died in a motor vehicle roll-over

Investigative Report Pertaining to the Death of ' Issam Judeh Mustafa Hamed
Palestinian Male, ID # 94426105
http://www.DOCUMENT: Physicians for Human Rights Reports: Issam Judeh Mustafa Hamed
died in a motor vehicle roll-over

Investigative Report Pertaining to the Death of ' Issam Judeh Mustafa Hamed
Palestinian Male, ID # 94426105
http://www.phrusa.org/research/forensics/israel/Israel_accident_2.html

A Report by Physicians for Human Rights
100 Boylston St., Suite 702
Boston, MA 02116
Tel: 617-695-0041
Fax: 617-695-0307

November 2, 2000

Summary

The International Forensic Program of Physicians for Human Rights (PHR) has
concluded that the controversial death of Palestinian 'Issam Judeh Mustafa
Hamed was the result of trauma sustained in a motor vehicle roll-over. PHR
dispatched to Israel and the territories two pathologists from the United
States, Dr. Robert Kirschner of the University of Chicago and Dr. Nizam
Peerwani of the University of North Texas. Drs. Kirschner and Peerwani, both
veteran medical examiners, noted that the type and distribution of injuries
observed on the body surface, including gliding abrasions (road rash) and
gravel abrasions, indicate that 'Issam Judeh was most probably thrown out of
the vehicle when it rolled over, impacting the ground mainly along the left
side of the body, including the left-side of the head. The fracture at the
base of the skull, evident on CT-scan, is indicative of medium or high
velocity impact generally seen in injuries sustained in a motor vehicular
crash. Furthermore, they noted that there were no defensive wounds or burns
on the body surface. Since an autopsy was not performed, presence of occult
internal blunt force traumatic injuries prior to vehicular crash could not
be ruled out. Similarly, events leading to the crash could not be
established including the possibility of the decedent being chased by the
Israeli Defense Forces.

Purpose

This report specifically addresses the findings pertaining to the cause and
manner of death of 'Issam Judeh.

A team of physicians from Physicians for Human Rights USA, consisting of
James C. Cobey, M.D., M.P.H., an orthopedic surgeon, Robert Kirschner, M.D.
and Nizam Peerwani, M.D., both forensic pathologists, traveled to Israel,
West Bank and Gaza from October 20 - 27, 2000 to assess following:

To determine cause and manner of death in the disputed case of 'Issam Judeh,
a 40-year- old Palestinian male, whose body was found next to a car.
Allegations are that he was beaten to death by Israeli settlers in West Bank
and/or by members of Israeli Defense Forces (IDF). Israeli officials claim
he died in a car accident;

At L. Greenberg Institute of Forensic Medicine in Tel Aviv, review autopsy
and forensic reports pertaining to, among others, the two Israeli soldiers
killed by Palestinians in Ramallah, Israeli Arabs killed in Nazareth as well
as any other deaths documented by Israeli pathologists. Only one of the two
Israeli soldiers was autopsied at the L. Greenberg Institute of Forensic
Medicine. A formal request has been made to obtain copy of the autopsy
report. None of the Arabs killed in Nazareth or other Arab towns and
villages in Israel were examined or autopsied by the L. Greenberg Institute
of Forensic Medicine in Tel Aviv.

Document injuries and deaths in Gaza and the West Bank via review of X-rays,
photographs, hospital records and interviews with doctors, nurses and
patients, and evaluate spent ammunition samples. The objective is to
establish, if possible, types of injuries sustained, types of firearms and
ammunition used, distribution of and number of gunshot wounds on the body,
as well as age and sex of victims. The goal is to determine whether
excessive and/or indiscriminate force has been used by the IDF.
(Please see separate PHR report ---www.phrusa.org)

Evaluate whether medical neutrality has been breached by IDF and/or
Palestinians by attacks on ambulances and health workers. (Please see
separate PHR report).

