MediCapt: Documenting Forensic Evidence of Sexual Violence

MediCapt allows clinicians to capture sexual violence forensic evidence and securely transmit it to police and justice officials for investigations/prosecutions

In 2011, Physicians for Human Rights (PHR) launched its Program on Sexual Violence in Conflict Zones to confront impunity for widespread sexual violence—used as both a weapon of war and a common crime. Rare cases that made it to court often failed because of insufficient evidence to support survivors’ allegations. In that context, PHR saw medical professionals as powerful change agents and created an initiative to enhance collaboration between medical and legal professionals to collect, document, and analyze forensic evidence to hold perpetrators accountable, and to improve medical care, and access to justice for survivors. PHR has been working with doctors, nurses, trauma counselors, police officers, lawyers, and judges in Kenya and the Democratic Republic of the Congo (DRC) to develop comprehensive, standardized methods for collecting forensic evidence of sexual violence to increase the likelihood of effective and successful investigations and prosecutions of these crimes.  

But health facilities and police stations using paper-based forms often lack proper storage for secure preservation or officials encounter difficulties traveling distances to retrieve evidence due to poor roads or lack of access to vehicles.

To address these challenges and to leverage mobile phone penetration even in the most resource-constrained environments, PHR has been developing a high-tech solution called MediCapt, a mobile application to help clinicians document forensic evidence of sexual violence during a patient encounter. This app converts a standardized medical intake form to a digital platform and combines it with a secure mobile camera to facilitate forensic photography. Clinicians will use the app to compile evidence, photograph survivors’ injuries, and securely transmit the data to authorities prosecuting these crimes. Digitizing these forms minimizes the chances of loss, tampering, or theft of medical evidence, while preserving chain of custody. 

Our partners in DRC and Kenya see MediCapt as a solution for yielding stronger evidence, preserving chain of custody, and improving data security, and privacy. Among its key features, MediCapt includes sophisticated encryption, cloud data storage, high fidelity to chain of custody standards, and tamper-proof metadata. The app’s data mapping feature will help to reveal patterns or prevalence of violence, including the widespread or systematic nature of offences critical to demonstrating crimes against humanity. MediCapt also facilitates early warning of and rapid response to mass crimes. Significantly, the Android-based app is designed to securely collect data in conflict zones, as well as remote locations where internet connectivity or wireless data transmission is limited.

PHR employs a participatory process called “co-design,” where we work with clinicians from DRC and Kenya – the end-users-- to obtain their feedback throughout the design and development process to ensure that MediCapt truly responds to their needs. MediCapt is designed to be scalable for use in many countries. It has been “future-proofed” to allow custom configuration of any national standard national form documenting sexual violence, and the app can be configured to accommodate multiple languages.

To our knowledge, no mobile health platforms have been developed specifically for use among frontline health providers to forensically and clinically document human rights violations, including sexual violence. MediCapt offers a new way of collecting and preserving sexual violence evidence to inform police investigations and be admitted to courts. MediCapt is creating a new platform at the intersection of the digital health field of data collection and legal documentation of evidence. MediCapt will strengthen the evidence gathered in a single case and it has the potential to aggregate de-identified data to establish key epidemiological trends and patterns of criminal activity.

MediCapt offers a technological solution to the real-life challenges of low-resource settings, when documenting, preserving, and transmitting forensic evidence from the clinic to the police. Most health and police facilities have no secure storage, and confidential medical files are kept on desks or on the floor, where they risk being damaged, tampered with, or stolen. MediCapt bypasses these infrastructure hurdles. The app provides an innovative solution that allows clinicians to gather evidence without internet connectivity, encrypt and secure sensitive data, and preserve chain of custody as evidence is transmitted from the clinic to the police. 

PHR has been collaborating with clinicians in DRC and Kenya to improve MediCapt’s features (offline printing, secure photo capture capacity, and back-end review for quality improvement and assurance). We have also been working with health care facilities to integrate the app into clinical workflows and co-developed implementation protocols. Over the next 12 months, we will (1) pilot and field test the app at new facilities in Kenya and DRC with local clinicians; (2) coordinate with police and justice officials to develop the web-based version of the app; and (3) prepare and release the code to make it open source.

