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A Forensic Study of Unnatural Deaths in Kuwait: Epidemiological, Virtual Autopsy and DNA Investigations

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A Forensic Study of Unnatural Deaths in Kuwait: Epidemiological, Virtual Autopsy and DNA Investigations by Nadiah Mohammad Al-Kandari A thesis submitted in partial fulfilment for the requirements for the degree of Doctor of Philosophy at the University of Central Lancashire September 2012 Declaration I declare that while registered as a candidate for the degree for which this submission is made that I have not been a registered candidate for another award by any other awarding body. No material contained in this thesis has been used in any other submission for an academic ward. Signature……………………………………………… Type of Award: (PhD) School: School of Forensic and Investigative Sciences Nadiah AL-Kandari ii Abstract Forensic science is growing rapidly in the world today. During the past decade, medico-legal investigations have been highly expanded to include all areas of forensic science. The present study investigated three important aspects of forensic biology. First, this present project investigated, a total number of 5,703 reported medico-legal cases diagnosed as un-natural deaths by The Forensic Department in Kuwait, during the year 2003-2009. The results show that accidental, homicidal and suicidal deaths accounted for 86%, 8% and 6%, respectively. The results showed that most people who died of unnatural deaths were more predominant in the age group 20-29 years (third decade). Road Traffic Accidents accounted for 65% of accidental deaths, and 4% out of them were related to alcohol consumption. The results also illustrated that the highest rate of homicide in Kuwait was due to stab wound injuries (38%) compared to the lower rate of homicidal pattern for infanticides (3%). Similarly, the study showed that the most common method of suicide in Kuwait was death by hanging and this accounted for (60%). This study further demonstrated the effectiveness of virtual autopsy technique as a new tool in forensic investigations to determine various un-natural death causes. A total of thirty (30) male forensic cadavers were employed in this project. The cases were RTA (11), firearm injuries (10), drowning (4), head injuries (3) and lastly strangulation (2). All these cases were compared to the findings of traditional autopsy. The results show similar findings for virtopsy compared to traditional autopsy. This study clearly revealed that virtopsy could be an effective alternative in certain situation, being noninvasive and rapid. The present project also investigated 28 samples of human blood, saliva or semen. The experiments were done at four different temperatures (55°C, 37°C, 24°C and 4°C) and four different humidity ranges (41%, 55%, 58% and 61%), respectively. The results showed that, DNA quantity in blood, saliva and semen samples remained more or less the same at temperatures of 4°C, 24°C and 37°C compared to values for day one with all other days. In contrast, when the temperature was raised to 55 °C, the DNA started to degrade with time until it reached zero at day 12 for saliva and day 15 for blood, but not for semen. The results clearly show that DNA in saliva and blood samples is extremely sensitive to heat compared to semen. In conclusion, the study reveals the different causes of unnatural deaths, the value of virtual autopsy and the need for early DNA measurement in Kuwait. iii TABLE OF CONTENTS Pages Declaration Ii Abstract iii Acknowledgments xiii List of tables ix List of figures xi Chapter 1: Introduction 1 1.1 Introduction to Research 2 1.2 The Skewed Record of Death 3 1.3 Kuwait, the Study Area 5 1.3.1 Overview of the General Department of Criminal evidence in Kuwait 8 1.3.2 Historical view of the GDCE 8 1.3.3 Current structure of the organization 11 1.3.4 Personnel of the GDCE, Kuwait Laws and Forensic practice 16 1.4 Medico-legal investigation of unnatural death in the Middle East 17 1.4.1 Death by Suicide 18 1.4.2 Suicidal Risk Factors 19 1.4.3 Epidemiology of Suicide 20 1.4.4 Gender and Suicide 21 1.4.5 Age and Suicide 22 1.4.6 Ethnicity and Suicide 22 1.4.7 Marital status and Suicide 24 1.4.8 Socio-Economic Factors 24 1.4.9 Methods of Suicide 25 1.4.9.1 Suicide by hanging 25 1.4.9.1.1 Crime scene investigation in hanging 26 1.4.9.1.2 Forensic investigation in hanging 27 1.4.9.2 Suicide by Drowning 28 1.4.9.3 Suicide by Suffocation 30 1.4.9.4 Suicide by Electrocution 32 1.4.9.5 Suicide by fall from Heights 33 1.4.9.6 Suicide by Fire Arms 34 1.4.10 Suicide in the Middle East 36 1.5 Homicide 37 1.5.1 Introduction 37 1.5.2 Investigation of homicide 37 1.5.3 Law and homicide 38 1.5.4 Motives for homicide 38 1.5.5 Relationship between victims and offenders 39 1.5.6 Homicide using firearms 40 1.5.7 Kuwait Firearms Unit 41 iv 1.5.7.1 