Medico Legal Protocol

The implementation of the EV. The R.S.O. protocol has significantly improved the health management of survivors of sexual violence in emergency care in wards. The use of standardized procedures to collect evidence of clinical/biological data, as indicated, may facilitate the forensic management of alleged victims. In the future, it is crucial to further promote the training and retraining of health workers in a multidisciplinary team. The activity of integrated network services with local support structures for the care of victims of abuse must be strengthened and ensured. This is the only way for citizens to benefit from a high level of protection against gender-based violence, psychological support and prevention against all forms of violence against these vulnerable people. Sexual assault (SA) is any form of sexual contact or behaviour that occurs without the explicit consent of the recipient of the unwanted sexual act (Ellison et al. 2008). It also includes all cases where the person, even if never physically touched, is exposed to inappropriate sexual content or a relationship with the offender. South Africa is a global problem that has not yet been sufficiently recognized or reported, as confirmed by analyses and studies at different levels and in different contexts (Finkelhor 2005; Tanakaa et al., 2017; Ji et al., 2013). Child sexual abuse is a global public health problem and human rights violation, affecting children and women of all ages, socio-economic levels and cultural backgrounds, leading to devastating health developments and economic consequences for victims and society (Cattaneo et al. 2007; Gilbert et al., 2009).

Data from the Italian National Institute of Statistics (ISTAT) from 2015 indicate that in Italy, about 6 million women have experienced some form of physical or sexual violence in their lifetime, or 31.5% of women aged 16 to 70. 20.2% were victims of physical violence; 21% of sexual violence and 5.4% of the most serious forms of sexual violence, such as rape and attempted rape: 652,000 women were victims of rape; and 746,000 were victims of attempted rape. 20.2% were victims of physical violence; 21% of sexual violence and 5.4% of the most serious forms of sexual violence such as rape and attempted rape. In addition, foreign women are victims of sexual or physical violence to the same extent as Italian women: 31.3 per cent and 31.5 per cent respectively. However, physical violence is more common among foreign women (25.7% vs. 19.6%), while sexual violence is more frequent among Italian women (21.5% compared to 16.2%). However, physical violence is more common among foreign women (25.7% versus 19.6%), while sexual violence is more common among Italian women (21.5% versus 16.2%). With regard to the age of the victim, 10.6% of women were victims of sexual violence before the age of 16 (ISTAT–Istituto Nazionale di Statistica 2015).

The 2005 WHO multi-country study on women`s health and domestic violence against women found that the percentage of women reporting sexual violence by a partner ranged from 6 per cent in Japan, Serbia and Montenegro to 59 per cent in Ethiopia, with the majority of attitudes ranging from 10 to 50 per cent. The proportion of women physically forced to have sex ranged from 4% in Serbia and Montenegro to 46% in the provinces of Bangladesh and Ethiopia (Berry et al., 2014). A 2013 report by the World Health Organization, the London School of Hygiene and Tropical Medicine and the South African Medical Research Council shows: Overall, 35% of women worldwide have experienced physical and/or sexual violence by their intimate partner or sexual violence without a partner and nearly one-third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner (WHO 2013). In recent years, the phenomenon of sexual abuse and other forms of violence against women and minors has affected political, health and social organizations. While in our culture the family is generally considered a safe place, violence is more often perpetrated in the home and the abuser is often someone known to the victim. Unfortunately, it is sometimes a life-threatening environment involving victims of all ages and cultural levels in various forms and degrees of violence, causing physical harm and serious mental health consequences (Saint-Martin et al., 2007; Ingemann-Hansen et al., 2009). According to the World Health Organization, gender-based violence is “the greatest public health problem and human rights violation in the world; it is a violation of the physical and mental integrity of a person (WHO 2014). SMA is a traumatic life event in which negative consequences increase with increasing severity of violence, including physical abuse (McCauley et al., 1997), such as lacerations, fractures, genital mutilation, sexually transmitted diseases (Lacey, 1990), gynecological disorders (Walling et al., 1994; Golding et al. 1998) unintended or pathological pregnancies (Murphy et al. 2001), depression (Wise et al. 2001), eating disorders (Goodwin et al. 2003), self-destructive behaviour (Alix et al.

2017), urogenital and sexual disorders (Vella et al. 2015), post-traumatic stress disorder (Kendler et al. 2000; MacMillan et al., 2001; Sprinter et al., 2007; Jonas et al., 2011; Gauthier-Duchesne et al., 2017; Bottomley et al., 1999). Internationally, different approaches are taken to collect forensic evidence and to clinically and psychologically assess alleged victims (Argo et al., 2012; Berry et al., 2014). Lastly, Italian Act No. 96 of 1996, which established standards for rape and abuse, attached considerable importance to sexual crimes, which were removed from the group of “crimes against morality and public decency” and rightly classified as “crimes against the person and against personal freedom”. This very important normalization brings together the crimes of rape and indecent assault into the same generic category of “crimes of sexual assault”. In 2004, the European Commission of Justice, Home Affairs and Social Policy supported a European programme called “Daphne II” with the aim of supporting victims of sexual abuse and combating and preventing violence, in particular against children and women. In particular, the project “Violence and Operative Health Care Networks” (Ve.R.S.O.), created within the Italian framework of the “Daphne II” programme, envisaged the development and practice of an integrated social and health service comprising social institutions, judicial authorities and medical personnel, as well as the application of the police, in order to create an effective specialized service for the care of victims of sexual assault/sexual abuse.

The EV. The R.S.O. project has been integrated into our daily lives and has been active since 2006 at the Palermo Polyclinic University Hospital, which serves about 1,500 inhabitants of the Western Sicily region. The main objective of the project was to establish a specific and improved health service for victims of sexual abuse and maltreatment and to create a dedicated clinical network to improve care for victims. The health professionals conducting the investigation are dedicated to providing compassionate and high-quality care to victims who are at risk of sexual assault.