Articles
British doctors call for boycott of IMA
BMJ 2007;334:871 (28 April), doi:10.1136/bmj.39196.455613.DB
Group of British doctors call for a boycott of the Israel Medical Association Owen Dyer London
A group of British doctors has called for a boycott of the Israeli Medical Association (IMA) and its expulsion from the World Medical Association (WMA) in a letter published in the Guardian newspaper. The petition, signed by 130 doctors, argues that by refusing to criticise Israeli policies in the Palestinian territories occupied by Israel, the IMA is failing to uphold international medical ethical standards.
The Israel Defense Forces "have systematically flouted the fourth Geneva convention guaranteeing a civilian population unfettered access to medical services and immunity for medical staff," the letter says, citing reports of soldiers attacking ambulances; patients and essential drugs obstructed at checkpoints, and bombing of the public health infrastructure.
Academic boycotts: RSM under attack by pro-Israel doctors
BMJ 2007;335:842 (27 October), doi:10.1136/bmj.39374.493218.BE
Letters
Academic boycotts Royal Society of Medicine under attack by pro-Israel doctors
In relation to the debate about academic boycott and freedom,1 2 it seems relevant to record another way in which the refusal to address the voluminous and independent evidence of medical ethical violations in Israel is being maintained.
The Royal Society of Medicine (RSM) has lately been under attack. Months ago, I was invited to speak at an RSM conference on religion, spirituality and mental health, to contribute to a session on the role of health professionals in conflict situations. As a reflection of my research interests and publications on medical ethics since 1992, my main case study was on Israel and Palestine. Once the conference was publicised, the RSM became subject to pressure from pro-Israel doctors to remove me from the conference programme. They went so far as to threaten a challenge to the RSM constitution as a charity if a "political" (and biased) person were permitted to speak.
After weeks of this, to save the conference the RSM asked me to withdraw. But, in the end the RSM steeled itself and decided to go ahead, and the conference was held on 9 October.
The editors of UK medical journals publishing human rights material on the Occupied Palestinian Territories have been subject to comparable pressures; in the US pro-Israel groups are hounding (and effectively) individual academics, conferences, publishers, and universities. These ominous developments recall the era of McCarthyism.
Derek A Summerfield, honorary senior lecturer, Institute of Psychiatry Maudsley Hospital, London SE5 8BB
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Competing interests: None declared.
References
1.Baum M. Should we consider a boycott of Israeli academic institutions? No. BMJ 2007;335:125. (21 July.)[Free Full Text]
2.Hickey T. Should we consider a boycott of Israeli academic institutions? Yes. BMJ 2007;335:124. (21 July.)[Free Full Text]
Meetings in Israel should be boycotted
BMJ 1996;312:57 (6 January) Letter
International congresses held in Israel should be boycotted
Consultant physician Frenchay Hospital, Bristol BS16 1LR
Chris Burns-Cox
1.Summerfield D. Raising the dead: war, reparation, and the politics of memory. BMJ 1995;311:495-7. (19 August.) [Abstract/Free Full Text]
ConnotRelated Article
Raising the dead: war, reparation, and the politics of memory
Derek Summerfield BMJ 1995 311: 495-497. [Extract] [Full Text]
Humanitarian crisis in Israeli occupied territories: letter
BMJ 2006;332:1276 (27 May), doi:10.1136/bmj.332.7552.1276-b
Humanitarian crisis in Israeli occupied territories
We should note with shame that the International Committee of the BMA, who are members of the World Medical Association (WMA, the international watchdog on medical ethics), has not raised in that forum the grotesque events unfolding in the occupied territories, still less challenged the persistent silence of fellow members, the Israeli Medical Association. The WMA is in violation of its own mandate. For the BMA International Committee, as members of the WMA, to ignore such massive and sustained violations of the Geneva convention, which guarantees a population's right to health care, and not to challenge the silence of the relevant national medical association, is to demonstrate straightforward collusion. If this is not a form of medical malpractice then I have lost my bearings: it should be a matter for the General Medical Council. I call on BMA members to speak out where it matters, including at the annual representatives meeting next month. I would be happy to hear from members who feel this cannot go on.
