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IMA Shirks 'Political Aspects' of Torture
BMJ 1995;311:755 (16 September 2007)
Letter
Israeli Medical Association shirks "political aspects" of torture
EDITOR,--There is a body of evidence, collated by both domestic1 and international human rights organisations,2 of the longstanding use of torture in Israel as an instrument of state policy that cannot be ignored. This material also documents the questionable role of doctors in army units and detention centres as well as the persistent silence of the Israeli medical establishment. Only in 1993, following publicity about the existence of a medical "fitness for interrogation" form (in effect fitness for torture), was the Israeli Medical Association prompted to intervene. They disavowed the use of this form by doctors, but they did not denounce torture per se nor the everyday presence of the same doctors in and around rooms where this was practised.
Torture in Israel continues, and indeed interrogators have been given official sanction to increase the coercive power of this work. Thus I recently wrote to the Israeli Medical Association to point out that they had returned to a position of silence and to urge them to take a stand. Dr Y Blachar, chairman of the centre committee, replied that the association responds when irregular behaviour by an individual member is brought to its attention, but "we are most careful not to get involved in the political aspects of the issue." This is an ethically untenable stance. The core problem is not isolated malpractice (and who would report this to the Israeli Medical Association anyway, given that the testimony of victims is discounted?) but the routine role of doctors in what Human Rights Watch calls a bureaucratised system that has processed thousands of Palestinian detainees. As the representative body, the Israeli Medical Association cannot evade a responsibility to offer ethical leadership to those examining detainees before or after interrogation and who are likely to be in collusion with torture. The association has a duty to ensure that the two international antitorture codes for doctors, the World Medical Association's Declaration of Tokyo and the United Nations' Principles of Medical Ethics, are adhered to by their members.
Further, the Israeli Medical Association cannot maintain that it has no position on the highly deleterious effects on physical and mental health that flow from the use of torture in Israel, as elsewhere.
It has been noted that medical associations in countries where torture is used systematically are often remarkably passive on this issue.3 This may be a survival strategy in states like Iraq or Syria, which do not hesitate to strike at doctors interested in justice for their patients, but this does not apply in Israel. The Israeli Medical Association's stance seems to threaten its standing in the international medical fraternity and representative institutions, as was the case with South Africa, for instance. I invite others to add their voices to this request for the association to rethink its position and to respond through the BMJ.
Principal psychiatrist Medical Foundation for Care of Victims of Torture, London NW5 3EJ
Derek Summerfield
1.Gordon N, Marton R, eds. Torture, human rights, medical ethics and the case of Israel. New Jersey: Zed Books/Association of Israeli-Palestinian Physicians for Human Rights, 1995.
2.Human Rights Watch/Middle East. Torture and ill-treatment. Israel's interrogation of Palestinians from the Occupied Territories. New York: Human Rights Watch, 1994.
3.British Medical Association. Medicine betrayed. The participation of doctors in human rights abuses. London: Zed Books, 1992
Take the Physicians out of the System and it Will Cease to Exist
Following the Israeli Supreme Court’s ruling in 1999 prohibiting torture, it seemed – or at least we hoped – that the era of torture in Israel was over, and with it the shameful complicity of medical personnel who served as a safety net for torture and as collaborators whose silence constituted consent. One might have assumed, then, that the various institutions that failed to extricate medical personnel from this terrible practice would follow the Supreme Court's ruling and recognize their failure. However, the reaction of the Ministry of Health was typical. For ministry officials, the ruling resolves the dilemma: if torture has ended, physicians are also no longer participating in torture. Therefore, it is of no surprise that none of those involved – chief medical officers or physicians who examined the prisoners – was summoned for review or punished. Everyone heaved a sigh of relief and left the past behind them.
In recent years, there is growing testimony that torture, albeit in a different form, has returned and is again being supported by the familiar “ticking bomb” argument. This argument should not affect the perspective of medical personnel, however, because even if one considers torture to be justified – and it is not – medical personnel are prohibited from participating in it in any shape or form. Yet it is impossible to ignore the fact that the prevalent environment has an impact on the willingness of physicians to turn a blind eye to torture and even participate in it in a monitoring role, such as by examining the prisoner before, during and after interrogation. Some will ask why we focus on medical personnel; shouldn’t torture itself be the focal point of the struggle? The answer is: Of course it should. However, we should not downplay the importance of removing physicians from the system as the most effective step toward eradicating torture entirely. Medical personnel are a central tool or a kind of fig leaf that enables others within the system to continue to carry out this prohibited activity under a veil. Try to imagine an execution taking place in the United States without an anesthesiologist to enable the execution to be conducted without pain. Or try to imagine the Shin Bet (GSS) designing methods of torture without seeking medical consultation, or an interrogator working without a medical safety net to treat those who are injured. In addition, the mere existence of torture harms the whole of society and the involvement of physicians in torture destroys the ethical cornerstone of the medical profession. Its ramifications extend to medical activity in general beyond the walls of the prison and interrogation facilities.
