Forensic Analysis of Firearm Injuries in Port said Governorate during the 2011 Egyptian Revolution 

Research Article

Forensic Analysis of Firearm Injuries in Port said Governorate during the 2011 Egyptian Revolution

Corresponding authorDr. Samar A. Ahmed, Rehab City area 36, villa 18, Cairo, Egypt,
Tel: +2-01062669970; Email: drsamer_ahmed@med.asu.edu.eg

Abstract

The use of firearms as weapons of assault criminally continues to increase worldwide. The 25th of January 2011 Egyptian revolution took place following a popular uprising that began on Tuesday, 25 January 2011. No study was done before to evaluate the incidence and pattern of firearm injuries and deaths in Port Said during the year of the Egyptian revolution, with all the security and ethical repercussions in Egypt in that period, which necessitated the conduct of this study. Data of cases of firearm injuries and fatalities examined in the departments and morgues of Port Said department of the medico-legal authority of the Ministry of Justice in Egypt during the year of 2011 was collected. Sixty seven cases were received and their files were tested for parameters including; data related to the crime, data related to the victim, data related to the assailant, data related to the victim, data related to the injury in addition to available information regarding the weapon and its mode of application. There was a significant difference in all tested parameters when comparing results of this study with previous studies performed in the same region. Most of the cases were males in the age group 20-29 (30.19%) with an injury related to male to male (88.68%) violence homicide (98.1%) with prevalent occurrence in the street (58.21%). Many weapons were plotted on the streets with a prevalence of locally made shotguns (31 cases).

Keywords: Egypt Revolution; Firearm; Trauma; Permanent Infirmity

Introduction

The use of firearms as weapons of assault criminally continues to increase. This fact is related to the relative ease in obtaining firearms whether firearm possession and use is permitted or not. Even when use of firearms is legal, they still can be involved in criminal activities; for example, shotguns on farms can be, and have been, used in suicides. Other legally held firearms have been stolen and have subsequently been used in criminal activities. The forensic practitioner therefore will encounter injury and death caused by a wide variety of firearms [1].

Firearms are generally divided into rifled bore and smooth bore. The rifled bore weapons have a barrel with spiral grooves running the length of the interior surface- rifling-. We see the same measurement between the grooves of the barrel on the projectile that was fired from it, giving the projectile a rotation around the long axis for the purpose of stabilization and accuracy [2].

Ammunition comes in two basic types: bullets and shells. Bullets have a single solid projectile, propellant, a primer to ignite the propellant, and a casing to hold the components together until fired. Shells are similar to bullets, except that the pellets or shots must also be held together and wadding is inserted between them and the propellant. The wadding maintains an even pressure on the pellets, pushing them all out of the barrel at about the same time [3].

When the bullet, missile, or shotgun pellets strike the target, which can constitute living tissues or some other material, the missile tends to suffer some degree of deformation, or disintegrates, and the target is perforated or otherwise is damaged.

The degree of destruction that takes place is dependent upon the mass of the projectile, its striking velocity, its design and construction, and the nature of the target [4].

There are limitations to findings that can be deduced from autopsies [5]. There is a large body of research attempting to establish a pathway for autopsy findings to aid in the understanding of the circumstances of the crime.

The 25th of January 2011 Egyptian revolution took place following a popular uprising that began on Tuesday, 25 January 2011. The uprising was mainly a campaign of non-violent civil resistance, which featured a series of demonstrations, marches, acts of civil disobedience, and labor strikes. Despite being predominantly peaceful in nature, the revolution was not without violent clashes between security forces and protesters, with a number of people killed and injured. The uprising took place in Cairo, Alexandria and in other cities in Egypt, following the Tunisian revolution that resulted in the overthrow of the long-time Tunisian president. On 11 February, following weeks of determined popular protest and pressure, Mubarak, the Egyptian president of 30 years, resigned from office (Ahmed and Zaki) Port said is a city that lies in north east of Egypt extending about 30 kilometers (19 mi) along the  coast of the Mediterranean Sea, north of the Suez Canal, with an approximate population of 603,787 (2010). The city was established in 1859 during the building of the Suez Canal (www. wikipedia.com).

