Journal of Forensic and Legal Medicine 37 (2016) 39e44
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Journal of Forensic and Legal Medicine j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Original communication
Survey of medico-legal investigation of homicide in the region of Epirus (Northwest Greece) Kleio Fragkouli, Vassiliki Boumba, Theodore Vougiouklakis* Department of Forensic Medicine and Toxicology, University of Ioannina, Greece
a r t i c l e i n f o
a b s t r a c t
Article history: Received 3 July 2015 Received in revised form 23 September 2015 Accepted 24 October 2015 Available online 2 November 2015
This study analyzed the forensic features of homicides in North-West Greece (Epirus) from 1998 to 2013, a borderland area between Greece and Albania. Although Greece is critically influenced by both the increasing flow of refugees and the current socioeconomic crisis, very little information has been published regarding the patterns of homicide in the country. Fifty-eight autopsied victims (36 males; 22 females) were investigated. The median age was 37 years old. The average annual homicide rate was 0.85 per 100,000 inhabitants and showed remarkable fluctuation, with largest increase during Greek financial downturn. Sixteen victims were not Greek citizens. The most common method of commitment was the use of firearm (40%). The main motives were economical causes (26%) and passion (14%). Four cases were categorized as matricide (7%), 3 as homicideesuicide (5%), 2 as patricide (3%) and 1 as infanticide (2%). Toxicological analysis proved negative for ethanol and other psychotropic substances in the majority of the victims (50%). There is an urgent need for public actions both in Epirus and in Greece, with the application of effective strategies against criminality. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords: Homicide Forensic Greece Homicide rate Refugees Socioeconomic crisis
1. Introduction Violent crime trends in Europe have changed during the last twenty years, since the opening of borders across the continent. These changes have been reflected to the homicide rates presented by various European countries.1 Although Greece is essentially affected not only by the increasing number of refuges crossing the borders but also by the current socio-economic crisis, very little data has been presented regarding the trends and patterns of homicide in the country.2,3 This study was undertaken to identify and analyze the characteristics of homicides in Epirus, north-western Greece, a borderland region between Greece and Albania. One of our main purposes was to compare our results to those encountered in other European countries as well as in countries outside the continent. The study was based on the medico-legal autopsies performed on the victims of a geographically restricted area, which is appropriate for epidemiologic studies. Medico-legal autopsies contribute significantly in providing useful statistical data related to legal
* Corresponding author. Department of Forensic Medicine and Toxicology, University of Ioannina, University Campus, 1186, 45110 Ioannina, Greece. E-mail addresses: [email protected] (K. Fragkouli), [email protected] (V. Boumba), [email protected] (T. Vougiouklakis).
occurrences in a given area. All available data was investigated; however, data regarding the offenders were restricted, mainly due to the existing private policies applied in Greece. The increased number of refugees who crossed the country borders during both 90s and the last 10 years streamed the study towards the impact of the nationality of the victims and perpetrators on homicide rates. Furthermore, the influence of the socio-economic crisis, which Greece undergoes the last 7 years, on the pattern of homicide is discussed. Identifying essential features of homicides in the Epirus area may contribute to the collection of important data at the disposal of the police, local and national authorities. This would promote preventive measures and society's awareness. 2. Material and method A retrospective investigation was conducted on a consecutive series of homicides that were autopsied at the Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Ioannina in Greece, in the 16-year period 1998e2013. Greece is a small, rather homogeneous country, with a population of approximately 10,820,000 inhabitants according to the National Statistical Service Bureau (2010).4 The region of Epirus is comprised of four prefectures and its population is 336,856 inhabitants, representing
http://dx.doi.org/10.1016/j.jflm.2015.10.003 1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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3.1% of the overall population of Greece. The cases were identified through the archives of autopsy cases maintained at our Department. The Department of Forensic Medicine and Toxicology, University of Ioannina, is legally authorized to perform all the medicolegal autopsies and investigate all the non-natural and violent deaths occurring at the region of Epirus. Information regarding the national statistical data of homicide was retrieved from Hellenic Police's archives.5 The investigation covered all cases of homicide, including violence or physical harm resulting in death. This applies to all intentional and unintentional deaths due to premeditated violence or other deliberate action resulting in injury and death. Unintentional homicides were excluded from the study. Thus, the material comprised all those fatalities where the manner of death at the autopsy report was registered as homicide-murder, infanticide, patricide, matricide and homicide followed by suicide. Toxicological analysis was performed in the majority of the cases. Excluded from toxicological examination were the cases of skeletonization (involving principally firearm fatalities) and dismemberment of the victims, where no appropriate biological material was available for the analysis. The data examined included the age and gender of victims, the nationality, the time of the assault (time, day, season), type of weapon used, location of fatal wound, motive of commitment and number of offenders involved in the crime. Data regarding the individual characteristics of assassinates and victims, circumstances, homicide category, method and motive of commitment was obtained from autopsy reports, police requisition forms and prosecution authorities' files. The data were analyzed using the R statistical software program (R 2.14.1 for Windows). 3. Results
(W ¼ 69, n1 ¼ 16, n2 ¼ 16, p ¼ 0.03) annual homicide rates of Epirus and Greece, respectively, with the national rate (median ¼ 1.29 per 100,000) being higher than that of Epirus (median ¼ 0.85 per 100,000). However, the homicide rate in Epirus fluctuated more than the national homicide rate, with a relative decrease during 1998e2005 and a steep increase during 2011e2013 (Fig. 1). 3.2. Gender, age and nationality of homicide victims In the total material of the study, 62% of the homicide victims were male (N ¼ 36), 38% being female (N ¼ 22). The median age of the victims was 37 years, with a significant gender difference (KruskaleWallis test: c2 ¼ 4.34, df ¼ 1, p ¼ 0.03); males were significantly younger than females (medians: 35 years old for males and 51 years for females). Fifty percent of the individuals were within the age range of 21e40 years, whereas 22.4% were over 60 years old (Table 1). Only two victims (3.4%) were under the age of 16. The majority of the victims (72.4%) were of Greek nationality, 19% were Albanians (due to the geographical position of the region, close to the border with Albania) and only 5% were migrants from an Asian country. 3.3. Toxicological analysis Seventy-four percent (n ¼ 28, 12 males and 16 females) of the 38 biological specimens sampled for toxicological analysis (including blood, urine and vitreous fluid) were negative for alcohol, drugs of abuse or other substances. Eight individuals (21%) were positive only for alcohol, with an average blood alcohol concentration (BAC) of 0.84 g/l. In one victim, BAC exceeded 2 g/l. One 28-year-old man killed by his father was found positive for heroin and in another 31year-old man toxicological examination revealed carbamazepine in his blood.
