Besigye Unable to Speak or Write — Medical Report

KAMPALA — Dr Kizza Besigye is unable to speak or write following a recent collapse in court, according to a psychiatric assessment that also raises questions about his ability to participate meaningfully in his ongoing trial.

The assessment, conducted at Luzira Staff Hospital on August 16 by senior psychiatric specialists from Mulago National Referral Hospital, found Besigye alert and apparently capable of understanding spoken information. However, his inability to communicate verbally or in writing has significantly limited the extent to which doctors could assess his participation in his defence.

The report describes the condition as a “significant expressive communication impairment” and says Besigye now relies on pointing at individual letters and numbers to respond to questions.

The findings have triggered a sharp reaction from Besigye’s political party, the People’s Front for Freedom (PFF), which accused the State of pursuing what it described as a predetermined political trial despite evidence of the former presidential candidate’s medical condition.

‘The world is watching’

In a strongly worded statement responding to the medical report, PFF said the latest findings had exposed what it called the State’s determination to continue with the proceedings regardless of Besigye’s condition.

“The state’s desperation to execute a predetermined political trial while completely disregarding human rights, basic decency and the rule of law keeps on being exposed,” the party said.

The statement directly challenged evidence previously presented about Besigye’s failure to attend court virtually.

PFF singled out Prisons Officer Hiire, accusing him of giving false testimony concerning Besigye’s willingness to participate in proceedings through Zoom.

“Prisons Officer Hiire claimed under oath that Dr. Besigye declined to attend court via Zoom, a lie aimed at covering up his critical condition,” the party noted.

The claim is part of the party’s broader argument that Besigye’s medical condition was known to authorities but was not adequately reflected in the conduct of the trial.

What the medical report actually says

The psychiatric assessment, signed by Dr Nalugya Joyce Sserunjogi, Senior Consultant Psychiatrist at Mulago National Referral Hospital, in the presence of Dr Julius Muron, Consultant Psychiatrist in Forensic Psychiatry, gives a detailed account of Besigye’s condition.

The doctors were asked to establish whether he was mentally fit to understand the nature of the court proceedings and participate meaningfully in his defence.

Their findings are nuanced.

Besigye was found to be alert and cooperative.

“He maintained appropriate eye contact and appeared to make an effort to participate in the assessment despite his communication difficulties,” the report states.

He also appeared oriented to person, place and time.

But when it came to speech, the finding was unequivocal: “He was unable to produce verbal speech.”

The doctors said his inability to speak appeared to represent “a significant expressive communication impairment.”

Besigye’s new way of communicating

Without speech, the psychiatrists used an alternative communication method involving a paper letter and numbers keyboard.

The process was laborious.

The report says information had to be obtained by asking questions and allowing Besigye to point to the appropriate letters and numbers.

“Information obtained from him was therefore elicited through pointing to letters and numbers, which took much longer time than was expected,” the doctors wrote.

Even with those difficulties, however, the medical team found that Besigye appeared to understand what was being asked.

“His comprehension appeared preserved,” the report says.

He could attend to verbal questions and instructions and respond using the alternative communication method.

The doctors further found his responses “consistent and relevant to the questions presented.”

But writing is also impossible

The communication problem is not confined to speech.

The report states: “The patient was unable to communicate through writing.”

This leaves Besigye dependent on pointing at individual letters and numbers when he needs to express himself.

The medical team noted that this method allowed him to respond, but also acknowledged that more detailed cognitive assessment was limited because of his inability to speak or write.

That limitation becomes particularly important when considering his ability to work with his defence lawyers.

PFF disputes the conduct of the trial

PFF argues that the medical findings should have immediate consequences for the proceedings.

The party said official medical reports from Luzira Prison had confirmed what it described as a much more serious level of incapacity.

“Official medical reports from Luzira Prison staff confirm that Dr. Besigye is currently unable to speak, write, follow proceedings or communicate with his legal team,” the party said.

The medical report supplied for the psychiatric assessment, however, contains a more qualified finding on some of those points.

It says Besigye’s ability to follow questions was preserved and that he appeared capable of understanding spoken information.

At the same time, it says the assessment of his understanding of the charges and the roles of the court, prosecutor and defence counsel was incomplete because of his inability to speak and write.

His ability to communicate preferences and communicate with defence counsel was also marked as “requires further assessment.”

That distinction is important because the report does not simply conclude that Besigye is unable to understand proceedings.

