Autopsy report for Arafat Jaradat [who died in Israeli detention]: No sign of heart attack, more tests ordered

Israel’s Ministry of Health issued an interim finding in the autopsy of Arafat Jaradat [see our earlier post] — this time, after examination of microscopy and toxicology findings.

The microscopy results apparently showed no sign of heart attack.   Therefore, the Israeli statement said, further tests will be conducted.

According to the Israeli statement, the only injuries appeared to be related to [“were consistent with“] a 50-minute attempt to resuscitate Jaradat, who had been undergoing days of harsh interrogation in Israeli custody.

The heart attack hypothesis was first announced by the Israeli Prison Services spokesperson Sivan Weizman, who was responding to inquiries from the media, just after Jaradat’s death was announced.

The Israel Prison Services said their staff began resuscitation efforts, then called in the MDA [Magen David Adom, or Red Star of David] to help try to resuscitate Jaradat.

From the Israeli Health Services statement today, we learn that resuscitation efforts went on for 50 minutes.  This is long, but not unusual in the case of a person in his early 30s, according to one American doctor in Jerusalem.

The full statement of the Israeli Health Ministry, sent around by the Israeli Government Press Office [GPO,  part of the Prime Minister’s Office] says:
“National Center for Forensic Medicine Director Prof. Yehuda Hiss, Health Ministry Medical Administration Director Prof. Arnon Afek, and Chaim Sheba Medical Center at Tel Hashomer Pathology Institute Director Prof. Iris Barshack, today (Thursday, 28 February 2013), examined the microscopy findings for Arafat Jaradat.
It was found that the hemorrhages and fractured ribs found during the autopsy occurred close to death and are characteristic of the resuscitation attempts that were performed on the deceased by Prison Service and MDA medical staff for 50 minutes in an effort to save his life.  No signs of other contusions were found. The toxicology tests were also negative.
There were no signs of significant change due to illness in other organs that could indicate cause of death; therefore, further tests to determine the cause will be performed”.

The  American doctor I consulted with in Jerusalem today agreed that the Israeli Health Ministry statement  dismisses “heart attack” as a the cause of Jaradat’s death…

The Palestinian forensic specialist who attended the autopsy conducted in Israel’s Abu Kabir instutute near Tel Aviv has now issued his own separate autopsy report, which concluded that the many injuries found on Jaradat’s body “had resulted from direct and extreme torture”.

Immediately after the autopsy, Palestinian officials ruled out a heart attack as cause of death — on the grounds that no blood clot had been found in Arafat Jaradat’s heart.

There was, in other words, no significant clogging of the heart’s arteries that could have brought on a “heart attack”, which causes clear damage to the heart’s muscles.

It is unclear if there is any way to test, after the fact, to see if there has been arrhythmia — an irregular heartbeat that can be the result of many causes, including fear and stress.   Arrhythmia is usually verified by an electrocardiogram done while an attack or episode of irregular heartbeat is in progress.

Arrhythmia could result in “cardiac standstill”, where the heart stops working — even though there has been no injury to the organ. This is technically not a heart attack, which would cause damage to the heart

One of the autopsy findings appears to confirm that Jaradat’s heart had stopped working: “Lungs: Severely congested and edematous“. Jaradat’s lungs were found to be full of fluids that back up into the lungs when the heart stops pumping.

Arrhythmia could also result from “shock” or  painwhich is basically what the Palestinian autopsy report says was the cause of death.

Another possible cause of arrhythmia is, apparently, electrical shock.   One medical site on the internet, here, notes that “A healthy person will hardly ever suffer from long-term arrhythmia unless he/she has an external trigger, such as drug abuse or an electric shock“.

Jaradat, 30 [or 33] years old, was arrested near his home in Sa’ir village in the southern West Bank near Hebron on 18 February. He admitted to accusations of throwing stones last November, during the IDF’s Pillar of Clouds/Defense Pillar operation in Gaza, and also in 2006, but denied tossing an incendiary device. He was brought to a military court in what his lawyer said was bad condition on 21 February, and the presiding military court judge ordered another 12 days of interrogation. But Jaradat died two days later, on 23 February, in Israeli custody in Megiddo jail in Israel, just north of the West Bank.