3.1. Homicide rates 3.4. Location and time of homicide The investigation included 58 homicide victims (36 males, 62%; 22 females, 38%) among 4005 autopsy cases (1.4%) performed during the study period. These victims were killed in 55 homicide episodes. The exact number of migrants (mainly Albanian) was not specified. The annual homicide death rate was 0.85 per 100,000 inhabitants for the 16-year period. The number of homicides per year (mean ¼ 4 homicides per year) in Epirus was independent of each other, showing no particular pattern or significant variation of homicide rate over time during the period 1998e2013 (c2 ¼ 7.25, p [by randomization, 5000 permutations] ¼ 0.39). Comparing the yearly homicide rates in Epirus with the respective Greek national rates, there was a significant difference between the median
Half of the victims were killed in a rural deserted area or close to agricultural terrain, 15 (26%) were killed in a public place and 14 homicides (24%) took place at home. In 16 cases (28%) the event occurred during afternoon and 14 homicides took place late at night (24%). The majority of homicides occurred during the week (Thursday, 18%; Friday, 18%) and during spring and summer (65% for both). 3.5. Homicide characteristics The present data was classified into five categories, with 48 victims (82.8%) being cold-blood murdered or physically injured
Fig. 1. The homicide rate in Epirus compared to the national Greek homicide rate, between 1998 and 2013.
K. Fragkouli et al. / Journal of Forensic and Legal Medicine 37 (2016) 39e44 Table 1 Age and gender distribution of the homicide victims.
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Table 3 Homicide method.
Age
Males
Females
Total
Category
Males
Females
Total No of cases
60 y Total
1 1 12 11 4 3 4 36
0 3 1 5 2 2 9 22
1 4 13 16 6 5 13 58
Firearm Sharp force Blunt force Combination of methods Strangulation Total
18 8 6 4 0 36
5 4 5 3 5 22
23 12 11 7 5 58
y y y y y
(1.7%) (6.9%) (22.4%) (27.6%) (10.4%) (8.6%) (22.4%) (100%)
Table 2 Homicide category. Category
Number of cases
Murder/physical Matricide Homicideesuicide Patricide Infanticide
48/58 (82.8%) 4/58 (6.9%) 3/58 (5.2%) 2/58 (3.4%) 1/58 (1.7%)
with fatal outcome, 4 homicides (6.9%) were categorized as matricide, 3 homicides (5.2%) were followed by suicide, 2 (3.4%) were classified as patricide and 1 case (1.7%) as infanticide (Table 2). The absolute number of intrafamily homicides (14/58, 24%) was distributed through the years, showing a decrease between 2001 and 2009, followed by an increase during the last 3 years (2010e2013). The number of intrafamily homicides and its fluctuation for the period 1998e2013 divided in 3-year periods appear in Fig. 2. Seven homicides (12%) were committed by the victim's expartner and in most cases the offender/s was/were acquaintances of the victims (26/58, 45%). Men were most often killed by an acquaintance (23/58, 61%), women by their ex-partner or a family member (15/19, 79%). In 42 cases (72.4%) the offender involved was a single person, in 11 homicides (19%) multiple (>2) offenders were involved and in 6 cases the number of offenders was not known. The most common homicide method was gunshot (39.7%), followed by sharp force (20.7%) and blunt force (19%) (Table 3). Our analysis showed there was an association between method of commitment and gender; males were more commonly killed by firearms (50%) and females by strangulation and this difference was statistically significant (Fisher's Exact Test: p ¼ 0.02). In particular, only women were killed by means of strangulation. In 20 cases (34.5%) multiple wounds were present on the victim's body,
(39.7%) (20.7%) (19%) (12%) (8.6%) (100%)
whereas in another 20 cases (34.5%) the only site of fatal wound was the head. No women were injured to the chest (Fig. 3). The main motives included economic cause (25.9%), passion (13.8%) and revenge reasons (12%) (Table 4). The absolute number of homicides with the offender's motive being criminal competition showed a sharp decrease after 2000. The percentage of these homicides out of the total number of homicides during 1998e2013 divided in 3-year periods and its distribution over time is presented in Fig. 4. Involved in these homicides were mainly Albanians (5 among 6 victims). Ten perpetrators received the diagnosis of personality disorder and they were more prone to intrafamily homicide (8/10). There was no data regarding the use of alcohol or other drugs of abuse among the offenders. 4. Discussion This study provides an overview of all homicides in a welldefined geographical area in Greece, with a low homicide rate and a high immigration rate, principally due to the region's proximity to the Albanian borders. The median homicide rate in Epirus
Fig. 3. The number of male and female victims classified according to the body region wounded.
Table 4 Offender's motive.
Fig. 2. The distribution of intrafamily homicides during the study period divided in 3year intervals.
Category
Number of cases
Economic cause Passion/erotic Revenge Criminal competition Spontaneous domestic Non-specific motive Conflict Staged domestic Argument Disorganized sexual Organized sexual
15/58 (25.9%) 8/58 (13.8%) 7/58 (12.0%) 6/58 (10.3%) 6/58 (10.3%) 6/58 (10.3%) 4/58 (6.9%) 2/58 (3.5%) 2/58 (3.5%) 2/58 (3.5%) 0/58 (0.0%)
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Fig. 4. The distribution of the homicides motivated by criminal competition during the study period divided in 3-year intervals.