Derek A Summerfield, honorary senior lecturer
Institute of Psychiatry, Maudsley Hospital, London SE5 8AP
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Competing interests: None declared.
References
1.McGreal C. Aid withdrawal is bringing health service in Gaza to brink of collapse. BMJ 2006;332: 1171. (20 May.)[Free Full Text]
2.Report: Collapse of the Palestinian health system. www.phr.org.il/phr/article.asp?articleid=338&catid=55&pcat=-1&lang=ENG (accessed 20 May 2006).
3.Amnesty International. www.amnesty.org.uk/
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Aid withdrawal is bringing health service in Gaza to brink of collapse
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Michael H Mitchell bmj.com, 1 Jun 2006 [Full text]
The BMA responds
Vivienne Nathanson bmj.com, 30 May 2006 [Full text]
Humanitarian crisis in Israeli occupied territories
Sylvia M Watkins bmj.com, 31 May 2006 [Full text]
Humanitarian crisis in Israeli occupied territories
Dr Brian Robinson bmj.com, 1 Jun 2006 [Full text]
Re: Humanitarian crisis in Israeli occupied territories
Dr Brian Robinson bmj.com, 2 Jun 2006 [Full text]
Re: The Collapse of Palestinian Health Care
Abdullah Yonis bmj.com, 4 Jun 2006 [Full text]
Making BMA effective for Palestinian's health problems
Christopher J Burns-Cox bmj.com, 3 Jun 2006 [Full text]
The Collapse of Palestinian Healthcare System in The Israeli Occupied Territories: A Medieval Siege of 1.4 million souls in Gaza
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IDF; Shoot to Kill - letter Derek A Summerfield
BMJ 2005;331:699 (24 September), doi:10.1136/bmj.331.7518.699
Letter
Israeli army's shoot to kill policy; Israeli soldiers confirm the policy documented in journal
EDITOR My personal view last October on the Israeli army operations in the Palestinian territories occupied by Israel, attracted support as well as vilification on bmj.com.1
I noted that two thirds of all Palestinian child fatalities had been caused by small arms fire (from relatively close range), in fully half of the cases to the head or upper torso—the sniper's wound. My statement that "clearly, soldiers are routinely authorised to shoot to kill children in situations of minimal or no threat" has now been confirmed in emphatic fashion—the authority being Israeli soldiers who have committed these acts themselves.2-4 They refer to one of the cases I described.
Several dozen former soldiers calling themselves "Breaking the Silence" are exposing the cynicism of the Israeli defence forces' mantra that everything possible is done to minimise the risk to Palestinian civilians. These soldiers testify that they were ordered in briefings to shoot to kill unarmed civilians, including children, even when there was no threat and in periods of calm. They were ordered to "fire at anything that moved" and were told "every person you see on the street, `kill him.' And we would just do it."4 The attitude was "so kids got killed. For a soldier it means nothing."4
The desire to avenge Israeli casualties and inflict collective punishment was an important factor. In Gaza in May 2004, "the commanders said kill as many people as possible,"4 and there were standing orders to shoot anyone on a roof or balcony, whoever they were. One former soldier said this was why the Moghayyer children (aged 16 and 13), collecting washing and feeding pigeons on the roof of their home, were shot. Israel's defence forces claimed that they had been blown up by a roadside bomb, until journalists were shown the bodies in the morgue, each with a single bullet wound to the head. I mentioned this case in my BMJ article.
Can those who saw my paper as antisemitic lies face "Breaking the Silence"? Will the Jewish organisations that made hostile statements about the BMJ, amid calls for the acting editor to be censured or removed, apologise? And who will challenge the Israeli Medical Association for its silence at the ongoing violations of the Geneva Convention I documented?5 w1
Derek A Summerfield, honorary senior lecturer
Institute of Psychiatry, Maudsley Hospital, London SE5 8AP
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Competing interests: None declared.
Reference w1 is on bmj.com
References
1.Summerfield D. Palestine: the assault on health and other war crimes BMJ 2004;329: 924.[Free Full Text]
2.Amnesty International. Israel/occupied territories: killing of children must be investigated. http://web.amnesty.org/library/index/ENGMDE150552004?open (accessed 16 Sep 2005).