No study was done before to evaluate the incidence and pattern of firearm injuries and deaths in Port Said during the year of the Egyptian revolution, with all the security and ethical repercussions in Egypt in that period, which necessitated the conduct of this study.

This study is a retrospective analysis of firearm injuries and deaths examined by the Medico-legal Department of the Ministry of Justice in Port Said governorate, which lies at the north of Egypt during the Egyptian revolution year 2011.

The study aimed to outline the pattern and incidence rate of firearm injuries and deaths in Port Said city during the year of the Egyptian revolution 2011, investigate the firearm cases from the medico legal points of view, highlight the outcome of the firearm injured cases as disfigurement, disabilities, and permanent infirmities, and hence compensation needed and highlight if any new types of weapons or missiles were used in the field of wounding during the year 2011.

Materials and Methods

1. Data of cases of firearm injuries and fatalities examined in the departments and morgues of Port Said department of the medico-legal authority of the Ministry of Justice in Egypt during the year of 2011 was collected from the archives of the  medico-legal reports written by the forensic pathologists who had examined the cases in our study, and from the files sent from the general prosecutor related to these cases. The total number of cases of alleged firearm injuries and fatalities referred to Port Said medico legal department in 2011 were a total of 69 cases. Two cases were excluded from those 69 cases in our study as they were proved not to have any firearm injuries from the medico-legal point of view.2. The study includes all the cases of firearm injuries and fatalities referred to Port Said medico-legal department of the medico- legal authority of the ministry of justice in Egypt in the year, they were 67 in number. Data of these 67 cases were collected to fulfill our study aims and objectives, as follows:

3. Data related to the incident

A. Season of injury
B. Time of the incident
C. Motive of the crime
D. Place of the crime
E. Relationship between the victim and assailant
F. Cross sex violence
4. Data related to the assailant
A. Age of the assailant
B. Gender of the assailant
C. Occupation of the assailant
5. Data related to the victim
A. Age of the victim
B. Gender of the victim
C. Occupation of the victim
D. Outcome of firearm injuries
E. The cause of death
6. Data related to the weapon and its firing
A. Type of weapon used
B. Allegation of the weapon type
C. Types of the missiles found
D. Calibers of weapons used in crimes
E. Range of firing
F. Direction of firing
G. Level of firing
7. Data related to the injury

A. Number of inlets
B. Site of inlet
C. Shape of inlets
D. Degree of healing of the inlet, shape of the edges and the
presence of loss of substance
E. Color of inlets
F. Presence or absence of powder marks around the inlet
G. Presence of abrasions or bruises around inlet
H. Number of exits
I. Site of exit
J. Shape of exits
K. Edges of exit
L. Color of exits
8. Other patterns of trauma present rather than firearm injuries
9. Data related to investigations and examination
A. If X-Ray was done or not
B. X-Ray findings
C. If clothes were examined or not
D. Clothes examination findings
E. Possibility of the allegation
F. Toxicological analysis of specimens taken from the victims
G. If blood was found on weapons
Data Analysis

The data collected were revised, coded, tabulated and statistically analyzed using Microsoft Excel and SPSS version 17 software programs.Chi-square test and Z test for two populations were used in analysis of Variables. A p-value of < 0.05 was considered significant.Ethical Considerations

Approval for appropriate data retrieval was obtained from the head of Forensic Medicine department of Port Said. Confidentiality of the records was maintained by giving a code number for every file and all the cases are anonymous.

Results

Data collected from the Medico-legal Department of the ministry of Justice in Port-Said during the year 2011 showed that there were 67 cases of firearm. This represented 11.09/100,000 incidence rate when compared to the total population in 2011 (603,858) and 11.59% of the total cases (578) arriving at the department during that year.

