The late Ian Munro
It is with great regret that I have to inform those members who remain unaware that our President, Ian Munro, died on the 22nd of January. Virtually the whole of Ian’s career was spent at the Lancet, ending with his editorship over the 12 years to his retirement in 1988. His skills as a medical journalist and editor, and his humane and liberal thinking, are legendary. Ian was a founder member of Physicians for Human Rights (UK), chairing the steering committee that translated concept to reality. I did not know him well, but he always impressed as a man of inexhaustible integrity. Such was his affection for Physicians for Human Rights that he requested contributions be sent to PHR in place of flowers at his funeral. His example sets us almost impossibly high standards.
2. Prison medicine conference
This, the third in PHR’s programme of conferences on prison medicine, took place immediately after the 1996 AGM. Entitled Prison Medicine: an abuse of human rights? it was organised in conjunction with INQUEST, an organisation that supports the relatives of victims who die in prison, in psychiatric care or in disasters.
Dr Christina Pourgourides, a psychiatrist, took a year out to research into the mental health implications of detention of asylum seekers in the UK following a wave of referrals of asylum seekers with symptoms of mental illness – depression, anxiety, psychosis, and of having deliberately harmed themselves. The research comprised the collection of date in two forms. A series of individual interviews with 15 detainees who had been referred for psychiatric assessment by legal representative and a more extensive consultation with the key players.
The average detention was 8 months. Typically detainees would cope with one to two months of detention and would break down in the 3rd or 4th month. One third had made attempts at deliberate self harm, notably by hanging. 27% fulfilled the criteria of post traumatic distress disorder; 60% for depression. Many had symptoms of anxiety, psychosomatic complaints, two were psychotic. Their presentations were characterised by resignation, profound despair and hopelessness.
Dr Johnson is a consultant psychiatrist at Charing Cross Hospital, who resigned his post at Parkhurst Prison in protest at the proposed changes in the therapeutic regime for lifers. He feels that civil and human rights are becoming of increasing importance in the whole of psychiatry, let alone society itself. He has spent 4 years in psychiatry – two in the USA – and has a degree in psychology. Before that he was 22 years in general practice and has just finished 5 years in Parkhurst Prison following up his model of the long term effects of child abuse. The last 9 months, he said, have been spent recovering from the 5 years in what is “an alien environment“. The comment “we are hiring thugs and expecting them to be nurses“ from a senior Parkhurst doctor sums up the regime.
The whole of the prison population, certainly the heavy end that Dr Johnson had talked to, have suffered gross child abuse, traumas in childhood, and no support. The absence of social skills in the prisoners he has talked to was “mind boggling.” He tells them “whatever happened in the past, think it through, because it is over.” Whilst he worked in the unit they managed to cut back on drugs from 220 Gms per inmate in July 1991 to 10 Gms per inmate in 1996.
Reem Abdelhardi is a Palestinian woman living in Britain who was remanded in Holloway Prison in connection with the bombing of the Israeli Embassy. She described the callous way she was treated despite suffering from severe back pain as a result of long standing spinal problems. She was eventually released after international protests, including one from PHR (UK). Her experiences have left her emotionally traumatised.
Deborah Coles, who is co-director of INQUEST, described Clare Bosley’s suicide. in Holloway prison It took place within minutes of her arrival at Holloway Prison as a result of a complete failure to implement suicide prevention guidelines. Whilst Clare had been held in police custody she made repeated attempts to take her own life. Police care was exemplary and they sent ample warning to the the prison authorities. On her arrival at Holloway she should have been identified as a high suicide risk not only as a result of these warnings but also by virtue of her offence of domestic murder, because she was in prison for first time and because she was extremely disturbed.
On entering the prison she was placed alone in a pre-search holding room. No one saw Clare Bosley alive again. A window into the room was fitted with a two way mirror facing the wrong way for staff to observe prisoners. No way was watching the close circuit TV that was covering that area. Later, when another prisoner was admitted to the same holding area it was empty. Clare remained unnoticed for an hour and a half, until her body was found on the floor of the toilet in the holding room. She had choked herself to death by swallowing toilet tissues down her throat in an exact repeat of her earlier attempt on her life when she was in police custody,as had been written in detail on the exceptional risk form.
3. The International Network of Health and Human Rights Organisations
The 7th meeting of the International Network of Health and Human Rights Organisations took place on 9th-10th November 1996 at the Ernest Sillem Hoeve (YMCA) in Lage Vuursche, near Amersfoort.
24 hours beforehand, as a celebration of the 10th anniversary of the Johannes Wier Foundation (Dutch medical human rights organisation), a unique one day conference entitled “Violations of medical neutrality” took place at the Domus Medicus, Utrecht.
Physicians for Human Rights (UK) was represented at both meetings by Drs Harold Hillman and Peter Hall (honorary secretary and chair respectively) and there were present representatives from 12 medical and human rights organisations, many of them Dutch.
(“Violation of medical neutrality” at the Domus Medicus, Utrecht.)
Colonel Kremer discussed the experience and the medical ethical dilemmas over neutrality faced by the Dutch army medical staff in Srebenica, because they had been ordered to treat UN personnel, not the local population who had no doctors and limited medical supplies. The area was under continual attack from Bosnian Serbs and some doctors defied orders and treated civilian casualties.
The second speaker was Professor Francoise Hampson, Dean of the School of Law at the University of Essex. She argued forcefully that the Medical Human Rights Network should concern itself with the derogations of medical ethics rather than general issues of conflict covered by other organisations which may have medical implications.
