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Evaluation of Forensic Deaths During the Month of
Ramadan in Konya, Turkey, Between 2000 and 2009
Serafettin Demirci, MD,* Kamil Hakan Dogan, MD, PhD,Þand Sermet Koc, MDþ
Abstract: Ramadan is a holy month for Muslim people and includes
long fasting periods. During Ramadan, practicing Muslims not only fast,
but they also abstain from any kind of medication, smoking, sexual
intercourse, and alcohol from sunrise to sunset. In the 10-year period
between 2000 and 2009, it was determined that a total of 4881 death
examinations and autopsies were performed at the Konya Branch of the
Forensic Medicine Council (Turkey). All of the reports were retro-
spectively evaluated for demographic features of the cases and the
manner of death. In the studied time period, a total of 491 deaths
(10.1%) occurred in Ramadan. The manner of death was accident in
369 (75.2%) of the cases in Ramadan, 3107 (70.8%) of the other cases;
suicide in 27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other
cases; and homicide in 28 (5.7%) of the cases in Ramadan, 375 (8.5%)
of the other cases. There was a significant statistical difference in terms
of the manner of death between the deaths in Ramadan and in the re-
maining partof the year (PG0.05). Our study suggested that there was an
increase in accidental and natural deaths and a decrease in suicide and
homicides in Ramadan.
Key Words: forensic, fasting, death, Ramadan
(Am J Forensic Med Pathol 2013;34: 267Y270)
One of the 5 fundamental rituals of Islam, the religion pro-
fessed by more than 1 billion people, is fasting during the
month of Ramadan. Muslims neither eat nor drink anything
from dawn until sunset.
1
Ramadan is the ninth month of the
Islamic lunar calendar. This calendar is based on 12 lunar
months in a year of 354 or 355 days, used to date events in many
Muslim countries (concurrently with the Gregorian calendar),
and used by Muslims everywhere to determine the proper day
on which to celebrate Islamic holy days and festivals.
During Ramadan, practicing Muslims not only fast, but
they also abstain from any kind of medication, smoking, sexual
intercourse, and alcohol from sunrise to sunset.
2
These dietary
and lifestyle changes may affect forensic deaths.
It is important to note that Ramadan is a lunar month, and
each year it occurs 11 to 12 days earlier. Each 9 years, Ramadan
occurs in a different season; the length and temperature of
fasting days also change.
3
The period in which the person fasts
may vary depending on the geographic location of the country
and the season of the year and can be as long as 20 hours per
day. Following fasting, at sunset people usually eat a great meal
and worship for a long time, which requires some effort. Before
dawn, men get a meal (sahoor) and perform the morning wor-
ship.
4
The first 3 days of the next month is spent in celebrations
and is observed as the ‘‘Festival of Breaking Fast.’’
To the best of our knowledge, there is not any study on
forensic deaths in Ramadan in the literature. This study aimed
to investigate forensic deaths in Ramadan.
MATERIALS AND METHODS
Konya is the fourth largest city in Turkey, which the study
was carried out in. It is located in the Middle Anatolia Region,
and according to the census data for 2011, the total population
is 2,038,555, of which 1,009,855 are male and 1,028,700 are
female.
5
This study retrospectively investigated 4881 death exam-
inations and autopsies that were performed at the Konya
Branch of the Forensic Medicine Council (Turkey) between
2000 and 2009. Since the lunar (Muhammadan) calendar is 11
to 12 days shorter than the solar year, time periods corre-
sponding to the month of Ramadan in the Gregorian calendar
were established,
6
and the deaths that occurred in these dates
were classified as Ramadan deaths (Table 1).
All of the reports were retrospectively evaluated for de-
mographic features of the cases, manner of death, and cause
of death. The forensic deaths that occurred in Ramadan were
compared with the forensic deaths that occurred in the remaining
part of the year. Statistical analysis was performed using SPSS
(Statistical Package for Social Sciences, SPSS Inc, Chicago, Ill)
version 16.0, and W
2
test was used for the evaluation of parameters.