during the 16-year period was 0.85/100,000 inhabitants per year, presenting a lower figure in comparison to the national rate which was 1.29/100,000. Interestingly, the homicide rate in our region showed a remarkable fluctuation through the years with a steep decrease between 1998 and 2000 and a steep increase after 2011. Possible explanations include the relative regional reduction of the number of refugees in Epirus after 2000 reflected in the decrease of homicide incidence, and the effects of Greek economic austerity measures on the criminality of Epirus after 2010, respectively. Recent research supported that the level of a country's development has an effect on the city-level homicide rate.1 The homicide rate in Greece has risen more than threefold during the past four decades, with a sharp increase more than double during the past decade.2 Regarding Greek socioeconomic crisis, the homicide rate increased by 38% (p < 0.001) during the crisis (2009e2012) compared with the pre-crisis period (2005e2008).2,5 The respective homicide rates in other European countries are similar both to that in Epirus and the national rate in Greece. In Northern Italy (Brescia) the homicide rate during a period of 30 years was 0.77/100,000 population.6 The annual homicide rate (2009) was 1.0/100,000 in Sweden, 0.6 in Norway and, during a 25year period, was 0.92/100,000 inhabitants in Southern Denmark.7e9 Finland showed a higher annual rate among Scandinavian countries, the figure being 2.3/100,000 according to the United Nations Office on Drugs and Crime (2011).8 In Turkey (Konya), the corresponding rate during an 8-year period was 2.6/ 100,000 population.10 Worldwide, the highest homicide rates were retrieved in South and Central America, with 68.5 homicide deaths/ 100,000 inhabitants in male population aged 15e29 years, whereas the lowest is found in South-East Asia, being 0.9/100,000.11,12 European Union presents a respective rate of 14.9/100,000 population.13 Nonetheless, although the majority of European and nonEuropean countries have shown remarkable decreases in homicide rates during the period 2000e2010, Greece confronts homicide as a threatening and growing public health issue.2,8 Of note, in 2011 homicide rate in Greece was the 6th highest among European countries, whereas it was the 6th lowest in 2006.14 The median age of the victims was 37 years in the present study, alike the results from other studies from Great Britain, Western Norway and Sweden, showing average ages of 34, 35 and 37 years, respectively.7,15,16 Noteworthy, males were significantly younger than females (medians: 35 years old for males and 51 years for females). Among female victims, 41% were over 60 years old. It seems that weak elderly women are more likely to represent easy targets in robbery murders, as shown in another recent study from Denmark.9 Data from the Hellenic Police have shown that in Greece, robbery motivated homicides have increased 87%
(p < 0.001) in 2011 in comparison with 2010, the majority of the victims being elderly individuals.5 On the other hand, the number of child/infant victims in our study was low, as the 3.4% of all cases were under the age of 16. A similar figure is presented in a recent research from Sweden (4%).17 Half of the victims were killed in a deserted area, rural in nature, which is justified considering that the major part of Epirus region shows an intense geophysical terrain. Most homicides took place during afternoon or late at night (52%), compatible with previous studies,18,19 and during the week (Thursday and Friday, 36%), similar to earlier published results.20 Spring and summer were the most common seasons of commitment (65%), unlike the results of other studies revealing the winter as the most likely season of homicide occurrences.21 In 74% of the blood samples analyzed, toxicological analysis was negative for ethanol and drugs of abuse. In cases where the toxicology revealed ethanol in the blood specimens, we considered postmortem ethanol formation to be minimal, as most homicide victims were discovered soon after death and the postmortem examinations of biological specimens were performed rapidly in the majority of cases. Noteworthy, only 21% of the victims were positive for ethanol per se, with no other legal or illegal drugs codetected in blood. This finding is quite different to other studies revealing ethanol detection in blood in 29%e74% of all the victims, usually combined with other drugs of abuse.7,22e24 Additionally, legal and illegal drugs were detected in only 3.4% of our sample, unlike other studies ranging 15e22% in Scandinavian countries and from 5% to 30% in Australia and USA.16,25e27 Perhaps ethanol consumption and drug abuse in Greece is, in general terms, lower in comparison to other countries. Also, probably most homicide cases in our cohort were committed under an ambush, rather than in a staged condition involving substances' consumption making the victims more vulnerable to a homicide episode. The most common method of homicide was the use of firearms (almost 40%), mainly shotguns, involving most frequently men. Epirus presents a high number of migrants, with an ease in gun access, and also, is an area where hunting is quite common. Scandinavian countries show lower figures of gunshot induced homicides (19e22%)7,28 and Asian countries even lower (1e3%).29,30 These results correspond to the restricted availability of guns and the firm legislation regarding firearm possession. On the contrary, in countries were law appears more tolerant, such as Italy, Holland, USA and Canada, homicides were committed by use of firearms in high percentages (30e60%).6,31e33 Sharp force was the second method of homicide in our cohort (21%) comparable to studies from other countries, such as the Nederlands and Western Norway,7,31 but differs remarkably compared to Russia, Denmark, Finland and India, where the corresponding figures were between 38% and 62%.9,23,30,34 Strangulation was less commonly used as a homicide method (8.6%) and involved only women in our study, obviously as a result of the advanced physical strength of men against women. Our results showed that 24% of homicides took place among family members. The number of intrafamily homicides showed a remarkable increase after 2007 in Epirus, possibly reflecting the intense intrafamily problems and arguments on the grounds of the financial crisis and the austerity measures applied in Greece during the last 8 years. Matricide, a type of intrafamily homicide, appears infrequent in our study and published research reveals that offenders killing their mothers almost always have a psychotic substrate or have received the diagnosis of personality disorder, as was also the case in our study.35 The offenders involved in patricide, on the other hand, seem to have crossed their limits against violent fathers; only two victims were killed by their father in our cohort. Infanticide, appeared only once in our material (1.7%), most likely due to better means of pregnancy prevention and a more tolerant
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public attitude toward undesirable pregnancies. Another subtype of intrafamily homicide, the partner killing, was almost exclusively committed by men against women in our sample. Interestingly, in Great Britain and USA, the prevalence of male victims killed by female partners was 3e8%,36e38 whereas in Finland the corresponding figure reached 35%.34 The perpetrator committed suicide after killing the victim in 5.2% of the study cases, representing an average rate of 0.06/ 100,000 inhabitants. These results are similar to those published in a recent study in Italy during a 24-year period, which showed that the average annual incidence of the so called ‘dyadic deaths’ was 0.04/100,000.39 Homicideesuicide episodes accounted for 5e10% of homicide cases in England, 10% in Switzerland (Geneva) and 42% of all homicides in Denmark.40e42 The majority of homicideesuicide cases take place in a family background, involving principally spousal or intimate link between the offender and the victim.40 Rarely, the relationship falls out of the family setting.43,44 Among three cases of homicideesuicide in the present study, 1 involved intrafamily setting, 1 was a case of killing an ex-partner and 1 involved extra-family (financial) link. The method of commitment, similarly to our research, is the use of firearms in most episodes.42,45,46 A recent analysis on 64 homicideesuicide instances proposed a potential relationship between homicideesuicide incidence and homicide: high homicide rate seems to be connected with high homicideesuicide rate.47 This notion has been supported by two other studies from Durban (South Africa) (homicide rate 22.7/100,000; homicideesuicide rate 0.89) and Pretoria (South Africa) (homicide rate 