Medical neutrality

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Medical Neutrality refers to a principle of noninterference with medical services in times of armed conflict and civil unrest: physicians must be allowed to care for the sick and wounded, and soldiers must receive care regardless of their political affiliations; all parties must refrain from attacking and misusing medical facilities, transport, and personnel. Concepts comprising the principles of medical neutrality derive from international human rights law, medical ethics and humanitarian law. Medical neutrality may be thought of as a kind of social contract that obligates societies to protect medical personnel in both times of war and peace, and obligates medical personnel to treat all individuals regardless of religion, race, ethnicity, or political affiliation. Violations of medical neutrality constitute crimes outlined in the Geneva Conventions.

Historical Background[edit]

The principle of medical neutrality has roots in many social traditions.

  • The Hippocratic Oath, which requires physicians to practice medicine ethically, dates back to the fifth century.[1]
  • The idea of ‘do no harm’ has histories in “Jewish and Islamic, as well as Chinese and Indian medicine”[2]
  • Geneva Conventions (the core of international humanitarian law, supported and protected by the International Committee of the Red Cross):
    • The First Geneva Convention was written by Henri Dunant in response to seeing such the difficulty of treating wounded soldiers at the Battle of Solferino.[3]
    • The first and the following Geneva Conventions created the Red Cross, outline the protections of medical personnel in times of war, codify the protections of citizens, soldiers, medical personnel, etc.
    • The First Geneva Convention states that there should be no “obstacle to the humanitarian activities” and that wounded and sick “shall be respected and protected in all circumstances.”[4]
    • Article 19 demands that medical units, i.e. hospitals and mobile medical facilities, may in no circumstances be attacked.[5]
    • The Declaration of Geneva was created as an amendment to the Hippocratic Oath in 1948, a response to the human experimentation on Nazi prisoners.

Violations of Medical Neutrality[edit]

Medical neutrality is violated when health care professionals, facilities, or patients come under attack, or when medical professionals are not allowed to provide treatment.[6] Examples include:[4]

  • Attacks on hospitals
  • Attacks on patients
  • Attacks on medical personnel
  • Attacks on medical transport
  • Misuse of medical facilities
  • Breaches of medical ethics by medical personnel

Recorded Historical Violations of Medical Neutrality[edit]

Bahrain[edit]

The Bahraini government’s crackdown on the Bahrain uprising in 2011 and 2012 included extensive violations of medical neutrality. An investigative report released by Physicians for Human Rights revealed that many doctors were attacked or incarcerated. Furthermore, Bahraini security forces have seized control of medical facilities, prevented patients from receiving treatment, misused ambulance services, and violently interrogated wounded patients.[7] In September 2011, 20 medical workers in Bahrain were sentenced to up to 15 years in prison for treating protesters.[8] These sentences were immediately condemned by United Nations secretary general Ban Ki-Moon and human rights groups such as Physicians for Human Rights.[9] Apparently in response to international pressure, the Bahrain government ordered that the doctors be retried in civilian court, but the verdict has yet to be decided.[10]

Chechnya (1996)[edit]

During the Battle of Grozny in 1996 during the First Chechen War, several hospitals were attacked. Municipal Hospital No. 9 was invaded by Russian soldiers and approximately 500 civilians were taken hostage.[11] The ICRC Hospital of Novye Atagi, which was created to symbolize medical neutrality in the war torn area, was ambushed and resulted in the killing of six members of the ICRC staff.[12]

Egypt (2011)[edit]

In 2011, during political unrest, state security forces directly attacked protestors and field clinics, injuring and killing numerous people. A state security officer even dressed himself as a doctor and administered fatal shots to those injured in a field clinic outside of Tahrir Square.[13] Medical supplies were confiscated by “military officers and field hospital tents were burned down during a Tahrir raid.”[13]

El Salvador (1980-1992)[edit]

In the Salvadoran Civil War, many field clinics were attacked by guerillas. Patients were commonly abducted from hospitals, and government forces greatly limited the movements of health workers. Medical transports were also attacked, in some cases resulting in the deaths of medical workers.[14]

Iran (2008-2011)[edit]

In June 2008, Iranian authorities detained Dr. Arash Alaei and Dr. Kamiar Alaei, two well-known Iranian physicians and leaders in the fight against HIV/AIDS. The physicians, who are brothers, were held in Tehran’s notorious Evin prison for over six months without being charged or tried. On December 31, 2008, a one-day, closed-door trial was held, in which the brothers were tried as conspirators working with an “enemy government” to overthrow the government of Iran. They were also tried at that time on unspecified other charges which neither they nor their lawyer were allowed to know, see the evidence of, or address.[15][16] They were charged with attempting to overthrow the Iranian government under article 508 of Iran’s Islamic Penal Code. Kamiar was sentenced to three years in prison and Arash to six. The government of Iran used the brothers’ travels to international AIDS conferences as the basis for these claims.[17][18]

The international community decried the sentences of the doctors, and Physicians for Human Rights launched a campaign for their release.[19] In 2010, Dr. Kamiar Alaei was freed after serving two years in prison. Dr. Arash Alaei was released in August 2011 after more than three years of detention. Since their release, the doctors have reunited in the United States, where they continue their medical and advocacy work.[20]

