The Assessment of Skin Lesions in Trafficking Victims: A Medicolegal Approach

Learning Overview: After attending this presentation, attendees will have a better understanding of the importance of a structured interview in a medicolegal examination to correctly discriminate the origin of skin lesions in trafficking victims. Impact Statement: This presentation will impact the forensic science community by underlying the need of a multidisciplinary approach based on an accurate forensic examination along with empathic communication with the patient. The case of a young trafficking victim from west sub-Sahara Africa with peculiar skin lesions will be presented. According to the United Nations Convention against Transnational Organized Crime, adopted by General Assembly resolution 55/25 of November 15, 2000, trafficking in human beings represents a serious violation of human rights. In recent years, in Italy, there has been a progressive increase in the number of asylum seekers and refugees with a history of exploitation (sexual slavery, forced labor, illegal activities, migrant smuggling). The identification of victims is a necessary prerequisite for assistance and protection measures provided by international laws.1 It is important to recognize those who have experienced a trafficking event as early as possible in order to prevent forms of exploitation within the national territory. The Italian procedure for victims of trafficking primarily provides the execution of a structured interview for the purpose of assertation and identification. During the medicolegal anamnestic investigation, thanks to the help of sociological and psychological experts and the use of a “nonjudgmental listening” approach, it was possible to create an empathic relationship with the victim. The next step involves carrying out a forensic examination focused on distinctive anthropomorphic and anthropometric traits, as well as particular characteristics ,such as scars or injuries. Victims of human trafficking may have skin lesions due to torture or other forms of mistreatment or abuse.2 They may also present scars related to ethnical practices, such as ritual scarifications. A self-proclaimed underage woman from west sub-Sahara Africa was forced to travel to Italy by migrant smugglers. She was then mistreated and forced to sell her body until she managed to escape from her persecutors. Since she had no identity documents, she was taken to an Italian hospital in order to assess her age. Therefore, she was visited by a pediatrician and a forensic expert for ascertaining and identifying purposes. The inspection of the left abdominal flank revealed the presence of three parallel oblique scars: the most proximal was 12 x 1.5cm, the central one was 12 x 1cm, and the distal one was 10 x 1.5cm. All the scars appeared diastased and superficial. During the structured interview, thanks to an empathic approach, it was possible to attribute the origin of the scars to traditional medical practices. As a cultural practice among African tribes, scarification consists in creating wounds in order to cause indelible markings associated with a spiritual, political, or sexual significance.3 They are generally performed methodically and may show macroscopic differences from other forms of abuse and mistreatment. However, there is a wide range of morphological patterns of lesions perpetrated for different purposes.4 Scarification marks may even change through the years, becoming hypertrophic or keloidal and thus complicating the differential diagnosis. 5 In a trafficking victim case, a multidisciplinary approach appears mandatory to correctly distinguish between cultural practices and signs of torture or maltreatment: the medicolegal assessment should be always supported by an empathic communication with the patient, in order to help the victim to reveal sensitive issues from his/her past. Understanding and interpreting such stories gives forensic experts the opportunity to better assess the origin of the lesions. Reference(s): 1. UNHCR. L’identificazione delle vittime di tratta tra i richiedenti protezione internazionale e procedure di referral. Linee Guida per le Commissioni Territoriali per il riconoscimento della protezione internazionale. 2021. https://www.unhcr.org/it/wpcontent/ uploads/sites/97/2021/01/Linee-Guida-per-le-CommissioniTerritoriali_identificazione-vittime-di-tratta.pdf. 2. Clarysse, K.; Grosber, M.; Ring, J.; Gutermuth, J.; Kivlahan, C. Skin lesions, differential diagnosis and practical approach to potential survivors of torture. The Journal of the European Academy of Dermatology and Venereology. 2019;33(7):1232- 1240. 3. Oultram, S. All Hail the New Flesh: Some Thoughts on Scarification, Children and Adults. Journal of Medical Ethics. 2009;35(10):607–610. 4. Bonnet, A.S.; Gorio, M.C.F.; Magli, F.; Martrille, L.; Cattaneo, C. Case study: Lesions due to forced ritual scarification in Cameroon – A warning from cultural anthropology to forensic medicine. Legal Medicine. 2021;53:101913. 5. Babatunde, O.; Oyeronke, A. Scarification practice and scar complications among the Nigerian Yorubas. The Indian Journal of Dermatology, Venereology and Leprology. 2010;76(5):571.