The government’s commitment to addressing sexual violence against women and girl children in Pakistan is called into question when considering the alarming rise in reported cases and low conviction rate of rape cases. Weak law and loopholes in the justice system delay justice for the victims.

Legal and gender experts often cite ‘medico-legal loopholes’ as the primary reason behind the regrettably low conviction rate. However, little or no explanation is given as to why rape accused are still not behind bars.

The umbrella term ‘medico-legal loopholes’ covers a large number of medical, legal and investigative breaches that covertly seek to undermine the veracity of an incident of sexual violence. Among many other breaches, delays in the medico-legal examination of victims is one major factor behind perpetrators escaping. A shortage of female medico-legal officers across the country has emerged as a major hindrance in the deliverance of justice to rape victims.

Collecting timely evidence is crucial for delivering justice to a victim of sexual violence. However, the collection is hampered due to a variety of factors.

“Our hospitals lack female medico-legal officers, which creates a hindrance in medical check-ups or DNA sampling,” confirmed Justice (Retired) Nasira Javed.

Javed’s concerns are justifiable in a society where the majority of women hold strict cultural and religious beliefs concerning modesty, under which getting a pelvic examination by a male doctor can be a significant cause of shame and distress especially when the woman in question is a victim of rape and experiencing significant post-traumatic stress.

Hence, a rape victim’s unwillingness to be examined by a male medico-legal officer, in the absence of a female counterpart, would force them to delay the critical stage of the investigation. The medico-legal examination, according to forensic experts, must be carried out within 72 hours of the incident.

According to Dr Ishtiaq Ahmed Khan, supervisor at the Sindh Forensic DNA and Serology Laboratory based in the University of Karachi, a rape victim must be presented as soon as possible for the medico-legal examination, which involves the collection of vaginal and anal swabs.

“To ensure accuracy in collecting the suspect DNA, the victim should avoid taking a bath, washing their private parts and changing or washing clothes before the medico-legal exam. Any delays in collection may lead to destruction of fluid evidence which will have an effect on the investigation,” explained Dr Khan. He also highlighted that delays in examination of rape victims occurred largely due to the lack of female medico-legal facilities in government hospitals.

Officials from the Sindh Health Department maintain that there is no shortage of female medico-legal officers in the province's hospitals. Meanwhile, talking to The Express Tribune, Police Surgeon Karachi Dr Summaiya Syed revealed that medico-legal facilities were available in only three major government hospitals in the city -- namely Jinnah Hospital, Civil Hospital and Abbasi Shaheed Hospital, where only 16 medico-legal officers were available.

According to the Health Department of Sindh, only 220 medico-legal officers were available in the whole of Sindh, where violence against girl children has increased by 43.7 per cent over the past year alone. Furthermore, for a province with a female population of over 26.64 million, only 53.6 per cent of all MLO’s in Sindh were female.

The largest province, Punjab, with a population of over 60 million women, reported 94 per cent of all rape incidents recorded last year. Far from ensuring an adequate number of trained female medico-legal officers, rape investigations in public hospitals where carried out by regular doctors across cities in Punjab, where as many as 3,317 rape cases have been reported from January 1 to September 30 this year.

Professor Arif Rashid Malik, who has been serving as a medico-legal officer at the King Edward Medical College and Mayo Hospital revealed that instead of hiring medico-legal officers, medical officers from Grades 17, 18 and 19, were appointed throughout Punjab.

“Medical students receive basic forensic training during their third year of education. However, there are no medico-legal experts as such,” said Malik. Furthermore, he said that almost 6,000 medico-legal doctors were needed across Punjab, where the non-availability of MLO’s in district and primary health centres increased the burden on major teaching hospitals in the cities.

Contrary to medical doctors, the expertise of medico-legal officers enables them to conduct thorough examinations, document injuries meticulously, and interpret findings objectively, which are essential for uncovering facts in cases of sexual abuse, where the MLO’s assessment provides the foundation for legal proceedings. MLO’s are trained to identify signs of trauma, differentiate between accidental and non-accidental injuries, and preserve evidence crucial to understanding the extent and nature of the abuse.

