A report of sexual abuse in an Afghan refugee boy in Iran

Introduction

According to the guidelines and instructions declared by the International Convention on the Rights of the Child, all children have the rights to complete and integrated physical and psychological protection against abuse. ¹ In fact, in almost all regions in the world, physical or mental violence to children leading to severe and even life-threatening injuries and even sexual harassment from their parents and caregivers are reported. ² This violence can occur in any conditions, including at home, at school, at work, and even in legal and child protection systems. In fact, children are abused with total disregard of their legitimate rights against abuse. In such a condition, early identification of the abused child, proper management of his or her injuries, and delivering the guilty to face justice is paramount. In this regard, detailed assessment of the affected child by forensic medicine experts is of particular importance. Here, we report a case of child abuse on an Afghan child in Iran with a background of mood disturbances who presented with multiple traumas and injuries.

Case presentation

A nine-year-old Afghan boy was referred to the central hospital in Robat Karim city (a small town on the outskirts of Tehran) with the primary diagnosis of child abuse. Because of the severity of injuries, he was referred to Rasoul-e-Akram general hospital in Tehran for a forensic medical consultation and further assessment. He was in good health and displayed normal growth, but he had no appropriate verbal communication and also did not make a proper eye contact during the interview. Regarding mood status, he seemed to be depressed. Because of having Afghan ethnicity, he was not allowed access to appropriate education. His parents had been divorced for seven years, and the child lived with his sister and his father. During physical examination, the following signs and injuries were evident: (1) bruising and swelling of the left earlobe, (2) bruising and scratching of the left forehead, (3) bruising of the left side of the face area with swelling, (4) a healing bruise on the left upper eyelid, (5) a 7 cm scar on the right cheek area, (6) bruising on the inner lining of the upper lip, (7) rail-shaped bruising at the top of the right shoulder and left shoulder (figure 1 & 2), (8) two circular healing bruises in the proximal left arm, (9) a healing laceration in the left arm, (10) multiple healing bruises posterior to the left forearm, (10) severe swelling and bruising on the left hand, (11) a laceration of the left hand, (12) scratching the first cause? (joint or pad?) of the left thumb, (13) healing bruise on the left hand, (14) about five rail-shaped bruises on the right forearm, (15) bruises on the left hand, (16) inflation combined with a healing bruise on the back of the right hand, (17) scratches on the right elbow, (18) two healing bruises in the outer part of the right arm, (19) an old scar behind his right elbow, (20) a healing bruise on the left side of the neck, (21) two old scars on the left upper chest, (22) scratches and bruises on the left side of the abdomen, (23) four old scars on posterior neck region, (24) a healing bruise on the left lower part of the trunk, (25) multiple bruises on the posterior and anterior thigh and calf of the left leg (figure 3), and (26) multiple rail-shaped bruises anterior and posterior to the anterior right thigh and right leg. Genitalia examination was unremarkable. In anal examination in knee chest position, a suspected mucosal injury was evident with a normal sphincter tone. Interviewing the patient and his sister revealed a history of anal sexual abuse by his father. OPEN IN VIEWER

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Figure 2.

Rail bruising on forearms and legs were formed as a result of lashes with a belt.

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Figure 3.

Rail bruising on the legs was formed as a result of lashes with a belt.

Conclusion

The most important reasons and risk factors for child abuse are social causes which include poor familial support, poverty, mood disorders in the family, and addiction. ³ The aetiologies of child abuse depend on different social levels. In underdeveloped communities, most cases of child abuse are induced by their parents. In fact, one cause of the abuse is a parent who is capable of abuse and another cause is a child who is actively or passively a target. ⁴ In such communities, a combination of physical, sexual, and psychological abuses are the reasons for child abuse. Sexual child abuse is known to affect approximately 100,000 children per year ⁵ in the United States of America. In sexual abuse, a combination of tactile abuse (touching the child's genitalia) and severe non-penetrating and penetrating oral and genital injuries can be found. Physical examination reveals a combination of superficial bruises on the skin, abrasions to upper and lower extremities and the body, and bruises to the genital organs can be highlighted.

In our case, severe multiple injuries on skin, trunk, genitalia, and extremities were revealed with the clear history of abuse by the father. Where there is high psychological pressure as in refugees, it may induce aggressive and antisocial behaviour. In fact, poverty, isolation from the greater family, social pressure and difficulties in all areas can make people susceptible to psychopathic behaviour.

The case presented here was managed by a special medical team and legal aspects of the issue were pursued by judicial authorities.

Ethical consent

This paper was approved by Ethic Committee of Iran University of Medical Sciences.

Patient consent

Verbal Consent for publishing the patient's photo, were taken from his mother and his sister.