29.6/100,000; homicideesuicide rate 1.3).48,49 Classifying homicides into categories by motive is a complicated task. In some instances more than one motive may exist and sometimes no motive can be inferred based on the available data. The classification used in the present study is based on the Crime Classification Manual50 after modification for the purposes of our investigation. It is basically a classification that provides an overview of the principal homicide types, triggered by personal and social motives and, also, motivations involving criminal enterprise.50 The largest group in the present research was homicides caused by economic reasons (26%) - including robbery murders, testament-related cases, personal debts - leading the perpetrators to aggressively kill their victims. Instability of the financial status involving the majority of Greek citizens and the economic insecurity of the incoming refugees, perhaps constitute reasons for this outcome. Passion-triggered murder was the second more frequent type of homicide in our cohort, representing the 13.8% of the whole. This figure appears rather lower compared with the results from other countries, such as Southern Denmark, where this kind of homicide occurred in 22% of the studied cases.9 Interestingly, 10.3% of the homicides were motivated by criminal competition and these episodes involved mainly Albanian and Asian victims killed by either Greek or homo-ethnic offenders. The distribution of these homicides during the 16-year study period showed a steep decrease after 2000 and an increase between 2007 and 2010. The major number of Albanian refugees crossing the country borders was noted during 90s, whereas, after 2007 a new wave of Asian refugees came into Greece and were allocated in various regions inside the country, frequently presenting criminal activity. These facts seem to correspond to the aforementioned homicide occurrences. However, our study has some limitations. This is a 16-year retrospective medico-legal analysis of homicides in a region of western Greece, with a small sample size coming from a single institution; therefore, any conclusions may be limited in strength and are made with caution. Additionally, because of the observational nature of the study, we cannot rule out the presence of other
43
possible variables which mold the crime. Nevertheless, this is, to our knowledge, the first medico-legal study investigating the patterns of homicide in Greece (or a part of it) and provides useful data for further analysis and evaluation of the factors engaged to the homicide occurrences. 5. Conclusion The average homicide rate in Epirus was 0.85/100,000 inhabitants and showed a remarkable fluctuation during the study period. Economic causes were the main motive of murder whereas criminal competition-related homicides involved mainly victims of other than Greek nationalities. Firearms, with an emphasis on shotguns, were most commonly used, compatible with the relatively liberal legislation regarding gun possession in Greece and the high prevalence of hunting in the region of Epirus. Although the average homicide rate in Epirus is low, it showed a marked raise which concurred in time with the Greek financial crisis, hence it should trigger public awareness. Homicides always represent a challenge to the forensic pathologists, the law enforcement officials, as well as the judicial system. Of utmost importance is the implementation of effective strategies in the context of opposition against violence both in Epirus and Greece. Conflict of interest The authors declare that they have no conflict of interest. Funding None declared. Ethical approval None declared. References 1. McCall PL, Nieuwbeerta P, Engen RL, Thames KM. Explaining variation in homicide rates across Eastern and Western European cities: the effects of social, political, and economic forces. In: Liem MCA, Pridemore WA, editors. Handbook of European homicide research: patterns, explanations, and country studies. Springer Science and Business Media; 2009. p. 137e50. 2012. 2. Vrachnis N, Vlachadis N, Vlachadi M, Mastorakos G, Iliodromiti Z. Letter to the editoreHomicides in Greece: trends and features. J Forensic Sci 2015;60(2): 536e7. 3. Vougiouklakis T, Tsiligianni C. Forensic and criminologic aspects of murder in North-West (Epirus) Greece. J Clin Forensic Med 2006;13(6e8):316e20. 4. National statistical service of Greece. 2013. Available at: www.statistics.gr/ portal/page/portal/ESYE [accessed 21.04.15]. 5. Data of Criminality in Greece e Hellenic Police's Archives. Available at: www. astynomia.gr/index.php?option¼ozo_content%perform¼view&id¼1831&Itemid¼528&lang¼EN [accessed 21.04.15]. 6. Verzeletti A, Russo MC, Bin P, Leide A, De Ferrari F. Homicide in Brescia County (Northern Italy): a thirty-year review. J Forensic Leg Med 2014;22:84e9. 7. Kristoffersen S, Lilleng PK, Mæhle BO, Morild I. Homicides in Western Norway, 1985e2009, time trends, age and gender differences. Forensic Sci Int 2014;238: 1e8. 8. United Nations Office on Drugs and Crime. 2011 Global study on homicide. 2011. http://www.unodc.org/documents/data-and_analysis/statistics/Homicide/ Globa_study_on_homicide_2011_web.pdf [accessed 25.04.15]. 9. Leth PM. Homicides in Denmark during 25 years. Homicide Stud 2010;14(4): 419e35. 10. Dogan KH, Demirci S, Gunaydin G, Buken B. Homicide-suicide in Konya, Turkey between 2000 and 2007. J Forensic Sci 2010;55(1):110e5. 11. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva: World Health Organization; 2002. 12. Geneva Declaration on Armed Violence and Development. Global Burden of armed violence. 2011. http://www.genevadeclaration.org/en/measurability/ global-burden-of-armed-violence/global-burden-of-armed-violence-2011. html. 13. Belanger F, Ung A-B, Falzon A, Bene M, Bruzzone S, Denissov G, et al. Homiciderelated deaths in an enlarged European Union. Saint-Maurice: Institut de veille sanitaire; 2008. 4p. Available at: http://www.invs.sante.fr. 14. United Nations homicide statistics. 2013. http://www.unodc.org/gsh/en/data. html [accessed 23.06.15].
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15. Henderson JP, Morgan SE, Patel F, Tiplady ME. Patterns of non-firearm homicide. J Clin Forensic Med 2005;12:128e32. 16. Karlsson T. Sharp force homicides in the Stockholm area, 1983e1992. Forensic Sci Int 1998;94:129e39. €ckstro € m B, Sprogøe-Jakobsen S, Eriksson A. Homicide among the young, 17. Ba Sweden. 2012. In: unpublished, poster presentation. Nordic Conference in Forensic Science, Aarhus, Denmark. 18. Lo Min, Jane CV, Koelmeyer TD. Homicide in Auckland, New Zealand, a 14 year study. Am J Forensic Med Pathol 1992;13:44e9. 19. Wecht CH. Legal medicine. New York: Praeger; 1985. p. 20e33. 20. Avis Sp. Homicide in Newfoundland: a nine-year review. J Forensic Sci 1996;41: 101e5. 21. Dikhit PC, Dogra TD, Chandra J. A comprehensive study of homicide in South Delhi, 1969e79. Med Sci Law 1986;26:230e4. 22. Kuhns JB, Maguire ER. Drug and alcohol use by homicide victims in Trinidad and Tobago, 2001e2007. Forensic Sci Med Pathol 2012;8(3):243e51. 23. Eckhardt K, Pridemore WA. Differences in female and male involvement in lethal violence in Russia. J Crim Just 2009;37(1):55e64. 24. Ormstad K, Karlsson T, Enkler L, Law B, Rajs J. Patterns in sharp force fatalities e a comprehensive forensic medical study. J Forensic Sci 1986;31(2):529e42. 25. Darke S, Duflou J. Toxicology and circumstances of death of homicide victims in New South Wales, Australia 1996e2005. J Forensic Sci 2008;53(2):447e51. 26. Rogde S, Hougen HP, Poulsen K. Homicide by sharp force in two Scandinavian capitals. Forensic Sci Int 2000;109:135e45. 27. Kuhns JB, Wilson DB, Maguire ER, Ainsworth SA, Clodfelter TA. A metaanalysis of marijuana, cocaine and opiate toxicology study findings among homicide victims. Addiction 2009;104(7):1122e31. 28. Hougen HP, Rogde S, Poulsen K. Homicide by firearms in two Scandinavian capitals. Am J Forensic Med Pathol 2000;21(3):281e6. 29. Chan CY, Beh SL, Broadhurst RG. Homicide-suicide in Hong Kong, 1989e1998. Forensic Sci Int 2003;137:165e71. 30. Vij A, Menon A, Menezes RG, Kanchan T, Rastogi P. A retrospective review of homicides in Mangalore, South India. J Forensic Leg Med 2010;17:312e5. 31. Smit PR, Bijleveld CCJH, Van der Zee S. Homicide in the Netherlands, an exploratory study of the 1998 cases. Homicide Studies 2001;5:293e310. 32. Chapdelaine A, Samson E, Kimberley MD, Viau L. Firearm-related injuries in Canada: issues for prevention. CMAJ 1991;145(10):1217e23. 33. Kellerman AL, Rivara FP, Rushforth NB, Banton JG, Reay DT, Francisco JT, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med 1993;329(15):1084e91. €kka €nen-Nyholm H, Putkonen H, Lindberg N, Holi M, Rovamo T, Weiz-mann34. Ha Henelius G. Gender differences in Finnish homicide offence characteristics. Forensic Sci Int 2009;186:75e80.
