“If any of you worry about the issues that are going on in the world as you listen to the news every day and you feel somewhat powerless because the problems, the fractures, are too large and too many, I think you and I can take comfort that PHR is playing its part everywhere in the world in building trust, in seeking truth, and in providing service […] The work of PHR is there to testify, to give witness, and to help.” 

Yo-Yo Ma, world-renowned cellist and music ambassador 

Dear PHR Supporters: 

As we reflect on the peaks and valleys of a momentous year, we are pleased to share with you some stories of transformation and success that your generosity has enabled. Your dedication to the cause of human rights has bolstered PHR’s relentless pursuit of justice and the fulfillment of human rights for everyone.

In the following pages, you will read about the impact of our work around the globe, touching lives at the intersection of health and human rights. In the United States, your support empowered us to bring PHR’s unique expertise to the cause of reproductive justice following the overturn of Roe v. Wade, shining a light on the damage caused by abortion bans on patients’ right to information and health and clinicians’ ethical obligations. PHR’s trailblazing research and advocacy led California and Colorado to ban the unscientific term “excited delirium,” which has been used to mask racist police violence, as a cause of death.

Around the world, we documented atrocities and pursued accountability in global crises from Ethiopia to Ukraine, Gaza to the DRC, and Syria to Sudan, standing as advocates for those whose voices often go unheard. While many excellent organizations respond to human rights violations and advocate for change, PHR mobilizes the global medical community to use its unique skillset, professional credibility, and moral authority for the defense of human rights. PHR’s singular approach has for decades shown that when health professionals rigorously document evidence using medical and scientific methods, expose and speak out about health and human rights abuses, and champion accountability for them, the world is a safer, more rights-respecting place.

As you know all too well, 2023 was marred by global crises and catastrophes. The suffering was immense and weighed on all of us profoundly. But as you read this annual report, we invite you to pause for a moment and join us in celebrating the victories, big and small, that we achieved together. There are no easy or quick wins in human rights, and our battles are often fought over the course of decades.

In the coming year, your contributions will help us make an enduring impact across diverse regions, ensuring that we can advocate for the most vulnerable and foster positive change where it is needed most. Thank you for being the heart of our movement. Your belief in our work propels us forward, and we are truly grateful for your unwavering commitment to creating a world where human rights are upheld for all.  

With deepest thanks,  

Countering The Illegitimate Science That Masks Police Violence 

Physicians for Human Rights (PHR) has been at the forefront of efforts to expose and ban the baseless concept of “excited delirium,” recognizing its particular harm in cases involving law enforcement. “Excited delirium” has been described by proponents as a potentially fatal condition characterized by sudden aggression, high pain tolerance, extreme strength, and elevated temperature, often accompanied by drug use. The concept has been used to justify racialized police violence and absolve law enforcement officers for deaths of individuals in their custody. Our research concluded that “excited delirium” is not a valid medical diagnosis or cause of death yet has been disproportionately used by medical examiners and others to explain the deaths of Black men in police custody.

In our campaign to counter this pseudoscientific concept, 2023 was a watershed year. After tireless advocacy by PHR and partners, the American College of Emergency Physicians (ACEP) and National Association of Medical Examiners (NAME), the last two major U.S. medical associations supporting “excited delirium,” officially withdrew their endorsement of the medically baseless concept. ACEP and NAME recently joined the American Medical Association, American Psychiatric Association, American Academy of Emergency Medicine, American College of Medical Toxicology, and College of American Pathologists in disavowing the term. Following campaigning by PHR and partners, with particular champions in the family of Angelo Quinto, California became the first U.S. state to prohibit the use of the term “excited delirium” in death certificates, autopsy reports, police reports, and civil litigation. Colorado followed suit in 2024. Still, our work is not done. PHR is actively urging other states to follow California’s pioneering example by passing legislation to ban the use of “excited delirium” as a diagnosis and cause of death. Now that there is a medical consensus that “excited delirium” is an invalid concept, PHR will redouble efforts to educate physicians, law enforcement, attorneys, and others on the need to abolish “excited delirium” for good.

PHR’s Innovative Methods for Documenting Human Rights Violations

PHR continues to make strides with the use of MediCapt, our groundbreaking and Anthem Award-winning mobile application that enables secure and ethical documentation of medical evidence of sexual violence. This technology, which has been used in four hospitals in 2023, empowers health care professionals to collect, store, and share medical information while prioritizing the safety and well-being of survivors.