Data Related to the Incident

Season of Incident

It was found that Most of the crimes occurred in the summer (22cases32.84%), followed by those in the winter (19 cases; 28.36%), followed by the spring (14 cases; 20.90%), the least of the crimes occurred in the autumn (10 cases;14.93%), in 2 cases (2.99%) the date of the crime was not mentioned.There was a significant difference between cases that happened in the summer and those in autumn (Z-score; 2.4314., P value; 0.00755) but no significant difference was found between cases that happened in the summer and those in the winter (The Z-Score is 0.5624. The p-value is 0.28774) which is not significant. Two of the case sheets did not have a specific date allocated to them.

Table 1.Chi-Square statistical analysis of the manner of the crime according to the motive of the crime among firearm cases referred to Port Said medico-legal department in the year 2011.
Motive of the Crime and Manner of Crime

Place of the Crime

It was found that (39 cases; 58.21%), (7 cases; 10.45%), (4 cases; 5.97%), (3 cases; 4.48%), (3 cases; 4.48%), happened in the street, highway, work place, coffee shop and home, consequently. Taking note that in (11 cases; 16.42%) the site of the crime was not mentioned. There was a significant difference between cases that happened in the streets and the rest of the cases regarding the tested parameter (Z score; 3.8533, P value; 0.0000005*)Relationship between the Victim and Assailant
Table 2.Chi-s quare test of the manner of the crime in relation to the relationship between the victim and the assailant in firearm cases referred to Port Said medico-legal department in the year 2011.
Cross Sex Violence
* Statistically not significant
Table 3.Chi-square statistical analysis for the Cross sex violence regarding the manner of the crime among firearm cases referred to Port Said medico-legal department in the year 2011.
Data Related to the Assailant

Gender of the Assailant

In 57 cases out of the 67 cases presenting to the department, the assailant was identified as male. The rest of the cases were
either not mentioned or marked as unknown rendering the prevalence of males among offender (z Score; 8.1204 and P value;0)Occupation of the Assailant

It was found that in (59 cases; 88.06%), (4 cases; 5.97%), (2 cases; 2.99%), (2 cases; 2.99%) the jobs were not mentioned, illegal (smugglers), police or army officers, private business, respectively.Occupation of the Victim

It was found that in (52 cases; 77.61%), the occupation of the victims was not mentioned. (6 cases; 8.96%), (4 cases; 5.97%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%) were working in private business, illegal workers, governmental employees (surgeon), a manual worker, a truck driver, a fisherman and a student, respectively.

The Cause of Death

It was found that (14 cases; 73.68%) died from bleeding, (5 cases; 16.32%) died from head injuries. There was a significant difference where (Z score; 2.92, P value; 0.00175).

Data Related to the Victim

Age of the Victim
Table 4. Chi-square statistical analysis of the age of victims regarding the manner of the crimes among firearm cases referred to Port Said medico-legal department in the year 2011.
Gender of the Victim
* Statistically not significant
Table 5. Chi-square statistical analysis of the manner of the crimes according to the gender of the victims among firearm cases referred to Port Said medico -legal department in the year 2011.
Outcome of Firearm Injuries
* Statistically not significant
Table 6. Chi-square statistical analysis of the outcome of firearm injuries in comparison to the manner of crimes and type of
weapon in firearm cases referred to Port Said medico-legal department in the year 2011.
Data Related to the Weapon and its Firing

Type of Weapon Used

It was found that the firearm injuries were caused by non-rifled weapons in (35 cases; 52.24%) and by rifled weapons in (32 cases; 47.76%). There was no significant difference in firearm cases of Port Said regarding the tested parameters.
Table 7 . Chi-square statistical analysis for the relevance of the manner of the crime regarding the allegation of the types of weapons used among firearm cases referred to Port Said medico-legal department in the year 2011.
Direction of Firing
Table 8. Chi-square statistical analysis for the direction of firing regarding the manner of the crime in firearm cases referred to Port Said medico-legal department in the year 2011.
Types of the Missiles Found