3.Urquhart C. Israeli troops say they were given shoot-to-kill order. Guardian 2005 Sep 6:1 www.guardian.co.uk/international/story/0,,1563476,00.html (accessed 15 Sep 2005).
4.Urquhart C. Israeli soldiers tell of discriminate killings by army and a culture of impunity. Guardian 2005 Sep 6:13. www.guardian.co.uk/international/story/0,,1563255,00.html (accessed 15 Sep 2005).
5.Barghouti M, ed. Health and segregation. The impact of the Israeli separation wall on access to health services. Ramallah: Health, Development, Information, and Policy Institute, 2004.
The assault on health and other war crimes
BMJ 2004;329:924 (16 October), doi:10.1136/bmj.329.7471.924
PERSONAL VIEWS
Palestine: the assault on health and other war crimes
Amnesty International has called for an investigation into the killing of Asma al-Mughayr (16 years) and her brother Ahmad (13 years) on the roof terrace of their home in Rafah on 18 May, each with a single bullet to the head. Asma had been taking clothes off the drying line and Ahmad feeding pigeons. Amnesty noted that the firing appeared to have come from the top floor of a nearby house, which had been taken over by Israeli soldiers shortly before. Amnesty suspects that this is not "caught in crossfire," this is murder.
Israeli military reoccupation of the West Bank and Gaza—a system of military checkpoints splitting towns and villages into ghettos, curfews, closures, raids, mass demolition and destruction of houses (more than 60 000), and land expropriations—has made ordinary life impossible for everyone, and is driving Palestinian society and its institutions towards destitution. Moreover, Israel has been constructing a grotesque barrier that, when completed, will total over 400 miles—four times longer than the Berlin Wall. Extending up to 15 miles into Palestinian territory, the real purpose of the wall is permanently to lock more than 50 illegal Israeli settlements into Israel proper. This is expansive, aggressive colonisation, in defiance of the International Court of Justice in The Hague and the United Nations General Assembly resolution of last July.
Last year a UN rapporteur concluded that Gaza and the West Bank were "on the brink of a humanitarian catastrophe." The World Bank estimates that 60% of the population are subsisting at poverty level (£1.12; $2; 1.6 per day), a tripling in only three years. Half a million people are now completely dependent upon food aid, and Amnesty International has expressed concern that the Israeli army has been hampering distribution in Gaza. Over half of all households are eating only one meal per day. A study by Johns Hopkins and Al Quds universities found that 20% of children under 5 years old were anaemic, 9.3% were acutely malnourished, and a further 13.2% chronically malnourished. The doctors I met on a professional visit in March pointed to a rising prevalence of anaemia in pregnant women and low birthweight babies.
The coherence of the Palestinian health system is being destroyed. The wall will isolate 97 primary health clinics and 11 hospitals from the populations they serve. Qalqilya hospital, which primarily serves refugees, has seen a 40% fall in follow up appointments because patients cannot enter the city. There have been at least 87 documented cases (including 30 children) in which denial of access to medical treatment has led directly to deaths, including those of babies born while women were held up at checkpoints. The checkpoint at the entrance to some villages closes at 7 pm and not even ambulances can pass after this time. As a recent example, a man in a now fenced in village near Qalqilya approached the gate with his seriously ill daughter in his arms, and begged the soldiers on duty to let him pass so that he could take her to hospital. The soldiers refused, and a Palestinian doctor summoned from the other side was also refused access to the child. The doctor was obliged to attempt a physical examination, and to give the girl an injection, through the wire.
The wall will isolate 97 primary health clinics and 11 hospitals from the population they serve - credit: LARRY TOWELL
There are consistent reports of ambulances containing gravely ill people being hit by gunfire, or detained at checkpoints while drivers and paramedics are interrogated, searched, threatened, humiliated, and assaulted. Wounded men are abducted from ambulances at checkpoints and sent directly to prison. Clearly marked clinics are fired on, and doctors and other health workers shot dead on duty.
Physicians for Human Rights (Israel) have lambasted the Israeli Medical Association (IMA) for its silence in the face of these systematic violations of the Fourth Geneva Convention, which guarantees the right to health care and the protection of health professionals as they do their duty. Remarkably, IMA president Dr Y Blachar is currently chairperson of the council of the World Medical Association (WMA), the official international watchdog on medical ethics. A supine BMA appears in collusion with this farce at the WMA. Others are silenced by a fear of being labelled "anti-semitic," a term used in a morally corrupt way by the pro-Israel lobby in order to silence. How are we to affect this shocking situation, one which to this South African-born doctor has gone further than the excesses of the apartheid era.
