COLOMBO — A medico-legal report on Major General (Retired) Thuwan Suresh Sallay, the former Director of the State Intelligence Service who is detained over the 2019 Easter Sunday bombings, has become a central document in proceedings before the Colombo Fort Magistrate’s Court. Prepared on the order of that court, it sets out Sallay’s own account of his detention, the results of his physical examination, the findings of five medical specialists, and a forensic psychiatric assessment.
This article describes what the report contains and sets out how doctors explain its findings. Throughout, it distinguishes between three different kinds of statement: what Sallay told the examiners, what the examiners objectively found, and how those findings are interpreted.
How the report came to be
The examination was ordered by the Fort Magistrate on April 22. Sallay was examined on April 29 at the Institute of Forensic Medicine and Toxicology in Colombo by Dr. Jeyaseelan Jeyakanthan, a Registrar in Forensic Medicine, who referred him to several specialists and certified the report.
A separate forensic psychiatric assessment was carried out on May 4 at the National Institute of Mental Health in Mulleriyawa by a team led by Dr. C.T.K. Fernando, a Consultant Forensic Psychiatrist. Sallay has been held since February 25 under the Prevention of Terrorism Act and is among the suspects being investigated in connection with the 2019 Easter Sunday bombings.
Sallay’s account of his detention
The report records, as the detainee’s own statements, a description of his conditions. He said he was held in a cell measuring about six feet four inches by four feet; that for roughly forty days he slept on the floor without a pillow or mattress until a one-inch sleeping pad was provided; and that the cell lights remained on twenty-four hours a day. He said that four days after admission, he was moved for four nights to a punishment cell in front of a bathroom, without a fan or internal light, and with rats present.
He described food delivered wrapped in paper with an unusual smell and eaten lying down; the presence of cockroaches; and weight loss that had loosened his clothing. He said he was given no pen to write with, no newspapers to read, and no contact with his family; that overnight toilet access was so restricted that he was made to use a tin to urinate and, by his account, to use his finger to defecate; and that his son had also been drawn into the investigation. He said he had recently been permitted an hour of outdoor walking.
He also stated that, about a week after his arrest, he was told to undress to his underwear, was handcuffed and instructed to bend forward, and that an officer separated his buttocks and touched the anal region in the presence of thirteen other detainees. He said the procedure caused no pain. He denied any history of physical assault. These are his allegations as recorded by the examiners; the report does not establish them as fact, and it does not assess the conduct of the investigators.
The physical examination
On examination, the Judicial Medical Officer recorded no visible external injuries anywhere on the body. An examination of the anal region found a small skin tag at the 6 o’clock position and no injury. Medical experts consulted by the Jaffna Monitor said a skin tag in that location is a common, benign finding — frequently the residue of a previous haemorrhoid or minor local irritation — and is not in itself evidence of trauma.
His blood pressure was recorded at 135/92 mmHg; doctors said this falls in the raised range that clinicians term stage 1 hypertension, while cautioning that a single reading is not diagnostic. The report notes a family history of hypertension and stroke.
Medical experts consulted by the Jaffna Monitor said the absence of external injuries neither confirms nor excludes the treatment Sallay alleged. Much of what he described — continuous lighting, disrupted sleep, dietary conditions, restricted sanitation, and psychological pressure — would not be expected to leave physical marks, they said, while the search he described, by his own account, involved no pain or injury. The weight the report ultimately gives his account, they noted, rests in the psychiatric assessment rather than in physical signs.
The findings of five specialists
The Judicial Medical Officer referred Sallay to five clinical specialists and incorporated each of their findings.
An ophthalmologist at the National Eye Hospital, Dr. K.R. Dayawansa, recorded vision corrected to 6/6 — the normal standard — in both eyes, normal eye pressure, and no need for intervention.