35. D'Orban PT, O'Connor A. Women who kill their parents. Br J Psychiat 1989;154: 27e33. 36. Roehl J, O'Sullivan C, Webster D, Campbell J. Intimate partner violence risk assessment validation study. U.S. Department of Justice; 2005. Final Report. In: Document No.: 209731. 37. Fox JA, Zawitz MW. Homicide trends in the U.S. e trends by gender. 2007. Available at: www.bjs.gov/index.cfm?ty¼pbdetail&iid¼966. 38. Smith K, Coleman K, Eder S, Hall P. In: Home Office Statistical Bulletin, Home Office Statistics, Government Statistical Service, editors. Homicides, firearm offences and intimate violence 2009e2010; 2011. p. 1e98. 39. Roma P, Spacca A, Pompili M, Lester D, Tatarelli R, Girardi P, et al. The epidemiology of homicide-suicide in Italy: a newspaper study from 1985 to 2008. Forensic Sci Int 2012;214(1e3):e1e5. 40. Shiferaw K, Burkhardt S, Lardi C, Mangin P, La Harpe R. A half century retrospective study of homicide-suicide in GenevaeSwitzerland: 1956e2005. J Forensic Leg Med 2010;17(2):62e6. 41. Milroy CM. Reasons for homicide and suicide in episodes of dyadic death in Yorkshire and Humberside. Med Sci Law 1995;35(3):213e7. 42. Saint-Martin P, Bouyssy M, O'Byrne P. Homicide-suicide in Tours, France (2000e2005)edescription of 10 cases and a review of the literature. J Forensic Leg Med 2008;15(2):104e9. 43. Barraclough B, Harric EC. Suicide preceded by murder: the epidemiology of homicideesuicide in England and Wales 1988e1992. Psychol Med 2002;32(4): 577e84. 44. Bossarte RM, Simon TR, Barker L. Characteristics of homicide followed by suicide incidents in multiple states, 2003e2004. Inj Prev 2006;12(Suppl.):ii33e8. 45. Saleva O, Putkonen H, Kiviruusu O, L4nnqvist J. Homicideesuicide e an event hard to prevent and separate from homicide or suicide. Forensic Sci Int 2007;166(2e3):204e8. 46. Logan J, Hill HA, Black ML, Crosby AE, Karch DL, Barnes JD, et al. Characteristics of perpetrators in homicide-followed-by-suicide incidents: national violent death reporting system e 17 US States, 2003e2005. Am J Epidemiol 2008;168(9):1056e64. 47. Large M, Smith G, Nielssen O. The epidemiology of homicide followed by suicide: a systematic and quantitative review. Suicide Life Threat Behav 2009;39:294e306. 48. Roberts K, Wassenaar D, Canetto SS, Pillay A. Homicide-suicide in Durban, South Africa. J Interpers Violence 2010;25(5):877e99. 49. Jena S, Mountany L, Muller A. A demographic study of homicide-suicide in the Pretoria region over a 5 year period. J Forensic Leg Med 2009;16:261e5. 50. Douglas JE, Burgess AW, Burgess AG, Ressler RK. Crime classification Manual: a standard system for investigating and classifying violent crime. 3rd ed. New Jersey: John Wiley & Sons, Inc; 2013.
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Original communication
Survey of medico-legal investigation of homicide in the region of Epirus (Northwest Greece) Kleio Fragkouli, Vassiliki Boumba, Theodore Vougiouklakis* Department of Forensic Medicine and Toxicology, University of Ioannina, Greece
a r t i c l e i n f o
a b s t r a c t
Article history: Received 3 July 2015 Received in revised form 23 September 2015 Accepted 24 October 2015 Available online 2 November 2015
This study analyzed the forensic features of homicides in North-West Greece (Epirus) from 1998 to 2013, a borderland area between Greece and Albania. Although Greece is critically influenced by both the increasing flow of refugees and the current socioeconomic crisis, very little information has been published regarding the patterns of homicide in the country. Fifty-eight autopsied victims (36 males; 22 females) were investigated. The median age was 37 years old. The average annual homicide rate was 0.85 per 100,000 inhabitants and showed remarkable fluctuation, with largest increase during Greek financial downturn. Sixteen victims were not Greek citizens. The most common method of commitment was the use of firearm (40%). The main motives were economical causes (26%) and passion (14%). Four cases were categorized as matricide (7%), 3 as homicideesuicide (5%), 2 as patricide (3%) and 1 as infanticide (2%). Toxicological analysis proved negative for ethanol and other psychotropic substances in the majority of the victims (50%). There is an urgent need for public actions both in Epirus and in Greece, with the application of effective strategies against criminality. © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords: Homicide Forensic Greece Homicide rate Refugees Socioeconomic crisis
1. Introduction Violent crime trends in Europe have changed during the last twenty years, since the opening of borders across the continent. These changes have been reflected to the homicide rates presented by various European countries.1 Although Greece is essentially affected not only by the increasing number of refuges crossing the borders but also by the current socio-economic crisis, very little data has been presented regarding the trends and patterns of homicide in the country.2,3 This study was undertaken to identify and analyze the characteristics of homicides in Epirus, north-western Greece, a borderland region between Greece and Albania. One of our main purposes was to compare our results to those encountered in other European countries as well as in countries outside the continent. The study was based on the medico-legal autopsies performed on the victims of a geographically restricted area, which is appropriate for epidemiologic studies. Medico-legal autopsies contribute significantly in providing useful statistical data related to legal
* Corresponding author. Department of Forensic Medicine and Toxicology, University of Ioannina, University Campus, 1186, 45110 Ioannina, Greece. E-mail addresses: [email protected] (K. Fragkouli), [email protected] (V. Boumba), [email protected] (T. Vougiouklakis).
