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Cases of systematic violent assault and torture overwhelm health professionals
Zimbabwe Association of Doctors for Human Rights (ZADHR)
June 17, 2008

ZADHR is deeply concerned about the continuing violent trauma being inflicted on the Zimbabwean population. The escalation in numbers and severity of cases of systematic violent assault and torture during May was of a scale which threatened to, and for brief periods did, overwhelm the capacity of health workers to respond. Both first line casualty officers and specialists, especially surgeons and anaesthetists, to whom patients were referred had great difficulty in adequately managing the burden of serious physical trauma.

ZADHR commends the efforts of health professionals in Zimbabwe who continue to provide the highest possible quality of health care to victims of violence under extremely difficult circumstances.

In addition to individuals with significant physical injuries, members of ZADHR saw over 300 displaced patients with medical conditions such as pneumonia or asthma, or psychiatric diagnoses, in particular anxiety and depression, and many with chronic conditions such as diabetes whose medication had been lost or destroyed when the patients were violently forced, by arson or the immediate probability of injury or death, from their homes.

It is certain that a far greater number of patients will have been attended to by other members of the health professions, especially nurses, but will never have been near a doctor. Psychiatric and social problems may result in an even greater burden on health care workers than the frequently complicated but relatively clear-cut diagnoses such as fractures.

One thousand and seven patients were seen during the month of May. 119 patients sustained fractures, more than 50 of which were recorded as confirmed on x-ray. The remainder were clinical diagnoses, either with clinically evident physical distortion or with the broken ends of bone protruding through an external wound (compound fracture). 36 patients had fractures of the ulna (the inner or medial bone of the forearm), 27 of the radius (the outer or lateral bone of the forearm). Of these 13 had fractures of both radius and ulna, 4 had fractures of the ulna bones of both arms, and one patient had both radius bones broken. Seventeen further cases of fractured wrist, forearm or elbow were recorded.

Most of these fractures will have been sustained in attempts to defend the face and upper body from violent blows with a weapon such as a heavy stick or iron bar. As evidence for the sustained severity of the violence of many of the assaults there were several cases of multiple fractures to different areas of the body, for example one patient with fractures of the left ulna, right radius and a metatarsal (small bone of the foot), and another with a patella (knee cap) and bilateral ulna fractures. Three patients had skull fractures and 9 had broken ribs. Two of these cases had multiple rib fractures associated with haemothorax (bleeding into the space between the lungs and the chest wall, probably caused by penetration of the broken end of a rib, which can be rapidly fatal).

Forty five cases of fractures of the small bones of the hands (31) or feet (12), both hands (1), or both hands and feet (1) were recorded. Many patients sustained fractures to several bones, again witness to the sustained brutality of the assaults, and consistent with reports of hands and feet being pounded by a pestle (mutswi) in a mortar (duri).

At least two pregnant women, one 24 and the other 32 weeks gestation, were systematically beaten on the back and buttocks, resulting in extensive lacerations, bruising and haematoma formation. They were among the 312 cases classified as having severe soft tissue injury. This category includes widespread severe bruising, haematoma (collection of blood) formation, necrosis (tissue death), sepsis (infection, usually where there is extensive skin loss or abscess formation in a haematoma), or deep and extensive lacerations (cuts or wounds).

One patient, beaten extensively on the shoulders, back, buttocks and thighs, was also struck in the face and suffered a leak of vitreous humour (the transparent gel-like substance behind the lens of the eye) resulting in blindness.

There have been reports of over 53 violent deaths up to the end of May 2008. However although post-mortem examinations are legally mandatory in such cases, few are being undertaken and therefore cases are only rarely confirmed by doctors. However 7 of these deaths occurred in hospital following admission for injuries sustained during violent assault or torture and a further three did have post-mortem examinations. One confirmed a broken neck as the cause of death. A second died as a result of intracranial haemorrhage (bleeding inside the head) with extensive facial injury indicative of having been beaten on the head. The second died as a result of probable acute renal failure secondary to extensive myolysis (destruction of muscle) and soft tissue necrosis with evidence of falanga and widespread whipping type injuries. In the third case, the body was found several days after abduction, and although it was partially decomposed, the detailed post-mortem which was carried out did not reveal evidence of beating or torture. The estimated time of death (nearer to the time of abduction rather than when the body was found) and the witnessed method of abduction in which the head was forcibly extended, the face covered and, with the victim prone, several attackers putting their weight on his back, are consistent with death due to asphyxia.

There has been a gross surge in both the quantity and severity of injury. Fracture cases alone increased three-fold in number from April to May. These documented cases speak for themselves in terms of the urgency of the need to stop the violence which is sweeping large areas of the country. ZADHR reiterates its call on all parties to cease the use of assault and torture intimidation, victimisation or retribution. In addition to cessation of violence there are other urgent needs for affected individuals including shelter, food and water for internally displaced persons and mental and physical rehabilitation for victims of violent trauma.

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