Derek Summerfield, honorary senior lecturer
Institute of Psychiatry, London
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Medical ethics: Summerfleld responds to allegation
BMJ 2003;327:1107-1108 (8 November), doi:10.1136/bmj.327.7423.1107-b
Letter: Author's response to allegation and to BMA
Medical ethics, the Israeli Medical Association, and the state of the World Medical Association
I and others are appalled by Nathanson's supine response to my open letter.2 Her statement that no country is blameless is a recipe for studied inaction. Imagine a doctor brought before the General Medical Council for malpractice whose defence is that there are many other doctors just as bad, so why pick on him?
There is no medical association whose track record on torture and violations of medical neutrality has been so comprehensively documented in recent years as has the Israel Medical Association (IMA). Multiple publications by Amnesty, Human Rights Watch, PHR USA, and others are in the public domain,3 yet Nathanson writes that allegations need investigation by an independent expert body "but the problem is to identify by whom." This is astonishing: has Amnesty not been such a body?
Nathanson states that she favours "education." This is rhetoric, surely. Blachar does not lack such education. He and other doctors in Israel have made their choices with their eyes open over many years (and it has been a choice, unlike the predicament facing ethically minded doctors in, say, Iraq, Syria, or Guatemala, where the price of breaking silence was frequently one's life). The IMA president, Blachar, has never denounced or seriously confronted the Israeli government over torture or violations of medical neutrality. How can the World Medical Association (WMA) be credible if its new council chairman stands in longstanding breach of the association's own anti-torture Declaration of Tokyo?
Nathanson's response, on behalf of one of the world's most influential medical associations, will have heartened the WMA and IMA leadership, endorsing their calculations. The Israeli political establishment, which is sensitive to Western professional and public opinion, will also have taken note. By contrast, Amnesty and the staff of international agencies such as the Red Cross must be dismayed that their testimony can be so casually discounted. Nathanson offers nothing to the doctors in Israel committed to ethical practice, not least PHR Israel, which deserves far better.
Finally there are the Palestinian doctors and other health staff who continue to risk death or maiming in pursuance of their duty to attend civilians injured by Israeli gun or rocket fire (a daily event). Nathanson's response is likely to increase the risks that they face every day.
There are historical precedents for the BMA to act with rigour and courage. Without an activist approach to the values at stake—which means sometimes being prepared to to confront—medical ethics on the international stage is reduced to a paper exercise. At present the WMA is a farce.
Derek Summerfield, honorary senior lecturer
Institute of Psychiatry, King's College, London SE5 8AP
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Competing interests: None declared.
References
1.Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859.
2.Nathanson V. Medical ethics, the Israeli Medical Association, and the state of the World Medical Association. BMJ 2003; 327: 561-2. (6 September.)[Free Full Text]
3.Amnesty International. Under constant medical supervision: torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: AI, 1996.
Medical Ethics, the IMA and the WMA
BMJ 2003;327:561 (6 September), doi:10.1136/bmj.327.7414.561
Open letter to the BMA
Medical ethics, the Israeli Medical Association, and the state of the World Medical Association
The WMA must know the well founded criticism over many years of the medical ethical track record of the Israeli Medical Association (IMA). In 1996 Amnesty International concluded that Israeli doctors working with the security services "form part of a system in which detainees are tortured, ill treated, and humiliated in ways that place prison medical practice in conflict with medical ethics."2 Other major human rights organisations, such as Physicians for Human Rights (USA) and Human Rights Watch, published similarly. The IMA did nothing, although when challenged tended to dismiss criticism as "political" and point to their membership of the WMA as evidence of their probity. Moreover Blachar is on record in the Lancet as defending "moderate physical pressure" during the interrogation of Palestinian detainees: it is not often that the president of a national medical association uses a medical journal to defend what the rest of the world, and the UN Committee Against Torture, regarded as torture.3 Thus the IMA have been in violation of the WMA's Declaration of Tokyo, which forbids the involvement or collusion of doctors with torture or other cruel, inhuman, and degrading procedures. The WMA has consistently chosen to ignore the mass of documentation pointing this way.