occurrences in a given area. All available data was investigated; however, data regarding the offenders were restricted, mainly due to the existing private policies applied in Greece. The increased number of refugees who crossed the country borders during both 90s and the last 10 years streamed the study towards the impact of the nationality of the victims and perpetrators on homicide rates. Furthermore, the influence of the socio-economic crisis, which Greece undergoes the last 7 years, on the pattern of homicide is discussed. Identifying essential features of homicides in the Epirus area may contribute to the collection of important data at the disposal of the police, local and national authorities. This would promote preventive measures and society's awareness. 2. Material and method A retrospective investigation was conducted on a consecutive series of homicides that were autopsied at the Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Ioannina in Greece, in the 16-year period 1998e2013. Greece is a small, rather homogeneous country, with a population of approximately 10,820,000 inhabitants according to the National Statistical Service Bureau (2010).4 The region of Epirus is comprised of four prefectures and its population is 336,856 inhabitants, representing
http://dx.doi.org/10.1016/j.jflm.2015.10.003 1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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3.1% of the overall population of Greece. The cases were identified through the archives of autopsy cases maintained at our Department. The Department of Forensic Medicine and Toxicology, University of Ioannina, is legally authorized to perform all the medicolegal autopsies and investigate all the non-natural and violent deaths occurring at the region of Epirus. Information regarding the national statistical data of homicide was retrieved from Hellenic Police's archives.5 The investigation covered all cases of homicide, including violence or physical harm resulting in death. This applies to all intentional and unintentional deaths due to premeditated violence or other deliberate action resulting in injury and death. Unintentional homicides were excluded from the study. Thus, the material comprised all those fatalities where the manner of death at the autopsy report was registered as homicide-murder, infanticide, patricide, matricide and homicide followed by suicide. Toxicological analysis was performed in the majority of the cases. Excluded from toxicological examination were the cases of skeletonization (involving principally firearm fatalities) and dismemberment of the victims, where no appropriate biological material was available for the analysis. The data examined included the age and gender of victims, the nationality, the time of the assault (time, day, season), type of weapon used, location of fatal wound, motive of commitment and number of offenders involved in the crime. Data regarding the individual characteristics of assassinates and victims, circumstances, homicide category, method and motive of commitment was obtained from autopsy reports, police requisition forms and prosecution authorities' files. The data were analyzed using the R statistical software program (R 2.14.1 for Windows). 3. Results
(W ¼ 69, n1 ¼ 16, n2 ¼ 16, p ¼ 0.03) annual homicide rates of Epirus and Greece, respectively, with the national rate (median ¼ 1.29 per 100,000) being higher than that of Epirus (median ¼ 0.85 per 100,000). However, the homicide rate in Epirus fluctuated more than the national homicide rate, with a relative decrease during 1998e2005 and a steep increase during 2011e2013 (Fig. 1). 3.2. Gender, age and nationality of homicide victims In the total material of the study, 62% of the homicide victims were male (N ¼ 36), 38% being female (N ¼ 22). The median age of the victims was 37 years, with a significant gender difference (KruskaleWallis test: c2 ¼ 4.34, df ¼ 1, p ¼ 0.03); males were significantly younger than females (medians: 35 years old for males and 51 years for females). Fifty percent of the individuals were within the age range of 21e40 years, whereas 22.4% were over 60 years old (Table 1). Only two victims (3.4%) were under the age of 16. The majority of the victims (72.4%) were of Greek nationality, 19% were Albanians (due to the geographical position of the region, close to the border with Albania) and only 5% were migrants from an Asian country. 3.3. Toxicological analysis Seventy-four percent (n ¼ 28, 12 males and 16 females) of the 38 biological specimens sampled for toxicological analysis (including blood, urine and vitreous fluid) were negative for alcohol, drugs of abuse or other substances. Eight individuals (21%) were positive only for alcohol, with an average blood alcohol concentration (BAC) of 0.84 g/l. In one victim, BAC exceeded 2 g/l. One 28-year-old man killed by his father was found positive for heroin and in another 31year-old man toxicological examination revealed carbamazepine in his blood.
3.1. Homicide rates 3.4. Location and time of homicide The investigation included 58 homicide victims (36 males, 62%; 22 females, 38%) among 4005 autopsy cases (1.4%) performed during the study period. These victims were killed in 55 homicide episodes. The exact number of migrants (mainly Albanian) was not specified. The annual homicide death rate was 0.85 per 100,000 inhabitants for the 16-year period. The number of homicides per year (mean ¼ 4 homicides per year) in Epirus was independent of each other, showing no particular pattern or significant variation of homicide rate over time during the period 1998e2013 (c2 ¼ 7.25, p [by randomization, 5000 permutations] ¼ 0.39). Comparing the yearly homicide rates in Epirus with the respective Greek national rates, there was a significant difference between the median
Half of the victims were killed in a rural deserted area or close to agricultural terrain, 15 (26%) were killed in a public place and 14 homicides (24%) took place at home. In 16 cases (28%) the event occurred during afternoon and 14 homicides took place late at night (24%). The majority of homicides occurred during the week (Thursday, 18%; Friday, 18%) and during spring and summer (65% for both). 3.5. Homicide characteristics The present data was classified into five categories, with 48 victims (82.8%) being cold-blood murdered or physically injured
Fig. 1. The homicide rate in Epirus compared to the national Greek homicide rate, between 1998 and 2013.
K. Fragkouli et al. / Journal of Forensic and Legal Medicine 37 (2016) 39e44 Table 1 Age and gender distribution of the homicide victims.
41
Table 3 Homicide method.
Age
Males
Females
Total
Category
Males
Females
Total No of cases
60 y Total
1 1 12 11 4 3 4 36
0 3 1 5 2 2 9 22
1 4 13 16 6 5 13 58
Firearm Sharp force Blunt force Combination of methods Strangulation Total
18 8 6 4 0 36
5 4 5 3 5 22
23 12 11 7 5 58
y y y y y
(1.7%) (6.9%) (22.4%) (27.6%) (10.4%) (8.6%) (22.4%) (100%)
Table 2 Homicide category. Category
Number of cases
Murder/physical Matricide Homicideesuicide Patricide Infanticide
48/58 (82.8%) 4/58 (6.9%) 3/58 (5.2%) 2/58 (3.4%) 1/58 (1.7%)
with fatal outcome, 4 homicides (6.9%) were categorized as matricide, 3 homicides (5.2%) were followed by suicide, 2 (3.4%) were classified as patricide and 1 case (1.7%) as infanticide (Table 2). The absolute number of intrafamily homicides (14/58, 24%) was distributed through the years, showing a decrease between 2001 and 2009, followed by an increase during the last 3 years (2010e2013). The number of intrafamily homicides and its fluctuation for the period 1998e2013 divided in 3-year periods appear in Fig. 2. Seven homicides (12%) were committed by the victim's expartner and in most cases the offender/s was/were acquaintances of the victims (26/58, 45%). Men were most often killed by an acquaintance (23/58, 61%), women by their ex-partner or a family member (15/19, 79%). In 42 cases (72.4%) the offender involved was a single person, in 11 homicides (19%) multiple (>2) offenders were involved and in 6 cases the number of offenders was not known. The most common homicide method was gunshot (39.7%), followed by sharp force (20.7%) and blunt force (19%) (Table 3). Our analysis showed there was an association between method of commitment and gender; males were more commonly killed by firearms (50%) and females by strangulation and this difference was statistically significant (Fisher's Exact Test: p ¼ 0.02). In particular, only women were killed by means of strangulation. In 20 cases (34.5%) multiple wounds were present on the victim's body,
(39.7%) (20.7%) (19%) (12%) (8.6%) (100%)
whereas in another 20 cases (34.5%) the only site of fatal wound was the head. No women were injured to the chest (Fig. 3). The main motives included economic cause (25.9%), passion (13.8%) and revenge reasons (12%) (Table 4). The absolute number of homicides with the offender's motive being criminal competition showed a sharp decrease after 2000. The percentage of these homicides out of the total number of homicides during 1998e2013 divided in 3-year periods and its distribution over time is presented in Fig. 4. Involved in these homicides were mainly Albanians (5 among 6 victims). Ten perpetrators received the diagnosis of personality disorder and they were more prone to intrafamily homicide (8/10). There was no data regarding the use of alcohol or other drugs of abuse among the offenders. 4. Discussion This study provides an overview of all homicides in a welldefined geographical area in Greece, with a low homicide rate and a high immigration rate, principally due to the region's proximity to the Albanian borders. The median homicide rate in Epirus
Fig. 3. The number of male and female victims classified according to the body region wounded.
