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The Courage and Resilience of Kenyan Survivors of Sexual Violence

The Survivors of Sexual Violence in Kenya Network is a movement which builds survivors’ capacity for self-agency and offers them a unified voice with which to address all forms of sexual violence, to restore their dignity, and to amplify their message across Kenya. 

At its 2019 gala, PHR honored the Network with the Physicians for Human Rights Award, which was accepted by Network Co-head Jaqueline Mutere, a survivor of rape during Kenya’s 2007-2008 post-election violence.

Blog

How a Small Room in a Kenya Hospital Can Make a World of Difference for Young Survivors of Sexual Violence

I recently stopped by the child-friendly room to admire the wonderful work done by the artist who decorated the walls of the Gender Based Violence Recovery Centre (GBVRC) at the Rift Valley Provincial General Hospital in Nakuru.

In an adjacent waiting room, a toddler was crying and fussing, waiting to be seen by a clinician. He escaped his mother’s grasp and ran by me. Just as I opened the door to the room, he stopped mid-cry and his eyes lit up at the sight of the walls and colors! He turned to me excitedly and asked if he could sit in the room and play with the toys. This was the exact reaction that we had hoped the child-friendly space would elicit from the children seeking care and treatment at the GBVRC!

Sexual violence is a significant problem in Kenya that cuts across gender, geographical locations, economic status, and age. According to the Kenyan Demographic and Health Survey of 2014, 14 percent of women aged between 15 years and 49 years reported that they were victims of sexual violence. Statistics also show that in 2013, the Kenya National Police Service received 3596 cases of sexual violence meted upon children. These numbers have steadily increased in recent years.

Child survivors of sexual violence require unique care. At Rift Valley Provincial General Hospital, where nearly half of the survivors who showed up at the GBVRC in 2018 were under 17 years of age, Physicians for Human Rights works closely with the staff to ensure that they have the necessary knowledge, skills, and resources to attend to this vulnerable demographic.

It’s part of a two-year partnership with the Nakuru County Department of Health to improve Rift Valley Provincial General Hospital’s post-rape care, including building capacity for medical-legal examinations, evidence collection and documentation, and the provision of comprehensive care to survivors of sexual violence. By turning the hospital into a county-wide center of excellence, we and our partners are investing in our ultimate goal: increasing access to justice for survivors.

For many survivors, there are huge barriers to seeking care for sexual violence, let alone pursuing justice. The stigma that comes with being a survivor often deters people from reporting and seeking healthcare. If a survivor does manage to overcome this, they may then be forced to deal with untrained service providers and further risk re-traumatization. For the youngest children, there is also the fear that through collusion and the exchange of money, the case may be settled at the community level, without the child receiving appropriate care and access to justice. 

We and our partners at Nakuru worked hard to identify and address any barriers to care and treatment faced by survivors, all the while focusing on a survivor-centered approach: one that recognizes that each survivor has different needs and will require different resources and approaches to treatment and follow-up care.

With input from our medical experts, we set out to establish a safe and inclusive space that would provide a nurturing environment for vulnerable and at-risk children to access treatment and follow-up care. We wanted a setting that would support the recovery of children through structured activities conducted in a safe and stimulating environment, and that would facilitate their referral to other steps along the chain of justice, such as police, mental health, and legal aid professionals. Most importantly, we wanted to create a space for children to play and engage in other creative activities as a form of therapy to help them express and communicate their feelings.

We also embarked on a three-month training period for staff – many of whom had received prior training from PHR – that included a session on responding to child survivors of sexual violence. We worked with the hospital to develop a set of best practices for their systems and procedures. One of these protocols*  was designed to guide their responses to vulnerable populations – specifically children and adolescents. Finally, we looked at how to make the space function effectively and efficiently. One easy fix: stock it with supplies like stationary, toys, books, and other educational materials.

To further enrich the utility of the child-friendly space, PHR connected hospital staff with various child-protection partners in Nakuru County who would provide increased expertise for child therapy, supervision for the staff at the facility, clarity on reporting structures for minors, and a robust referral directory for child/adolescent needs.

Since its launch, the child-friendly space has received about 80 young patients. Our partners say that having this dedicated space has definitely had an impact on the experiences that the young survivors have when receiving treatment and counselling – most don’t want to leave! Combined with the knowledge the staff have gained, the room is drastically shifting the paradigm on what it means to offer post-rape care services to children in the region.

All the effort and thought we put into this process was definitely worth it. This became very clear to me when that young boy with teary eyes smiled up at me, as I welcomed him into the room.

*Special Considerations for Vulnerable Populations – Children and Adolescents

Blog

Face to Face with the Trauma of Asylum Seekers

The Honduran couple had fled their home just a few weeks earlier, racing to get away from the gang that had tormented them. As the woman’s partner told us about the horrific gang rape that she had survived, she did not speak. She only stared straight ahead and tore a Styrofoam cup into little pieces. Her pain was palpable.