During an interview in 1999 with a delegation from the Medical Foundation for the Care of Victims of Torture, London, the then head of ethics of the IMA, E Dolev, stated openly that "a couple of broken fingers" during the interrogation of Palestinians was a price worth paying for information.4 This was sent to Delon Human, WMA secretary general, whose response was telling. He wrote back to say, "I must come to the defence of the IMA in affirming that they are co-signatories of the WMA Declaration of Tokyo. They have been active collaborators in the WMA's continued struggle to eradicate torture of any kind in prisons or other settings all over the world" (personal communication, 29 October 2001). He later added that he had spoken to Blachar, already a WMA council member. Blachar had reassured him that the IMA had done nothing wrong and had shown him "classified material," presumably from military sources. It is preposterous that Human was satisfied by this.
The other major ethical issue is medical neutrality. The blatant and apparently systemic disregard shown by the Israeli defence force during its reoccupation of the West Bank early last year and subsequently, has been widely reported: Palestinian ambulances fired on (231 incidents to date) and their personnel killed, sometimes after the ambulances had been cleared for safe passage, the International Committee of the Red Cross and other aid agencies obliged to limit activities in the West Bank as a result of threats to staff and attacks on vehicles and officers, severely injured Palestinians dying of blood loss because their relatives were not permitted by Israeli soldiers to take them to hospital, the safe passage of emergency supplies of food and medicines blocked, wilful destruction of water supplies, electric power, and the public health and medical infrastructure. Blachar's response to an editorial in the Lancet last year on these events makes his and the IMA position clear.5 6 Bar a one sentence reference to the principle of medical neutrality, he emphatically attacked the editorial en bloc and unconditionally defended the behaviour of the Israeli army. He implies that the death of Palestinian civilians was not morally equivalent to the death of Israeli civilians: this dehumanisation is the enemy of any universal application of medical ethics and medical humanitarianism.
A recently published report by Physicians for Human Rights Israel (PHR, www.phr.org.il) states that "we believed that the IMA might be able to curb the appalling deterioration in the attitude of Israeli military forces towards Palestinian health and rescue services. Yet despite severe injury to medical personnel and to the ability of physicians to act in safety to advance their patients' interests, despite Israeli shells that have fallen on Palestinian hospitals, despite the killing of medical personnel on duty—IMA has chosen to remain silent."7 The IMA has refused to answer any of PHR's detailed complaints. Hadas Ziv of PHR Israel charged in the Lancet recently that the IMA was merely an executive arm of the Israeli establishment, working to support political imperatives rather than serving universal medical ethics.8
It seems to many that it is PHR Israel not the IMA who are the upholders in Israel of what the WMA exists for. Thus I question the judgment and rigour of Human in his scarcely credible public defence of the IMA, and of Blachar, whose presence at the WMA affords him the opportunity to "explain" why the IMA should not be the subject of serious scrutiny. For Blachar to now take up the chairmanship of the WMA Council is to reduce things to a mockery of what was intended when the WMA was created in 1947.
Until now the BMA has relied on discreet methods but these have not worked. Once before the BMA took a robust approach—in relation to the Medical Association of South Africa (MASA) during the apartheid era—and for a time withdrew from the WMA in protest at their re-admittance of the MASA. The BMA surely needs to use its weight to confront the WMA leadership and the IMA. Things cannot go on like this: please act on our behalf. For a start, Blachar cannot remain as chairman.
Derek Summerfield, honorary senior lecturer
Institute of Psychiatry, King's College, London SE5 8AP
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References
1.Summerfield D. What is the WMA for? The case of the Israeli Medical Association. Lancet 2003; 361: 424.[Medline]
2.Summerfield D. Medical ethics: the Israeli Medical Association. Lancet 1997; 350: 63.[CrossRef]
3.Blachar Y. The truth about Israeli medical ethics. Lancet 1997; 350: 1247.[CrossRef]
4.Bamber H, Gordon E, Heilbronn R, Forrest D. Attitudes to torture. J R Soc Med 2002; 95; 271-2.[Free Full Text]
5.Failure to address the health toll of the Middle East crisis. Lancet 2002; 359: 1261.[CrossRef][ISI][Medline]
6.Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859.
