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«HEALTH CRISIS SYRIAN GOVERNMENT TARGETS THE WOUNDED AND HEAlTH WORkERS Amnesty International is a global movement of more than 3 million supporters, ...»

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HEALTH CRISIS

SYRIAN GOVERNMENT TARGETS THE

WOUNDED AND HEAlTH WORkERS

Amnesty International is a global movement of more than 3 million supporters,

members and activists in more than 150 countries and territories who campaign

to end grave abuses of human rights.

Our vision is for every person to enjoy all the rights enshrined in the Universal

Declaration of Human Rights and other international human rights standards.

We are independent of any government, political ideology, economic interest or religion and are funded mainly by our membership and public donations.

First published in 2011 by Amnesty International Ltd Peter Benenson House 1 Easton Street London WC1X 0DW United kingdom © Amnesty International 2011 Index: MDE 24/059/2011 English Original language: English Printed by Amnesty International, International Secretariat, United kingdom All rights reserved. This publication is copyright, but may be reproduced by any method without fee for advocacy, campaigning and teaching purposes, but not for resale.

The copyright holders request that all such use be registered with them for impact assessment purposes. For copying in any other circumstances, or for reuse in other publications, or for translation or adaptation, prior written permission must be obtained from the publishers, and a fee may be payable.

To request permission, or for any other inquiries, please contact copyright@amnesty.org Cover photo: A health worker in his bloodstained gown stands in an emergency room in a hospital in Syria after treating wounded people, March 2011.

© ANWAR AMRO/AFP/Getty Images amnesty.org CONTENTS

1. Introduction

2. Abuses in hospitals

National hospitals

Homs military hospital

3. Denial of medical care

Ambulances impeded and attacked

Hospitals and Health professionals facing obstacles

Torture and denial of medical care at detention facilities

4. Arrest and torture of health workers

5. Conclusions and recommendations

Recommendations

6. Endnotes

Annex I

Annex II

Annex III

Health crisis:

Syrian government targets the wounded and health workers

1. INTRODUCTION “I’m not going to clean your wound… I’m waiting for your foot to rot so that we can cut it off.” A doctor at Homs military hospital, as reported by a 28-year-old patient who was shot in the foot on 16 May 2011 1 The Syrian authorities have turned hospitals and medical staff into instruments of repression in the course of their efforts to crush the unprecedented mass protests and demonstrations that have wracked the country since March 2011. People wounded in protests or other incidents related to the uprising have been verbally abused and physically assaulted in staterun hospitals, including by medical staff, and in some cases denied medical care, in gross breach of medical ethics, and many of those taken to hospital have been detained.

As casualties from the current unrest have mounted, so President Bashar al-Assad’s government has intensified its hunt for the wounded, who are generally deemed to be opponents and outlaws. Some army soldiers and members of the security forces loyal to the government have also been killed or injured while combating the unrest but Amnesty International has received no reports of medical abuses in their cases.

In Homs, one of Syria’s major cities and governorates, government security forces have obstructed ambulances on their way to pick up wounded people and when ferrying the wounded to hospital, threatened Syrian Arab Red Crescent (SARC) workers with violence or detention and interrogated wounded patients while they were still being conveyed in ambulances. They have ordered all those with firearm or other injuries related to the unrest to be directed to the military hospital, which is controlled by the Ministry of Defence, and such patients have been treated effectively as detainees while in hospital and held incommunicado.

Hospitals have increasingly come to be seen as dangerous places for people whom the authorities suspect of opposing the government, and both private and public hospitals have been instructed to report to the authorities any patients who have sustained firearm or other unrest-related injuries. The security forces have regularly entered state hospitals in search of people injured during the protests, who are liable to be arrested, detained incommunicado and subjected to torture or other ill-treatment. In consequence, unsurprisingly, many people are now reportedly avoiding state-run hospitals if they or their relatives have been wounded during the protests and unrest, and turning instead to private hospitals where they may obtain treatment without exposing themselves to likely arrest or to the makeshift field hospitals that have been set up by some local communities to treat people shot or otherwise wounded by the army and security forces.

These private and field hospitals, however, face problems in obtaining adequate medical supplies, including blood for use in transfusions, which they can obtain only from the Central Blood Bank controlled by the Ministry of Defence. When private hospitals request new supplies from this Central Blood Bank, it inevitably triggers official suspicion that they may

–  –  –





be providing medical treatment to people wounded during anti-government protests, funerals of killed protestors or other unrest-related incidents.

Doctors, nurses and other health workers who encounter people wounded in the unrest are now being confronted with a daunting dilemma – whether to obey the government’s instructions and report patients to the authorities, knowing that this may very well lead to the patients’ arrest, detention and possible torture, or to ignore or disobey those instructions, put their patients welfare first and thereby expose themselves to the risk of government reprisals.

Many know that the security forces have raided hospitals in which they believed wounded unrest victims were being treated and are probably aware that a number of health professionals have been detained, and in some cases tortured, for seeking to protect patients in their care.