I. Introduction

The team from Physicians for Human Rights USA which evaluated the death of
'Issam Judeh consisted of Robert Kirschner, M.D., and Nizam Peerwani, M.D.,
forensic pathologists from the United States, who traveled to Ramallah, West
Bank, on October 22, 2000. The team was, however, unable to obtain
permission to perform an exhumation autopsy. Hence, this evaluation is based
on review of the medical records, CT-scans, postmortem photographs,
clothing, the wrecked vehicle, scene of death as well as interviews with
persons having knowledge or involved in the investigation of 'Issam Judeh's
death.

The team interviewed Dr. Munther Alsherif, Deputy Minister of Health for the
Palestine Authority; Dr. Nasri Mu'allem, neurosurgeon at Ramallah Hospital;
Bassam Judeh, brother of the decedent; and Raslan Mahagna, who had obtained
witnesses testimonies pertaining to death of 'Issam Judeh. The team also
evaluated the following:
A color video recording of the cutaneous (external) traumatic injuries
A six-page typed document detailing the circumstances of the death of 'Issam
Judeh, prepared by B'Tselem
A two-page typed report prepared by Dr. Nasri Mu'allem, a neurosurgeon at
Ramallah Government Hospital
Fifteen (15) color photos detailing external (or cutaneous) trauma
CT-scans of the head
Green denim overalls and blue briefs

In addition, the team visited the scene where the body was discovered and
inspected a wrecked orange colored 4-door Subaru (1979 model) which was last
seen being driven by 'Issam Judeh.

II. Circumstances of the Death

'Issam Judeh Mustafa Hamed (henceforth 'Issam Judeh) was 40 at the time of
his death. He was married with five children and was a painter by
profession. He lived in Uhm Safa, a village near Ramallah, north of
Jerusalem in the occupied West Bank. The village is along a main road,
flanked by two Israeli settlements, Ateret on the east and Halmish
(Neve-Tzuf) on the west. Israeli Defense Forces (IDF) guard both these
Israeli settlements. Uhm Safa had remained generally calm throughout the
recent Intifadah Al-Aqsa, which began on September 29, 2000.

On Saturday, October 8, 2000 at 1500 hours, 'Issam Judeh started for the
village cemetery where he had a paint job. The cemetery is located along the
main road on the east side of the village. 'Issam Judeh was driving a 1979
Subaru, which he had purchased in Israel, and had failed to pass inspection
for road worthiness there. It continued to bear Israeli license plates. He
was the sole occupant in the automobile. To get to the cemetery, he had to
leave the village and travel along the main road by the Israeli settlement
Ateret. According to testimonies collected by B'Tselem, Musa 'Obeid, a
village resident, observed an IDF jeep begin a chase of the vehicle driven
by 'Issam Judeh, with both the cars driving westwards towards Halmish.

Later that afternoon, Musa 'Obeid received an inquiry from 'Issam Judeh's
wife, who was concerned about her husband's whereabouts. Musa 'Obeid
expressed the opinion that 'Issam Judeh was perhaps being detained by IDF at
Halmish because of the presence of unauthorized Israeli license plate on his
Subaru and that he would be released after a fine.

When 'Issam Judeh had not arrived home by 1900 hours, the village organized
a search party that combed the route 'Issam Judeh may have driven along, and
made inquiries with the IDF guards at the Halmish settlement. The search
party then notified the Palestinian Television, as well as al-Watan, a local
TV Station, the Palestinian police and the Palestinian DCL (liaison office).

On the following day, early in the morning of October 9, 2000, Bassam Judeh,
brother of 'Isaam Judeh proceeded to Beit El Police Station and was told
that 'Issam Judeh was not being held there. At approximately 0930 hours,
'Issam Judeh's wife observed a car along the shoulder of the road, some 400
meters from her house. She descended to the scene and found her husband
lying face down in a pool of blood, fully clothed, some two meters away from
the over-turned vehicle, which had come to rest on its right side. An IDF
army jeep arrived and stood some ten meters away, and did not interfere with
the subsequent transfer of the body first to the decedent's house and then
to Ramallah Government Hospital.


