The right to health and Physicians for Human Rights–UK
PHR-UK has documented terrible human rights abuses perpetrated in conflicts such as those in Rwanda, Kashmir or Azerbaijan. It has also fulfilled its role as a medical human rights organisation by publishing two major reports on the delivery of health care – in the Occupied Territories and in South Africa during Apartheid. Death from preventable or remediable disease kills more than violence and is no less permanent – this often disregarded fact was impressed on the PHR-UK team by a Palestinian doctor, a former student at the London School of Hygiene and Tropical Medicine, during evidence collection in 1997 . Every preventable death is equally tragic - be it natural or at the hand of man.
Article 12* of the International Covenant on Economic, Social and Cultural Rights deals with a State’s obligations to maintain the health of its population. Every state signatory is required to make ‘periodic reports’ to the Committee on Economic, Social and Cultural Rights (CESCR) at five year intervals. In November 1998 PHR-UK gave evidence before the CESCR on healthcare in the Occupied Territories on the occasion of Israel’s quinquennial report. Paragraph 18 of the concluding observations of the CESCR deals with the most substantive issue within PHR-UK’s submission “... [the Committee] notes with grave concern the severe consequences of closure on the Palestinian population. Closures have prevented access to health care, first and foremost during medical emergencies, which at times have tragically ended in death at checkpoints and elsewhere”
PHR-UK’s convener, Bernie Hamilton, took the opportunity to suggest to the CESCR’s chairman that PHR–UK help develop Article 12 on behalf of the Committee:
“... We write to ask whether the Committee might wish to hold a hearing regarding Article 12, the right to physical and mental health. We note the Committee's interest in this right from its General Comments on persons with disabilities (No. 5) and on older persons (No. 6) and its questions and comments on reports submitted by States parties under Article 16. It is our view that such a hearing might well provide the Committee with an opportunity to review Article 12 with a view to issuing a General Comment that could facilitate States' approaches to implementation. PHR–UK would be very pleased to assist the Committee in this task, and arrange consultations with its eight affiliates, the four observers at the International Federation of Health and Human Rights Organisations (IFHHRO), and other appropriate bodies.”
The summary record of the second part (public) of the 51st meeting: 03/12/98 records the discussion as members of the CESCR considered PHR–UK’s suggestion
“Future days of general discussion
51. The CHAIRPERSON invited members to consider possible subjects for the days of general discussion to be held at forthcoming sessions of the Committee. He had received a letter from the NGO Physicians for Human Rights, urging the Committee to return to the question of the right to health. That was one possible topic for a day of discussion.
52. Mr. GRISSA supported the Chairperson's suggestion.
56. Mr. RIEDEL said that all the proposed topics were worthy of consideration; the Committee must decide which should be accorded priority. He favoured taking up the right to health at the next session, as that was a topic of which the Committee already had some experience. Refugees' rights should be taken up at the Committee's November 1999 session, but would require careful preparation if the day of general discussion was to be properly focused. The right to work was another fascinating and difficult issue that the Committee should address at some point.
57. Ms. BONOAN-DANDAN agreed with Mr. Riedel. The right to health was a subject very familiar to the Committee, whereas considerable preparation would be required for discussions on refugees and on the right to work. Anyway, those should be the first three topics. In future the Committee might adopt the more focused approach used by the Committee on the Rights of the Child in preparing days of discussion. That would discourage participants from contributing standard statements that did not address the specific concerns on which the Committee wished to concentrate.”
Bernie Hamilton will attend the May 1999 CESCR session in Geneva to monitor further discussion of our proposal regarding Article 12.
* Article 12 of the International Covenant on Economic, Social and Cultural Rights
1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
2. Steve Biko
PHR-UK monitors and supports the development of human rights whenever it can. The Amnesty Committee of South Africa’s Truth and Reconciliation Commission has refused an application for amnesty by one of five person’s in respect of the killing of Steve Biko. The grounds for refusal are that the actions which led to the death of Mr. Biko are far too remote and distinct from any political motive.
Members may recall that the family of Steve Biko and others unsuccessfullychallenged the amnesty provisions of legislation establishing the Truth and Reconciliation Commission, in the South African Constitutional Court case AZAPO and Ors V. The President (1996). Subsequently, Steve Biko’s widow attended the Truth Commission hearing, and, according to The New Republic, heard how five interrogators drove her husband 's head "like a battering ram" into a prison wall. Whether this latest decision will result in a right to justice and a right to reparation being added to Mrs. Biko’s right to know remains to be seen.