MediCapt has significant potential for scale up within and beyond the current implementing countries. Over the next 3-5 years, we will: (1) expand MediCapt’s use among health facilities in the current pilot countries (Kenya, DRC); (2) Deepen partnerships among health and justice authorities to integrate the app into their processes and reinforce local ownership and sustainability; (3) field-test the app in two new countries (Central African Republic, Colombia); (4) build the mapping feature to aggregate de-identified data from multiple forensic medical records to establish epidemiological trends for early warning and rapid response; and (5) create an IOS version of MediCapt. 

PHR is developing MediCapt as part of a capacity development initiative. Our current end-users, clinicians at hospitals in Kenya and the DRC, have been selected through our networks of partners across multiple communities. We work closely with hospital administrators, county officials, and national authorities to integrate the app into national medical-legal protocols and processes to ensure long-term sustainability. The app will be deployed through current users, who will become trainers or ‘super-users’ themselves and they will help their colleagues adopt the technology regionally and nationally. The app is available for download in the playstore and will be open source code.

We have trained 30 clinicians in DRC and Kenya to collect forensic evidence of sexual violence on the app. These clinicians each examine approximately 155 survivors/year, amounting to 4,650 survivors/year. With the patient’s informed consent, this evidence is transmitted to police and justice officials to inform investigations and prosecutions. On the back end, researchers and epidemiologists will also have access to aggregated de-identified data for analysis and mapping trends, allowing for early warning or rapid response. The ultimate beneficiaries of the app are survivors who are empowered with compelling evidence to bring their cases to court and obtain justice.

We currently have capacity to reach more than 4,000 sexual violence survivors at clinics where MediCapt is being field-tested. We expect to reach double that amount upon our expansion to five new clinics this year. In three years that reach can quadruple. During this time, we hope MediCapt will be adopted by national health care services and provide a model for digital evidence collection in these pilot countries. When MediCapt expands to new countries, it can potentially impact millions. When clinicians conduct medical evaluations using MediCapt, survivors obtain comprehensive forensic medical evidence, which increases the likelihood of successful prosecutions.

We have a multinational and multidisciplinary team of experts designing and developing MediCapt. We work with: (1) independent technologists, who help build the code and test the strength and durability of its security features; (2) a forensic medical expert, who provides guidance on medical ethics, informed consent, deploying technology in a manner consistent with best practices and patient-centered approaches to empower and reinforce the survivor’s dignity; (3) a police and justice expert, who helps clarify legal aspects necessary to integrate the app in new jurisdictions; and (4) clinicians from Kenya and DRC, who field-test the app and provide feedback. 

Physicians for Human Rights (PHR) is a not-for-profit NGO based in the United States. PHR secures most of its funding from private foundations and governments. In recent years, PHR has received funding from the US Department of State, the United Nations, the World Bank Group, and private foundations to support our Program on Sexual Violence in Conflict Zones, a training and advocacy initiative that bolsters the ability for medical, law enforcement, and legal professionals to gather and preserve forensic evidence of sexual violence to strengthen prosecutions of and accountability for sexual violence in East and Central Africa. We launched MediCapt as a tool to be implemented in resource-constrained contexts to build on and reinforce the sustainability of our initiative. Donors are seized with MediCapt’s potential impact and that it is being developed with national medical leaders and end-users to support local ownership of the app. We hope to cultivate new partnerships with private sector stakeholders to support scale up, maintain the open source code, and provide in-kind services. MediCapt will be a free app available for download in Google Play Store for any clinician to use to document medical findings when conducting forensic evaluations of sexual violence survivors. 

We are eager to connect with the MIT Solve Frontlines of Health community of technologists, security experts, entrepreneurs, and ethicists to learn how we can improve the design and development of the app and how we can intelligently and responsibly take the app to scale to new communities and locations. We also welcome the opportunity to exchange ideas and lessons learned with colleagues and peers who have been experimenting with new technology in low resource environments. We value working in partnership and the mutual growing and learning that comes with collaboration. 

Successful adoption depends on user behavior, meaning how the technology is incorporated into patient-care workflow at a health facility. Limited tech literacy by end-users, limited access to hardware, power outages, and unreliable connectivity present infrastructural barriers. Reliance on paper, and potentially unsupportive leadership present system-based hurdles. We are also trying to develop an app that can be used universally while adapted to unique contexts and jurisdictions. It is also critical for the human rights and technology communities to explore together the technological, legal, and ethical issues raised when digital technology is used to document human rights abuses.