MediCapt is currently being deployed in the Democratic Republic of the Congo and Kenya – as of December 2023, we have 3,812 cases recorded on MediCapt for both the DRC and Kenya – and we are working toward scaling MediCapt across Kenya so that any survivor who experiences sexual violence in the country can access comprehensive forensic documentation services and ensure that evidence is available to pursue justice.  

A “simulated patient” research methodology equipped PHR and partner organizations to gather unprecedented information about the impacts of the Dobbs decision on the availability of abortion care in the United States. Following the U.S. Supreme Court overturn of Roe v. Wade, PHR and partners investigated the accessibility and quality of information related to emergency pregnancy care in the state of Oklahoma, where abortion bans had been implemented. The “simulated patient” approach involved research assistants posing as prospective patients and calling hospitals that provide prenatal and peripartum care across the state. The method aimed to replicate realistic interactions between patients and hospital staff, minimizing social desirability biases associated with self-reporting. The findings of this innovative research method have informed advocacy efforts, policy discussions, and, ultimately, the provision of emergency medical care for pregnant individuals in the challenging legal environment created by the recent abortion bans in Oklahoma. 

Exposing the Health and Human Rights Harms of Crowd-Control Weapons and other “Tools of Torture”  

In protests from Lima to Los Angeles to Lagos, rubber bullets, tear gas, and other dangerous crowd-control weapons have caused irreparable harm to the human body and to human rights. 

A 2023 investigation by Physicians for Human Rights (PHR) and partners revealed that more than 119,000 individuals have suffered injuries from chemical irritants like tear gas since 2015, and at least 2,190 people have been harmed by kinetic impact projectiles such as rubber bullets during global protests. Our study “Lethal in Disguise 2” stands as the most comprehensive research on crowd-control weapons to date and follows up on an earlier landmark report. In an era of global protest movements, the report unearthed new weapons used and new evidence of deaths, injuries and violations of freedom of assembly, association, and expression resulting from the abuse of crowd-control weapons. PHR has turned that research into action through leadership in the international campaign to adopt a legally binding Torture-Free Trade treaty. That campaign gained ground this year, with the UN being called on to end the use of inherently abusive weapons, such as multi-projectile kinetic impact projectiles. PHR’s advocacy has already contributed to improvements in law enforcement practices. Following a lawsuit which cited PHR’s research, the New York Police Department in 2023 banned kettling, a controversial crowd-control tactic that boxes in protestors, making them more vulnerable to harm. This victory manifests PHR’s commitment to reducing health and human rights harms by holding authorities accountable for abusive practices. 

Protecting the Right to Seek Asylum

In the face of unprecedented challenges to the right to seek asylum in the United States, Physicians for Human Rights (PHR) took action to safeguard and advance a secure, compassionate, and rights-centric asylum system.  

In the past 12 months, PHR has directly helped 730 individuals seeking asylum and other protections in the United States – including approximately 50 children – by connecting them with volunteer clinicians in our nationwide Asylum Network. Those clinicians conducted forensic medical evaluations that helped to corroborate accounts of their experiences for use as evidence in immigration court.

PHR has long been vocal in advocating for the rights and protection of people seeking asylum or other protection in the United States who have suffered harm through forced family separations. The Trump administration’s policy aimed to deter migrants from seeking asylum in the United States by systematically separating children from their parents, which PHR research showed to meet the UN criteria for torture. An estimated 4,500-5,000 children and their parents will be covered under a settlement deal reached between the lawyers representing asylum-seeking families and the U.S. Department of Justice regarding the forced family separations that occurred during the Trump administration. The long-awaited settlement permits these families to remain in the United States and apply for asylum, setting them on a path toward permanent legal residency.

In 2023 PHR helped 730 individuals seeking asylum and other protections in the United States. 

In February 2024 and in collaboration with Harvard Law School’s Immigration and Refugee Clinical Program and Harvard Medical School, PHR drew attention to the use of solitary confinement in U.S. Immigration and Customs Enforcement (ICE) facilities and called for the end to solitary confinement in ICE detention. Drawing on interviews with survivors of solitary confinement and extensive data gathered through Freedom of Information Act requests, the report offered critical insights into the often abusive and excessive deployment of solitary confinement within immigration detention.

