Monday, January 25, 2010

Torture: Health providers forced complicty in human rights abuses

BY BABUKAR KASHKA Republished kind permission of IDN-InDepth NewsAnalysis

NAIROBI (IDN) - Health providers in medical facilities, juvenile detention centres, orphanages, drug treatment and so-called social rehabilitation centres are forced to withhold care or engage in treatment that intentionally or negligently inflicts severe pain or suffering for no legitimate medical purpose.

This is just one of many facts stated by Human Rights Watch (HRW) in an essay in its 2010 World Report.

The essay, entitled ‘Abusing Patients: Health Providers' Complicity in Torture and Cruel, Inhuman or Degrading Treatment,’ reveal most cruel examples of this kind of torture.

It describes “government health policies that subject patients to torture or ill-treatment and the failure of national and international medical societies to prevent medical provider complicity in such abuse.”

The essay drew upon Human Rights Watch research from Egypt, Libya, Jordan, Iraqi Kurdistan, China, Cambodia, India, and Nicaragua.


In many countries, HRW documented the human rights violations suffered by women and girls, including those related to pregnancy, birth, and women's role as caregivers and providers.

For example, preventable maternal mortality and disability as a result of negligent policies and laws kill and maim more women annually than the impact of armed conflict, the Washington-based rights organization said.

For his part, HRW Health and Human Rights director, Joe Amon, underlined that "Ethical guidelines and international human rights law expressly condemn health providers' involvement in torture or ill-treatment."

"Yet providers engage in a wide range of abuses in the name of ‘medical treatment,' often because they are following abusive government health policies."


The essay documented health providers' complicity in torture or cruel, inhuman, or degrading treatment in many countries throughout the world, including:

- Government physicians conducting forcible anal exams of men suspected of engaging in homosexual activity in Egypt and forcible vaginal exams to assess virginity in Libya and Jordan.

- The practice of female genital mutilation by lay midwives in Iraqi Kurdistan, and government physicians promoting the practice and disputing negative health consequences.

- Staff at drug "treatment" centres in China and Cambodia denying care for drug users in withdrawal and subjecting individuals dependent upon drugs to forced labour or exercise in place of evidence-based treatment.

- Physicians in Nicaragua denying women life-saving abortions, resulting in preventable deaths.

- Health providers in India withholding pain medicine for those suffering from severe, chronic pain.


Human Rights Watch said that in each of these cases, the health providers' conduct “amounted to cruel, inhuman, or degrading treatment because providers unjustifiably or deliberately caused severe mental or physical suffering.”

Where there was government involvement and a specific intent, the organization said health providers could potentially be complicit in torture.

“In many cases, healthcare providers are constrained by government action or inaction to provide care that violates international standards.”

According to HRW, in Nicaragua, for example, physicians risk criminal charges if they perform life-saving abortions.

In India, the government has failed to take measures to ensure the availability and access to appropriate pain medications.

In China, the government has expanded access to substitution therapy for individuals with drug dependency in community-based clinics but not in drug rehabilitation centres.

HRW called on national and international medical societies to reinforce health providers' understanding of how their actions can result in torture and ill-treatment, and to speak out more forcefully against laws and practices that compel health providers to be complicit.


It also called on the international human rights protection system to address state-sponsored torture and ill-treatment in medical settings.

"The Hippocratic Oath declares that physicians must treat all patients to the best of their abilities and do them no ‘harm or injustice," Amon said.

Medical societies need to show leadership to empower health providers to act to prevent patients from being tortured or abused, and the international human rights community needs to join in these efforts, he added.


The 612-page report, released on January 21, summarizes major human rights trends in more than 90 nations and territories worldwide, reflecting the extensive investigative work Human Rights Watch carried out in 2009.

The report reveals other violent abuses by those national institutions, which are supposed to protect human rights.

“Governments responsible for serious human rights violations have over the past year intensified attacks against human rights defenders and organizations that document abuse,” it says.