I spend most of my work day screening requests for forensic evaluations from attorneys working with people, like this couple, who are desperately seeking safety from violence and persecution by applying for asylum in the United States. I also recruit volunteer clinicians from Physicians for Human Rights’ (PHR) Asylum Network to conduct these medical and psychological examinations. Forensic evaluations are integral to asylum applications: by corroborating a migrant’s story of physical and psychological trauma, they can persuade an asylum officer or immigration judge to approve a case.

I work with over 1,300 Asylum Network members throughout the country, but almost all my interactions with them take place via email or phone. It is very rare that I get to interact with the members in person. It is even rarer for me to directly interact with the asylum seekers themselves.

But on a recent trip to Tijuana, Mexico, I spent several days in migrant shelters speaking with asylum seekers about their journey to the border, the dangers and trauma they had fled back home, and their hopes of finding safety in the United States.

This one woman’s story deeply impacted me and reminded how personal this work is, how it affects lives, and can shape the trajectory of a person’s future. The PHR team learned from the woman’s partner that gang members in their home country wanted to retaliate against him for refusing to join the gang and pressure him to give in. Her gang rape was his punishment. The woman silently nodded along as her partner recounted the details of this traumatic event. I could feel how profoundly sad she was and continued to listen as my eyes teared up.

In the past year and a half working at PHR, I have coordinated more than 1,000 forensic evaluations for asylum seekers – but this time the asylum seeker was standing right in front of me. I knew that this family’s best chance for safety was to wait in Tijuana for weeks, or even months, hiding in their small tent in the shelter until the day the U.S. government allows them to present themselves at the border and make their case. Their greatest fear is to be returned to the very dangers they traveled thousands of miles to escape.

Those fears are well founded. Over the past several years, the United States has adopted increasingly restrictive border policies which prevent migrants from exercising their legal right to seek asylum. The medical community has been quick to respond. Over a year ago, I supported the establishment of the Los Angeles Human Rights Initiative and two other PHR partner clinics in Los Angeles and helped organize a training there to teach clinicians how to conduct forensic evaluations.

Now those same clinicians had joined PHR in Tijuana to carry out evaluations of asylum seekers, including the family from Honduras. With the medical evidence we gathered, we are advocating for an end to the harsh U.S. policies that victimize these already extremely vulnerable people.

We are continuing to train doctors at the border and in the interior of the United States to perform evaluations of asylum seekers, both those in detention and those living in the community. Just this past week, I helped organize a training in Houston with a new medical school partner attended by more than 120 health professionals. And we are continuing to conduct medical evidence-based research, which sheds light on the persecution asylum seekers have fled and the legitimacy of their asylum claims, as well as the harms arising from severe and punitive U.S. policies of apprehension and detention.

I often think about the survivor’s story that I heard in Tijuana, and the hundreds of others that I’ve come across while working with PHR. I think about the dangers these asylum seekers faced and the fear they felt. But most importantly, I think of the hope they keep alive. The hope that one day they will be safe and secure, despite all that they’ve endured.

Report

Intimidation and Persecution: Sudan’s Attacks on Peaceful Protesters and Physicians

Executive Summary

Since Sudanese protesters took to the streets in December 2018 to demonstrate against government corruption, economic mismanagement, and brutal repression, forces loyal to the government of President Omar al-Bashir have carried out massive violations of human rights. Peaceful protesters have been attacked by government security forces using disproportionate, unnecessary, and sometimes lethal force.[1] They have been arrested and detained without charges and denied access to their families or medical care. Government security forces and police have prevented medical personnel from attending to the wounded and, in many cases, have arrested and detained these personnel, conducted incursions and attacks inside medical facilities, and targeted, injured, and even killed health workers while they have been carrying out their medical duties or participating in the protest movement.[2]

To date, police and National Intelligence and Security Services forces have entered and conducted attacks on at least seven medical facilities, arrested at least 136 health personnel, fired teargas and other weapons into hospital wards, and closed access to medical care for patients.[3][4][5] At the time of publication, 60 protesters had been killed by government forces (one was a practicing doctor and two were medical students). Virtually all of these violations are explicitly prohibited by international law and by Sudanese national law. These incidents also have long-lasting impacts on health[6]: tear gas and rubber bullets have significant medical impacts and can cause permanent disability and even death; live ammunition utilized on this massive scale against crowds causes many injuries in addition to the deaths already reported, and the severe reduction in health care capacity from attacking hospitals and detaining and torturing doctors undermines the already strained Sudanese health care system.

By reviewing and confirming reliable on-the-ground reporting from contacts in Sudan and employing open-source investigation methodologies for verification, this report details these attacks. Based on the available information, Physicians for Human Rights (PHR) finds that the government of Sudan has used unnecessary and disproportionate force against its citizens, illegally attacked medical responders and facilities, and tortured detainees. This campaign of intimidation and persecution violates both national and international laws and interferes with basic norms of medical ethics and care for the wounded and sick. PHR calls on the government of Sudan to immediately cease attacks on medical personnel, release detainees being held without charge or trial for exercising their fundamental rights and ethical obligations, ensure basic protections for medical facilities, seek accountability for members of the government and security forces who have perpetrated these crimes, and demand justice for the victims. Additionally, PHR calls on UN member states, regional bodies, and the international medical community to press the government of Sudan to stop the violent suppression of dissent, to respect the ethical obligations of doctors and the sanctity of health facilities, and to hold the government of Sudan accountable for its human rights violations.