3. Conflict in central Africa beginning to resemble the 30 Years War in Europe
The deaths of the US, British and New Zealand tourists in western Uganda brings home, as little else could, the savagery of contemporary life in central Africa. The eight who were brutally murdered were chosen by members of the same ‘interahamwe’ who four years ago picked out 800,000 Tutsis to die in the Rwandan genocide. Within days, unreported by Western media, five Ugandans were hacked to death 210 km north of Bwindi tourist camp by a rebel group opposed to President Museveni's rule. Meanwhile across the border in the Democratic Republic of Congo (DRC) eight armies and at least 12 other armed groups roam the country – mostly in the east near to Rwandan and Ugandan borders. Today, fear of the ‘interahamwe’ is so pervasive in the region that any Hutu with a weapon often is assumed to be a member. Roberto Garreton, the UN special rapporteur on the human rights in the region, describes the population there as living in fear.
The current chaotic battle for the DRC follows the collusion by the international community with the regrouping of the Rwandan genocide perpetrators under the wing of the UNHCR in refugee camps sited (illegally) near to the Zairean/Rwanda border. An initiatives to create a UN force tasked with separating genuine refugees from genocidaires remained stillborn through lack of commitment by UN member countries.
Two years on the region resembles the Thirty Year War (1618-48):–
“The principal battlefield for all these intermittent conflicts was the towns and principalities of Germany, which suffered severely. During the Thirty Years' War, many of the contending armies were mercenaries, many of whom could not collect their pay. This threw them on the countryside for their supplies, and thus began the "wolf-strategy" that typified this war. The armies of both sides plundered as they marched, leaving cities, towns, villages, and farms ravaged. When the contending powers finally met in the German province of Westphalia to end the bloodshed, the balance of power in Europe had been radically changed.”
The ‘contending armies’ in the DRC include Zimbabwe, Angola, Namibia, Chad, Uganda, Rwanda and some say Sudan, in addition to the DRC troops. The UN secretary-general, Kofi Annan, estimates that a peace force possibly numbering as many as 15,000 would probably be needed in Congo once a solid cease-fire deal emerges. Meanwhile the missionary news service MISNA alleges that pillaging " beyond biblical proportions" is taking place.
Having witnessed the 1994 Rwandan genocide, PHR-UK remains desperately concerned for the safety of all civilians in the region.
4. The second House of Lords Judgment on Pinochet (and Chile and PHR)
It is difficult to overestimate the significance of the second House of Lords judgment on General Augusto Pinochet’s right to immunity from extradition to Spain. The determination is a landmark decision in international case law, and has the effect of transforming the context within which human rights activists and perpetrators alike exist. For the first time the prospect of life long impunity can no longer encourage ruthless leaders and demoralise survivors and those who resist tyranny. What happens to Pinochet, though important to the victims, is of little significance compared to the new reality - that from now on, no person, from head of state down to least significant accomplice, is protected from the international laws that any country they visit has ratified. Also, the high profile and the protracted process of the House of Lords determination may have a knock on effect, generating a sea change in the general public's perceptions of the importance of human rights issues that enhances their status and influence.
Dr Sheila Cassidy, a PHR-UK member, spoke at the press conference held immediately after the announcement of the House of Lords decision – as someone who had been tortured in Chile, for providing medical care to dissidents. She referred to the ordeal of a women in her prison who had been subjected to repeated rape by an Alsatian dog and then to rats being inserted into her vagina. She emphasised the life long nature of the effects of torture, describing the legacy continuing into old age as ‘demons of the past’. Her experience of torture makes made her feel different to those who has never suffered it.
Interestingly, the events in Chile influenced the creation of the the United States PHR in 1986 (and therefore ultimately PHR-UK in 1989). In June 1981 Dr Jonathan Fine received a call asking for a Spanish speaking doctor to go to Santiago, where it was feared 3 physicians had been tortured and possibly murdered. Fine went himself within a week. PHR's first mission, in August 1986, was to Chile, at the request of Chile's medical association – the first of seven trips there within 2 years, culminating in the 1988 report ‘Sowing Fear’
5. PHR-UK to host 1999 IFHHRO meeting
PHR-UK is honoured to be hosting the 9th annual International Federation of Health and Human Rights Organisations (IFHHRO) meeting, November 19th to 21st, at the All Saints Pastoral Centre just off the M25 near St Albans.
The meeting will be preceded by an international conference organised in London by the BMA, following which the delegates from the 8 affiliated medical human rights organisations, and representatives of potential new affiliate organisations and observer status organisations will collect on the evening of the 19th at the Pastoral Centre. The meeting will last until late afternoon on Sunday 21st.
Last year’s IFHHRO took place, linked to a very successful 3 day Health and Human Rights conference, in Bombay - but PHR-UK’s representative, along with those from Amnesty and US PHR, were refused visas. Delegates specifying vacation as the reason for the visit all received visas.