Professor Zuhal Amato of the University of Izmir in Turkey spoke next on the derogations of human rights in Turkey, in particular the effects of being tortured. The government‘s excuse is that they have to deal with civil disorder due to the Kurdish separatists. There have been advances in human rights education in medical schools but the language of human rights has to be avoided, rather referring to them as ethical issues so as to avoid government disapproval.
Dr Amar Jesani of CEHAT (Research centre of Anusandhan Trust India) talked about the work in his centre, that had been done in spreading the concept of human rights and preventing torture. They have had some success in introducing the concept to medical students.
Dr Mustafi Barghouthi, director of the Palestine Medical Relief Service, told of the obstructive effect of the Israeli Occupation on the delivery of health care to Palestinians.
Dr Jonothan Fine, founder and first director of Physicians for Human Rights, said that he believed that the time had come for more direct political action to pursue the aims of the organisations.
The afternoon session was initially taken up with discussing guidelines for the protection of medical neutrality, particularly in theatres of war, and later the development of a support network to be known as “doctors of confidence“ to advice medical personnel at odds with authorities. The second part of the afternoon was spent discussing the case for requesting the UN to set up a special rapporteur on violations of medical neutrality. There was much support for the formation of a subcommittee under the chairmanship of Professor Cees Flinterman, Professor of International Law at the University of Limburg, Maastricht, to continue to pursue that goal although it was accepted that many years may pass before such a rapporteur might be appointed
Over the next two days the annual health and human rights network meeting took place, hosted as has become customary by the Johannes Wier Foundation. Individual Physicians for Human Rights organisations were represented and there were non-voting medical representatives from other countries and from national and international organisations such Amnesty, ICRC, BMA,
1. Matters for attention:
i) the motion on preventing doctors against whom allegations of crimes against humanity have been made, proposed by the BMA for the WMA meeting was discussed. It was discussed by the WMA conference and had been sent to be discussed by national medical associations
ii) The Amnesty International‘s representative, Jim Welsh, tabled Amnesty's Declaration of the Principles for the medical investigation of torture and other cruel, inhuman or degrading treatment and the Declaration on the role of health professionals in the exposure of torture and ill treatment.
2. It was agreed that the United Nations be requested to approve a rapporteur for violations of medical neutrality (see conference report above)
3. Reports were presented on:
i) forensic examination of bodies in former Yugoslavia
ii) the human rights situation in Turkey
iii) the difficulties experienced by Palestinian doctors in Palestine
4. Human rights education
The Johannes Wier Foundation has prepared a pack of human rights education based on sample situations. The attention of the meeting was drawn to the existence of the Physicians for Human Rights (UK)'s 2 week educational module developed by Rachel Izzard under Derrick Pounder‘s direction. The different approaches to education on human rights was discussed, country by country, in the USA, Turkey, India, Israel, and South Africa.
5 The results of the matters for action agreed at last year’s network meeting were assessed and it was acknowledged that few had been pursued.
6. During the evening the ABC TV film on exhumations in former Yugoslavian carried out under the auspices of Physicians for Human Rights (based in USA) was screened for the meeting. The importance of the information as a historical record was understood and the deep interest of the relatives of victims was regarded as an important stimulus to continue the work
7. It was agreed to affiliate CEHAT from India, the South African PHR and the Palestinian PHR, and to invite the Turkish Medical Association to be an associate member with observer (non-voting) status.
8. Johannes Wier can no longer bear the financial burden of hosting the conference and have to ask all participants to pay for accommodation and travel. It was decided that the next annual meeting will take place in Gaza or, failing that, in London. In 2 years it is hoped to meet in India.
9 There was discussion about the name of the network, the future constitution, and the possibility of an umbrella secretariat. It was agreed that the name should be changed from “International Network of Health and Human Rights Organisations” to “The International Federation of Health and Human Rights Organisations” but to defer other decisions while organisations are still affiliating.
10 Resolutions were passed supporting the following:
i) A letter to the French Minister protesting the licence to practice medicine in France allowed to a Rwandese gynaecologist who has been accused of crimes against humanity.
ii) a press release criticising the delay in arresting war criminal in former Yugoslavia,
iii) The PHR/Israel letter to the Israeli Medical Association about the failure to treat Arab prisoners adequately was supported and publication in international medical journal was advised
4. Peter Kandela
Peter Kandela - 7 years
Peter has been interested in international human rights for many years. Physicians for Human Rights (UK) was his idea, based on the lines of Physicians for Human Rights in Boston.
In 1989 a notice publicising the meeting at which Physicians for Human Rights (UK) was to be established was published in the Lancet, and duly took place in St Thomas Hospital. From there a steering committee was set up comprising Ian Munro, Peter Kandela, Ian Pollock, Anthony Zwi, and Marion Steiner.
At the first annual general meeting, in Dundee in 1990, Peter became the, sometimes benign - sometimes fierce, first secretary for 2 years. Over the remaining 4 years Peter has been chairman.
During his 7 year stewardship Physicians for Human Rights (UK) has published major reports of fact finding investigations in Kashmir, Kuwait, Egypt, South Africa and Rwanda, as well as organising conferences on prison medicine and disappearances in the Arab World. Members have regularly published information on international human rights issues in the Lancet, the BMJ and other journals. Lastly and importantly, the organisation has recently developed, under the auspices of Derrick Pounder, a two week modular course on human rights.
Peter Kandela conceived, acted as midwife and fathered the organisation. If Physicians for Human Rights (UK) owes its existence to any one person, it is to him. Congratulations Peter and thank you.