“There is a need to recruit more trained MLO’s who have decent forensic expertise since these officers have to go to courts in connection with cases of sexual violence,” said Dr Chaudhry Ajmal, the assistant medical superintendent at the General Hospital.

Miles away, the country’s northern province of Khyber Pakhtunkhwa is home to a female population of over 16.8 million. An inquiry into the status of rape investigations tyere unveiled a shocking fact.

Despite the medico-legal officers’ irreplaceable intersectional role in identifying sexual trauma and analysing its legal implications, the designation of an MLO was entirely non-existent in K-P. A total of 1,195 cases of sexual violence were reported over the past five years, with an average conviction rate for perpetrators in cases of sexual violence against women and girl children barely 14.97 per cent.

“Unfortunately, there are no posts for medico-legal officers in K-P and its merged areas. The rape investigation duties of MLO’s are being performed by the Civil Medical Officer (CMO) in public hospitals. However, often times the CMO is unable to issue a timely medico-legal report for rape victims since they are busy with the patients in the emergency and casualty departments. Due to the lack of MLOs, the conviction rate for cases of rape is very low,” revealed Professor Dr Hakim Afridi, Chairman of the Department of Forensic Medicine at the Khyber Medical College.

Afridi went on to highlight how all officials would visit the forensic lab in Peshawar whenever a high profile rape case was reported. However, no one tried to resolve the actual problem by recruiting MLOs at all hospitals to improve the criminal justice system for rape victims.

“The forensic lab in Peshawar is working with limited resources since only a budget of Rs1 crore has been reserved for us in the annual budget, with which we have to train medical staff. There is a dire need of a state-of-the art forensic lab for training MLO’s. I have also tried to convince the government to introduce MLOs in K-P and its merged areas,” added Aridi, who revealed that in 2024 the forensic lab investigated 73 rape cases. However, due to the lack of MLOs the conviction rate in cases of sexual violence against women was just five per cent.

According to Imran Takkar, a child’s rights activist from Peshawar, without MLOs, abuse cases often lacked the precise documentation and scientific evidence needed to support legal claims. “This gap can result in compromised investigations, leaving room for perpetrators to evade accountability, denying victims the justice they deserve. For abused children, the lack of an MLO's involvement often means that critical injuries or signs of trauma may be overlooked or misinterpreted. In turn, courts may struggle to recognise the full extent of harm endured by these young victims. The absence of expert medical evidence also weakens the prosecution’s case, leading to a greater risk of acquittals and an erosion of trust in the justice system,” said Takkar. He pointed out that the absence of skilled medico-legal officers (MLOs) in cases of abuse severely undermined justice for vulnerable victims, especially children.

Speaking of undermining justice for rape victims, apart from delays in the performance of medico-legal examinations, specific outdated practices like the two-finger test, which interpret signs of sexual trauma based on the virginity of the woman, have also weakened the veracity of a victim’s claims.

According to Dr Shazia, a MLO at the General Hospital, as per the directives of the Lahore High Court in 2021, the virginity test is no longer conducted the way it was done earlier in Punjab. “Now, when a rape case is reported, forensic tests are conducted as per the instructions of the High Court, and samples of the victim are obtained and sent to the forensic lab for testing,” denied Dr Shazia.

“Despite being widely criticised and deemed scientifically invalid, the invasive and degrading ‘two-finger test’ is sometimes still used in assessments. This practice violates the dignity and privacy of the victim and provides no valid information regarding rape,” differed Muhammad Ali Sarang, a women’s rights activist, who also highlighted the fact that the absence of modern, trauma-informed examination techniques was a major barrier in ensuring justice for survivors.

Sarang further revealed that there is a lack of standardised protocols for examining rape survivors, leading to inconsistent evidence collection, mishandling of samples, or delays that compromise the integrity of evidence. “Many medical professionals lack training on how to handle cases of sexual violence sensitively and effectively, leading to inadequate documentation and failure to collect critical evidence,” opined Sarang.