According to HRW executive director Kenneth Roth the ability of the human rights movement to exert pressure on behalf of victims has grown enormously in recent years, and that this development has spawned a reaction from abusive governments that grew particularly intense in 2009.

"Attacks on rights defenders might be seen as a perverse tribute to the human rights movement, but that doesn't mitigate the danger," Roth said. "Under various pretexts, abusive governments are attacking the very foundations of the human rights movement."


HRW adds that attacks on human rights monitors are not limited to authoritarian governments like Burma and China. In countries with elected governments that are facing armed insurgencies, there has been a sharp rise in armed attacks on human rights monitors.

“Some governments are so abusive against individuals and organizations that no domestic human rights movement can function, citing Eritrea, North Korea, and Turkmenistan.”

The introduction to the report said that in addition to Russia and Sri Lanka, other countries where human rights monitors were murdered in order to silence them in included Kenya, Burundi, and Afghanistan.

Human Rights Watch cited Sudan and China as countries that routinely shut down rights groups and Iran and Uzbekistan as countries that openly harass and arbitrarily detain human rights workers and other critics.

Colombia, Venezuela, and Nicaragua threaten and harass rights defenders. Human rights advocates face violence in countries such as The Democratic Republic of Congo and Sri Lanka.

Some governments such as Ethiopia and Egypt use extremely restrictive regulations to stifle the work of non-governmental organizations.

Other countries use the disbarment of lawyers (China and Iran, for example), criminal charges -- often faked from staged attacks (Uzbekistan and Turkmenistan), and criminal libel laws (Russia and Azerbaijan) to silence critics.


Local and international human rights groups working in Israel have experienced a more hostile climate than ever before after documenting abuses committed by Israel, as well as Hamas, during the December 2008 -- January 2009 fighting in Gaza and Israel and in connection with Israel's ongoing blockade of Gaza.

In Gaza and Israel, Human Rights Watch documented laws-of-war violations by both Israel and Hamas.

“Israel's military assault on Gaza a year ago included the unlawful use of white phosphorus munitions, the killing of civilians with missiles launched by drones, and the shooting of civilians waving white flags.”

Hamas and other Palestinian armed groups launched rockets at Israeli population centres, and Hamas killed alleged collaborators and abused political opponents during the war.

Roth said that the only way that abusive governments will end their assault on rights defenders is if other governments that support human rights make rights a central part of their bilateral relations.

"Governments that support human rights need to speak out, to make respecting human rights the bedrock of their diplomacy -- and of their own practices," he added. "They need to demand real change from abusive governments."


Roth also said that the Barack Obama administration, in particular, faced the challenge of restoring America's credibility on human rights. “So far,” he said, “the results are mixed, with a marked improvement in presidential rhetoric, but an incomplete translation of that rhetoric into policy and practice.”

The report adds that the U.S. government has ended the CIA's coercive interrogation programme, “but should still uphold domestic and international law against torture by investigating and prosecuting those who have ordered, facilitated, or carried out torture and other ill-treatment.”

On closing the detention facility at Guantanamo, the deadline has slipped, but the more important issue is how it will be closed, Roth stressed.

Human Rights Watch and others have urged the administration either to prosecute detained suspects before regular federal courts or safely repatriate or resettle them elsewhere.

“The Obama administration has insisted on maintaining military commissions that provide substandard justice and on continuing to hold suspects indefinitely without charge or trial, both of which risk perpetuating the spirit of Guantanamo,” Roth said.


Human Rights Watch said that despite the growth in the human rights movement, human rights defenders remain vulnerable and greatly in need of support by rights-respecting governments.

"Governments that consider themselves human rights supporters often keep silent in the face of these abuses by allies, citing diplomatic or economic priorities," Roth said.

"But that silence makes them complicit in the abuse. The only proper response to serious human rights violations is to turn up the heat on the abusers." (IDN-InDepthNews/22.01.2010)

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