World Report: Stop Torture, Cruel Treatment in Health Settings

Health providers in medical facilities, juvenile detention centers, orphanages, drug treatment centers, and so-called social rehabilitation centers are forced to withhold care or engage in treatment that intentionally or negligently inflicts severe pain or suffering for no legitimate medical purpose, Human Rights Watch said today in an essay in the 2010 World Report.

The 612-page report, the organization's 20th annual review of human rights practices around the globe, summarizes major human rights trends in more than 90 nations and territories worldwide, reflecting the extensive investigative work Human Rights Watch carried out in 2009. The essay, entitled "Abusing Patients: Health Providers' Complicity in Torture and Cruel, Inhuman or Degrading Treatment," shows recent research by Human Rights Watch.

"Ethical guidelines and international human rights law expressly condemn health providers' involvement in torture or ill-treatment," said Joe Amon, health and human rights director at Human Rights Watch. "Yet providers engage in a wide range of abuses in the name of 'medical treatment,' often because they are following abusive government health policies."

The essay documented health providers' complicity in torture or cruel, inhuman, or degrading treatment in many countries throughout the world, including:

• Government physicians conducting forcible anal exams of men suspected of engaging in homosexual activity in Egypt and forcible vaginal exams to assess virginity in Libya and Jordan.
• The practice of female genital mutilation by lay midwives in Iraqi Kurdistan, and government physicians promoting the practice and disputing negative health consequences.
• Staff at drug "treatment" centers in China and Cambodia denying care for drug users in withdrawal and subjecting individuals dependent upon drugs to forced labor or exercise in place of evidence-based treatment.
• Physicians in Nicaragua denying women life-saving abortions, resulting in preventable deaths.
• Health providers in India withholding pain medicine for those suffering from severe, chronic pain.

Human Rights Watch said that in each of these cases, the health providers' conduct amounted to cruel, inhuman, or degrading treatment because providers unjustifiably or deliberately caused severe mental or physical suffering. Where there was government involvement and a specific intent, the organization said health providers could potentially be complicit in torture.

In many cases, healthcare providers are constrained by government action or inaction to provide care that violates international standards. In Nicaragua, for example, physicians risk criminal charges if they perform life-saving abortions. In India, the government has failed to take measures to ensure the availability and access to appropriate pain medications. In China, the government has expanded access to substitution therapy for individuals with drug dependency in community-based clinics but not in drug rehabilitation centers.

Human Rights Watch called on national and international medical societies to reinforce health providers' understanding of how their actions can result in torture and ill-treatment, and to speak out more forcefully against laws and practices that compel health providers to be complicit. Human Rights Watch also called on the international human rights protection system to address state-sponsored torture and ill-treatment in medical settings.

"The Hippocratic Oath declares that physicians must treat all patients to the best of their abilities and do them no 'harm or injustice,'" Amon said. "Medical societies need to show leadership to empower health providers to act to prevent patients from being tortured or abused, and the international human rights community needs to join in these efforts."