As the report reveals, ICE oversaw more than 14,000 placements in solitary confinement between 2018 and 2023. Many people who are detained in solitary confinement have preexisting mental health conditions and other vulnerabilities. The average duration of solitary confinement is approximately one month, and some immigrants spend over two years in solitary confinement. Almost half of the ICE facilities with the lengthiest periods of solitary confinement detained people with mental health conditions and other vulnerabilities. Immigration detention facilities have also deviated from their intended purpose, becoming sites of discrimination and arbitrary punitive actions. Mistreatment of transgender immigrants, documented instances of discriminatory practices, and the arbitrary nature of punitive measures – such as placing individuals in solitary for minor infractions – cast a grim light on the treatment of people within these facilities. In many instances, such conditions would appear to meet the definition of torture, or cruel, inhuman, or degrading treatment under international human rights law. 

“Sometimes I feel like someone’s following me and I’m afraid they’ll take me to solitary confinement. Sometimes I’ll wake up and think that I’m in solitary confinement. I’ll have to look out of the window to remind myself I’m not there. I still have the same nightmares I did while in solitary confinement.”

33-year-old man, Caroline Detention Center, Bowling Green, VA

Tracking Attacks on Health Workers and Facilities in Ukraine  

Russia has carried out both targeted and indiscriminate attacks on Ukraine’s hospitals, doctors, and health infrastructure as a barbaric strategy of war. Physicians for Human Rights (PHR) and partner organizations have documented and condemned more than 1,350 attacks on health care facilities and personnel in Ukraine since February 2022, averaging almost two attacks per day. After Russia’s full-scale invasion in Ukraine in 2022, we quickly identified and cultivated Ukrainian and international partners and jointly researched and documented attacks on health in Ukraine. In 2023, we jointly published a report, “Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System,” to mark one year of the full-scale invasion. We also launched a map tracking attacks on health and we’ve continued to maintain and update it in the months since.

Our case study, “Coercion and Control: Ukraine’s Health Care System under Russian Occupation” documented ways in which Russian forces have used health care to enforce control over Ukraine’s civilian population, including by limiting and conditioning access to health care in Russian-occupied territories through a range of coercive practices. Ukrainian medical personnel face significant pressure as they are forced to work in occupied hospitals, compelled to operate under Russian law, face reprisals, pushed to undergo retraining in Russia, and replaced by Russian doctors. Hundreds of health care workers have been detained, arrested, tortured or otherwise persecuted by Russian forces. These attacks on Ukraine’s health care system likely constitute war crimes and potentially crimes against humanity. The apparent policy to attack the Ukrainian health system as a means of punishing the civilian population cannot be viewed in isolation as similarly unlawful practices by Russian forces were also documented by PHR in prior conflict theaters in Syria and Chechnya. We have been cooperating with accountability mechanisms and are working to transfer evidence over to them to support case-building and accountability. With the strong partnership we have forged with a coalition of Ukrainian human rights organizations, we have developed a range of activities to strengthen and support rigorous documentation of torture and other forms of violence for accountability mechanisms. 

Spotlighting The Harms of Abortion Bans 

Together with U.S. partners, Physicians for Human Rights (PHR) has helped bring to light the far-reaching health and human rights harms of the Dobbs decision on pregnant people and health care providers across the United States.  

Abortion bans have disrupted the practice of medicine in Texas, exacerbating pregnancy-related mortality and morbidity and straining access to maternal health care. PHR filed an amicus brief in 2023 that argued that the bans have created “maternity care deserts” across the state, forcing patients to travel at great cost or over great distances for care while in crisis and delaying necessary medical care at the risk to patients. The brief, which focused on the impossibility of practicing medicine under these bans, asks the Texas Supreme Court to uphold a lower court order preventing the prosecution of clinicians for using their good faith medical judgment in consultation with their patients to perform life or health-saving abortions in accordance with medical ethical guidelines. Zurawski v. State of Texas is the first lawsuit brought on behalf of individuals denied abortions since the U.S. Supreme Court overturned the constitutional right to abortion in June 2022.

“The Dobbs decision has placed a target on the backs of pregnant patients and health care providers. The criminalization of abortion in many U.S. states has resulted in health care workers being mandated to act in complicity with violations of their patients’ rights, or to face imprisonment, professional sanction, fines, or harassment.”  

Payal Shah, Director of the Program on Sexual Violence in Conflict Zones at Physicians for Human Rights 

PHR is also training and supporting clinicians across the country to speak out against human rights violations in the context of reproductive autonomy and health. We spotlight how antiabortion legislation has exacerbated “dual loyalty” challenges for clinicians across the country, trapping providers between the law and their patients’ health. By shedding light on the consequences of restrictive abortion laws, PHR advocates for reproductive rights and equitable access to health care. 