Background

Sudan has experienced an unprecedented series of social protests since December 19, 2018. In response to a chronically corrupt and repressive government and most recently triggered by rapidly rising food and fuel costs as well as the removal of subsidies for vital resources, tens of thousands of students, professionals, religious and community leaders, and workers across many fields have participated in largely peaceful marches and rallies.[7][8][9][10]Of note, it has been a deliberate decision of the movement to ensure that the protests are peaceful. Protesters have demanded better economic conditions and control of corruption and have called for the president of Sudan, Omar Hassan al-Bashir, to step down after 30 years of oppressive rule.[11] According to recent reports, the government has responded by shutting down social media access, closing newspaper offices, arresting and imprisoning scores of people, and attacking and killing more than 60 protesters.[12][13] On February 22, 2019, President al-Bashir announced a state of emergency, effectively dissolving federal and state governments and replacing civilian leadership with military leaders in an effort to end protests and regain authority.[14][15]

Physicians and other medical personnel have played an important role, speaking out in support of the rights of protesters and caring for the wounded.[2][16][17] Two of the leading medical associations in Sudan (Central Committee of Sudan Doctors and Sudan Doctors’ Syndicate) have joined together to form a consolidated office (along with the Consultants and Specialists Committee), which has taken a leading role in demanding change, bearing witness to the violence, and providing medical care.[18] Doctors have also been a part of the Sudanese Professionals Association to empower professionals who engage in the protests and calls for reform.[19][20]

News reports and direct communications note that medical personnel have been prevented from attending to the wounded and, in many cases, have been arrested and detained, or attacked inside medical facilities[17][18] and targeted for carrying out their duties.[2] National Intelligence and Security Services forces have entered medical facilities, arrested health professionals, fired tear gas and other weapons into hospital wards, and closed access to medical care for citizens.[3][4][5] Virtually all of these violations are explicitly prohibited by international law and by Sudanese national law.

Physicians for Human Rights (PHR) is working with our Sudanese colleagues to bring attention to the egregious violations of human rights of protesters in general, and the specific targeting of health care. PHR is deeply concerned that the government’s actions are having dramatic negative impacts on health, both in the short and long term.

This report addresses Sudan’s use of unnecessary and disproportionate force that endangers the health of peaceful protesters and the targeted attacks on health personnel who play an essential role in civil society.

Methodology

Physicians for Human Rights (PHR) sought to triangulate eyewitness accounts of attacks with reports from other witnesses, news reports and video footage, legal records, medical documentation, and other sources to produce sufficient data to make assessments. Data was compiled from direct communications with Sudanese medical organizations and their members as well as open-source videos and images. Direct communications with Sudanese physicians as well as expatriate Sudanese physicians living in North America included interviews of physicians who had participated in protests or cared for injured activists. In cases where physicians were injured or abused by government officials, PHR researchers attempted to obtain and analyze any available medical records to corroborate their reports.

Human Subjects Protections

Interviews were conducted using a range of security precautions and protections. For all interviews, the PHR team obtained informed oral consent from each interview subject following a detailed explanation of PHR, the purpose of the investigation, and the potential benefits and risks of participation. PHR researchers did not record subjects’ names, nor did they make audio or video recordings of these interviews. Participants could stop the interview at any time or refuse to answer any questions. Interviews were conducted in the language preferred by the respondent.

Interview methods were reviewed and exempted by the Ethical Review Board (ERB) at PHR based on Title 45 CFR Part 46 provisions, which are used by academic Institutional Review Boards.[21] All of PHR’s research and investigations involving human subjects must be reviewed by the ERB and conducted in accordance with the Declaration of Helsinki as revised in 2013.[22]

Limitations

Given that this data was primarily collected through secondary sources on an urgent basis in a volatile context, there are limitations in duration, scope, and access. The study covers events between December 19, 2018 and March 17, 2019. The scope of the investigation focuses on human rights violations of protesters and medical personnel. PHR’s analysis is based on data that was safely obtainable from Sudanese health professional colleagues and from open sources. The forced closure of newspapers, shutdown of social media channels, and limitation of access to information have significantly affected the availability of information on the protests, living conditions, and arrest details of the detained. Virtual private networks, however, have allowed citizens to share information. Notwithstanding these limitations, the evidence available and the trends noted have produced sufficient data to make informed conclusions and recommendations about alleged reports of human rights violations during the recent protests in Sudan.

Findings

Findings in this report focus on: reports of the use of disproportionate and/or unnecessary force; attacks on medical facilities; violations against medical personnel; and evidence of torture and abuse of activists as well as medical personnel.

Disproportionate and/or Unnecessary Use of Force in Protests

There are multiple reports of unnecessary, disproportionate, and improper use of force during the recent protests against peaceful and unarmed Sudanese protesters. This report highlights: information gathered from open sources; information gathered from protesters; and injuries from unnecessary and disproportionate use of force.