Table 4 Offender's motive.
Fig. 2. The distribution of intrafamily homicides during the study period divided in 3year intervals.
Category
Number of cases
Economic cause Passion/erotic Revenge Criminal competition Spontaneous domestic Non-specific motive Conflict Staged domestic Argument Disorganized sexual Organized sexual
15/58 (25.9%) 8/58 (13.8%) 7/58 (12.0%) 6/58 (10.3%) 6/58 (10.3%) 6/58 (10.3%) 4/58 (6.9%) 2/58 (3.5%) 2/58 (3.5%) 2/58 (3.5%) 0/58 (0.0%)
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Fig. 4. The distribution of the homicides motivated by criminal competition during the study period divided in 3-year intervals.
during the 16-year period was 0.85/100,000 inhabitants per year, presenting a lower figure in comparison to the national rate which was 1.29/100,000. Interestingly, the homicide rate in our region showed a remarkable fluctuation through the years with a steep decrease between 1998 and 2000 and a steep increase after 2011. Possible explanations include the relative regional reduction of the number of refugees in Epirus after 2000 reflected in the decrease of homicide incidence, and the effects of Greek economic austerity measures on the criminality of Epirus after 2010, respectively. Recent research supported that the level of a country's development has an effect on the city-level homicide rate.1 The homicide rate in Greece has risen more than threefold during the past four decades, with a sharp increase more than double during the past decade.2 Regarding Greek socioeconomic crisis, the homicide rate increased by 38% (p < 0.001) during the crisis (2009e2012) compared with the pre-crisis period (2005e2008).2,5 The respective homicide rates in other European countries are similar both to that in Epirus and the national rate in Greece. In Northern Italy (Brescia) the homicide rate during a period of 30 years was 0.77/100,000 population.6 The annual homicide rate (2009) was 1.0/100,000 in Sweden, 0.6 in Norway and, during a 25year period, was 0.92/100,000 inhabitants in Southern Denmark.7e9 Finland showed a higher annual rate among Scandinavian countries, the figure being 2.3/100,000 according to the United Nations Office on Drugs and Crime (2011).8 In Turkey (Konya), the corresponding rate during an 8-year period was 2.6/ 100,000 population.10 Worldwide, the highest homicide rates were retrieved in South and Central America, with 68.5 homicide deaths/ 100,000 inhabitants in male population aged 15e29 years, whereas the lowest is found in South-East Asia, being 0.9/100,000.11,12 European Union presents a respective rate of 14.9/100,000 population.13 Nonetheless, although the majority of European and nonEuropean countries have shown remarkable decreases in homicide rates during the period 2000e2010, Greece confronts homicide as a threatening and growing public health issue.2,8 Of note, in 2011 homicide rate in Greece was the 6th highest among European countries, whereas it was the 6th lowest in 2006.14 The median age of the victims was 37 years in the present study, alike the results from other studies from Great Britain, Western Norway and Sweden, showing average ages of 34, 35 and 37 years, respectively.7,15,16 Noteworthy, males were significantly younger than females (medians: 35 years old for males and 51 years for females). Among female victims, 41% were over 60 years old. It seems that weak elderly women are more likely to represent easy targets in robbery murders, as shown in another recent study from Denmark.9 Data from the Hellenic Police have shown that in Greece, robbery motivated homicides have increased 87%
(p < 0.001) in 2011 in comparison with 2010, the majority of the victims being elderly individuals.5 On the other hand, the number of child/infant victims in our study was low, as the 3.4% of all cases were under the age of 16. A similar figure is presented in a recent research from Sweden (4%).17 Half of the victims were killed in a deserted area, rural in nature, which is justified considering that the major part of Epirus region shows an intense geophysical terrain. Most homicides took place during afternoon or late at night (52%), compatible with previous studies,18,19 and during the week (Thursday and Friday, 36%), similar to earlier published results.20 Spring and summer were the most common seasons of commitment (65%), unlike the results of other studies revealing the winter as the most likely season of homicide occurrences.21 In 74% of the blood samples analyzed, toxicological analysis was negative for ethanol and drugs of abuse. In cases where the toxicology revealed ethanol in the blood specimens, we considered postmortem ethanol formation to be minimal, as most homicide victims were discovered soon after death and the postmortem examinations of biological specimens were performed rapidly in the majority of cases. Noteworthy, only 21% of the victims were positive for ethanol per se, with no other legal or illegal drugs codetected in blood. This finding is quite different to other studies revealing ethanol detection in blood in 29%e74% of all the victims, usually combined with other drugs of abuse.7,22e24 Additionally, legal and illegal drugs were detected in only 3.4% of our sample, unlike other studies ranging 15e22% in Scandinavian countries and from 5% to 30% in Australia and USA.16,25e27 Perhaps ethanol consumption and drug abuse in Greece is, in general terms, lower in comparison to other countries. Also, probably most homicide cases in our cohort were committed under an ambush, rather than in a staged condition involving substances' consumption making the victims more vulnerable to a homicide episode. The most common method of homicide was the use of firearms (almost 40%), mainly shotguns, involving most frequently men. Epirus presents a high number of migrants, with an ease in gun access, and also, is an area where hunting is quite common. Scandinavian countries show lower figures of gunshot induced homicides (19e22%)7,28 and Asian countries even lower (1e3%).29,30 These results correspond to the restricted availability of guns and the firm legislation regarding firearm possession. On the contrary, in countries were law appears more tolerant, such as Italy, Holland, USA and Canada, homicides were committed by use of firearms in high percentages (30e60%).6,31e33 Sharp force was the second method of homicide in our cohort (21%) comparable to studies from other countries, such as the Nederlands and Western Norway,7,31 but differs remarkably compared to Russia, Denmark, Finland and India, where the corresponding figures were between 38% and 62%.9,23,30,34 Strangulation was less commonly used as a homicide method (8.6%) and involved only women in our study, obviously as a result of the advanced physical strength of men against women. Our results showed that 24% of homicides took place among family members. The number of intrafamily homicides showed a remarkable increase after 2007 in Epirus, possibly reflecting the intense intrafamily problems and arguments on the grounds of the financial crisis and the austerity measures applied in Greece during the last 8 years. Matricide, a type of intrafamily homicide, appears infrequent in our study and published research reveals that offenders killing their mothers almost always have a psychotic substrate or have received the diagnosis of personality disorder, as was also the case in our study.35 The offenders involved in patricide, on the other hand, seem to have crossed their limits against violent fathers; only two victims were killed by their father in our cohort. Infanticide, appeared only once in our material (1.7%), most likely due to better means of pregnancy prevention and a more tolerant