It was found that in (38 cases; 55.07%) missiles were found during autopsy or by the medical personal during treatment of the cases or during examination of the crime scene or by imaging techniques, of which (20 cases; 52.63%), (7 cases; 18.42%), (3 cases; 7.89%), (2 cases; 5.26%), (2 cases; 5.26%), (1 case; 2.63%), (1 case; 2.63%), (1 case; 2.63%), (1 case; 2.63%) the missiles found were lead shots, metal jackets of bullets, plastic wads, lead shots and plastic wads, cartridge cases found at the crime scene, a 8.5 mm caliber bullet, a deformed bullet, a lead core of a bullet, a projectile that wasn’t sent to be examined, respectively.Calibers of Weapons Used in Crimes

Table (): Z-test statistical analysis of the calibers of the weapons used in In (5 cases; 7.46%), (2 cases; 2.99%), (4 cases; 5.97%), (3 cases; 4.48%) and in (53 cases; 76.10%), the calibers of weapons were 12 mm shotgun, 16 mm shotgun 7.62 * 39 mm automatic rifle, 9 mm automatic guns and could not be detected, respectively.There was a significant difference (Z score; 6.7382, P value; 0) Range of Firing

It was found that (53 cases; 79.10%), (7 cases; 10.45%), (1 case; 1.49%) and (6 cases; 8.96%) were far in range of firing, near, was shot from both near and far ranges and cannot be detected, respectively. There was a significant difference in firearm cases of Port Said between the cases with far range of firing and the rest of the ranges regarding the tested parameter ( Z score; 6.7382 and P value;0).

Level of Firing

It was found that in (6 cases; 8.96%), (5 cases; 7.46%), (5 cases; 7.46%) (51 cases; 76.12%), the level of firing was from above-downwards, below upwards, at direct level and can’t be detected, respectively.

Data Related to the Injury

Number of Inlets

It was found that (40 cases; 59.70%) there were multiple inlets and in (27 cases; 40.30%) there was a single inlet. There was a significant difference (Z Score; 2.1845, P value; 0.01463). In injuries caused by rifled weapons, 21 cases (65.63%) had a single inlet while 11 cases (34.38%) had multiple inlets. On the contrary, it was found that in injuries caused by non rifled weapons, 29 cases (82.86%) had multiple inlets while 6 cases (17.14%) had a single inlet. There was a significant difference in firearm cases of Port Said regarding the tested parameter (x2 value 16.332 and P value; < 0.0001).

Site of Inlet

It was found that in (29 cases; 43.28%), (18 cases; 26.87%), (8 cases; 11.94%), (3 cases; 4.48%), (3 cases; 4.48%), (2 cases; 2.99%), (2 cases; 2.99%), (2 cases; 2.99%) the site of the inlet wounds were in multiple sites, lower limbs, head, chest, abdomen, back, ilea and upper limbs, respectively. There was a significant difference between cases in the lower limbs and those in the head. When site of the inlet was analyzed in relation to the manner of crime it was found that:

In accidental cases: It was found that (2 cases; 33.33%), (2 cases; 33.33%), (1 case; 16.67%), (1 case; 16.67%) were injured in multiple sites, head, lower limbs and upper limbs, respectively. In homicidal cases: It was found that (25 cases;47.17%), (16 cases; 30.19%), (5 cases; 9.43%), (2 cases; 3.77%), (2 cases; 3.77%), (1 case; 1.89%), (1 case;1.89%), (1 case; 1.89%) were injured in multiple sites, lower limbs, head, chest, ilea, abdomen, back and upper limbs, respectively. In the suicidal case (1 case; 100%) was shot in the head. These results were statistically
insignificant.

Shape of Inlets

It was found that in (44 cases; 65.67%), (10 cases; 14.93%), (7 cases; 10.45%), (6 case; 8.96%), the shape of the inlet wounds were rounded, oval, irregular and other shapes, respectively. There was a significant difference between the rounded shape of the inlets and the rest of the shapes (Z score; 3.6282, P value; 0.00014).

Degree of Healing of the Inlet

It was found that in (32 cases; 47.76%), (16 cases; 23.88%), (14 cases; 20.90%), (5 cases; 7.46%) the wounds were completely healed scars, fresh wounds with inverted edges and loss of substance, in the process of healing wounds covered with a dried scab and were not mentioned, respectively. There was a significant difference between healed cases and fresh cases (Z score; 2.8827, P value; 0.00199).

