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Editorial: How complicit are doctors in abuses of detainees?
Posted by Habibi (Guest) - Friday, August 20 2004, 20:56:29 (CEST)
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Editorial
The Lancet
Volume 364, Number 9435
21 August 2004

How complicit are doctors in abuses of detainees?


Almost 3 years ago, we asked, "Does the western world still take human rights seriously?" We did so in response to the UK's 2001 Anti-terrorism, Crime, and Security Act, which itself was a reaction to the events of Sept 11 that year. We were disturbed by a Newsweek columnist's suggestion that the use of torture on suspected terrorists should be considered as a legitimate means of obtaining information. As more details about the treatment of detainees in the Abu Ghraib prison in Iraq and the US Guantanamo Bay detention centre in Cuba come to light, disquiet about contemplating or debating the use of torture to secure information has given way to certainty that this is precisely what took place under US command. The answer to our question posed three years ago is clearly "no"; human rights have become a casualty in the desperate attempt to get results in the war against terrorism. The question we now need to ask is, what part have doctors played in these abuses?

The UK Court of Appeal ruled last week in a two-to-one judgment that evidence obtained by torture is admissible as long as it is not procured by British officials. The ruling was made in response to an appeal brought by 10 foreign nationals detained in the UK for more than 2 years without charge or trial under the Anti-terrorism, Crime and Security Act. The dissenting judge, Lord Justice Neumeister, argued that "by using torture or even by adopting the fruits of torture, a democratic state is weakening its case against terrorists, by adopting their methods, thereby losing the moral high ground an open democratic society enjoys". The case will almost certainly go on to the House of Lords.

Currently, 585 people are held in Guantanamo Bay without charge and many have been there for 2 years or longer. 156 have so far been released. The official number of suicide attempts is given as 34. None has been successful because detainees are checked by guards every 45 s. According to the Guantanamo Bay press officer, about 10% are receiving counselling or medical treatment for mental illness. However the number of detainees with mental health problems may be much higher, given the details of detention conditions and methods of interrogations that are coming to light through the reports of those released. Lawyers for three UK citizens arrested in Afghanistan and held in Guantanamo Bay, who were sent back to the UK in March this year only to be released without charges by UK authorities, have compiled a report based on interviews with their clients. This report describes how confessions that were later proven by MI5 to be false were made allegedly under coercive conditions. How can the UK Home Secretary David Blunkett and the Court of Appeal justify using, for example, such evidence to detain people indefinitely?

Even more disturbing is the emerging evidence that doctors and other medical personnel have helped, covered up, or stood by silently when humiliation, degrading treatment, and physical abuses have taken place. As Steven Miles describes in this week's issue of The Lancet, there are now reports of medical personnel in Afghanistan and Iraq allegedly abusing detainees, falsifying and delaying death certificates, and covering up homicides. No unprompted reports of abuses were initiated by medical personnel before the official investigation into practices at Abu Ghraib. At Guantanamo Bay, medical records were routinely shared with interrogators in a clear breach of confidentiality and with the knowledge that such information can be misused despite objections by the medical team of the International Committee of the Red Cross, who in protest suspended their medical visits.

Military doctors can be placed in a difficult position, but the problem of dual loyalty, to patients and to their employers, is well recognised. Guidelines and codes of practice state that doctors, even in military forces, must first and foremost be concerned about their patients and bound by principles of medical ethics. Given these events, the World Medical Association saw the need to re-emphasise its strong and unambiguous 1975 Tokyo Declaration in June: "Doctors shall not countenance, condone, or participate in torture or other forms of degrading procedures . . . in all situations, including armed conflict and civil strife". As one of the other few medical bodies to speak out, members of Physicians for Human Rights wrote an open letter on Aug 6 to James Schlesinger, Chair of the independent panel to review US Department of Defense detention operations (and due to report later this month), questioning the role and use of physicians and other medical personnel in detention centres in Afghanistan, Iraq, and Guantanamo Bay.

Health-care workers should now break their silence. Those who were involved in or witnessed ill-treatment need to give a full and accurate account of events at Abu Ghraib and Guantanamo Bay. Those who are still in positions where dual commitments prevent them from putting the rights of their patients above other interests, should protest loudly and refuse cooperation with authorities. The wider non-military medical community should unite in support of their colleagues and condemn torture and inhumane and degrading practices against detainees. Abu Ghraib should serve as an eleventh hour wake-up call for the western world to rediscover and live by the values enshrined in its international treaties and democratic constitutions. * The Lancet



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