III. Medical Examination at Ramallah Government Hospital on October 9, 2000

The body of 'Issam Judeh arrived at Ramallah Government Hospital on October
9, 2000 at 1030 hours, and was examined by Dr. Nasri Mu'allem, a
neurosurgeon. Examination included external inspection, video and 35 mm
color photo recording of injuries, radiography of the left upper distal
extremity as well as CT scan of the head. An autopsy was not performed.
Partial clothing were retained including a green sleeveless overalls and
blue briefs. Dr. Mu'allem concluded that 'Issam Judeh "...received severe
head trauma with multiple skull fractures and high tension
pneumo-encephalus, causing severely increased intra-cranial pressure". He
also noted that there were "Other lesions of different sizes, scattered all
over the body, most likely due to dry burns". The mechanism of head trauma
was defined in the report.

IV. Evaluation of CT scans, Color photos and Clothing by PHR team members

The CT scans

1. Multiple facial and skull fracture with left-sided distribution
involving the:

a. Maxillary sinus with tension pneumo-encephalus (air within the cranial
cavity) causing a mass effect of the anterior region of the cranium
b. Depressed temporal skull fracture
c. Linear, non-depressed parieto-occipital skull fracture
d. Fracture of the petrous ridge (at the base of the skull)

2. Bi-hemispheric subarachnoid hemorrhage (bleeding within the coverings
of the brain)

3. Compression of lateral ventricles (1) due to severe cerebral edema
(swelling)

The color photos: Fifteen (15) color photos were made available.

1. HEAD: The unwashed face is covered in multiple foci with dried and
crusted blood, and road dirt mainly along the central portions including the
glabella (between the eyes) and the nasal surface. Blood is noted within the
nostrils, mouth, as well as oozing from the left external auditory meatus
(left ear canal). There is prominent left peri-orbital ecchymosis with edema
("black eye"). Also noted is facial lividity (2) with contact pallor of the
mid-forehead and left zygoma (cheek bone area), consistent with the body
lying face down for some duration of time. Blunt force cutaneous traumatic
injury of the face and scalp is present with pre-dominant left-sided
distribution and includes:

a. Two small non-patterned gliding abrasions of left forehead and one of
left upper eyelid with the intervening forehead depicting patchy areas of
contusions
b. Bilateral bulbar sub-conjunctival hemorrhage
c. Non-patterned gliding abrasions with surrounding contusion of left cheek
and zygoma (cheek bone)
d. Non-patterned gliding abrasion of left nasal surface
e. Two scalp lacerations including one of left parietal scalp due to
tangential blow with slightly avulsed superior margin, and the other of the
left parieto-occipital scalp.

2. TORSO: The torso is clothed in a blue underwear only. Anterior lividity
is once again noted, involving the anterior neck, chest and abdominal areas,
consistent with the body lying face down for some period of time. Confluent
areas of blunt force traumatic injuries are noted, consisting mainly of
abrasions (3) with predominant left sided distribution. All the injuries are
confined to the back, including the upper and left back, and the left flank
with sparing of the chest and abdominal surfaces. These injuries include:

a. Linear patchy vertically oriented gliding abrasions (road rash) of the
left and right upper back
b. Gravel abrasions of left scapular region (shoulder blade area), extending
to the left posterior shoulder and posterior axilla (arm-pit)
c. Large confluent area of deep gliding abrasion (road rash) involving the
left mid-flank and bac
d. Gliding abrasions of left lower flank extending to the pelvic rim (hip
region) and incorporating a superficial linear laceration


3. EXTREMITIES: Prominent blunt force traumatic injuries are noted,
consisting mainly of abrasions, with predominant left-sided distribution.
These injuries include:

a. Linear gliding abrasions of the left lateral arm extending from shoulder
to the elbow with the distal area depicting distinct gravel abrasions
b. Prominent rectangular area of deep patterned abrasion (4) of left mid
anterior thigh with surrounding soft tissue contusion and edema
c. Focal non-patterned abrasions of left distal thigh and left knee.