Color of Inlets

It was found that in (20 cases; 29.85%), (14 cases; 20.90%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (28 cases; 41.79%), the colors of inlet wounds were red, brown, purple, white, yellow, black, pale and were not mentioned, respectively.

Site of Exit

It was found that in (9 cases; 13.43%), (5 cases; 7.46%), (5 cases; 7.46%), (2 cases; 2.99%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), (1 case; 1.49%), the site of the exit wound(s) were in the lower limbs, multiple sites, head, upper limbs, ilea, neck, back and chest, respectively. In (42 cases; 62.69%) there were no exit wounds.

Shape of Exits

It was found that in (12 cases; 48%), (10 cases; 40%), (3 cases; 12%), the shape of the exit wounds were irregular, oval and other shapes, respectively showing non-significant difference.

Degree of Healing

It was found that there was no significant difference as regards the degree of healing of the exits where (10 cases; 40%), (10 cases; 40%), (3 cases; 12%), (2 cases; 8%), the exit wounds were completely healed leaving scars, fresh exit wounds with everted edges and loss of substance, in the process of healing wounds covered with a dried scab, were not mentioned, respectively.Associated Patterns of Trauma

It was found that 17 cases (25.37%) of the total cases had associated other patterns of trauma, of which (7 cases; 41.18%), (3 cases; 17.65%), (3 cases; 17.65%), (1 case; 5.88%), (1 case; 5.88%), (1 case; 5.88%), (1 case; 5.88%) had cut wounds, abrasions due to blunt trauma, bruises due to blunt trauma, fractures of bones due to blunt trauma, contused wounds, cut wounds and abrasions due to blunt trauma, cut wounds and fractures of bones due to blunt trauma, respectively. All of these cases were homicidal in manner.Data Related to Investigations and Examination X-ray Findings

In 42 cases (62.69%) x-ray was done while, in 25 cases (37.31%) it was not done. It was found that in (38 cases; 90.48%) the X ray showed positive findings and in (4 cases; 9.52%) there were no findings in the x-ray.
Presence or Absence of Powder Marks and Abrasions around the Inlet
Table 9. Z test Analysis of the presence of Gun Shot Residues (GSR) and Abrasions in or around the inlet wound(s) in firearm cases referred to Port Said medico-legal department in the year 2011.
Number of Exits
Table 10. Chi-square statistical analysis of the number of the exit wounds regarding the type of weapon and manner of the crime in firearm cases referred to Port Said medico-legal department in the year 2011.
Clothes Examination Findings

In the records 23 cases were noted to have clothes examination where 19 cases (82.61%) showed positive findings and 4 cases (17.39%) showed negative findings. The discrepancy in findings was found to be statistically significant (Z score; 4.4233 and P value; 0)
Discussion

Most homicidal incidents tended to occur in the summer and were motivated by conflict that generally happened in the streets where subjects were generally male to male strangers. Victims were generally males of no specific age group who generally died from hemorrhage. Majority of weapons on the street in the tested period were non rifled homemade guns where lead shots were used as the majority of ammunition. Most of the homicidal incidents were shot at a large distance of firing indicating more than 1-3 meters according to the type of weapon. The direction of firing was found to be irrelevant when tested as a predictor and all directions were equally reported among our cases. Although direction was of no significant importance, yet the level of firing was found mainly to be from above downwards indicating the presence of intentional hunting from a higher level. This was also indicated by the prevalence of multiple inlets in victims and by the variation in the sites of these inlets.

In a study that was conducted in the Suez Canal cities in a 6 years period- from 2005 to 2010, it was found that in the 6 years before the year of our study, 2011, [6] found that the total number of firearm injuries and fatalities in Port Said was 58 cases. This reveals the marked increase in the number of cases in PortSaid in 2011 that revealed the huge magnitude of the problem that our study deals with in 2011. In that same study the majority of subjects were found to be males.

