Physicians are often the first to be confronted with the consequences of violence. Victims are sometimes afraid to report to the authorities concerned, particularly when the population affected is vulnerable (refugees, prisoners, civilian victims of war etc.). In such a situation, the physician should try to determine if the event was isolated or part of larger scale violence (e.g. systematic rape).
Faced with sexual violence, the physician is obliged to complete a medical certificate for the benefit of the victim, irrespective of the country in which (s)he is practising.
The certificate is individual (for the benefit of the individual or their beneficiaries) and confidential (it falls within professional confidentiality). The examples of certificates presented in the following pages are written for sexual violence, but the approach is the same for all forms of intentional violence.
All medical certificates must include:
– The identity of the signing physician.
– The identity of the victim (except for certificates passed on to HCR or to ICRC without the consent of the victim, see below).
– The complete date and the time of the examination.
– The statement of the victim in his/her own words.
– The findings of the clinical examination.
– The samples taken and the examinations carried out.
• The name of the victim (except for certificates passed on to HCR or to ICRC without the consent of the victim, see below), the name of the physician and his/her signature, as well as the date of the examination must appear on each page.
• A copy containing the victim’s name is given to the victim for future legal use. Keep a copy of the medical certificate (or, if the case should arise, of the mandatory report1 ) in the patient record, archived to allow future authentication of the certificate given to the victim.
What the practitioner should not do:
– Rephrase the words of the victim as the practitioner ’s own.
– Endorse the identity of the aggressor nor the nature of the crime, this must be left to the legal authorities.
– Conclude that there was no sexual violence in the absence of lesions on clinical examination.
With the consent of the victim, the physician gives a copy of the certificate containing the victim’s name:
– to HCR (to the protection officer only) if the victim is a refugee or displaced, so that protection measures may be put in place for the individual;
– to ICRC if the victim is a victim of war or a prisoner.
Without the consent of the victim, the physician may give a copy of the certificate to HCR or ICRC, but without revealing the identity of the victim (concretely, the sections “family name, first name and precise address” should not appear).
In principle, legal reporting of sexual violence against children under 15 years is mandatory. The only exception is if there is a risk that reporting may further harm the situation of the child. Consider each case individually.