4. POSTMORTEM ARTIFACTS: Postmortem artifacts were noted on the body surface
with slippage of skin. Such lesions generally lack vital tissue reaction and
present yellow dry surface, except in dependent portions where such slippage
of skin may have a reddish base due to presence of postmortem lividity. Such
artifacts may be produced by radiant environmental heat. There are many such
artifacts present some of which include:

a. Small abrasion of left lateral buttock (antemortem injury) associated
with a large inferior area of postmortem slippage of skin, the denuded
(naked) area presenting a yellow parchment-like appearance without
discernible tissue reaction
b. Small non-patterned irregular abrasion of left upper medial buttock
(antemortem injury) with postmortem slippage of skin, the denuded (naked)
area presenting a yellow parchment-like appearance without discernible
tissue reaction
c. Two focal areas of postmortem slippage of skin along the left posterior
thigh
d. Patchy areas of postmortem slippage of skin along the right posterior
buttock with rolled-up skin along the inferior border and yellow pale
denuded surface without vital reaction
e. Postmortem slippage of skin along the right medial arm
f. Postmortem slippage of skin along the distal right medial forearm
extending from the mid forearm to the wrist joint along the ulnar border,
without vital tissue reaction but with reddish base due to associated
postmortem lividity
g. Patchy areas of postmortem slippage of skin along the medial surface and
the ulnar border of left forearm, extending from the elbow to the wrist
joint without vital tissue reaction but with reddish base due to associated
postmortem lividity
h. Focal area of erythema of left penile shaft


V. Examination of the Clothing Worn by 'Issam Judeh


Two items of clothing were made available including a blue briefs and a
green denim overalls. The briefs appeared intact, without blood or serum
stains. The overalls depicted several areas of tear (age of the tear cannot
be established), staining by paint and dirt as well as drip and transfer
blood mainly along the anterior surface. Inspection of the inner surface of
the overalls did not yield significant blood, and most importantly, there
was absence of linear streaking of blood from raw or bleeding wounds of the
thigh and/or the torso had the decedent been dressed after death.

VI. Visitation of Scene by PHR Team where Body was Discovered


The wrecked over-turned vehicle was discovered along the road side
approximately 10 meters from the edge of an asphalted road. A sharp curve
along the road is noted, some 40 meters from the site. The general terrain
is hill with small and large rocks, and pebbles along the road-side. The
exact location where the wrecked vehicle and the body were discovered is
unmarked and cannot be established. Tissues or body parts were absent. Large
amounts of broken laminated Subaru-brand windshield glass were present,
clustered in a tight geographical area.


VII. Examination of Wrecked Vehicle by PHR Team


The orange colored wrecked Subaru was parked along the rear of the decedent'
s residence in Uhm Safa, a village near Ramallah. The vehicle depicted
considerable amount of damage most of it recent with absence of rust in the
areas where the paint had peeled or scratched away. The predominant areas of
vehicular damage include the left frontal region with unhinged hood and
partial cave-in of the roof mainly along the right anterior region. The
windshield is broken and absent. The rear-view mirror on the driver's side
is also broken and missing. There is some compromise of the driver's
compartment , mainly due to partial roof cave-in, however, the dash board,
steering column and steering wheel all appear in the pristine location. The
front under-carriage and wheel assembly are damaged. Body tissue or
desiccated blood is absent.