One doctor employed at a state-run hospital in Damascus who has also assisted as a

volunteer in makeshift field hospitals, told Amnesty International:2

“At the early stage of the uprising, I treated some wounded people in field hospitals set up near sites of shootings, and referred them to government-run hospitals… They were all detained… and we all know that they’d be subjected to harsh torture… I cannot send them to torture.” As has been the case for decades, people in Syria who speak to international human rights organizations risk severe repercussions. Consequently, Amnesty International exercised great caution when compiling the information contained in this report and has omitted the names of individuals it interviewed or other information that could expose these sources to serious risk.

Amnesty International was not able to conduct research on the ground in Syria; like other international human rights organizations and most international journalists and other independent observers, the organization has been effectively barred by the government from visiting Syria since the current protests and unrest broke out in mid-March. Likewise, by early October 2011 the UN High Commissioner for Human Rights was still awaiting permission from the Syrian authorities to visit the country to “investigate all alleged violations of international human rights law and to establish the facts and circumstances of such violations and of the crimes perpetrated”, as mandated by the UN Human Rights Council on 29 April 2011.

This report is based on research conducted in August and September 2011. Interviews were conducted with individuals wounded during the ongoing disturbances; relatives of those wounded and subsequently detained; relatives of people with firearm and other injuries related to the ongoing unrest; and health professionals and medics, including surgeons, doctors, nurses and other hospital employees. Government surveillance and restrictions on means of communication, and the poor quality of the internet connection in Syria were among the obstacles to research. The deteriorating security situation also meant that health professionals were often too busy treating patients to speak to Amnesty International or were too afraid to do so.

Despite these challenges, the patterns of abuse recorded in this report and the evidence garnered from other sources provide a compelling picture of how the Syrian authorities are blocking access to health care for people wounded during the unrest and preventing health

–  –  –

care professionals from treating such patients freely and without fear. Such actions flagrantly violate Syria’s obligations under international human rights law.

Amnesty International is calling on the Government of Syria, among other things, to:

Give strict and clear instructions to all public and private hospitals to accept and treat  all wounded patients without delay, and to prioritize the interests of the patients over any other priorities set by the security and other authorities;

Hold to account any health professional or employee at hospitals and other health  facilities who violates medical ethics by misusing their position to subject vulnerable individuals, including wounded patients, to verbal or physical abuse, torture or other illtreatment, or to deny them necessary medical care;

Instruct all members of the military and security forces to prioritise the treatment of  wounded individuals over interrogation, treat such individuals humanely, allow without any interference medical treatment of these and other patients, and hold to account anyone proved to have delayed, obstructed or interfered in the work of health workers providing treatment to the wounded;

Stop arbitrary detentions of health professionals for performing their duty of attending to  persons with medical needs or for exercising their right to freedom of expression or other peaceful activities, and release without delay all wounded persons, health workers and other detainees unless they are promptly charged with internationally recognizable crimes and tried in full conformity with international standards for fair trial.

–  –  –

2. ABUSES IN HOSPITALS “He opened the morgue door, blindfolded me again and pushed me inside and I fell face down on what I could feel was a body.” Testimony given by a wounded man, “Samer”, who was taken to the morgue in Homs military hospital to identify bodies.3 Wounded patients perceived as government opponents have been verbally and physically assaulted by medical staff, health workers, and security personnel in at least four government-run hospitals – the National Hospital in Homs, the National Hospital in Tell Kalakh, and the National Hospital in Banias, all of which fall under the jurisdiction of the Ministry of Health; and the military hospital in Homs, which falls under the jurisdiction of the Ministry of Defence. Some of those already wounded were beaten by security officials.

There have also been reports of ill-treatment of patients wounded in the unrest by medical staff in other government-run hospitals, including in Damascus and Latakia. These reports come from doctors who did not witness the abuses but learned of them from patients who had been targeted, from fellow doctors who witnessed such practices, and from complaints raised by doctors to hospital managers.

Assaults on wounded patients by medical staff and other health workers have gone largely unpunished by hospital managements, government ministries and official medical bodies.

Amnesty International is aware of only two disciplinary actions for alleged misconduct committed against wounded patients – these were both initiated by managers at Homs military hospital against two doctors reported to be army officers. Doctors and nurses working in state-run hospitals concerned by their colleagues’ abuse of patients told Amnesty International that they feared to make official complaints for fear that this would be interpreted as opposition to the government and expose them to reprisals by the security forces.

Since the uprising began in March 2011, Syrian security officials have had ready access to state-run hospitals and are reported to have intimidated health professionals working within them and on occasions to have forcibly removed wounded patients without consideration of their medical needs and without consulting the medical staff treating them.

At the National Hospital in Homs, the number of people admitted with firearm or other wounds4 sustained in the unrest has dropped significantly since early May 2011, according to doctors who worked there and Homs residents despite the spiralling number of people shot and killed or injured by the army and security forces. This decline, doctors and residents say, stems directly from growing public mistrust of this and other state-run hospitals as word has spread about incidents of mistreatment of wounded patients and the hospital’s compliance

–  –  –

with instructions issued by the Homs Health Directorate5 requiring medical staff to report wounded people to the authorities.

In Tell Kalakh, a western town that falls under the governorate of Homs, residents opposed to Homs: wounded people have no safe place to go. © Digitalglobe / Tomnod 2011. (Lat 34.711561 Long 36.707211).

the government told Amnesty International that they and others like them have not sought medical care at the local national hospital, also known as al-Bassel,6 since the army and security forces occupied it in mid-May during a security crackdown on the town.



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