Read more: Take the Physicians out of the System and it Will Cease to Exist
Letter by Dr Derek Summerfield to the British Medical Journal
Owen Dyer quotes from a recent response from the IMA to the arguments for boycott made recently by the 18 leading Palestinian organisations in the health field we alluded to in our letter. I'm afraid the IMA response is empty rhetoric written for public relations purposes. A world away from these words are the decisions the IMA has taken with its eyes open over many years: it is on this account that the Israeli Physicians for Human Rights (PHRI), a principled and committed group, labelled the IMA in the Lancet, as an arm of the Israeli establishment whose role it was to obscure the health-related realities of Israeli occupation. IMA President Blachar has taken this Duty with him to the World Medical Association: his presence there - as Chair of Council no less - ensures that the WMA does nothing. True to form, I note that the WMA Secretary General has declined to comment on our letter – yet this is a matter that goes to the heart of their mandate as the world's official watchdog on medical ethics. The charges against the IMA are broadly in 2 categories.
Read more: Letter by Dr Derek Summerfield to the British Medical Journal
Medical Ethical Violations in Gaza
PHRI is also highlighting the coercion being applied to patients by the Israeli General Security Service to inform on others if they want permission to exit Gaza for medical treatment.
It is noteworthy that PHRI is speaking out, not the Israeli Medical Association (IMA), which, as the official body, is mandated to challenge breaches of medical ethics. Indeed the IMA also continues to stay silent about the continued use of torture by Israel. A report by the Public Committee Against Torture in Israel,2 carrying detailed testimony of nine Palestinian men tortured between 2004 and 2006, again makes clear how Israeli doctors form an integral part of the running of interrogation units whose output is torture. Doctors, several of whom are named, saw the prisoners at various points before, between, or after episodes of torture (which in one case led to spinal damage and disability), did not take a proper history, made no protest on these men’s behalf, and typically prescribed simple analgesia before returning them to their interrogators. There was also direct involvement in several cases by the Chief Medical Officers of the Israeli Prison Service and Police Service, and by no less than the Chairman of the Ethics Board of the IMA, all named. How long can this grotesque situation continue?
ChestDoc in Palestine
In summer 2007, a UK doctor spent two weeks in the West Bank. This is his story.
(Full version at http://chestdocinpalestine.blogspot.com)
THURSDAY, SEPTEMBER 20, 2007A Village in Northern England
My life has changed forever. What I witnessed in those two weeks in the West Bank will haunt me till I die. I am almost resentful of my idyllic life here, and sometimes I wish I was back in Palestine- my second home.
Some people have told me I was 'brave' to go to such a dangerous place. There is nothing brave about what I did- breathing in a bit of teargas and dodging a few rubber bullets does not make me a hero. I am back in England living my comfortable life, driving my fast car to my secure job. Yet my friends in Palestine are still queuing at checkpoints in the sun, facing tanks and live bullets in the camps, coming home to find their houses demolished, and watching helplessly as the evil Wall and the greedy settlements devour their land.
I have been speaking to friends and family since my return, and they have been horrified by what they have heard. Most of them had no idea how bad things were. A few have criticized me for being 'too one-sided'. In the weeks and months to come, when I do my talks and write my articles, some people will be baying for my blood. I know that. But I couldn't care less. I've been there and I know the truth.
I shall attempt to counter these arguments here.
Go and see the truth for yourself. I did.
We spent a lot of time at checkpoints in the West Bank. Unfortunately, the word 'checkpoint' sounds so benign that it hardly conveys the horror of the place. Have you seen a cattle shed crammed full of animals? With only one gate to get out, guarded by a farmer with a stick? Well, just replace him with an Israeli soldier with a rifle- and the animals with Palestinians- and you're not far. At Huwwara checkpoint near Nablus, we saw a queue extending for half a kilometre out of the cramped shed and into the merciless sun. One by one, the Palestinians were called forward and their documents inspected. Some got through, others were turned back. Depending on the mood of the soldier. The explanation given for the checkpoints- 'security'- is a lie, as the barriers mostly stand between Palestinian cities and towns, not between Palestine and Israel.
Israel, through its system of 700 checkpoints, roadblocks and earth mounds in the West Bank strangles the Palestinians' freedom of movement. 68 women have been forced to give birth at checkpoints since the year 2000 (www.ifamericansknew.org). Half of the babies involved have died, as have 4 of the women. Many of the babies born have suffered irreversible brain damage. Imagine being the helpless husband or son of a woman forced to endure the pain of labour on the baking earth at a checkpoint- with an armed soldier looking on- and you will begin to understand how suicide bombers are born.
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