Libya (2011)[edit]

During the 2011 Libyan Civil War, human rights groups documented violations of medical neutrality along with many other gross violations of human rights. Physicians for Human Rights conducted investigations within Libya in 2011, and found that the military had attacked and destroyed hospitals. Several eyewitnesses reported that Gaddafi forces attacked ambulances carrying injured combatants, despite the fact that the ambulances were marked with the emblematic Red Crescent. Medical personnel were kidnapped by Gaddafi’s forces, and military forces used people as human shields.[21][22]

Mozambique (1977-1992)[edit]

During the Mozambican Civil War, the resistance group RENAMO was responsible for many violations of medical neutrality. Attacks on hospitals and health clinics were common. In one instance, RENAMO soldiers raided the town of Homoine, killing 442 civilians including hospitalized patients.[23]

Panama (1988)[edit]

Civil unrest and demonstrations began in Panama in June 1987. During the unrest, human rights groups such as Physicians for Human Rights documented a variety of human rights abuses and violations of medical neutrality. The military blocked access to hospitals and interfered with provision of medical care, took control of ambulance services for military purposes, and interrogated wounded patients. In addition, Panamanian physicians were kidnapped, beaten, and tortured for speaking out against government policies which prevented them from providing their patients with adequate care.[24]

Sri Lanka (2009)[edit]

Sri Lanka’s lengthy civil war was marked by extensive human rights abuses. In 2009, the Sri Lankan air force violated the principle of medical neutrality when it destroyed the Ponnampalam Memorial Hospital in Puthukkudiyiruppu.[25]

Syria (2011)[edit]

The Syrian civil war has been marked by widespread human rights abuses, including violations of medical neutrality. Government forces have invaded, attacked, and misused hospitals and medical transports, preventing civilians from receiving health care. An estimated 250 doctors have been detained and tortured for treating wounded civilians.[26] An investigation by Physicians for Human Rights revealed that these circumstances have led to the rise of an underground health network.[27]

Thailand (1992)[edit]

A year after a bloodless military coup in Bangkok in February 1991, the new government responded to the pro-democracy movement opening fire on a May opposition rally, resulting in 52 deaths, hundreds of injured, and many disappearances. Physicians for Human Rights reported that health professionals were prevented from reaching the wounded and the police shot at ambulances.[28]

Organizations with a specific focus on medical neutrality[edit]

Medical Neutrality Protection Act of 2011 (H.R. 2643)[edit]

The Medical Neutrality Protection Act of 2011, (H.R. 2643), is a bipartisan bill introduced by Representatives Jim McDermott (D-WA), and Walter B. Jones, Jr. (R-NC) that intends to make the protection of medical professionals and access to medical services a global policy priority for the US government.[29]

  • The bill calls for the creation of the position of a United Nations Special Rapporteur on the Protection and Promotion of Medical Neutrality and calls for investigations of violations of medical neutrality. It also limits military aid from the USA to countries that have engaged in violating medical neutrality, and as well bans their government officials from attaining visas to the United States.[30]
  • As codified in the Medical Neutrality Protection Act of 2011, violations of medical neutrality are:[30]
    • Militarized attacks on health care facilities, health care service providers, or individuals in the course of receiving medical treatment
    • Wanton destruction of medical supplies, facilities, records, or transportation services
    • Willful obstruction of medical ethics as specified in the World Medical Association’s International Code of Medical Ethics, including preventing medical professionals from administering ethical medical care to individuals in need
    • Coercion of medical personnel to commit acts in violation of their ethical responsibilities
    • Deliberate misuse of health care facilities, transportation services, uniforms, or other insignia
    • Deliberate blocking of access to health care facilities and health care professionals
    • Arbitrary arrest or detention of health care service providers or individuals seeking medical care

References[edit]

