The death of one-and-a-half-year-old Arshid from Kerala’s Nedumangad has left many disturbed. The grief of losing a toddler is difficult enough. The grief of losing a toddler allegedly at the hands of a person entrusted with his care is something else altogether.
Children have the right to be protected from violence, exploitation, and abuse. Yet violence against children remains a reality across every social and economic group, religion, age, and culture. Children face domestic violence, sexual abuse, trafficking, child labour, bullying, and neglect. The consequences often extend far beyond childhood. More than half of the world’s children are estimated to have experienced acute violence, with South Asia carrying a substantial share of this burden.
What makes violence against children particularly disturbing is that it frequently originates within spaces that are expected to be safe. The perpetrator is often not a stranger but someone known to the child: a parent, caregiver, relative or trusted adult.
The allegations emerging from the Nedumangad case paint a grim picture. Arshid is reported to have died following a grievous physical assault allegedly inflicted by his mother’s live-in partner. He was reportedly brought to the hospital with the explanation that he had aspirated food. The circumstances surrounding his death came under scrutiny only after his grandparents demanded a post-mortem examination.
The findings that subsequently emerged were shocking. Investigators reported more than 90 separate injuries, both old and recent. These reportedly included rib fractures, intracranial bleeding, and burn injuries allegedly caused by cigarette butts on different parts of the child’s body, including the genitals. Medical findings indicate that the assaults may not have been confined to a single episode but may have occurred repeatedly over a period of weeks.
The case also raises uncomfortable questions beyond the events immediately preceding his death. News reports suggest that the accused had a prior history of severe domestic violence. Reports also indicate that family members had raised concerns regarding Arshid’s safety earlier. His grandparents reportedly made attempts to obtain custody of the child and are said to have raised allegations of abuse.
Were formal complaints filed? Were they investigated? If complaints existed, what action followed? If a history of violence had already been documented, was there an opportunity for intervention before the situation escalated to this point?
One detail stands out among the many disturbing findings. Several weeks before his death, Arshid reportedly underwent treatment for fractures involving both arms. The explanation offered was a fall. Yet bilateral arm fractures in a toddler rarely fit comfortably into ordinary explanations. Medical students encounter such examples early in forensic medicine while studying battered baby syndrome and non-accidental injuries.
Park’s Textbook of Preventive and Social Medicine describes battered baby syndrome, also known as Caffey-Kempe syndrome or non-accidental injury of childhood, as the infliction of wholly inexcusable violence upon a young child by an adult in a position of trust.
Forensic textbooks describe certain recurring warning signs. These include repeated injuries occurring at different stages of healing, explanations that do not adequately match the injuries observed, delays in seeking medical attention, bruises, fractures, and soft tissue injuries that suggest force rather than accident. These patterns are not viewed in isolation but are pieced together as part of a larger clinical picture.
For doctors, this is not merely a textbook definition but a warning that carries legal implications.
Suspected child abuse is a recognised indication for registering a medico-legal case. The purpose of the medico-legal system is not simply documentation. It is to ensure that suspicious injuries do not disappear into hospital records without scrutiny. Even when family members are unwilling or hesitant to approach the police, doctors possess the authority to initiate medico-legal reporting through established mechanisms.
Under the medico-legal framework, the duty to report suspected abuse rests equally upon all healthcare institutions. The responsibility arises from the nature of the injuries and the circumstances surrounding them, not from whether the hospital is public or private, big or small. It would be useful to understand that doctors are encouraged to make medico-legal entries even on the slightest suspicions.
Once registered, a medico-legal case enters a formal process of police inquiry and documentation, making it considerably more difficult for allegations of violence to be overlooked or ignored.
This is where the Nedumangad case demands closer examination. Where was the child treated for the fractures? Was a medico-legal case registered? Were the injuries documented as suspicious? Were the police informed? Was any inquiry initiated? If such processes were undertaken, what became of them? If they were not, why not?
India possesses an extensive legal framework for child protection. The National Policy for Children, 1974 recognises children as the nation’s most important asset and places responsibility for their protection upon the state. In the context of the Nedumangad case, two legislations assume particular significance: the Protection of Children from Sexual Offences (POCSO) Act, 2012, and the Juvenile Justice (Care and Protection of Children) Act, 2000, amended in 2021.
The POCSO Act defines various forms of sexual abuse, including both penetrative and non-penetrative assault, and deems sexual assault to be aggravated under certain circumstances, including when the child is mentally ill or when the abuse is committed by a person occupying a position of trust or authority. The Juvenile Justice Act, meanwhile, extends beyond children in conflict with the law and creates a separate framework for children in need of care and protection, including those who are abused, neglected, abandoned or otherwise vulnerable.
Through Child Welfare Committees, foster care, adoption, and sponsorship provisions, the legislation envisages mechanisms for intervention even before harm becomes irreversible. Yet every major child abuse case inevitably raises the same question: when warning signs emerge, how effectively do these systems communicate with one another?
The tragedy at Nedumangad is not only about a child who died. It is also about a child who appears to have suffered repeatedly before he died. A fracture, repeated injuries, multiple concerns raised by relatives and neighbours, history of repeated violence. Viewed separately, each may appear insufficient. Viewed together, they form a pattern that is difficult to ignore. The question is not merely who saw them, but whether those signs travelled far enough through the community and institutions to trigger protection.
The primary healthcare system in India often focuses on reducing infant mortality, improving nutrition, expanding immunisation, strengthening maternal care, and protecting the rights of a child. These efforts have saved countless young lives. Yet violence remains one of the least discussed threats to child survival. Children are often the first victims of conflict, whether societal, familial or interpersonal.
The Sustainable Development Goals call upon nations to end all forms of violence against children by achieving target 16.2 by 2030. The aspiration is global, but the responsibility is intensely local. It begins in homes, schools, police stations, hospitals, and communities. It begins whenever an injury appears inconsistent with an explanation, whenever a complaint is filed, whenever a neighbour, teacher, doctor or relative senses that something is not right.
Arshid’s death will now be investigated by courts, police officers, and forensic experts. Their findings will determine criminal responsibility.
The larger question belongs to society itself. How many opportunities existed to protect this child before a post-mortem examination became his final voice?
Dr A Chandiran Joseph is a Chennai-based community physician and public health researcher. Dr J Amalorpavanathan is a Chennai-based vascular surgeon.
Views expressed are the authors’ own.