WARNING: This article contains graphic content.

EDMONTON—Silva Koshwal admitted in an Edmonton court Monday to stabbing his ex-girlfriend more than a hundred times and pinning her heart to the wall of her apartment with a knife in 2015.

The violence endured by Nadine Skow, 38, in her final moments was described as “highly disturbing,” by Koshwal’s defence lawyer Peter Royal.

According to an agreed statement of facts, Skow and Koshwal had been in a romantic relationship for three years before they broke up in 2014, but problems between the couple persisted.

Skow had worked at the Chimo Child Youth Retreat Centre for five years and had attended a work-related camping trip in Nordegg, Alta., the weekend before her death.

Skow had called her supervisor on Aug. 23, 2015, saying she got sick during the retreat and was unable to come into work. She was expected to return for a scheduled meeting two days later.

She would never make it.

A neighbour testified that on the night of Aug. 23, 2015, Koshwal had been trying to get into Skow’s apartment building by hitting all of buzzers at the front door.

Surveillance footage showed Koshwal walking from his apartment at 107 Ave. and 108 St. towards Skow’s apartment a few blocks away just after midnight on Aug. 24.

Around that time, Brooke Miles — who lived across the hall from Skow — heard her door open and footsteps inside her apartment. She awoke to a stranger standing at the foot of her bed.

Miles screamed and beat the intruder out of her apartment with an umbrella.

Miles did not call the police then, nor did she think to call police when she later heard screams coming from Skow’s apartment.

Others in the building heard a woman screaming, “Help” and “He’s going to kill me” repeatedly that night, but no one answered her calls.

On Aug. 25, concerned after not hearing from Skow, her supervisor and a colleague arrived at the apartment to check on her. When she didn’t answer her buzzer, her colleagues were let in by a man who lived on the third floor.

When they opened the door, they found Skow lying face down on her bedroom floor covered with blood, a knife and a phone sitting on her blood-soaked mattress.

Police arrived just before 9:30 a.m. and detailed the carnage.

Skow’s internal organs were coming out of her abdomen. Her heart had been nailed to the wall with a large kitchen knife. Someone had scrawled a letter “A” in blood above her heart.

There was blood smeared and spattered around her apartment and a heavy pool near her bed.

Skow’s body had been mutilated with knives from her own kitchen. Her heart, ovaries, uterus and part of her lung had been cut from her abdomen.

An autopsy detailed injuries all over Skow’s body, including four bite marks.

Chief medical examiner Elizabeth Brooks Lim counted 101 stab wounds on the surface of Skow’s skin, 63 believed to have been suffered while she was alive.

Skow had 30 defensive wounds on her hands and wrists.

Investigators found a knife underneath Skow’s body that had DNA from Skow and Koshwal on it, and Koshwal’s bloody fingerprint was found on a liquor bottle in Skow’s bedroom.

On Aug. 25, Koshwal turned himself in at Edmonton police headquarters. Police noted Koshwal had blood under his fingernails and was wearing a blue lanyard with Skow’s keys on it at the time of his arrest.

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Police searched Koshwal’s apartment on Aug. 26 and Aug. 27, seizing two knives from his bed that matched those from Skow’s kitchen.

While Koshwal admitted he was guilty of second-degree murder and causing indignity to human remains, Justice Sterling Sanderman said there was “overwhelming” circumstantial evidence to support Koshwal’s guilt.

In court Monday, the question posed by Koshwal’s defence was not whether Koshwal had brutally killed Skow, but whether Koshwal can be held accountable for his actions given his allegedly disturbed mental state.

Forensic psychologist Leslie Block testified that he had interviewed and assessed Koshwal.

Block said that while Koshwal was fit to stand trial, Koshwal suffers from a complex and extreme form of post-traumatic stress disorder that could have caused him to be in a dissociative state at the time of the crime.

Block admitted it was difficult to assess Koshwal because he proved to be a “poor historian” of his own life and has cognitive and language difficulties.

Block did say, however, that over 11 hours of interviews, he observed Koshwal was emotionally flat, with a gazing, dreamy, vacuous stare that suggested to Block he was preoccupied with something internally.

Though Koshwal could provide few details, Block said he believed Koshwal was exhibiting signs from past trauma suffered as a child in South Sudan.

The Second Sudanese Civil War is reported to have the highest civilian death toll of any conflict since the Second World War and was characterized by extreme violence.

“He’s seen every type of carnage no one should ever have to see,” said Block.

Block said Koshwal reported hearing voices, sometimes just screams, in his head, and would see visions of dead bodies on 107 Ave. His nights are haunted by “ghosts of his past,” Block said, including the belief that he had to sleep with an axe in case a militia attacked him while he slept.

While on the outside Koshwal maintained a flat affect, inside Block described him as being “a volcano ready to erupt” when visions of the past overwhelm his sense of present reality. Koshwal would try to self-medicate with alcohol and crack cocaine.

Block said complex PTSD could explain the “vicious and heinous” acts Koshwal committed without Koshwal being able to clearly recall or understand what happened.

Crown prosecutor Laurie Trahan seemed less convinced, suggesting in her line of questioning that Koshwal’s “amnesia” could be an attempt to escape responsibility and that Koshwal could have been simply a jilted ex-lover looking to stop Skow from moving away from him by any means possible.

Trahan brought up Koshwal’s past criminal record, which includes an assault on the mother of his child and a charge of sexual assault where Koshwal was accused of groping a woman. In both instances, Trahan said Koshwal has deflected responsibility.

Koshwal’s trial continues on Tuesday.

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