7.Physicians for Human Rights. A legacy of injustice: a critique of Israeli approaches to the right to health of Palestinians in the Occupied Territories. Israel: Physicians for Human Rights, 2002: 74..
8.Ziv H. The role of the Israel and World Medical Associations. Lancet 2003; 361: 1827-8.
Fighting "terrorism" with torture: torture is a form of terrorism
BMJ 2003;326:773-774 ( 12 April )
Editorials
Fighting "terrorism" with torture
Torture is a form of terrorism: there are no justifications for it
The accounts of torture victims are horrifying enough but at least these victims survived: Primo Levi reminded us in The Drowned and the Saved that the public record is denuded of the accounts of the drowned.1 In recent years, reflecting the authority imputed to instrumental reasoning and medical arguments, the anti-torture movement has publicised the physical or mental injuries that can result from torture. However, the ordinary citizen does not regard torture as repugnant because it may have medical consequences, but because its use (typically by the state against its own citizens) seems so extreme a violation of the collective values and morality that hold a social fabric together. Indeed the economist and Nobel laureate Amartya Sen points out that torture, political imprisonment, and assassinations seem more shocking and "wrong" than the failure of states to provide basic means of survival, even though such failures cause far greater loss of life.
Since 11 September 2001 public advocacy of torture no longer seems taboo. The Washington Times recently published a method for the efficient interrogation of Al Qaeda suspect Khalid Shaikh Mohammed, suggested by the president of the Freedom Research Foundation. This involved ventilation by nasal mask of a paralysed subject, with the ventilator turned off to provide transient suffocation whenever the interrogator was dissatisfied.2
The New York Times and International Herald Tribune last month published apparently well founded accounts of the techniques applied to Abu Zubaydah and other Al Qaeda suspects in US custody. These included deprivation of food, water, sleep, and light; covering subjects' heads with black hoods for hours at a time; forcing them to stand or kneel in unnatural positions in extreme cold or heat; keeping them naked; prolonged chaining or shackling; hooking them up to sensors during serial interrogations; and denial of medical attention. There have been persistent reports of beatings at some US operated centres, and a military pathologist has determined that the deaths of two prisoners at Bagram, Afghanistan, last December were homicides. At Bagram "disorientation is a tool of interrogation and therefore a way of life." At Guantanamo Bay, Cuba, where around 650 men continue to be held, largely in solitary confinement and beyond the jurisdiction of US law, there have been 20 suicide attempts so far. 3 4
US officials maintain that the treatment of detainees does not violate international law. They are wrong: this is torture by the definition in the World Medical Association's Declaration of Tokyo (1975): "the deliberate, systematic or wanton infliction of physical or mental suffering, to force another person to yield information, to make a confession, or for any other reason." It is also in breach of article 5 of the United Nations Declaration of Human Rights: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment." The UN Committee against Torture ruled in the 1990s that similar practices by Israel where they were called "moderate physical pressure" and considered legitimate were indeed torture.5 The UN Committee also denounced the "ticking bomb" defence: the justification that information needs to be obtained quickly to avert an atrocity. Yet this remains the central plank of the argument US officials are using to justify what they are doing. The US is also refusing to support the proposed International Criminal Court unless US citizens have permanent immunity.
The Federal Bureau of Investigation is reportedly to interrogate tens of thousands of Iraqis resident in the USA25 000 in San Diego alone under an order from the Justice Department: are we witnessing a re-emergent McCarthyism?6 US leaders and other opinion formers appear to be legitimising a seige mentality and demonisation of the "other" (especially the Muslim other) which risks drawing ordinary citizens into the normalisation of torture and other civil violations in the name of "security." As a telling example of this, a study of the behaviour of doctors during military dictatorships in Argentina, Chile, and Uruguay concluded that they attended normally to ethical issues like confidentiality, but could collaborate with torture because they saw themselves as patriotic.7 Have the doctors assigned to US interrogation centres protested, for example, at the denial of painkillers to Abu Zubaydah, though he had been shot several times during capture?