Jaradat was apparently badly beaten when arrested, interrogated for days, transported between jails + military court. He was exposed to harsh treatment at every step along the way. When he saw his lawyer for the first and only time on 21 March, he complained of extreme back pain apparently from being forced into stress positions for long periods during interrogation sessions.

The Palestinian Government Media Center provided a translation of a statement provided by made by Jaradat’s lawyer [Kamil Sabbagh] that says: “I sat next to him, his back was bent, he looked tired and scared; I asked if he was ok, he said that he’s suffering from sharp pain in the back and other parts of his body as he was interrogated for several hours. Afterwards, I questioned the police investigator; I summed up what I wanted to say and directly asked him about Arafat’s health conditions and that he was suffering from back pain since he was arrested and interrogated for several hours, which caused his back pain and other aches and that his detention conditions are not appropriate”.

UPDATE: Haaretz’s Gideon Levy reported, in a story published on 2 March, that he was told by Kamil Sabbagh, the lawyer who saw Jaradat in court on 21 February, that: “The fellow came in – doubled over, scared, confused and shrunken…The judge gave us two minutes to talk. He told me he suffered from back pain that had been exacerbated by prolonged sitting on a chair with his hands tied behind his back during his interrogation.” This story is posted here.

However, another report, published by Ma’an News Agency here, translated the lawyer’s remarks in a different way, [or perhaps relied on some other testimony? this is not clear] to say Jaradat “was being beaten up and hanged for many long hours”]. No other source reports this.

Gideon Levy and a group of 14 Palestinian and Israeli human rights organizations note that at Attorney Sabbagh’s request, the military court judge ordered a medical examination of Jaradat — but it is not clear if this ever took place.

UPDATE: On Friday 1 March, a group of 14 Palestinian and Israeli human rights organizations issued a joint statement today saying that when Arafat Jaradat was taken before a military court judge on 21 February, “his lawyer, Mr. Kamil Sabbagh, reported that Arafat was suffering from severe pain in his back and appeared to be psychologically and physically weak after three days under interrogation. According to Mr. Sabbagh, Arafat also expressed strong fear at the prospect of returning to interrogation when his detention order was extended by 12 days. After a request from Mr. Sabbagh, the Israeli military judge ordered that a full physical and psychological examination of Arafat be carried out, the results of which were to be presented to the Israeli Security Agency (ISA) and the court. It is unclear if this medical examination ever took place. If it did, the results of the exam should be disclosed. If it did not, the Israeli authorities must explain why this order was not complied with”.

The statement said that the autopsy “found that Arafat displayed severe bruising on his upper back, deep bruising along the spine, and significant bruising on both sides of the chest. The postmortem also discovered bruising on both arms and inside the mouth, blood around the nose and three fractured ribs. In addition, the examination discounted the claim by the Israeli authorities that Arafat died of a heart attack. His heart was completely healthy and there was no evidence of damage or weakness of any kind”.

The group of 14 Palestinian and Israeli human rights organizations added that “Arafat’s death is symptomatic of the utter disregard with which Israel holds the lives of Palestinian prisoners. Since the beginning of the occupation in 1967, 203 Palestinians have died in Israeli detention centres. At least 71 of these died as a direct result of torture…”

According to the Israeli Health Ministry statement, three Israeli medical officials today examined the microscopy and toxicology findings on samples taken during the autopsy carried out on 24 February in the presence of the chief Palestinian medical examiner.   “Hemorrhages and fractured ribs found during the autopsy” are, according to the Israeli doctors, “characteristic of the resuscitation attempts that were performed on the deceased by Prison Service and MDA medical staff for 50 minutes in an effort to save his life”.

The Israeli statement said: “No signs of other contusions were found”.   So, for the Israeli medical officials involved, all the injuries found on Jaradat’s body were caused by resuscitation attempts.

A Palestinian autopsy report released yesterday said that there were “multiple injuries on Jaradat’s body”.