A dermatologist at the National Hospital, Dr. Janaka Akarawita, diagnosed intertriginous dermatitis. Dermatologists consulted by the Jaffna Monitor explained that this is inflammation of skin where two surfaces meet and trap heat and moisture — here, the groin — a common condition often complicated by fungal overgrowth and encouraged by heat, sweating and limited ventilation or washing, though not specific to any single cause. He was prescribed fexofenadine, an antihistamine to reduce itching; fluconazole, an oral antifungal; a combined antifungal-and-steroid cream; and an emollient.
A neurologist, Dr. Gamini Pathirana, recorded that Sallay had a prior history of migraine that had become more frequent after his detention and was now controlled on prophylactic, or preventive, medication. An MRI scan of the brain was normal. Neurologists consulted by the Jaffna Monitor said a normal scan indicates no structural cause, such as a tumour or bleed, consistent with primary migraine.
The report also records, from his medical history, that Sallay is receiving treatment and assessment for a hearing impairment at an ear, nose, and throat clinic.
The clinical nutrition assessment, by Dr. Nalinda Herath, was the most detailed of the physical findings. It recorded a weight loss of 6.3 kilograms over two months and a fall of more than half in his usual food intake. His body-mass index was 25.6. Doctors consulted by the Jaffna Monitor noted that this falls within the “overweight” band on the standard scale — meaning that, despite the recent loss, he was not underweight at the time of examination.
Blood tests showed marginally elevated fasting blood sugar, elevated total cholesterol, and a marginally elevated serum creatinine; physicians said the blood-sugar level fell in what is often termed the pre-diabetes range, and that a raised creatinine is a marker of kidney filtration that can rise with dehydration or reduced kidney function.
The assessment also recorded vitamin D insufficiency, proximal muscle weakness, reduced hand-grip strength, bone tenderness, and mild wasting — findings that, doctors said, can follow undernutrition, low vitamin D, and reduced physical activity. He was advised on diet, three litres of fluid a day, permission to urinate at night, daily sunlight, exercise, and supplements, with follow-up blood tests recommended. The report notes that these findings were also communicated to the Director of the CID.
The psychiatric assessment
The forensic psychiatric assessment is the report’s most consequential section. The team diagnosed a moderate-to-severe depressive episode with prominent anxiety symptoms and features of post-traumatic stress disorder, and assessed Sallay as being at high risk of suicide after he expressed suicidal thoughts during the interview.
Psychiatrists consulted by the Jaffna Monitor explained that a depressive episode of this severity denotes persistently low mood and loss of interest, together with disturbances of sleep, appetite, energy and concentration. The PTSD features the assessment described — among them derealization, a sense of unreality; an exaggerated startle response; anticipatory anxiety; and disturbed sleep with nightmares — fall within the re-experiencing, avoidance, and heightened-arousal symptoms that can follow a severely threatening experience, they said.
The assessment contrasted what it called a pre-morbid personality that had been “devoted” and “ambitious” with a “massive deterioration” it recorded during the evaluation. It noted that the one anchoring point of hope Sallay expressed was seeing his daughter succeed in her upcoming examinations.
The mental-state examination recorded depressed and restricted mood, tearfulness, withdrawn eye contact, slowed responses, and reported short-term memory difficulty, with no psychotic symptoms and intact orientation to time, place, and person. He was observed to weep through the assessment and to press one side of his forehead repeatedly. The assessment recorded that he was preoccupied with what it described as the agony of his situation and expressed ideas of guilt, worthlessness, and hopelessness. His insight was assessed as good, and he was recorded as willing to undergo treatment.
The report states that no psychiatric medication was commenced, giving as the reason that a safe therapeutic environment was unavailable and that beginning treatment in such a setting could aggravate the risk of suicide. It records that Sallay denied any family history of mental illness, described himself as a non-smoker and occasional wine consumer, and maintained that the allegations against him were fabricated, that he had been in Malaysia at the time of the events under investigation, and that he was “completely out of the cycle” of those events.
