1. PHR-UK's Health and Human Rights Course Judged Excellent
PHR-UK's first evening course has been judged a huge success - participants rated its 10 sessions as mostly excellent. The course attracted CME approval from the Royal College of Physicians, each 2 hour session securing 2 credits – 20 for the whole course, with 2 extra per day for those we took advantage of the unique optional visit to the United Nations in Geneva. The RCP evaluation forms assessed relevance to educational need and quality of education offered. Those attending mostly rated the sessions in the highest category. "This has surpassed our wildest hopes," commented course director and Chair Dr. Peter Hall, as the assessment was independently verified. "We thought we would be very lucky to be able to bring all these experts to London; but to get each of them in peak form has been enormously exciting. I have learned a very great deal from them."
Students picked up some unusual information along the way. What percentage of prisoners who are hung die from asphyxia and not a broken neck ? Are women human ? What is the link between coffee, TV and torture ? How did the Nazis come to be the world’s first organisers of a forensic investigation into war crimes ? What is a parasitic right ? All these and more were explained in stimulating fashion, by experienced speakers, using slides, overheads and the whiteboard to increase our understanding.
PHR-UK is fortunate to be able to tap into an extraordinary rich seam of world class human rights teachers and opinion formers - including Eva Gamarnikow, Chris Milroy, Jim Welsh, Harold Hillman, Derek Pounder, Derek Summerfield, Christine Gosden, and Michael Peel. The subjects covered the place of health in human rights, the death penalty, women's health and human rights, the involvement of doctors in torture, identifying dead bodies, determining cause of death and giving evidence, the documentation of torture and the role of doctors in protecting human rights. An unanticipated supplementary session hosted by Redress dealt with torture survivors' perceptions of reparation.
But PHR-UK won't rest on its laurels if Peter Hall has anything to do with it. "I want to see this course offered to a broader audience," said Peter. "We had a lot of inquiries from overseas this year, but there are always issues of visas and costs to be confronted. I would like to us to be able to raise funds to enable people from developing countries to come and experience what we are being privileged to experience." Raising funds for such projects is very difficult. The Foreign Office Human Rights Dept announced in May that its entire grants budget for the year commencing April 1st had been allocated. It was good to see our own members attending this course, but perhaps some of those who did not have time to could consider making a contribution to the cost of bringing someone from overseas. If you can help in any way or have any thoughts on this, please contact Peter Hall.
2. Healthcare delivery in the middle of a conflict
Regular Newsletter readers will recall PHR-UK’s concern over the conflict being waged across former Zaire, now known as the Democratic Republic of Congo (DRC) – not least because it developed directly as a result of the international community’s failure to deal with the former genocidaires that fled Rwanda in 1994.
According to a study just released by the International Rescue Committee in New York, four times as many people have died in the area since August 1998 as would be expected under normal conditions. Two years of war have caused the deaths of more than 1.7 million people in eastern Congo, where people who manage to flee the fighting often die of hunger and malaria while hiding in impenetrable forests. Although the expected death toll in the five-province area of 18 million people would be 600,000, the actual number was 2.3 million. Of the additional deaths reported in the survey, 200,000 were caused by acts of violence, whereas the rest of the remaining one and a half million were attributed to the war-related collapse of health services and food supplies. Children younger than 5 account for more than one-third of the excess deaths. "Men with guns come and wreak havoc on a very regular basis," said Les Roberts, an epidemiologist at the Johns Hopkins University, who supervised the study.
The Director-General of WHO, Dr Gro Harlem Brundtland, has cited the DRC as an example of how conflict in the world's poorest nations can lead to "the virtual dismantling of even modest health and education systems that existed.” In the late 1980's and early 90's the DRC had reasonably high immunization coverage and primary school attendance. During the survey which was conducted in April and May, researchers found abandoned health clinics, local economies in shatters and families struggling without the subsistence agriculture or barter systems that had sustained them. The study concluded that eastern Congo had become "an unchecked incubation zone for disease." Mr. Roberts said malaria and diarrheal diseases, including cholera, appeared to be the leading causes of death, although meningitis and suspected cases of polio were also found.