IFHHRO Affiliated Organisations:
PHR (South Africa)
Observers status organisations:
British Medical Association
International Cmte of the Red Cross
Turkish Medical Association
World Medical Association
*Johannes Wier Foundation for Health and Human Rights
*Centre for Enquiry into Health and Allied Themes
6. Charitable status
One of the more important policy decisions of the October 1998 ARM was that PHR-UK should apply to become a charity. It was also agreed that PHR-UK should become a limited company to limit liability of the organisation’s officers. The incorporation needs to be completed before the application for charitable status can be submitted as the incorporation documents will need to be submitted to the Charity Commission. The process of incorporation has required a considerable amount of work now completed. Once the documents Memorandum of Association and Articles of Association have been processed the application for charitable status can be embarked upon.
7. PHR–UK and the Courts
- by Bernie Hamilton, Convener
Doctor to appear before Edinburgh High Court:
According to the Sunday Times of July 6, 1997, two Sudanese doctors who worked in torture centres for their military government and are accused of depriving prisoners of medical treatment, were subsequently employed by the UK national health service in Scotland and in England. The doctor working in England was reported to have been investigated by PHR-UK.
It is now believed that one of these doctors, who had been employed in Scotland, is to appear before Scotland's High Court of Edinburgh later this year. This will be the first case to be taken in conformity with the UK's obligations under Article 5.2 of the UN Convention Against Torture, which the UK incorporated under Section 134 of the Criminal Justice Act of 1988.
General Pinochet’s Health:
Article 5.2 obliges States Parties to the Convention to either extradite torture suspects within their territory or investigate them with a view to prosecution. At a November hearing attended by PHR-UK’s Convener the Committee against Torture, which meets in Geneva, urged the UK to take this approach with General Pinochet.
PHR-UK wrote to the Home Office in October seeking assurances that any decision on whether or not to return Pinochet to Chile on health grounds would be based upon an independent assessment by qualified specialists in the appropriate fields. PHR-UK received a detailed response from Jack Straw explaining his decision to uphold the House of Lords decision in support of extradition.
8. Doctors charged with torture and PHR-UK’s part in preventing perpetrating doctors from practising abroad.
The Brazilian medical associations have begun hearings to revoke the medical licences of doctors who took part in the torture of political prisoners carried out by the military regime that ruled from 1964 to 1985. One doctor was accused of overseeing the torture of 11 political prisoners in 1969 - others of signing necropsies listing false causes of death for political prisoners. Reports suggesting this was the first time doctors were being called to account in this way since the Nuremberg trials may have failed to note the recently delayed trial of a Sudanese doctor in Scotland. This first trial for torture to be heard in the UK was due to be heard at the High Court in Edinburgh in January 1999 but was postponed. The accused, a Sudanese doctor called Dr Mohammed Mahgoub is alleged to have to participated in torture in Sudan before coming to Britain to study in Dundee. Doctors are known to take part in torture in for instance Turkey and Israel.
The Doctors Trial at Nuremberg opened on December 9, 1946 and lasted into 1947. Evidence was presented of murder and torture under the guise of medical experimentation. 20 physicians were found guilty and 7 were executed.
In 1996 PHR-UK became aware of doctors alleged to have taken part in the genocide in Rwanda were continuing to practising medicine having fled to other countries such as France. One of the measures PHR-UK took was to lobby for action and to facilitate a debate among medical human rights organisations internationally that ended in the World Medical Association’s adoption of the following BMA sponsored resolution at 49th General Assembly in Hamburg in November 1997:
“National medical associations should use their own licensing powers to ensure that physicians against whom serious allegations of participation in torture war crimes or crimes against humanity have been made are not able to obtain licences to practise until they have satisfactorily answered these allegations. National medical associations that do not have licensing powers should inform the appropriate licensing authorities of information they receive regarding physicians against whom serious allegations of participation in torture war crimes or crimes against humanity have been made , and should encourage the licensing authorities to take appropriate actions to ensure that such physicians have satisfactorily answered these allegations before granting the licenses to practise. Where evidence of involvement in abuses is compelling national member associations or licensing authorities should draw such evidence to the attention of the appropriate authorities.”
9. Retirement of 1996-98 executive committee members
Sadly, four members of the committee that led PHR-UK over the 2 years to October 1998 decided against forwarding their names for nomination to the new executive committee for the next 24 months.
Jill Van der Knapp
All have served the organisation with great commitment and enthusiasm and PHR-UK has benefited hugely from their influences. Their contribution to the success of the organisation is a matter of record and will be remembered with gratitude.
Professor Pounder more than merits special mention. He was the first PHR-UK chairman 1990-1992 and has been treasurer ever since. Crucially, he has been responsible for the International Secretariat throughout (and will continue to be so) and, with Rachel Maxwell, created the jewel in PHR-UK’s crown, the unique Medicine and Human Rights course which is currently taught at two UK medical schools. Lastly, with his international reputation as a forensic pathologist leading him to his being in constant demand from around the world, the organisation benefits from its being associated with his name.