AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. September 2004, Volume 6, Number 9.

Medical Humanities

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Physicians Speak out for Health and Human Rights at Great Cost

Many physicians assist others at great risk to their personal safety as part of Physicians for Human Rights.

Holly G. Atkinson, MD, and Gina Coplon-Newfield

Across the globe, many physicians face grave dangers simply for performing their professional duties or speaking out against human rights abuses. As punishment for exercising their rights or adhering to medical ethics under their national and international laws, health professionals may be threatened, detained, arrested, tortured, or murdered by their governments or nonstate actors. Particularly during times of armed conflict, health professionals sometimes put themselves at enormous risk merely by practicing ethical, non-discriminatory medicine that does not favor one ethnic or political group over others.

As chief surgeon at Alkhan-Kala Hospital in Chechnya during the Chechen War of the late 1990s and in early 2000, Dr. Khassan Baiev was, for a period, the only doctor serving a population of up to 100 000 people. He sometimes performed as many as 60 surgeries a day to save lives and limbs, often without gas, electricity, running water, or dressings. Dr. Baiev believed it was his medical and ethical obligation to treat all people, though each side of the conflict insisted that he adopt a political approach and aid only its partisans. He was threatened and eventually imprisoned in Russia, and is now a refugee in the United States [1].

On March 18, 2003, the Cuban government launched a massive crackdown on 75 dissidents, arresting independent journalists, human rights defenders, labor unionists, librarians, teachers, and 6 medical doctors. Dr. Marcelo Cano Rodríguez, one of the physicians detained, is national coordinator of the unofficial Colegio Médico Independiente de Cuba (Cuban Independent Medical Association). He is also a member of the unofficial Comisión Cubana de Derechos Humanos y Reconciliación Nacional (Cuban Commission for Human Rights and National Reconciliation). He was arrested on March 25, 2003, as he was investigating the arrest and detention of a fellow physician. He had no previous criminal record. The activities that the prosecution cited against Dr. Cano Rodríguez included visiting prisoners and their families as part of his work with the human rights group and maintaining ties to the organization Doctors without Borders. Yet, he was tried, convicted, and sentenced to 18 years in prison [2].

Dr. Matthys Johannes van Mollendorff, from South Africa's province of Mpumalanga, was discharged from his duties as superintendent of the Rob Ferreira Hospital, Nelspruit, South Africa, in early 2002 for "insubordination" after he allowed the Greater Nelspruit Rape Intervention Project (GRIP) to use space in his facility. GRIP, in cooperation with physicians, provided antiretroviral prophylaxis for rape survivors. Dr. Mollendorff stated that he followed national policy in doing what is best for his patients and followed WHO and UNAIDS guidelines for prophylaxis treatment of rape victims at high risk for HIV. At the time Dr. Mollendorff was fired, the South Africa National Ministry of Health prohibited the use of antiretroviral drugs as a method of prevention and treatment after HIV exposure [3]. International pressure has since convinced the South African government to change this policy.

In 1998, 6 Bulgarian nurses and one Palestinian physician arrived in Libya to provide treatment to Libyans at the Al-Fateh Children's Hospital in Benghazi, northeast of Tripoli. In 1999, these health workers, Kristiana Malinova Valcheva, Nasya Stojcheva Nenova, Valentina Manolova Siropulo, Valya Georgieva Chervenyashka, Snezhanka Ivanova Dimitrova, all nurses, and Ashraf Ahmad Jum'a, a physician, were arrested and detained by Libyan authorities, charged with having infected more than 400 children at the hospital with HIV. Since that time, some of the 6 detainees maintain that they gave false confessions because they were tortured by Libyan authorities by subjection to electric shocks, suspension from heights by the arms, beatings, and rape. In early May of 2004, these Bulgarian and Palestinian health workers were convicted of the charges and sentenced to death by firing squad, despite a report presented during the trial by Dr. Luc Montagnier, the French co-discoverer of HIV, stating that the infections were probably spread by unsterile hospital practices, rather than by deliberate actions of health workers [4].

Efforts on Behalf of Physicians

The Physicians for Human Rights' Colleagues at Risk Program advocates on behalf of many brave health professionals around the world who attempt to treat all types of patients or speak out on behalf of persecuted groups, often at great personal and professional cost. PHR sends letters to government officials, reaches out to the media, and urges its members and the general public to write letters on behalf of health professionals in danger. In the case of Libya, PHR mobilized 30 prominent physicians and scientists from 10 countries including the United States, several European nations, Iran, Egypt, and the West Bank and Gaza, to sign a letter to Libyan authorities calling for the release of the health workers, who are appealing their sentences at the time of this writing. In 2003, PHR monitored, publicized, and provided advocacy support for colleagues in South Africa, Pakistan, Cuba, Burma, Iran, Malaysia, Azerbeijan, China,Vietnam, Egypt, Colombia, and Turkey.

PHR's efforts have contributed to the dismissal of charges, release from prison, improved treatment, and even saved lives of health professionals, as well as improved government policies on human rights and health. Following advocacy on behalf of Dr. Mollendorff, for example, the South African Department of Health agreed in March of 2003 to pay his back salary and benefits for 12 months and compensate him for his legal costs. The government unconditionally withdrew the charges against Dr. Mollendorff and offered him the opportunity to reclaim his job.

Physicians for Human Rights was also successful in helping Dr. Khassan Baiev safely leave Chechnya in 2000 and gain asylum for himself and his family in the United States. For many other colleagues at risk, however, Physicians for Human Rights and others are still advocating. The more individual health professionals and medical associations that support our Health Professional Colleagues At Risk Program, the larger and louder will be the collective voice we have to help our brave colleagues throughout the world practice medicine and speak their minds safely. It is also through this advocacy that we are able to improve national and international human rights policies, which inevitably affect the health and well-being of all people.



References

  1. Baiev K. The Oath: A Surgeon Under Fire. New York: Walker & Co.; 2003.
  2. Physicians for Human Rights. Update: six Cuban physicians sentenced from 13 to 25 years. Accessed July 20, 2004.
  3. Physicians for Human Rights. Dr. Thys Van Mollendorff—charges dropped! Accessed July 20, 2004.
  4. Physicians for Human Rights. Bulgarian and Palestinian health professionals in Libya sentenced to death by firing squad. July 1, 2004; Nature, 430:8. Accessed July 20, 2004.

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Holly G. Atkinson, MD, is the president of Physicians for Human Rights, editor of HealthNews, and assistant professor in the Department of Public Health at Weill Cornell Medical College.

Gina Coplon-Newfield is the senior organizing associate at Physicians for Human Rights and also serves as coordinator of the US Campaign to Ban Landmines.

The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.