Documenting Widespread and Systematic Sexual Violence in Ethiopia  

Physicians for Human Rights (PHR) was instrumental in bringing to light widespread and systematic conflict-related sexual violence in the Tigray region of Ethiopia. PHR collaborated with the Organization for Justice and Accountability in the Horn of Africa to review hundreds of medical records of conflict-related sexual violence from multiple health facilities in Tigray, Ethiopia, between the start of the armed conflict in November 2020 and June 2023. The report revealed widespread and systematic acts of conflict-related sexual violence perpetrated by armed forces in Tigray, including the Eritrean and Ethiopian military, and ethnoregional militia groups. PHR’s research also showed that widespread conflict-related sexual violence continued despite the 2022 Cessation of Hostilities Agreement. PHR documented 128 cases of conflict-related sexual violence occurring after the signing of that agreement. The report emphasizes the urgent need for accountability and justice for war crimes and crimes against humanity in Ethiopia, access to immediate humanitarian support for survivors, and comprehensive support for their long term medical and psychosocial recovery. Through rigorous documentation and advocacy, PHR provided valuable medical evidence of the scale, scope, and impact of these human rights violations to the world. 

Expanding Our Global Impacts 

In the Democratic Republic of the Congo (DRC), where violence has shifted a very precarious security context into a deadly conflict crisis, intensified fighting has led to massive population displacement. Communities in the eastern region of the DRC, such as those in North Kivu, where Physicians for Human Rights (PHR) works, have been particularly affected by devastating levels of conflict-related sexual violence, including more than 90,000 reported cases in 2023 alone. To provide care to survivors of conflict-related sexual violence in North Kivu, PHR has partnered with clinicians at HEAL Africa, which serves as a one-stop center to provide medical, psychosocial, and legal support to the most vulnerable populations in the DRC. Working at the center of a crisis where access to health has been disrupted and other health facilities have become non-functional due to the conflict, HEAL Africa is a beacon of hope and healing for survivors of conflict.

In collaboration with the Iraqi Medical-Legal Directorate and Institutes, we finalized a newly designed Forensic Medical Form that reflects good practice for documenting torture and sexual violence. In 2023, PHR conducted training workshops on the new form with 86 forensic doctors from across Iraq, including the Kurdistan Region of Iraq.

To date, PHR has trained more than 1,750 professionals in the DRC to provide survivor-centered, trauma-informed care and strengthen investigations and prosecutions.

In the wake of Hamas’s brutal October 7th attacks on Israeli civilians and the taking of more than 200 hostages, and the devastating Israeli government reprisals on Gaza, PHR has urgently demanded the protection of healthcare facilities and ensuring civilians retain access to healthcare. Even in this highly polarizing conflict our central message remains clear that atrocities by one side do not justify atrocities by the other. All parties to the conflict must abide by international law and civilians must be protected. Violations must be investigated and perpetrators brought to justice. Our experience around the world clearly shows that only by establishing the truth and providing accountability under the law can we advance human dignity and improve lives around the world. 

To date, PHR has trained more than 1,750 professionals in the DRC to provide survivor-centered, trauma-informed care and strengthen investigations and prosecutions. In September, PHR’s Medical Director Michele Heisler led a training in Peru for forensic physicians working for accountability mechanisms to investigate the deaths and injuries from police and military officials during the protests in Peru between December 2022 through March 2023. 

Equipping Physicians to Advocate for Human Rights 

More than 125 people attended the 2023 National Student Conference at the University of Michigan Medical School. Attendees came from 16 states, 24 institutions, and a variety of disciplines, including medicine, social work, data science, nutrition, public health, law, global health, acupuncture, and engineering. PHR’s student program is comprised of over 90 chapters at leading universities around the globe. 

Financials

We Thank All Our Donors  

Our work at Physicians for Human Rights (PHR) is made possible through the generosity of individuals, families, foundations, governments, and corporations. We are grateful for your continued support and dedication. PHR applies strict accountability and transparency standards to its funding relationships. Every contribution counts. Thank you for supporting us in our vital work to defend human rights.  

Top photo: PHR partner Christine Matindi, Government Chemist Analyst, at a laboratory in Nairobi, Kenya. Matindi, who is a PHR Trainer of Trainers, supports PHR’s programming in Kenya as an expert and mentor to the professional networks that PHR has fostered to combat sexual violence. Photo: Adriane Ohanesian for PHR, 2018