‘Fit to plead’: a separate question
Notwithstanding those findings, the assessment concluded that Sallay is fit to plead and stand trial. Medical and legal experts consulted by the Jaffna Monitor said this is a distinct determination from how unwell a person is: it means he understands the nature of the charge, can distinguish between pleading guilty and not guilty, and can instruct his lawyers and follow proceedings. A person can be found seriously unwell and, at the same time, fit to plead, they said; the two assessments answer different questions.
The report closes its clinical section with a recommendation that Sallay undergo a multidisciplinary assessment by the relevant medical specialties, for a comprehensive evaluation of his physical and mental well-being and further management.
The Istanbul Protocol and the phrase ‘typical of’
The assessment describes its findings as “typical of torture or ill-treatment. The phrase is technical. It is drawn from the Istanbul Protocol — the United Nations Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment — the international standard for the medical documentation of such allegations.
Under that standard, a clinician rates how closely the medical findings match the account a person gives, on a five-point scale: not consistent, consistent with, highly consistent, typical of, and diagnostic of. “Typical of” is the fourth of the five — an appearance usually found with the type of abuse described, though other causes remain possible. The assessment applies the term to the psychological findings, stating that they are of a kind typically found as a consequence of the alleged treatment and that there are few other likely causes.
Forensic specialists consulted by the Jaffna Monitor noted two qualifications. The rating is a clinical opinion about the consistency between Sallay’s account and his psychological state, they said; it is not, on its own, a legal finding that torture occurred, and a court weighs it alongside all other evidence. And because the psychiatric conclusion rests partly on the account Sallay gave of his treatment, it carries the same dependence on that account as his other statements.
The case and the State's position
Counsel for the victims of the attacks, President's Counsel Rienzie Arsecularatne, who appears for the Archbishop of Colombo, Cardinal Malcolm Ranjith, and for affected families, has opposed producing Sallay in open court while he remains under detention orders. To "produce" a detainee in open court means to bring him in person before the magistrate at a public hearing, where he appears in the courtroom in view of the public and may be able to address the court directly. Asking that he not be produced, while the detention order is in force, would keep him out of the public courtroom and defer any statement he might seek to make there. The Archdiocese has separately urged that the case not be politicised.
When the medical findings were raised in court on 3 June, the magistrate directed the CID to respond. At the hearing that followed, the Attorney General's Department rejected the claims.
Additional Solicitor General Dileepa Peiris submitted that Sallay had raised a mental condition only after the medical reports were obtained in May, and argued that a genuine psychiatric disorder would have surfaced earlier; he said the suspect had reportedly wept throughout the psychiatric examination yet had never behaved that way before the court and had no prior history of mental illness, and he contended that the defence was using the reports to gain an advantage in related proceedings and to divert attention from the investigation.
The prosecution also noted that Sallay meets his lawyers weekly and speaks with his wife, child, and mother by telephone each Friday, and questioned why he had not raised ill-treatment with his family.
Mr. Arsecularatne contended that the report had not been prepared by a Judicial Medical Officer and that distress of the kind described is common among people held in custody. The document is itself a court-ordered medico-legal report from the Institute of Forensic Medicine and Toxicology, examined and certified by a Registrar in Forensic Medicine, with its specialist referrals signed by the Chief Consultant Judicial Medical Officer. The CID has issued no public statement on the specific clinical findings.
What happens next
The report has set several decisions in motion. The Fort Magistrate is due to rule on 10 June on whether to appoint an independent psychiatric medical board to examine Sallay afresh, and on 1 July, both on the prosecution's request not to produce him in open court and on his own request to make a statement to the court under Section 127 of the Criminal Procedure Code.
The Court of Appeal is to take up his petition challenging the legality of his detention on 11 June. Separately, on 6 June, his wife, Manori Sallay, wrote to the Inspector General of Police alleging torture and degrading treatment and stating that her husband had begun a "fast unto death" in custody. His detention and the wider investigation into the Easter Sunday attacks continue.
