.

The overall shortage of doctors in the province has started reflecting on medico-legal services of the health department, which will most likely collapse, said a senior doctor serving at a medico-legal centre in Karachi.



"Medico-legal services are an integral part of prosecution," said Additional Police Surgeon Dr Rohina Hasan, while speaking to The Express Tribune about the importance of MLOs. She added that they provide medical services for the legality of the cases. "Although the medico-legal section is a part of the Sindh government's health department, its primary objective is to help the police department in their investigations," she said.

According to Dr Hasan, unnatural deaths or injuries are referred to the medico-legal section, as the MLOs decide about the nature and cause of injuries in assaults, road accidents and poison or bullet inflicted injuries or deaths. "Had there been no medico-legal services, no one would get justice and bodies would not even be released, [as medico-legal formalities would not be completed]," Dr Hasan added.

Medical examinations of patients are conducted at medico-legal centres, from where medico-legal certificates are issued. Besides this, MLOs are also responsible for conducting post-mortems and exhumations, issuing death certificates and, at times, appearing before a court to give statements.



According to Dr Hasan, the medico-legal section in all the three major hospitals is so understaffed that they do not have replacements when one of the doctors goes on leave. Currently, she said, no specialised qualification is required to become an MLO. She said that training of six months under senior doctors after the completion of MBBS is enough for them to start working as an MLO.

The medico-legal section works under medical jurisprudence law and relevant MLOs conduct autopsies and exhumations under the Pakistan Penal Code (PPC). They issue certificates based on different sections of the PPC, depending on the nature of the injuries inflicted on the body, explained one of the senior medical officers working at JPMC.

Apart from Karachi, casualty medical officers have the power to issue medical certificates and provide medico-legal services, which do not fall under the jurisdiction of the police surgeon of Sindh. Currently, there are no permanent police surgeons in the province. However, an additional police surgeon is acting as a police surgeon and has drawing and dispensing powers.

Only four female MLOs in the entire city

According to a female medico-legal officer (MLO), as per the Supreme Court's ruling of 1996, all female victims will only be examined by female doctors and staff. However, due to the non-availability of female staff in the medico-legal section, the post-mortems of female victims are conducted by female MLOs in the presence of male staff.



There are only nine sanctioned posts of female MLOs in Karachi, whereas the working force has decreased to five. Out of these sanctioned posts, four are for senior MLOs of BPS-18 and five of BPS-17. The existing hierarchy and sanctioned posts to provide medico-legal facilities at public hospitals were approved more than 30 years ago when the crime rate and population were relatively very low.

Currently one of the doctors is on medical leave, leaving behind only four female MLOs for the entire city. Other than this, there are no female MLOs available to work in the night shift due to a shortage, due to which female patients are left unattended.

Out of four female MLOs at government hospitals, one is serving at the JPMC while three are serving at Civil Hospital, Karachi. Abbasi Shaheed Hospital, which is one of the major public hospitals in the city, does not have any female MLO and a grade-19 additional police surgeon has been performing duties instead of a female MLO. In the absence of the additional police surgeon, the patients and bodies are referred to Civil Hospital, Karachi or JPMC.



Speaking to The Express Tribune, police surgeon Dr Aijaz Ahmed Khokhar said the sanctioned strength should be doubled. According to Dr Khokhar, out of the total cases that they receive at the medico-legal facility, 30% cases are of female victims that are attended by only three female MLOs in Karachi.

Out of 71 sanctioned posts of male MLOs, 31 are vacant, which has resulted in late and delayed provision of medico-legal facilities, Dr Khokhar said.

"The lack of doctors and provision of facilities has resulted in our suffering," said Muhammad Ibrahim, who was waiting to get his sister examined for more than three hours outside the examination room of the medico-legal section in Civil Hospital, Karachi. Ibrahim said he came all the way from Landhi, where there are no nearby facilities providing such services.

An official health department told The Express Tribune that the shortage of doctors in the province has resulted in a lack of applicants to fill the vacant positions in the medico-legal section. However, he said, through appointment of medical officers, this long-pending problem will be resolved in the upcoming few months.