It is important to note that tear gas, rubber bullets, and other crowd-control weapons pose particular health risks to those with underlying medical conditions and may cause death in some cases.[6][23][24][25] Live ammunition can cause severe injuries to all body systems, in addition to death. Our findings also note the use of shotguns with solid metal pellets that project in an array. These weapons are particularly dangerous when used against crowds, where many people, including unintended targets and bystanders, can be hit simultaneously. Most international regulations [41] ban the use of live ammunition, shotguns, and metal-composition projectiles in these contexts.

Information Gathered from Open Sources

Physicians for Human Rights (PHR) researchers reviewed more than 50 videos and images of protests in several cities in Sudan to evaluate claims of attacks and corroborated this information with interviews with Sudanese physicians. These were just a fraction of the open-source media available online to illustrate the massive scale of human rights violations. Our open-source investigation team was able to collect media found in publicly available online resources, confirm the geographic location and time and date data, and verify them. These images were categorized as definite confirmations (multiple established sources, clear images, metadata available), probable confirmations (with fewer or less established sources or less clear images but still containing valuable data), or unconfirmed (initial or unestablished sources or unclear images). Based on the confirmed data, PHR identified the following incidents of serious concern:

  • Sudanese security and police deployed unnecessary, indiscriminate, and disproportionate force to repress protests and violate freedoms of assembly and speech.
  • Government security forces used weapons not appropriate for crowd control of peaceful protests, such as live ammunition and lead shot,  and used lethal force on unarmed civilian protesters without cause.
  • Uniformed and plain-clothed National Intelligence and Security Services (NISS) forces pulled civilians out of their homes in Khartoum, and beat many people with batons, dragging them to vans.
  • In districts of the greater Khartoum urban area such as Omdurman and al-Souq al-Arabi, security forces used tear gas and stun grenades. On an almost daily basis, they also simultaneously fired into crowds of protesters without any previous indication of violence or threats to public order and without any prior warning.
  • Uniformed and plain-clothed NISS forces fired live ammunition at protesters in the al-Souq al-Arabi, Nasir Extension, and Burri al-Daraisa districts of Khartoum.
  • Multiple images and videos show that this violent suppression of dissent inflicted traumatic injuries on protesters. These injuries include a man with extensive linear contusions and bruising on his back consistent with being beaten with a stick or baton and others with facial and body trauma consistent with shotgun injuries and contusions and burns on their face and arms from tear gas canisters.

The following case examples list open-source data that PHR used to triangulate initial reports of unnecessary and disproportionate use of force during protests.

Example 1: https://twitter.com/BenDoBrown/status/1087719227086262272

Both images and videos shared and verified on Twitter depict the tear gassing of peaceful protesters at the National University of Sudan. Footage and images, from a multitude of angles, show students chanting before tear gas appears into the frame, engulfing the students in smoke as they run away. Students are shown covering their mouths with their hands and coughing as they flee the area. The before and afterimages in the media show the use of tear gas directly toward and against peaceful protesters, constituting an unnecessary and disproportionate use of force by police and state security forces.

Example 2: https://twitter.com/BenDoBrown/status/1085908513778483200

This graphic footage, shared on Twitter, shows the brutal beatings and detention of protesters outside their homes in the Shambat district of Khartoum. This video illustrates the excessive use of force by President Bashir’s security and police forces.

Example 3: https://twitter.com/Spestian_MG/status/1086284730465767426

This verified video shows state security forces firing ammunition at protesters from pick-up trucks.


Information Gathered from Protesters

One witness told PHR of the terror he felt when NISS forces attacked a peaceful protest in Khartoum in which he was taking part. “On December 25, a central protest was taking place downtown…. When the NISS started firing tear gas, about 800 of us divided off and went off on a different route. NISS was chasing us with live fire into the air. We had to go into a parking structure with one big door. Then, the armed forces started firing tear gas inside. We had to jump between different houses and buildings to get away. I and two other protesters ended up in a small hotel. We found six other protesters already there. The total ended up being 15. Then we heard the armed forces following us. I and another person had to hide under a bed. Then, we heard that the rest were arrested. They were shouting at us and arresting the rest.”

Another noted that the use of tear gas is frequent: “In the seven protests that I’ve attended, I’ve felt tear gas in every one of the seven. When we get just tear gas, we just are thankful that it wasn’t something else. That is a lucky day.”

One witness said: “I myself that day saw many, many, many situation of violence. We [were] hit multiple times by tear gas and stun guns…. A lot of tear gas. Heavy tear gas. They may even shoot it inside the building. Just everywhere. Inside the building, inside the house, you don’t know where it will land.”

The witnesses also noted that live ammunition and shotguns were being used more often in the early weeks of the protests. “Now, they are just shooting live ammunition into the air. I didn’t see a lot of injured protesters as much in the past month. Different tactics are being used.” Another witness confirmed that “Since mid-January, you haven’t really heard live ammunition. But, I have experienced tear gas in every single protest I have participated in.” Regarding new tactics, the witness noted that “At first, they use tear gas during a live gathering even when it was peaceful. We made a decision to be very careful to be peaceful. After that, they go to the gathering points that are announced before. They even start firing tear gas before the gathering gets started. If the protest is scheduled at 1 p.m., they will start firing tear gas in that area at 12:45 just to prevent it.”