The American doctor in Jerusalem who I consulted today said SOME of the injuries listed in the Palestinian report are consistent with resuscitation attempts — in particular, the fractured upper ribs.  But, he said, some aren’t — in particular, the bruising on the back, and injuries to the back + shoulder…

According to the Palestinian Centre for Human Rights, in Gaza, which sent out a statement on Wednesday with translated excerpts from the Palestinian autopsy report, it concluded that: “Jaradat’s death was caused by nervous shock resulting from severe pain, which was caused by multiple injuries inflicted through direct and extreme torture”.

A new and apparently complete translation of the full Palestinian autopsy report was released on Friday, and the English translation is posted here.

It says: “In light of forensic evidence and scientific forensic explanations, it is the opinion of the technician, as a Palestinian forensic doctor and as an expert in the field of forensic medicine, that THE REASON OF DEATH [is]: nervous shock as a result of extreme pain from the intensity of the injuries described above, which resulted from multiple direct and extensive acts of torture“.  This new + fuller translation is posted here.  The original report in Arabic is posted here.

The Palestinian autopsy report was prepared by Dr Saber al-‘Aloul, Director of the Palestinian Medico-legal Institute, who was present at the Israeli autopsy done in Abu Kabir National Center for Forensic Medicine near Tel Aviv.  The Palestinian report said:  “Contrary to Israeli claims that Jaradat died due to an apparent heart attack, the autopsy showed, according to the Palestinian physician’s report, that ‘the heart muscle is perfectly healthy; no signs of harm or signs of a recent or previous myocardial infarction […]”

The Palestinian statement also said that “the report indicated that there were multiple injuries on Jaradat’s body“:

‘”There are recent excoriations and bruising on the inside of the lower lip; there is severe bruising on the upper right back; there are circle-shaped bruises on the bottom of the front right side of the chest; there is bruising on the facis lateralis brachii of the left elbow; there is bruising on the back of the right arm; there are deep bruises, 4 x 9 centimetre in diameter, on the muscle of the upper left shoulder, adjacent to the spine, below the neck; the bruises damaged the tissue of the muscle; there are 4 x 10 centimetre bruises on the right side of the chest; the bruises penetrated the skin and caused damage to the muscle tissue; they were located 27 centimetres from the spine, 53 centimetres below the top of the head; there is a fracture in the second and third ribs on the front left side with bruises around the fracture; and there is a fracture in the second rib on the front right side of the chest. The report emphasised that all fractures or wounds were recent, that the injuries were severe, and had resulted from direct and extreme torture“…

UPDATE: On Saturday, 2 March, Ma’an News Agency reported here that Jaradat “died in an interrogation room in Megiddo prison known for holding informers, says the Palestinian ministry of prisoners affairs. In a report made public Saturday, the ministry detailed that Jaradat was detained on Feb. 18 and went through a tough interrogation process at a Shin Bet facility in Jalameh detention center. ‘He was tortured savagely and was put under psychological pressure on suspicion that he threw stones at Israeli troops’, the report said. ‘Then he was moved to an interrogation facility in Megiddo (the “stool pigeons” room) for further investigation because he wouldn’t admit to the charges at Jalameh. Two days after he was moved, he was murdered’. The ministry’s report described the ‘stool pigeons’ room’ as the most dangerous arm Israeli intelligence services turn to when interrogating Palestinian detainees. ‘Prisoners are beaten, tortured, blackmailed and threatened in that room in the absence of any watchdog’. The report added: ‘Israeli courts and intelligence services rely on the results of investigations conducted in informer rooms without questioning and scrutinizing the interrogation methods used in these rooms’.”

Earlier, Gideon Levy wrote in the Weekend section of Haaretz here, “Did he really die in the solitary confinement cell at Megiddo Prison, or had he been transferred there after his death in Jalameh in order to blur the fact that he had died under interrogation, as his family suspects?”

Even earlier, on 25 February, Amira Hass reported for Haaretz that Palestinian organizations representing prisoners say one possibility is that [Arafat Jaradat] was placed in a cell with informants at Megiddo Prison. This is published by Haaretz here. It is not clear exactly when Jaradat was moved from Kishon/Jalameh to Megiddo, but it happened after the military court hearing on 21 February. In her article, Hass notes that military judge Maj. David Kadosh presided over Jaradat’s hearing on 21 February — apparently Jaradat’s only day in court.

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