By Nurliza Abdullah, Lay See Khoo and Mohd Shah Mahmood – National Institute of Forensic Medicine (NIFM), Hospital Kuala Lumpur, Malaysia
A century ago, the development, production and use of biological and chemical weapons have been prohibited by international treaties signed by most world countries. Among the most important treaties are the 1925 Geneva Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases, and of Bacteriological Methods of Warfare, the 1972 Biological and Toxin Weapons Convention for the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and the 1997 Chemical Weapons Convention. The Organization for the Prohibition of Chemical Weapons (OPCW), which is the international authority set up by in the 1997 Chemical Weapons Convention, is in charge of taking practical arrangements with regards to matters involving chemical weapons. As of yet, no organization similar to the OPCW with regards to biological weapons exists.O-Ethyl S-2-diisopropylaminoethyl methyl phosphonothioate – better known as VX – is one of the nerve agents designated as a Schedule I chemical warfare agent according to the Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons, also regarding their destruction. VX can be manufactured using relatively simple chemical methods and inexpensive and readily available raw materials, which has turned VX into a feared second ‘nuclear weapon’ of less technologically developed countries. Previously, nerve agents have been designated as chemical warfare agents due to their use in warfare. Nevertheless, chemical warfare agents such as Sarin and Soman have recently become a popular choice for non-state entities in situations outside the battlefield. The infamous 2017 case of a North Korean assassinated at the Kuala Lumpur International Airport using a poisonous fluid believed to be VX will be examined in detail in this article. 6
Chronology of the incident
On the morning of 13 February 2017 a 46-year-old North Korean man was allegedly sprayed with a fluid by two females at the Kuala Lumpur International Airport (KLIA) in Malaysia.
The victim then continued walking, albeit stumbling, into an KLIA Outpatient Clinic at around 9.15 am after the attack to seek medical assistance (Figure 1).
The Medical Officer who attended to the victim said that both his eyes appeared to be teary whilst the victim continued to sweat profusely and had an unpleasant smell surrounding him. He complained about severe pain in both of his eyes and his vital signs showed high blood pressure with an elevated heart rate. Shortly afterwards he collapsed in the clinic as he lost consciousness, displaying sever symptoms such as convulsions and twitching of the muscles as well as drooling from his mouth. He was immediately intubated and given one ampoule of adrenalin and atropine intravenously. At this time, his vital signs showed low blood pressure with an elevated heart rate and he was arranged for transfer to the hospital via the KLIA2 ambulance accompanied by the paramedics (Figure 2).
Upon arrival at the Emergency Department of the Putrajaya Hospital at 11 am he showed no signs of life. Cardiopulmonary Resuscitation (CPR) was performed by combining cardiac compressions with the intravenous injection of several ampoules of adrenaline. The attending Medical Officer at the Emergency Department noted the victim’s pupils to be constricted, pronouncing the victim dead after the failed resuscitation. As the victim was a foreign national and died under suspicious circumstances, the death was categorized as a high-complexity case involving an unknown agent where an intense discussion was held between the Forensic Medicine Consultants with the Royal Malaysia Police (RMP) to decide on the next course of action in the case on the 14 February 2017. Meanwhile, the body of the deceased was securely kept in a cold body storage in the Forensic Unit at the Putrajaya Hospital. The victim’s body was then transferred to the National Institute of Forensic Medicine (NIFM) in the Kuala Lumpur Hospital for postmortem examination.
Postmortem examination
The deceased was brought in to the NIFM and registered at 11.30 am on the 15 February 2017. Before the commencement of the autopsy, Postmortem Computed Tomography (PMCT) was performed by a forensic radiologist at 11.56 am in the same NIFM building. Subsequently, autopsy was carried out at 12.45 pm by two forensic medicine consultants. The postmortem examination took approximately 6 hours and was completed on the same day at 6.45 pm.
External examination
The deceased body was in a good state of preservation. The face and neck of the deceased were congested while the lips were cyanosed and both eyes appeared mildly congested. A few minor injuries were noted on the left upper lip, left lower lip and left angle of the mouth.
Internal examination
The scalp was mildly congested and there were minimal patchy areas of congestion over the vertex and left frontal lobe of the brain. Rib cage showed several CPR-related rib fractures and the trachea and bronchi contained a blood-tinged fluid. The lungs were moderately oedematous and congested. The heart was mildly enlarged but of normal shape. The left anterior descending coronary artery showed moderate luminal narrowing by atherosclerotic plaque. The right coronary artery and left circumflex artery showed minimal luminal narrowing by atheromatous plaques. On sectioning, the myocardium showed no gross infarcts or fibrosis, and there was no evidence of pulmonary thromboembolism. The liver was enlarged but grossly intact. Similarly, the spleen was externally intact and showed congestion of its cut surfaces upon serial sectioning. Both kidneys were intact but showed uniform granularity of the cortical surfaces.
Odontology examination
A dental examination was performed by a forensic odontologist on 17 February 2017. Dental charting, photographs, dental impressions and video were taken to capture the facial profile of the deceased for further analysis. In relation to the incident, it was noted that whitish lesions were present on the right and left buccal mucosa.
Postmortem specimens
There were more than 10 different types of specimens taken from the deceased for the purposes of further laboratory analysis. These were handed over to the Investigating Officer (IO) to be sent to the assigned laboratories on the same day immediately after the completion of postmortem examination. Table 1 below summarized the types of specimens taken:
For Part II of this article see here.
About the Author
Lay See Khoo is a senior Forensic Scientist who has been working for the National Institute of Forensic Medicine under Ministry of Health Malaysia for more than 15 years. She is currently a Member of Panel Evaluator in the field of Forensic Science for the Malaysia Qualifications Agency (MQA) appointed by Chief Executive Officer MQA since 2017, as well as a Permanent Representative for the Forensic Sciences Technical Committee to develop the Malaysian Standards appointed by the Director of Standards Development Agency, Malaysian Institute of Chemistry (IKM) since 2016.