Injuries from Unnecessary and Disproportionate Use of Force

“He was shot by live ammunition and was immediately unconscious. I saw this patient. The bullet was in his brain through his eye.”

A Sudanese doctor who attended to a student killed during protests

Interviews conducted by PHR with Sudanese physicians confirm the use of unnecessary and disproportionate force by government security forces. One witness recalls that he saw 15 patients in one day. “The majority of the cases were live ammunition – five to six – then four to five [cases] of rubber bullets and a few tear gas cases.… One protester was shot by a bullet which caused a pneumothorax (collapsed lung). But we believe that was a rubber bullet. There was another case that they shot a [shotgun]. When they wanted to examine the patient, he had multiple shots all over his body that were bleeding. They penetrated. The rubber bullets mostly caused some superficial wounds but the shotgun wounds, they would penetrate deep.”

On January 17, 2019, an electrical engineering student named El Fatih Omer was killed during the protests. He was participating in the protests when he was shot in the eye and was brought, unconscious, to a makeshift clinic. The doctors who received him assessed that the bullet was life threatening and immediately took him to a hospital where he survived for four days before dying. A witness confirmed to PHR that Omer was killed by live ammunition: “He was shot by live ammunition and was immediately unconscious. I saw this patient. The bullet was in his brain through his eye.”

A second doctor interviewed by PHR had attempted to attend Omer’s funeral at his home. This witness recalled that “after his death, we went to his family’s house. They fired tear gas into the family’s house in Omdurman when we gathered in his house. There were a lot of people, maybe 400-500, not all of them are protesters. It is just a culture in Sudan that family and neighbors and relatives gather. They were not all protesters. They fired tear gas into us. It was peaceful. We all ran into the neighbor’s houses. I felt the tear gas that day.”

Based on PHR’s interviews, there are also many highly credible reports of tear gas canisters being aimed directly at protesters, and reports of many wounds caused not by bullets (rubber of otherwise) but by the metal tear gas canisters themselves.


“They hit me in over 100 spots.”

PHR interviewed one witness who was beaten during a protest and sustained a debilitating hand fracture. He described that during one of the protests in which he was peacefully protesting, National Intelligence and Security Services (NISS) forces came and started firing tear gas into a crowd. The group of protesters that he was with then dispersed and went in different directions. He was running with a small group of about 10 people when a woman next to him tripped and fell. He instinctively stopped to help her up when he was caught by the NISS.

He recalled that “then they caught up to me and began beating me viciously. They were using hoses, black hoses, to beat me that were coated in the inside with a hard material. At first, they hit me in the head, which caused me to fall directly on the floor and so I got cut and bled. Five people ganged up on me. These five are said to be the police for crowd control but they themselves are from the NISS. They were beating me severely and I begged them to stop. One officer began to reprimand me strongly. He told one of the others to grab me and make sure that I didn’t get away and then they took me to their Toyota car. When I got there, there were three other cars each with seven to eight people who are wearing different uniforms but spoke to each other in the same way, and they seemed to be familiar with each other and they followed the same directions.

As soon as they saw me being taken by the others they said ‘Oh, I see you guys got this guy’ as if they just trapped a new catch. They also began to beat me and shout to get in the truck quickly. They then took me to the spot where they keep the captured. They hit me in over 100 spots.… One remarked that he should cut off my legs so that I knew not to go to the protests again. After that when they make you get in the car, they tell you to put your head down, so you don’t see where we are going. They also told me to close my eyes, they took me to this place, when I arrived … it took about a quarter of an hour … I didn’t know where they took me exactly, but I knew it was a national security building. When I arrived, I had many cuts and was bleeding heavily. I was released many hours later and went to the hospital, where I found that my XXXX [redacted for security] was broken.”

PHR forensic experts have reviewed this witness’s medical files, including X-rays, and confirm the injuries he described – which are consistent with his report of being beaten with blunt objects – and that he has sustained debilitating fractures consistent with the manner that he reported.

Attacks on Medical Facilities

PHR has collected data on attacks on medical facilities during and after protests based on reports from Sudanese medical colleagues and corroborated with open-source data. Attacks on medical facilities impose critical health risks in both the long and short term. Tear gas and other chemicals can contaminate the hospital environment, especially injuring those with existing illnesses and injuries. Exposure to tear gas in closed indoor environments extends exposure time and dose, exacerbating their effects, particularly on people who are not able to walk and/or escape. These chemicals also pose longer-term health risks for patients and medical personnel that work or are being cared for in these contaminated spaces. In the long term, attacks on facilities can erode trust in the health system and intimidate people from accessing necessary health services. PHR’s previous research into crowd-control weapons and their health impacts[6] illustrates that, far from being benign, these weapons impose heavy short- and long-term burdens on patients, health workers, and the health system as a whole.