The age group found to have the most prevalence of firearm injuries was the age from 20- 29 years and that the majority of them were found to be homocide. This agrees with [7]. A study done in Assiut Governorate, Egypt, reported that the highest incidence of firearm injuries and fatalities occurred in the age group 21–30 years (31.3%), followed by the age group 31–40 years (25.5%). Results are similar to [8]. A study in El-Monofia Governorate, Egypt, during the year 2000, where the highest incidence occurred in the age group 20–30 years. Results also agree with [9]. A study in Pakistan that collected data about firearm injuries and fatalities in the years 2007 and 2008. shown that almost all age groups were represented, with the majority of victims being adults and middle-aged persons. These findings differ from [10]. A study done in Qena Governorate, Egypt that outlined the pattern of firearm injuries.There, the rate of incidence was in the age group 30–40 years (49.5%), followed by the age group 40–50 years (25.2%). No victims were younger than 20 years. This can be owed to the circumstances in Egypt during the year of the Egyptian revolution, with the security chaos, lawlessness and bullying in Egypt and in Port Said following the January 2011 revolution that led to the easy availability of illegal firearms at this period. The magnitude of crimes involving firearms indicate that firearms were sold legally and illegally across the country without a lot of control at this period. According to researches supported by the UNSCAR (United Nations Support Cooperation on Arms regulation). It was found that the Firearm-related death rate per 100,000 of population in the year 2011 in different countries were as follows: Australia (0.86), Bulgaria (2.35), Denmark (1.28), Germany (1.24), Mexico (15.511) and Panama (16.10).

There is a significant difference between cases in Port Said in 2011 and cases in the developed countries. This can be owed to the stability in the developed countries from the financial and the security states that led to the difference in the incidence rates here. While, in the developing countries like Mexico, Panama we find a high incidence rate as in Port Said, Egypt in 2011, due to the similarity in the financial and the security conditions and the case of lawlessness that led to the widespread and the usage of illegal weapons in crimes in those countries.

Many weapons were found on the streets during the year 2011. These weapons were either machine made or local manufactured and this was a prevalence that was associated with the political and security situation in Egypt. When the inlets of the firearms were analyzed in relation to the number and site, it was found that more cases were presenting with multiple inlets in various sites signifying an intention of harm that was not available in previous studies in the region [6]. This was also highlighted by the fact that most cases showed no signs of near firing, a fact that coincides with the concept of mass targeting. This fact was obvious in the 2011 statistics in comparison to old studies conducted on almost the same pool. Data retrieved reflecting management, follow up and thus outcome of the injuries was very scarce reflecting the poor sheeting and the situation of absolute chaos that was in the hospitals in this year.

Conclusion and Recommendations

The current study has offered an evaluative perspective on an important problem nationally and internationally which affects the world medically, legally, financially and emotionally. The study encountered a set of conclusions, which need to be considered. Certain changes may minimize mortality, disability, and costs to the community. Those changes include: Law enforcement and security stability which is very essential in minimizing the spread of firearm violence in the country. There is a need to decrease the number of firearms used and sold in Egypt. We need to eradicate illicit local community gun manufacturing units. There is a need for educational efforts, community and societal curriculum to reduce the number of firearm-related injuries, and specially addressing the youths by applying efficient programs to solve their problems and increase their awareness against violence and use of firearms by applying national programs for youths and organizing widespread media campaigns to increase the awareness against violence. Better training for medical personnel for better diagnosis and documentation of injuries and possible complications, especially the serious ones. A detailed form should be sent to the forensic pathologist from the general prosecution members explaining all the circumstances of the crime available before autopsy or medico-legal examination of victims. There is an urgent need for using every possible and available mean during autopsy and examination in order not to miss any injury, finding, or information that will help to reach the final opinion. Better training of police officers and policemen for dealing with protesters and crowds is essential.

Acknowledgments

A deep acknowledgement to the forensic medicine authority of Port-said Governorate for the help and enthusiasm in collecting this data.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
1. Payne-James J, Jones R, Karch SB, Manlove J. Ballistic injuries in: Simpson’s forensic medicine, 13th edition, CRC press, 2011.

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