VIII. CONCLUSION


It is the opinion of the PHR Team, within a reasonable degree of medical and
forensic certainty that:

1. 'Issam Judeh Mustafa Hamed died in a motor vehicular roll-over accident
(5). The type and distribution of injuries observed on the body surface
including the road rash (gliding abrasions) and gravel abrasions indicate
that 'Issam Judeh was most probably thrown out of the vehicle when it rolled
over, impacting the ground mainly along the left side of the body, including
the left-side of the head. The fracture of the left petrous ridge at the
base of the skull, evident on CT-scan, is indicative of medium to high
velocity impact, generally seen in the setting of a motor vehicular crash.
Absence of dicing injuries (angulated cuts produced by fractured wind-shield
glass) indicates that the body was most probably thrown out of the car as
the car began to roll-over before the wind-shield smashed. This may account
for the fact that the inspection of the vehicle near the time of accident
failed to yield presence of blood or tissue within the compartment. Finally,
had 'Issam Judeh sustained these cutaneous injuries from an assault, the
injury would be distributed on both the sides of the body, across the face,
upper torso and extremities and not merely one-sided.

2. There are no defensive wounds. Defensive wounds consist of contusions
when a blunt instrument is being used or cuts and stabs when a sharp
instrument is being used. Such wounds are typically distributed along the
dorsal surfaces of the hands, wrist joints and forearms and are sustained
when a victim is attempting to ward off blows.

3. Although the PHR team was not able to independently verify, medical
records reviewed indicate that 'Issam Judeh also sustained fractures of the
distal left radius and ulna (bones of the forearm). There are several
mechanisms by which both radius and ulna are simultaneously fractured,
including direct blow, however, the most common mechanism is in the setting
of a motor vehicular accident. Fractures due to a direct blow or impact by a
blunt instrument, called "nightstick fractures", typically consist of a
non-displaced fracture of ulna alone.

4. The rectangular area of patterned abrasion of the left thigh is most
probably due to the impact of left thigh on the rear-view mirror as the body
was being thrown out of the vehicle, although it may also have occurred when
the thigh impacted a similar hard rectangular object at the scene.

5. Body depicts scattered foci of postmortem artifacts with slippage of
skin, without chemical or electric burns.

6. The pattern of lividity indicates that the body lay on its ventral
surface (on its face) for several hours, perhaps as much as 6-7 hours.

7. Occult internal injuries cannot be assessed since an autopsy was not
performed and hence occult blunt force traumatic injuries prior to vehicular
crash cannot be ruled out. Similarly, events leading to the crash cannot be
established including the possibility of the decedent being chased either by
the Israeli Defense Forces and or the Israeli settlers.

Endnotes:

(1) ventricle, cavity within the brain normally filled with cerebrospinal
fluid

(2) With cessation of circulation after death, the blood, while it is still
fluid, gravitates to the dependent portions of the body thereby distending
the dependent capillaries and veins. This capillovenous distension is known
as postmortem livor mortis (lividity) or hypostasis. Lividity occurs in all
the dependent tissues and viscera. It is readily observed in lightly
pigmented skins where it appears as mottled patches which gradually extends
and coalesces. Under ideal conditions, lividity may be visible as early as _
hour death and fully developed in 6-10 hours. Thereafter, it is "fixed",
i.e. it does not shift with changing of body position.

(3) An abrasion (scratch or scrape) represents the tearing away of the
epidermal or the outer layer of the skin by crushing injury or friction.
Abrasions are of two types: (i) Compression Abrasion, where the force
causing the injury is directed perpendicular to the body surface thereby
imparting a pattern which resembles the object which produced it; and (ii)
Gliding Abrasion where the force causing the injury is directed tangential
to the body surface scrapping the epidermis, as in a passenger thrown out
from a motor vehicle in a crash. When such an abrasion is extensive it is
called road rash (or brush burn).

(4) The location of the patterned rectangular abrasion is consistent with
that produced by impaction with a rear-view mirror. Inspection of the
motor-vehicle reveals a broken rear-view mirror along the driverÕs side.

(5) This case was independently reviewed by Dr. Chris Milroy of the UK and
his colleagues. They have independently come to a similar conclusion.

Physicians for Human Rights mobilizes the health professions and enlists the
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