PHR has identified at least seven incidents that support allegations of multiple intentional attacks on Sudanese medical facilities:

Omdurman Hospital (January 9, 2019)
Multiple verified and geolocated videos and images from various individuals illustrate that uniformed NISS forces entered hospital premises, shooting from rifles into the hospital and then entering the facility. They fired tear gas and other weapons into medical wards and then stood outside and arrested medical personnel that evacuated the building. The videos show that at least one ward of the hospital was filled with tear gas, causing chaos as personnel tried to open windows, release oxygen tanks to dilute the gas, and evacuate patients.

Al-Arbaeen Specialized Hospital (January 9, 2019)
Although the exact sequence of events is unclear from the media provided, videos show that glass doors and windows facing steps (presumably the entrance to the hospital) were broken, with glass shattered in the entrance way. Security forces were not visible in the videos. Patients and families were evacuated in the aftermath of the attack and some appear to be suffering from tear gas effects (tearing of the eyes and redness and inflammation of the skin).

Bahri Hospital (January 13, 2019)
Sources reported that the hospital was attacked on January 13. No other data was available at the time of this report.

Madani General Hospital (January 13, 2019)
Sources reported that the hospital was attacked. No other details were available at the time of this report.

Al-Faisal Hospital (January 17, 2019)
Sources reported that NISS forces entered the hospital and fired tear gas. At least one doctor was arrested and taken away.

Haj al-Safi Hospital (January 2019, exact date unverified)
Sources describe NISS forces firing tear gas and ammunition inside the Haj al-Safi Hospital. One report notes that plain-clothes officers are stationed inside the hospital. This incident was also reported by the United Nations Office of the High Commissioner for Human Rights.

“I know that if a doctor gets arrested, they will be detained for a long time. I’m afraid of being a doctor in Sudan. We are all afraid.”

A Sudanese doctor 

Violations Against Medical Personnel

PHR has communicated with colleagues in Sudan and elsewhere to compile accounts of the targeting of medical personnel and to detail incidents of their arrests and/or detentions since the beginning of the protests. Some, but not all, of these medical professionals were noted to have been involved in the care of protesters, to have made statements supporting the protest movement, or simply to have participated in protests along with other professionals and community members. Based on communication with local sources, at least 136 physicians have been arrested and detained. Doctors were arrested while participating in protests, while working in hospitals or clinics, and in their homes.

Interviews with Sudanese physicians noted that doctors are being directly and intentionally targeted by government forces as a form of intimidation because “they hate us so much. They blame us for the revolution.” Another doctor stated that he takes explicit measures to avoid being targeted as a physician: “It is important that when attending the protest you leave your identification papers or documents far away and even your phone.” A third doctor stressed the point that “I just know that being arrested as a doctor, you will be treated very differently from others…. They do not release doctors. We are more exposed to violence and assault…. This regime believes that doctors have a major role in leading the protests.” Another reported the intimidation he feels as a result of what has happened when his medical colleagues have been targeted: “I know that if a doctor gets arrested, they will be detained for a long time. I’m afraid of being a doctor in Sudan. We are all afraid.”

Violations reported by PHR take the form of specific attacks on physicians as well as general incidents of intimidation, persecution, and violence against medical personnel.

Specific Attacks on Physicians

“They killed him for doing his job, for just helping others.”

A colleague of Dr. Babiker Abdul Hamid, who was shot in the chest and killed while attending to injured protesters
  • In one widely reported incident during the January 17 protests, a physician, Dr. Babiker Abdul Hamid, was killed while attending to an injured protester and urging the security forces to help the victim. Police reportedly shot the medical responder in the chest with a shotgun.[17][26][27] Dr. Babiker had helped set up an ad hoc field emergency hospital in a small school just adjacent to the protest site. While the clinicians were working, a witness told PHR that NISS members in plain clothes were shooting guns in the air and making noise outside, demanding that the doctors evacuate and bring out the injured protesters. Dr. Babiker went outside to urge the NISS to retreat, stating that those inside were injured and that the doctors were just trying to help. He was shot directly in the chest and died soon thereafter. Of note, PHR has assessed Dr. Babiker’s post-mortem records and attests that shotgun pellets were widely dispersed in his body.

    The witness told PHR: “That day, I remember well, because there was a group of doctors that was helping the injured protesters. They were there without any sort of arrangements. I just found myself among other doctors that were helping. We made a makeshift clinic in a small elementary school. We had referral IV lines, normal saline, gauze, and basic supplies. We just treated what we could do. There were 10-20 people injured who were affected by live ammunition, rubber bullets, and tear gas. We would do the basic stuff and then transfer to the hospital once they were stabilized. It was very scary. The NISS were surrounding the school.” Of Dr. Babiker, the witness said: “They killed him for doing his job, for just helping others.” Another witness confirmed that “He said he was a doctor and he was shot point blank.”

Dr. Babiker went outside to urge the NISS to retreat, stating that those inside were injured and that the doctors were just trying to help. He was shot directly in the chest and died soon thereafter. PHR has assessed Dr. Babiker’s post-mortem records and attests that shotgun pellets were widely dispersed in his body.