Some weeks ago health workers tried to vaccinate 16 million children in central Africa in an attempt to rid the region of polio. The five day campaign aimed to immunise all children under five in Gabon, Congo Brazzaville, the Democratic Republic of Congo and Angola. By simultaneously targeting the population at risk in one of the last reservoirs of polio, the campaigners hope to cut the viral transmission chain and finally eradicate the crippling disease. Similar campaigns have been carried out throughout the region during the past few years, but this year vaccinators aim to improve their coverage by going "door to door" instead of waiting for parents to bring their children to a vaccination site. "We shall also vaccinate children in the street, the market places, work places and wherever we find them," said Dr Jean Claude Mubalama, who is coordinating the campaign in DRC, where 86,000 health workers were involved.
This was the first time in the region that so many countries and their partner agencies organised a joint campaign. The total cost is put at US $44 million, of which US $32 million was to be spent in the DRC – the biggest logistical challenge, as some settlements may not be reached within the period that the vaccines can be conserved in portable containers. During the past few years, the UN system has been gearing up to announce the final eradication of polio worldwide, but a few cases were still notified in the DRC last year. Final eradication cannot be declared until no cases have been notified for five years.
Five health care workers involved in the vaccination campaign were alleged to have been beaten up and arrested by rebel soldiers in northwest DRC. Representatives of the WHO said the incident took place in the Bikombi area of Ikela in Equateur province. The Ikela health zone is split by a former military frontline where the majority of the town's estimated 50,000 people have been displaced into a forest on the eastern side of the line. The population is cut off from even irregular medical supplies, and it is unclear whether there are still government soldiers and/or other armed groups in the town itself.
The Rassemblement congolais pour la democratie (RCD-Goma) has denied allegations that it was involved in arresting and beating up the health workers. An RCD spokesman said that Ikela, in northwestern Equateur Province, where the incident occurred, was under the control of DRC government soldiers.
Despite a ceasefire in the DRC holding for the last six months, the situation remains "fragile", Kamel Morjane, the Special Representative of the UN Secretary-General in the DRC, recently told the press. However, he noted that there were still difficulties. "We have to continue efforts, in particular in the east, where there is still fighting between the Rwandan forces and the RCD”. The Rwandan government recently said that it would not trust DRC President Joseph Kabila until he promised to stop backing the insurgents.
PHR applauds this initiative, which was carried out at considerable risk to those concerned. We will continue to watch the situation with interest.
3. PHR-UK in Washington DC
Bernie Hamilton returned to Washington in April, where he met with Len Rubinstein of PHR and Audrey Chapman of the American Association for the Advancement of Science (AAAS). PHR's DC office currently features an exhibition of photographs taken in East European mental facilities. The facilities receive very little support in the post Soviet era, and conditions appear to be very sparse. Although there is no PHR amongst former Soviet states, IFHHRO meetings are occasionally attended by representatives from there. Len Rubinstein is trying to raise funds so that this year's annual IFHHRO meeting can be in the US. Funding will enable representatives of developing countries to attend. The annual conference is expected to focus some of its time on a draft UN Declaration on Human Rights and Health Practice, which a number of US experts have been working on. Copies of the current draft are available from Dr. Peter Hall.
Audrey Chapman needs little introduction to members. She chaired the day of discussion on the Right to Health organized by PHR-UK on behalf of the UN Committee on Economic, Social and Cultural Rights (CESCR), in November 1999 when it hosted the annual IFHHRO conference. The AAAS has now commissioned a manual on the right to health for NGOs and others concerned with health and health-related issues. The text will consist of an overview, and an analysis of the right to health, which will follow the structure of the CESCR General Comment on the right to health. The final section covers such practical aspects, as measuring implementation, identifying violations, participating in the reporting process and the role of health service providers and medical associations. Others from our day of discussion who are advising on the book include CESCR members Eibe Riedel and Paul Hunt, and Ann Sommerville, who coordinated the recent BMA handbook, The Medical Profession and Human Rights.