  1. ^ Ludwig Edelstein. The Hippocratic oath: text, translation and interpretation. Johns Hopkins University Press, 1996, p.56.
  2. ^ Sheila McLean, First Do No Harm: Law, Ethics, and Healthcare, at 83 (Ashgate Publishing, 2006)
  3. ^ Sperry, C.S. (1906), "The Revision of the Geneva Convention, 1906", Proceedings of the American Political Science Association 3: 33 
  4. ^ a b ”Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. Geneva, 12 August 1949.” International Committee of the Red Cross. http://www.icrc.org/ihl.nsf/FULL/365?OpenDocument. Retrieved February 21, 2012
  5. ^ ”Article 19, First Geneva Convention.” Library of Congress. http://www.loc.gov/rr/frd/Military_Law/pdf/GC_1949-I.pdf. Retrieved February 21, 2012
  6. ^ Physicians for Human Rights. "The Principle of Medical Neutrality." http://physiciansforhumanrights.org/library/multimedia/principle-of-medical-neutrality.html. Retrieved February 21, 2012
  7. ^ Physicians for Human Rights, Do No Harm: A Call for Bahrain to End Systematic Attacks on Doctors and Patients, http://physiciansforhumanrights.org/issues/persecution-of-health-workers/bahrain/
  8. ^ "Bahrain Court Hands Down Harsh Sentences to Doctors and Protesters". New York Times. Retrieved February 14, 2012.
  9. ^ Press Release, Physicians for Human Rights, "PHR Denounces Sentences Passed on Bahraini Medics and Protestors", (September 2011) http://physiciansforhumanrights.org/press/press-releases/phr-denounces-sentences-on-bahraini-medics.html
  10. ^ "Bahrain Orders Retrials for Medical Workers", The New York Times, October 5, 2011,
  11. ^ Memorial. “Occupation of Municipal Hospital No. 9.” http://www.memo.ru/hr/hotpoints/chechen/szczyt/eng/Chapter7.htm. Retrieved February 21, 2012.
  12. ^ ICRC. “17 December 1996: Six ICRC delegates assassinated in Chechnya.” http://www.icrc.org/eng/resources/documents/misc/57jnj3.htm. Retrieved February 21, 2012.
  13. ^ a b Amani Massoud, A brief history of field hospitals in Tahrir Square, AlMasry Alyoum, November 27, 2011, http://www.almasryalyoum.com/en/node/521861.
  14. ^ Physicians for Human Rights. “El Salvador: Health Care Under Siege”. https://s3.amazonaws.com/PHR_Reports/el-salvador-health-care-under-siege.pdf. Retrieved February 28, 2012.
  15. ^ Iran Free the Docs. “Background.” http://iranfreethedocs.org/background/. Retrieved February 28, 2012
  16. ^ Physicians for Human Rights. “PHR Criticizes Iran for Trying AIDS Doctors on Secret Charges.” http://physiciansforhumanrights.org/press/press-releases/news-2008-12-31.html. Retrieved February 28, 2012.
  17. ^ Physicians for Human Rights. “Background: Jailed Doctors in Iran (updated)”. http://physiciansforhumanrights.org/issues/persecution-of-health-workers/iran/iran-free-the-docs.html. Retrieved February 28, 2012.
  18. ^ PharmPro. “Iranian Physician Describes HIV/AIDS Work That Led to Imprisonment.” http://www.pharmpro.com/News/Feeds/2011/10/agencies-and-organizations-pan-american-health-organization-iranian-physician-describes-hiv-aids-work-that-led/. Retrieved February 28, 2012.
  19. ^ Iran Free the Docs. http://iranfreethedocs.org/. Retrieved February 28, 2012.
  20. ^ Physicians for Human Rights. “Released Iranian AIDS Doctors Share Their Story.” http://physiciansforhumanrights.org/library/multimedia/released-iranian-aids-doctors-share-story.html. Retrieved February 28, 2012.
  21. ^ MSNBC. “Report: Gadhafi forces perched children on tanks to deter NATO attacks”. http://today.msnbc.msn.com/id/44323971/ns/today-today_news/t/report-gadhafi-forces-perched-children-tanks-deter-nato-attacks/. Retrieved February 21, 2012.
  22. ^ Physicians for Human Rights. “Witness to War Crimes: Evidence from Misrata, Libya”. https://s3.amazonaws.com/PHR_Reports/Libya-WitnesstoWarCrimes-Aug2011.pdf. Retrieved February 21, 2012.
  23. ^ Mozambique History Net. “The Massacre at Homoine on Saturday, 18 July 1987”. http://www.mozambiquehistory.net/homoine.html. Retrieved February 28, 2012.
  24. ^ Physicians for Human Rights. “Panama 1987: Health Consequences of Police and Military Actions.” https://s3.amazonaws.com/PHR_Reports/panama-1987-health-cons.pdf. Retrieved February 21, 2012.
  25. ^ Julian Shear. “The Sri Lankan doctors and the challenge for medical ethics.” Indian Journal of Medical Ethics. http://www.ijme.in/174ed179.html Retrieved February 21, 2012.
  26. ^ The Syrian Regime Targeting Doctors, Local Coordination Committees of Syria, October 17, 2011, http://www.lccsyria.org/207. Retrieved February 21, 2012.
  27. ^ Physicians for Human Rights. “Syria: Attacks on Doctors, Patients, and Hospitals.” https://s3.amazonaws.com/PHR_Reports/syria-attacks-on-drs-patients-hospitals-final-2011.pdf Retrieved February 21, 20122.
  28. ^ Physicians for Human Rights, Bloody May: Excessive Use of Lethal Force in Bangkok: The Events of May 17–20, 1992, (Oct 1992) https://s3.amazonaws.com/PHR_Reports/bloody-may-bangkok-1992.pdf. Retrieved February 21, 2012.
  29. ^ Physicians for Human Rights. “Introducing Medical Neutrality Protection Act of 2011: Representative Jim McDermott’s Statement for the Record”. http://physiciansforhumanrights.org/library/other/introducing-medical-neutrality-protection-act.html. Retrieved February 21, 2012.
  30. ^ a b U.S. Government Printing Office, “H.R. 2643”, http://www.gpo.gov/fdsys/pkg/BILLS-112hr2643ih/pdf/BILLS-112hr2643ih.pdf. Retrieved February 21, 2012