  • In another case, a physician was physically assaulted by security forces in his home and suffered a broken femur (thigh bone) during his arrest. It is important to note that femur fractures require significant force and are rarely the result of accidental trauma in adults. PHR was not able to review the images as the patient is still in detention.
  • On March 2, 2019, Dr. Mohammed Abdulkareem Mohammed Abdulraheem, assistant professor at the al-Zaeem al-Azhari University, was sentenced to three years by the emergency courts on February 28, 2019 and moved to al-Huda prison to serve his sentence. He was convicted of disrupting public order and is the first doctor to be sentenced under state of emergency laws. He was later acquitted on appeal.
  • PHR has confirmed reports that on January 25, 2019, Dr. Shihabeldin Ibrahim, a general practitioner in el-Obeid, was targeted by security forces for participation in the protest movement and aiding injured protesters. NISS forces had attacked him at his own home, beaten him, and taken him to security facilities (colloquially known as the “fridge” for the exposure to very cold temperatures there as a form of torture). After repeated requests by his family, Dr. Ibrahim was allowed to be visited by his family after about 40 days in detention. According to a source interviewed by PHR, he appeared unwell and had been tortured into signing an affidavit, admitting to alleged crimes he did not commit. As of this report, he has been held in detention without any formal charges and without being guaranteed his rights to legal representation or freedom from torture and abuse.
  • Dr. Mohamed Naji al-Assam was the spokesperson of the Sudanese Professionals Association (SPA). He appeared in a live stream video denouncing the government and was a leader of the protest movement. He was arrested in Bahri town, where he was seeking refuge, when his apartment was raided. NISS tortured and interrogated Dr. al-Assam, seeking information about the SPA and its members. After six weeks in custody, Dr. al-Assam’s family was briefly allowed to visit him and found him psychosocially impacted and physically diminished. He remains in detention, and his family has not been able to visit him again.
  • On January 28, Dr. Ali Ahmed Mohamed Matar was seeking refuge in a hotel room when he was arrested by the NISS. He remains in detention. Reports from now-released detainees describe that he was tortured and forced to confess to being an atheist and communist. They describe hearing him screaming and crying for several days. He was later moved to a more secret detention facility where his lawyers and family have not been able to visit him.
  • PHR has identified that detainess have had urgent medical needs that are not being provided for.

One of these cases concerns Dr. Muaz Faisal, an obstetrician who was arrested during a silent protest on January 29 in Port Sudan. According to a witness interviewed by PHR, Dr. Faisal was being targeted for his participation in the protests in el-Obeid in Sudan’s North Kordofan region. NISS forces allegedly made death threats, after which Dr. Faisal fled his home and went to Port Sudan City, where he stayed with friends. The security forces tracked him and two friends down and entered the complex where he was staying. According to the witness, “Dr. Faisal saw the NISS officers in uniform approaching the complex where they were staying. Then he jumped from the balcony of the second floor after security forces fired live ammunition to break the door of the apartment (the team was 10 agents, all of them had guns). He jumped from the second floor in order to save his life and call for help to save the life of his friend, but in vain. He jumped and broke his right leg.”

The witness related that Dr. Faisal sustained a compound leg fracture that was reset at Port Sudan Hospital. He was transferred a few days later to al-Amal Hospital in Khartoum (administered by the NISS), where contacts have confirmed that he has been detained, essentially in solitary confinement, in a dark room with poor ventilation. Dr. Faisal’s medical condition is poor. He cannot move independently and was not provided with any physical therapy or crutches during six weeks of detention. According to the Sudan Doctors’ Syndicate, X-rays repeated at Dr. Faisal’s insistence reveal poor fracture healing. Given his poor nutrition, psychological stress of isolation, and lack of proper treatment, Dr. Faisal’s health deteriorated significantly. He remained in hospital solitary detention until March 15, when a local association reports that he was released from detention.

General Incidents of Intimidation, Persecution, and Violence against Medical Personnel

“When they arrest anyone, they ask what they do. If you say doctor, or if they find out you are … then you are arrested at least for one month. When they get arrested, they usually undergo solitary detention and psychological abuse.”

A Sudanese doctor who witnessed attacks on medical personnel

In addition to corroborating incidents of violence against individual doctors, PHR has verified that Sudanese doctors are being targeted in all facets of their lives and their work. The following incidents indicate the scope of the persecution as well as the resilience of the doctors.

Large-scale Attacks
A dormitory housing resident physicians was invaded by the security forces at 10 p.m. on February 22. Some 56 physicians-in-training were arrested by security forces, who entered the building carrying rifles and tear gas. Some of the physicians tried to run away and were injured. Among these, one man fell from a second story balcony and fractured his spine. He was taken to a nearby hospital and treated after his arrest, and was then sent to another town, where his colleagues have not been able to meet with him. A doctor interviewed by PHR confirmed the incident, saying his friend had broken his L2 vertebra. Most of the other doctors were taken to a detention facility and kept overnight without being charged before being released the next day. Witnesses told PHR that “it was terrifying” and that “if they know you are a doctor, they won’t let you alone.”