RESULTS
In the studied time period, of the 4881 total forensic deaths
491 (10.1%) of them occurred in Ramadan. Most of the Ram-
adan deaths were in 2003 (n = 69), and most of the non-
Ramadan deaths were in 2007 (n = 639). The distribution of
TABLE 1. Exact Dates of Ramadan According to the Gregorian
Calendar Between 2000 and 2009
Common
Era
Ramadan
Starting Date End Date Lunar Year
2000 27 November 26 December 1421
2001 16 November 15 December 1422
2002 5 November 4 December 1423
2003 26 October 24 November 1424
2004 14 October 12 November 1425
2005 4 October 2 November 1426
2006 23 September 22 October 1427
2007 12 September 11 October 1428
2008 1 September 30 September 1429
2009 21 August 19 September 1430
ORIGINAL ARTICLE
Am J Forensic Med Pathol &Volume 34, Number 3, September 2013 www.amjforensicmedicine.com 267
Manuscript received December 17, 2012; accepted February 22, 2013.
From the *Department of Forensic Medicine, Meram Medical School,
Necmettin Erbakan University; and †Department of Forensic Medicine,
Faculty of Medicine, Selcuk University, Konya; and ‡Department of
Forensic Medicine, Cerrahpasa Medical School, Istanbul University,
Istanbul, Turkey.
The authors report no conflicts of interest.
Reprints: Kamil Hakan Dogan, MD, PhD, Department of Forensic Medicine,
Faculty of Medicine, Selcuk University, Aleaddin Keykubat Campus,
42075 Selcuklu, Konya, Turkey. E-mail: drhakan2000@gmail.com.
Copyright *2013 by Lippincott Williams & Wilkins
ISSN: 0195-7910/13/3403Y0267
DOI: 10.1097/PAF.0b013e3182a0a430
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Ramadan and non-Ramadan deaths according to years is shown
in Figure 1.
As the Ramadan is a month of the lunar calendar, between
the years 2000 and 2009, Ramadan months were overlapping
with the months August, September, October, November, and
December of the Gregorian calendar. Most of the Ramadan
deaths occurred in November (n = 172), and most of the non-
Ramadan deaths occurred in August (n = 502) in the time pe-
riod studied (Fig. 2).
Mean forensic deaths per year were 49.1 for Ramadan
and 43.9 for the other months. Mean ages of the victims were
38.4 T21.7 years for Ramadan and 37.5 T22.1 years for the
remaining period. Seventy-four percent (n = 363) of the vic-
tims were male in Ramadan, and 73% (n = 3206) were male
for the remaining period (Fig. 3).
The manner of death was accident in 369 (75.2%) of the
cases in Ramadan, 3107 (70.8%) of the other cases; suicide in
27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other
cases; homicide in 28 (5.7%) of the cases in Ramadan, 375
(8.5%) of the other cases; and natural causes in 64 (13.0%) of
the cases in Ramadan, 523 (11.9%) of the other cases (Table 2).
It was determined that the difference of the ratio of manner of
death between Ramadan and non-Ramadan was statistically
significant (PG0.05).
DISCUSSION
Some studies indicate changes in specific mortality rates
during special festivals or holiday periods.
7Y11
Several series
also have evaluated Ramadan’s effect on general health in Muslim
populations.
4,12Y19
However, any studies that evaluate the re-
lationship between Ramadan and forensic deaths could not be
found in the literature review.
Turkey is a secular Islamic country, and more than 99% of
the population is Muslim.
20
Although a significant proportion
of Muslims may not follow all the Islamic principles, Ramadan
fasting is the most popular ritual in the country, and at least 70%
of Muslims fast regularly during the month of Ramadan.
4,21
Ramadan fasting differs from other types of hunger as it
is also a self-discipline.
1
Muslims have a more sedentary life
both spiritually and physiologically during the month of Rama-
dan.