Instead, it establishes that he appears cognitively engaged while highlighting significant limitations on his ability to communicate.

The collapse behind the condition

The report links the communication impairment to a syncope episode that occurred after prolonged standing and an emotional outburst in court.

It records that Besigye had suffered a “Syncope attack secondary to prolonged standing and emotional outburst while in court.”

The report adds: “Since that syncope episode, he has been unable to speak and is unable to write.”

Besigye is undergoing speech and language therapy, with the doctors noting some slight improvement in attempts to pronounce words.

But his ability to communicate remains severely restricted.

Brain scans found chronic changes

The psychiatric team also reviewed Besigye’s medical investigations.

An ECG and echocardiogram showed no significant findings.

An EEG, however, showed “features of diffuse encephalopathy.”

Brain scans also recorded chronic abnormalities.

The CT scan showed “mild generalized cerebral atrophy” and “mild microangiopathic white matter change.”

The MRI found “mild chronic microangiopathic white matter ischemic changes” and “cerebral volume loss.”

The report found no acute stroke or brain haemorrhage.

“No evidence of acute infarct or hemorrhage,” the doctors stated.

No evidence of major psychiatric disorder

The report also distinguishes Besigye’s communication difficulties from a major psychiatric disorder.

The doctors found no evidence of delusions or marked suspiciousness.

They also found no suicidal or homicidal ideation based on the information obtained through the alternative communication method.

There was no observed evidence of perceptual disturbance.

Although the psychiatrists acknowledged that formal assessment of his thought process was limited by the absence of verbal speech, they concluded that his responses suggested organised thinking.

“His thinking appeared coherent, logical and goal directed, with no clear evidence of formal thought disorder,” they wrote.

His insight into his condition appeared adequate, while his judgment was considered preserved based on the information available.

A frustrated man who still understands

The assessment describes Besigye as emotionally affected by his condition.

He reportedly described his mood as frustrated.

His affect was tearful but reactive and congruent with the emotional content of the interview.

Yet the doctors continued to find evidence that he was mentally engaged.

He could attend to questions.

He appeared to comprehend verbal information.

He could retain and respond to information.

And he could use the alternative communication system to convey relevant answers.

The central problem, therefore, appears to be expression rather than a complete loss of comprehension.

PFF: ‘This is not justice’

PFF nevertheless says the State’s handling of the case amounts to persecution.

The party accused the court process of proceeding despite evidence that Besigye was unable to participate fully.

“Despite clear medical evidence showing an incapacitated defendant, Mr. Baguma insisted the trial proceed, hiding behind the guise of the ‘interest of justice,’” PFF said.

The party also levelled broader allegations against the proceedings, claiming that medical evidence had been concealed and that witnesses had given false testimony.

“A trial where medical reports are concealed, witnesses fabricate accounts under oath and an incapacitated political prisoner cannot follow court proceedings is not justice but state-sponsored persecution,” the statement said.

Those are allegations by PFF and have not been established by the court.

The unresolved fitness question

The psychiatric report does not provide the kind of simple medical verdict that either side might prefer.

It establishes significant communication impairment but also records preserved comprehension, orientation, attention and apparent cognitive functioning.

The doctors specifically found that Besigye appeared able to understand spoken information and follow questions.

But they could not fully assess his understanding of the charges, the roles of the court, prosecutor and defence counsel because of his inability to speak and write.

They also said further assessment was required to establish his ability to communicate preferences and engage with his lawyers.

That leaves a difficult legal and medical question at the centre of the case: Can a defendant who appears to understand proceedings but cannot speak or write participate meaningfully in his own defence?

The answer may depend not only on psychiatric findings but also on the practical communication arrangements available to him.

For now, doctors have established that Besigye remains alert and apparently capable of understanding spoken information, while his ability to express himself has been dramatically impaired.

PFF sees something more troubling.

The party argues that the medical findings expose a trial proceeding against a defendant who is unable to participate adequately.

It ended its statement with a warning aimed beyond Uganda’s courtroom.

“Lies may buy time, but truth commands the final word. The world is watching.”

As the legal battle continues, the medical report has added a new and deeply consequential dimension to Besigye’s case: the former opposition leader is not described as mentally unaware of what is happening around him, but he is currently unable to speak or write — and doctors say further assessment is needed to determine the full extent to which he can communicate with those defending him.