4. Developments on behalf of Iraqi Victims
From March 29 to April 1, 2001, Dr. Christine Gosden (University of Liverpool) and the Washington Kurdish Institute hosted a seminar in Oxford, with representatives of the regional health ministries, deans of three regional medical colleges, doctors, and representatives of non-governmental organizations providing health-care in northern Iraq.
Participants analyzed clinical video studies and data collected in a medical survey of 2000 households (one percent) throughout northern Iran. Effects of high incidences of cancers, cardiopulmonary disease, congenital anomalies, and other major medical disorders were examined in relation to regional demographic structures. Researchers have identified 250 villages and towns, and 31 other uninhabited strategic areas believed to have been attacked by the Iraqi regime in 1987 and 1988. Preliminary evidence suggests that in addition to chemical weapons, including nerve agents, biological and radiological weapons were also possibly used, with genocidal intent. Researchers discussed preparation of relevant papers for submission to scientific peer-review journals.
Based on examination of preliminary survey data and clinical studies, participants planned for medical treatment, research and environmental safety pilot programs. Diagnostic and treatment capacities were considered in relation to the UN Oil-for-Food program and other available medical and health resources. Discussion of program development focused on priority areas identified as cancer, maternal and child health, including congenital abnormalities, and general medical disorders. Working partnerships between the ministries of health, the medical colleges, NGOs and local doctors were strengthened to better secure international support and to effectively implement programs at the primary, secondary and tertiary care levels.
Participants reviewed ongoing treatment and research programs supported by HMI for survivors of non-conventional weapons attacks in northern Iraq. To further address urgent medical needs in Halabja and elsewhere, participants agreed to support:
- Establishment of a community center to assist disabled persons in Halabja. ·
- Continued employment of three medical specialists in the Halabja hospital.
- Provision of an anesthesia machine, slit lamp (for ophthalmology), coronary care and other medical supplies for Halabja hospital.
- Providing a functional bronchoscope for physicians in Erbil.
Participants emphasized the urgent need to take further measures to build upon initial steps, given the scale of health problems facing a civilian population exposed in varying degrees to weapons of mass destruction deployed by the Iraqi regime.
Participants agreed that urgent appeals should be made to the international community to support continued development of medical treatment, research and environmental safety programs throughout the region.
Dr. Gosden, has made a number of visits to Northern Iraq to research the nature and effects of the 1980s bombings, and was one of the speakers on PHR-UK’s evening course on health and human rights this spring.
On March 23 - 24, 2001 the Iraqi National Congress held a conference in London on Transitional Justice and the Practical Application of Human Rights Advocacy in Iraq. Speakers included Ann Clwyd MP, Emma Nicholson MEP and international law expert Professor Jordan M Paust. The application of international criminal law, the availability of evidence and the difficulty of finding an appropriate court to hear a case were among the topics discussed.
Bernie Hamilton discussed jurisdiction with Ann Clwyd, who subsequently questioned the Foreign Secretary in Parliament over inaction by the UK government in investigating or prosecuting overseas crimes alleged to have been committed by visitors to this country [Hansard 3 April 2001]. PHR-UK remains concerned about the reluctance of the Westminsater Parliament to add universal jurisdiction to the International Criminal Court Bill, in the way that Canada, Germany and other states have done. The Scottish Parliament in Edinburgh is displaying a greater interest in this. We are currently supporting efforts to see the ICC Bill (Scotland) reflect the Preamble of the International Criminal Court Statute, which states that "it is the duty of every State to exercise its criminal jurisdiction over those responsible for international crimes".
5. Book review
The Constant Gardner, by John le Carre (2001) London; Hodder and Stoughton, 508pp.
"I mean, Jesus. Foreign Office isn't in the business of passing judgement on the safety of non-indigenous drugs, is it? Supposed to be greasing the wheels of British industry, not going around telling everybody that a British company in Africa is poisoning its customers. You know the game. We're not paid to be bleeding hearts. We're not killing people who wouldn't otherwise die. I mean Christ, look at the death rate in this place. Not that anybody's counting."