4
According to Muslim teaching, Ramadan is the month
during which the holy Koran was revealed. Fasting is thought
to endow the believer with the habit of self-control, helping
FIGURE 1.Distribution of the Ramadan and non-Ramadan deaths according to years.
FIGURE 2.Distribution of the Ramadan and non-Ramadan deaths according to months of the Gregorian calendar.
Demirci et al Am J Forensic Med Pathol &Volume 34, Number 3, September 2013
268 www.amjforensicmedicine.com *2013 Lippincott Williams & Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
to avoid sin.
22
Most people also continue to abstain from al-
cohol intake after sunset until Ramadan month is over.
23
The physical fatigue associated with fasting lowers one’s
sense of well-being and results in impairment of cognitive
function, as shown by performance in flicker fusion tests.
24
Bener et al
25
reported that the number of people injured in
traffic accidents was slightly higher during Ramadan than at
other periods of the year. In another study from England, it was
stated that emergency department admission rates were higher
during Ramadan among the Muslim population, and both nonY
accident-related and accident-related attendances were high dur-
ing Ramadan than the periods before and after Ramadan.
22
The
higher rates of accidents as the manner of death in Ramadan than
the remaining part of the year may be related with the impairment
of cognitive function due to physical fatigue, and this finding is
consistent with the literature.
In fact, Ramadan fasting has some probable negative
effects on patients with coronary heart disease; the obligation
that the daily calorie intake has to be taken in 1 or 2 meals,
instead of 3 to 5, is an effort. The obligation that a heavy
physical worship is performed after a heavy meal and after
sahoor, which is before dawn in relatively cold weather, walk-
ing toward the mosque seem to be unwise for patients with
coronary heart diseases The other negative effects are that
during fasting patients cannot take any drugs, such as coronary
dilatator, antihypertensive drugs, antiaggregant drugs, or fast-
reacting nitrites. The regimen of patients with diabetes is also
negatively affected by unfamiliar diet and restrictions on drug
use during fasting and so on.
4,26,27
‘‘Natural causes’’ as the man-
ner of death were found slightly higher in Ramadan in this study.
Under Islam, birth and death are considered divine decrees,
and therefore, suicide is considered a crime, and even thinking
about suicide is prohibited, because this would be a reflection
of one’s lack of commitment and degree of despair. Suicide
is killing oneself who was created by God, andVas in other
monotheistic religionsVsuicide is one of the greatest sins
in Islam. Thus, this specific commandment plays a great role
in the prevention of suicides among Muslim communities.
28Y31
It was found that suicide rate was slightly lower in Ramadan in
this study. This may be due to the fact that most of the people’s
religious feelings are higher in Ramadan than in the other
months of the year.
Daily routines are markedly changed during Ramadan.
Although people fast during the daytime, they supply their bodies’
needs between sunset and sunrise. Thus, the obligation to eat
and smoke only during the night has been shown to change the
rhythm of life, including sleep and eating schedules and alter-
nation of working and resting times. As a result of withdrawal
during the daytime and massive intake after sunset, people
have been shown to have more irritability and anxiety during
Ramadan.
32
However, broad-based market research conducted
throughout Turkey during Ramadan has shown that alcohol
sales and consumption decrease noticeably during Ramadan.
Consequently, decreased alcohol consumption results in a de-
creased ratio of fights, loss of self-control, and violence, all of
which result in a decreased ratio of violence-induced pene-
trating injuries such as stab wounds and gunshot wounds.
23
We
found a slight decrease in homicide rates in Ramadan in this
study. As penetrating injuries are the most used methods of
homicides, our finding is consistent with the literature.
According to the findings of this study, it may be con-
cluded that physiologic and behavioral changes during Rama-
dan in the Muslim community may affect forensic death cases’
profiles, but there is need for multicentric international studies
to better identify the differences of forensic deaths between
Ramadan and the other months.
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270 www.amjforensicmedicine.com *2013 Lippincott Williams & Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.