Homicide by stab wound 42 1.5.7.2 Stab wounds in Homicides 44 1.5.7.3 Homicide by strangulation 44 1.5.7.4 Homicide by using blunt force 44 1.5.7.4.1 Inspection of crime scene in blunt force injury 45 1.5.7.4.2 Inspection for trace evidence 45 1.5.7.4.3 Signs of blunt force trauma 45 1.6 Infanticide 46 1.6.1 Medico legal aspects 46 1.7 Accidental Death 48 1.7.1 Death by Drug or medical over dose toxicity 51 1.7.1.1 Type of drug evidence 52 1.7.1.2 Kuwait Drug Laboratories (KDL) 55 2.8.1.3 Drugs and alcohol combination 55 1.8 Domestic Accidents 56 1.9 Kuwaiti System in dealing with cases of death 58 1.10 Types of cases received 58 1.11 Laws of Kuwait 60 1.12 Aim of the Research 61 Chapter 2: Epidemiology of un-natural death in Kuwait during 2003-2009 63 2.1 Introduction 64 2.2 Material 65 2.3 Methods 66 2.3.1 Research design 66 2.3.2 Data collection and preparation 66 2.3.4 Statistical Analysis 67 2.4 Results 70 2.4.1 Reported natural and un-natural death cases in the GDCE 70 2.4.2 Reported Unnatural death cases in the GDCE 70 2.4.3 Un-natural death cases according to Kuwait Governorates 71 2.4.4 Reported un-natural death cases in Kuwait according to gender 71 2.4.5 Reported un-natural death cases in Kuwait according to age 72 2.4.6 Reported un-natural deaths according to nationalities 73 2.4.7 Reported cases of unnatural deaths according to the years 73 2.4.8 Trends of homicidal mechanism in Kuwait during 2003-2009 74 2.4.9 Trends of homicide in Kuwait according to nationalities 74 2.4.10 Patterns of homicidal death in Kuwait according to gender 75 2.4.11 Reported death cases due to blunt force injuries according to age group 75 2.4.12 Reported death by the use of firearm injuries according to age group 76 2.4.13 Reported death due to stab wound injuries according to age group 76 2.4.14 Reported death due to strangulation according to age group 77 2.4.15 Reported death due to smothering injuries according to age group 77 2.4.16 Areas of the body involved in fatal injuries of homicidal death 78 v 2.4.17 Reported mode of strangulation in homicidal death in Kuwait 78 2.4.18 Trends and patterns of accidental death cases in Kuwait 79 2.4.19 Trends of accidental death according to nationality 80 2.4.20 Reported accidental death cases due to occupational 81 2.4.21 Reported death cases due to mine explosion according to age group 81 2.4.22 Reported accidental death due to electrocutions according to age group 82 2.4.23 Reported accidental death due to poisoning according to age group 82 2.4.24 Reported accidental death cases due to drowning according to groups 83 2.4.25 Reported drug over dose according to age group 83 2.4.26 Reported accidental death due to burning according to age group during 85 2.4.27 Reported road traffic accidents according to age group 85 2.4.28 Reported accidental fall from height according to age group 86 2.4.29 Reported accidental death cases due to according to age group 86 2.4.30 Trends and patterns of suicidal death cases 87 2.4.31 Trends and patterns of suicidal death cases according to nationalities 87 2.4.32 Trends of suicidal deaths according to gender 88 2.4.33 Trends and patterns of suicidal death cases according to governorate 89 2.4.34 Reported suicidal deaths due to bleeding according to age group 90 2.4.35 Reported suicidal deaths due to hanging according to age group 90 2.4.36 Reported suicidal deaths due to toxicity according to age group 91 2.4.37 Reported suicidal deaths due to stab wound according to age group 91 2.4.38 Reported suicidal deaths due to fall from height according to age groups 90 2.4.39 Reported suicidal deaths due to firearm according to age groups 90 2.4.40 Comparison between suicide rates in Middle Eastern Countries 93 2.4.41 Comparison between homicide rates in Middle Eastern Countries 94 2.5 Discussion 96 2.5.1 Prevalence of unnatural death in Kuwait 96 2.5.2 Geographical distribution of unnatural death in Kuwait 97 2.5.3 Distribution of unnatural death according to the gender 99 2.5.4 Age distribution of un-natural in Kuwait 99 2.5.5 Relationship between Unnatural death and nationality 100 2.5.6 Pattern of homicide in Kuwait 101 2.5.6.1 Trends of homicidal deaths in Kuwait according to gender 101 2.5.6.2 Geographical distribution of Homicidal deaths 102 2.5.6.3 Pattern of homicidal deaths according to nationalities 106 2.5.6.4 Age group distribution of homicidal death due to firearms 107 2.5.6.6 Blunt force trauma 109 2.5.6.7 Incidence of stab wound injuries 109 2.5.6.8 Incidence of strangulation 110 2.5.6.9 Area of the body involved in fatal injury 111 2.5.7 Pattern of suicide in Kuwait 112 2.5.7.1 Gender and suicide 113 2.5.7.2 Suicidal deaths according to nationalities 114 vi 2.5.7.4 Suicide according to Governorates 115 2.5.7.5 Suicidal deaths by cut wounds deaths according to age groups 117 2.5.7.6 Age distribution of suicidal
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