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public attitude toward undesirable pregnancies. Another subtype of intrafamily homicide, the partner killing, was almost exclusively committed by men against women in our sample. Interestingly, in Great Britain and USA, the prevalence of male victims killed by female partners was 3e8%,36e38 whereas in Finland the corresponding figure reached 35%.34 The perpetrator committed suicide after killing the victim in 5.2% of the study cases, representing an average rate of 0.06/ 100,000 inhabitants. These results are similar to those published in a recent study in Italy during a 24-year period, which showed that the average annual incidence of the so called ‘dyadic deaths’ was 0.04/100,000.39 Homicideesuicide episodes accounted for 5e10% of homicide cases in England, 10% in Switzerland (Geneva) and 42% of all homicides in Denmark.40e42 The majority of homicideesuicide cases take place in a family background, involving principally spousal or intimate link between the offender and the victim.40 Rarely, the relationship falls out of the family setting.43,44 Among three cases of homicideesuicide in the present study, 1 involved intrafamily setting, 1 was a case of killing an ex-partner and 1 involved extra-family (financial) link. The method of commitment, similarly to our research, is the use of firearms in most episodes.42,45,46 A recent analysis on 64 homicideesuicide instances proposed a potential relationship between homicideesuicide incidence and homicide: high homicide rate seems to be connected with high homicideesuicide rate.47 This notion has been supported by two other studies from Durban (South Africa) (homicide rate 22.7/100,000; homicideesuicide rate 0.89) and Pretoria (South Africa) (homicide rate 29.6/100,000; homicideesuicide rate 1.3).48,49 Classifying homicides into categories by motive is a complicated task. In some instances more than one motive may exist and sometimes no motive can be inferred based on the available data. The classification used in the present study is based on the Crime Classification Manual50 after modification for the purposes of our investigation. It is basically a classification that provides an overview of the principal homicide types, triggered by personal and social motives and, also, motivations involving criminal enterprise.50 The largest group in the present research was homicides caused by economic reasons (26%) - including robbery murders, testament-related cases, personal debts - leading the perpetrators to aggressively kill their victims. Instability of the financial status involving the majority of Greek citizens and the economic insecurity of the incoming refugees, perhaps constitute reasons for this outcome. Passion-triggered murder was the second more frequent type of homicide in our cohort, representing the 13.8% of the whole. This figure appears rather lower compared with the results from other countries, such as Southern Denmark, where this kind of homicide occurred in 22% of the studied cases.9 Interestingly, 10.3% of the homicides were motivated by criminal competition and these episodes involved mainly Albanian and Asian victims killed by either Greek or homo-ethnic offenders. The distribution of these homicides during the 16-year study period showed a steep decrease after 2000 and an increase between 2007 and 2010. The major number of Albanian refugees crossing the country borders was noted during 90s, whereas, after 2007 a new wave of Asian refugees came into Greece and were allocated in various regions inside the country, frequently presenting criminal activity. These facts seem to correspond to the aforementioned homicide occurrences. However, our study has some limitations. This is a 16-year retrospective medico-legal analysis of homicides in a region of western Greece, with a small sample size coming from a single institution; therefore, any conclusions may be limited in strength and are made with caution. Additionally, because of the observational nature of the study, we cannot rule out the presence of other
43
possible variables which mold the crime. Nevertheless, this is, to our knowledge, the first medico-legal study investigating the patterns of homicide in Greece (or a part of it) and provides useful data for further analysis and evaluation of the factors engaged to the homicide occurrences. 5. Conclusion The average homicide rate in Epirus was 0.85/100,000 inhabitants and showed a remarkable fluctuation during the study period. Economic causes were the main motive of murder whereas criminal competition-related homicides involved mainly victims of other than Greek nationalities. Firearms, with an emphasis on shotguns, were most commonly used, compatible with the relatively liberal legislation regarding gun possession in Greece and the high prevalence of hunting in the region of Epirus. Although the average homicide rate in Epirus is low, it showed a marked raise which concurred in time with the Greek financial crisis, hence it should trigger public awareness. Homicides always represent a challenge to the forensic pathologists, the law enforcement officials, as well as the judicial system. Of utmost importance is the implementation of effective strategies in the context of opposition against violence both in Epirus and Greece. Conflict of interest The authors declare that they have no conflict of interest. Funding None declared. Ethical approval None declared. References 1. McCall PL, Nieuwbeerta P, Engen RL, Thames KM. Explaining variation in homicide rates across Eastern and Western European cities: the effects of social, political, and economic forces. In: Liem MCA, Pridemore WA, editors. Handbook of European homicide research: patterns, explanations, and country studies. Springer Science and Business Media; 2009. p. 137e50. 2012. 2. Vrachnis N, Vlachadis N, Vlachadi M, Mastorakos G, Iliodromiti Z. Letter to the editoreHomicides in Greece: trends and features. J Forensic Sci 2015;60(2): 536e7. 3. Vougiouklakis T, Tsiligianni C. Forensic and criminologic aspects of murder in North-West (Epirus) Greece. J Clin Forensic Med 2006;13(6e8):316e20. 4. National statistical service of Greece. 2013. Available at: www.statistics.gr/ portal/page/portal/ESYE [accessed 21.04.15]. 5. Data of Criminality in Greece e Hellenic Police's Archives. Available at: www. astynomia.gr/index.php?option¼ozo_content%perform¼view&id¼1831&Itemid¼528&lang¼EN [accessed 21.04.15]. 6. Verzeletti A, Russo MC, Bin P, Leide A, De Ferrari F. Homicide in Brescia County (Northern Italy): a thirty-year review. J Forensic Leg Med 2014;22:84e9. 7. Kristoffersen S, Lilleng PK, Mæhle BO, Morild I. Homicides in Western Norway, 1985e2009, time trends, age and gender differences. Forensic Sci Int 2014;238: 1e8. 8. United Nations Office on Drugs and Crime. 2011 Global study on homicide. 2011. http://www.unodc.org/documents/data-and_analysis/statistics/Homicide/ Globa_study_on_homicide_2011_web.pdf [accessed 25.04.15]. 9. Leth PM. Homicides in Denmark during 25 years. Homicide Stud 2010;14(4): 419e35. 10. Dogan KH, Demirci S, Gunaydin G, Buken B. Homicide-suicide in Konya, Turkey between 2000 and 2007. J Forensic Sci 2010;55(1):110e5. 11. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva: World Health Organization; 2002. 12. Geneva Declaration on Armed Violence and Development. Global Burden of armed violence. 2011. http://www.genevadeclaration.org/en/measurability/ global-burden-of-armed-violence/global-burden-of-armed-violence-2011. html. 13. Belanger F, Ung A-B, Falzon A, Bene M, Bruzzone S, Denissov G, et al. Homiciderelated deaths in an enlarged European Union. Saint-Maurice: Institut de veille sanitaire; 2008. 4p. Available at: http://www.invs.sante.fr. 14. United Nations homicide statistics. 2013. http://www.unodc.org/gsh/en/data. html [accessed 23.06.15].
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