The speaker is Sandy, Head of Chancery at the British High Commission in Nairobi, in le Carre's eighteenth novel. He is trying to justify his behavior to the book's subject, the constant gardener. The constant gardener is Justin, a junior official in the High Commission, who spent much of his spare time gardening. The book opens with the discovery that Justin's wife Tessa has been murdered. Justin seeks to discover why. Gradually, Justin discovers how little Tessa shared with him. He finds a note threatening her with death unless she ceases her investigation into a drug trial going on in Kenya. He comes across a love letter to her from Sandy. From her laptop, from disks and from her friends and opponents Justin pieces together the story. Tessa had presented her report on the drug trial and the cover-up to the British authorities. She asked them to persuade the drugs company to withdraw the drug until it was safe. But senior officials are unaccustomed to having foreign policy dictated to by an embassy wife; and if one of them fancies a seat on the company's board, policy change is unlikely.
Justin's quest for the truth changes him. As Sandy remarks during his interrogation, Justin, who was supposed to have reached his ceiling, has grown up. He mails details of his findings to various friends so that questions can be asked should anything happen to him. Justin becomes constant, not in the sense of an incessant gardener, but as someone loyal to Tessa. Justin takes up the cause of his late wife. He travels over some of the familiar le Care terrain, to Germany, Switzerland and Canada. He deals with blunt-speaking but helpful police and more obsequious Foreign Office officials. He is beaten up and threatened with death, but he persists.
Writing ten years after the end of the Cold War, the author who gave the world George Smiley has found further uses for his skill and knowledge. Le Carre's description of diplomatic life in Kenya is particularly readable. In an afterward, he insists that his tale is pure fiction; but adds that by comparison with the reality, his story was as tame as a holiday postcard. He credits a number of doctors amongst his informants, as well as people from Medecins sans Frontieres and the London School of Hygiene and Tropical Medicine. Those interested in ethics, human rights, foreign policy or the developing world are likely to find this novel of interest.
6. PHR-UK in Geneva
PHR-UK was again in Geneva this May, as Bernie Hamilton led students from our Wednesday evening Health and Human Rights Course on a trip to see how the UN human rights procedures operated. Students were able to attend treaty monitoring sessions each day at the Office of the High Commissioner for Human Rights. Meetings were arranged with committee chairs, other committee members and staffers. A lunch was arranged with a local NGO. Students saw the Committee against Torture question Brazil, the Czech Republic, Georgia, Costa Rica and other states on their implementation of the Convention against Torture. Also, they attended a discussion on the right to development between the Committee on Economic, Social and Cultural Rights, members of the international financial institutions and others. They saw the conference room where the Commission on Human Rights meets each year, and also the Serpent Bar, where NGO lobbying takes place. The week ended with a tour of the UN library, conducted by the law librarian. Anyone who would like to join the next trip, in November should contact Bernie Hamilton or Peter Hall.
Bernie Hamilton also visited Daniel Premont and his staff at the UN Voluntary Fund for Victims of Torture. The fund raises about $10 million each year from UN members, which it distributes to support projects that will assist in the rehabilitation of torture victims. The UK is one of the largest donors to this Fund.
Bernie also spoke with members of the High Commissioner's staff about her recent complaint at the start of this year's session of the Commission on Human Rights concerning the scarce resources with which her office is expected to manage its various human rights responsibilities. Two per cent of the UN budget is simply not enough for what is one of the main pillars of the UN's work, according to the Charter. Many staff are on short term contracts. Some work for eleven months, and then are re-hired after a month. Morale certainly improved with the arrival of Mary Robinson, and the move to the very modern Palais Wilson. It is disappointing to see the air of optimism begin to dissipate so soon. PHR-UK hopes that UN member states will take measures to increase the resources of the Office of the High Commissioner for Human Rights.