To use torture to fight "terrorism" and to use war to fight "weapons of mass destruction" is perverse: torture is a form of terrorism, and so are the bombs"shock and awe"raining down on the citizens of Baghdad as I write. What moral authority can the USA claim in its prosecution of "just" war when it has been the world's major arms manufacturer and exporter to repressive regimes, with the UK not far behind? One of those regimes was, until 1991, Saddam Hussein's Iraq, where extrajudicial execution and torture were always institutionalised.
Historically torture has targeted the poor and those who spoke for the poor. We need a mature understanding of the felt impact of Western led politics, economics, and culture as globalising forces, and of the stark fact that issues of human rights and social justice have weighed little in the geopolitical and business calculations at play. People without power in the non-Western world, even in their millions, are strategically unimportant and therefore ignorable.8
In addition to what they do for the individual patient, doctors have a wider duty to speak out about the social and political roots of suffering and disease. It is arguable how seriously the profession en masse, not just Physicians for Human Rights or the medical section of Amnesty International, has taken this part of its remit. After all, the social and economic status of doctors has tended to place them closer to the better off and influential than to those social sectors for whom issues of equity really count. In challenging terroristic violence in all its forms, what is at stake are the imperatives not of medical ethics but of empowered citizenship.
Derek Summerfield, honorary senior lecturer.
Institute of Psychiatry, King's College, London SE5 8AP (
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)
Footnotes Competing interests: None declared.
1.
Levi P. The drowned and the saved. London: Penguin, 1988.
2.
Wheeler J. Interrogating KSM. Washington Times 2003; 5 Mar.
3.
Van Natta D. A dark jail for Qaeda suspects. International Herald Tribune 2002;10 Mar.
4.
Van Natta D. Questioning Terror Suspects in a Dark and Surreal World. New York Times 2003 March 9.
5.
Summerfield D. What is the WMA for? The case of the Israeli Medical Association. Lancet 2003; 361: 424[Medline].
6.
Vulliamy E. Passions stirred as intensity rises. Observer 2003;23 Mar:14.
7.
Riquelme H. Entre la obedencia y la oposicion. Caracas: Neuva Sociedad, 1995.
8.
Summerfield D. Raising the dead: war, reparation, and the politics of memory. BMJ 1995; 311: 495-497[Free Full Text].
Torture in Israel; evidence of HRW and others
BMJ 1995;310:1413 (27 May 1995)
Letters
Torture in Israel
Since 1988 there has been only one case in which interrogators were jailed for serious abuse of a detainee, and Human Rights Watch concludes that official policy has been to permit the security services to operate with impunity. An important aspect of what Human Rights Watch calls the "bureaucratisation" of torture has been the way the medical profession has been drawn in. Human Rights Watch notes that Israeli prison doctors have consistently violated the ethics of their profession by primarily serving the interests of the interrogators, a charge comparable to those levelled at doctors in South Africa after the internationally famous Biko case in 1977. In 1993 the existence of a "medical fitness for interrogation" form was uncovered; doctors who completed such forms could not credibly claim to have no idea that they were certifying detainees to undergo some degree of abuse amounting to torture.
Last November the Israeli cabinet was reported to have eased "restrictions" on the use of physical force during interrogations to improve their efficiency. The international medical community is in aposition to add its condemnation to that of bodies like the Israeli-Palestinian Physicians for Human Rights, which is also highlighting the continuing ethical challenge facing army doctors. Torture will continue to be an enemy of Israel's longer term interests and security. And what of the rights of victims, which include the fullest possible acknowledgement of what has been done to them? In South Africa this question is being addressed through a Truth Commission as a contribution to the making of a just peace. Is there a lesson here?
Principal psychiatrist Medical Foundation for the Care of Victims of Torture, London NW3 3EJ
Derek Summerfield
1.Immanuel J. Torture and ill-treatment: Israel's interrogation of Palestinians from the occupied territories [book review]. BMJ 1995;310:339. (4 February.) [Free Full Text]
2.Physicians for Human Rights. Human rights on hold: a report on emergency measures and access to health care in the occupied territories 1990-1992. Boston: Physicians for Human Rights, 1993.
3.Summerfield D. Health and human rights in Gaza. BMJ 1993;306:1416.
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