Concluding observations on the fourth periodic report of Ireland: Symphysiotomy 11. The Committee expresses concern that symphysiotomy, childbirth operations which sever one of the main pelvic joints and unhinges the pelvis, was introduced into clinical practice and performed on approximately 1,500 girls and women in public and private hospitals between 1944 and 1987 without their free and informed consent. While noting the publication of a report by Professor Walsh in 2012, the review of the findings of the report by Judge Murphy and the planned establishment of the an ex-gratia scheme for the survivors of symphysiotomy, the Committee expresses concern at the State party’s failure to: (i) initiate a prompt, and comprehensive independent investigation into the practice of symphysiotomy; (ii) identify, prosecute and punish, where still possible, the perpetrators for performing symphysiotomy without patient consent; and (iii) provide effective remedies to survivors of symphysiotomy for the damage sustained as a result of these operations (arts. 2 and 7). The State party should initiate a prompt, independent and thorough investigation into cases of symphysiotomy, prosecute and punish the perpetrators, including medical personnel, and provide an effective remedy to the survivors of symphysiotomy for the damage sustained, including fair and adequate compensation and rehabilitation, on an individualized basis. It should facilitate access to judicial remedies by victims opting for the ex-gratia scheme, including allowing a challenge to the sums offered to them under the scheme.