Extended Detention and Torture
Fifteen physicians remained in detention at the time of publication. Information on the circumstances of detention or treatment in custody of these physicians is limited, but Sudanese colleagues report that doctors are kept separate from the general population. Reports from Sudanese colleagues also note that physicians are being kept in facilities separate from the other protesters and have been denied any due process or contacts with legal representation or their families. Witnesses report that physicians are specifically abused while in detention and are detained for longer than other protesters: “I know that if a doctor gets arrested, they will be detained for a long time.”

Targeting of Physicians
Witnesses noted that physicians are specifically targeted during protests, in their homes, and in their places of work. Many doctors said that they do not carry any identification or even a cell phone when they attend protests or go outside. “They may arrest you. A lot of people tell us not to take any identity. I was stopped multiple times. I just say I’m a student.” Another witness noted that “the regime militias and armed forces and police men are focused on doctors. They know that the doctors are contributing a lot to SPA (Sudanese Professionals Association), which is leading the revolutions. When they arrest anyone, they ask what they do. If you say doctor, or if they find out you are [a doctor] from your [identification card], then you are arrested at least for one month. When they get arrested, they usually undergo solitary detention and psychological abuse.” Despite this, many doctors still participate in the protests. One stated that “if I am completely honest, every time I participated, I was terrified that something would happen to me because I’m a doctor. But I didn’t want to be selfish. I wanted to participate because I believed in what’s right for my country.”

Workplace Intimidation
Physicians have also experienced threats, intimidation, and other extreme pressures in their work places. One witness noted that in Khartoum and many other cities, doctors are striking from working in government-run outpatient clinics. However, they still have strong obligations to their communities, so they are seeing their patients in private clinics, hospital wards, offices, and emergency rooms. In response, the government is threatening them with arrest, canceling their opportunity to use their medical work as their military service (Sudan has compulsory military service), and not paying them wages or denying them access to training and education. One witness stated that “a lot of doctors have stopped getting paid.”

These findings indicate that Sudan is violating the basic civil rights of Sudanese physicians, including freedom of expression, freedom of assembly, the right to liberty, and the right to a fair trial. The government is also restricting heath access to people who depend on these medical personnel. Specifically, there is evidence that security forces are:

  • Targeting doctors involved in the protest movement and those who have voiced support for activists with detention, beatings, intimidation, and, in a few cases, shooting and death;
  • Carrying out a campaign of persecution and intimidation of medical personnel and other professionals with arbitrary arrests, identification checks, and attacks on facilities and places of residence;
  • Preventing doctors and other medical personnel from carrying out their duties in medical facilities, their clinics, and their offices by attacking facilities, withholding income, and threatening to renege on obligations to educate and support trainees;
  • Illegally detaining and torturing medical personnel and preventing due process, access to legal representation, family visitation, or medical care.

The attacks on medical facilities, doctors, and patients represent an egregious violation of human rights when health care is most needed in Sudan. PHR’s analysis of video and clinical images and direct communication with medical colleagues in Sudan make it clear that medical personnel are being deliberately intimidated and persecuted. Importantly, detaining medical personnel has the compounded effect of preventing them from caring for the wounded and sick, thus expanding the impact of these attacks to entire communities. There is also the potential for long-term impact on health facilities that may be contaminated by chemicals from the attacks, eroding the sanctity of medical care and preventing patients from accessing medical care.

“Every time I participated, I was terrified that something would happen to me because I’m a doctor.”

A Sudanese doctor who took part in protests

Torture and Other Abuses

Little is known of the detention conditions of doctors, especially those who have been arrested in the current crisis. However, years of human rights reporting by PHR in Sudan has revealed the extensive use of torture and other human rights violations in Sudan’s prisons and detention centers.[28][29][30][31][32][33][34][35] PHR’s witnesses confirm that physicians are being targeted in this manner: “We have heard details from our colleagues who were released. There is solitary detention and psychological and physical abuse. Doctors are kept in a very dark room where they don’t know the time. Or they are kept in a very cold room with AC on all the time and there is nothing to keep warm. Or one advertisement is played on the channel over and over again without the detainee knowing the time. It is physical and mental torture.”

PHR has assessed several cases of torture and ill-treatment among recent detainees.

  • One physician was reportedly tortured while in detention, resulting in vision and hearing loss and severe motor disability. He now reportedly requires assistance by the other detainees to stand or walk.
  • Another physician was undergoing chemotherapy for a malignancy but has been denied any care while in detention, seriously disrupting his treatment plan.
  • A witness reports that many of his colleagues who were detained have been terrorized by the torture. “One friend got caught December 24 and released one month later. He hasn’t gone again for a protest. He’s very afraid now and very cautious. They destroyed him totally.”
  • Another witness reported: “I know many people who tell stories of being tortured by electricity, beatings, and mental torture. They are people I know.”

Legal Standards

Sudan’s International Human Rights Obligations

The government of Sudan is a signatory to major human rights treaties, including as a State party to the International Covenant on Civil and Political Rights (ICCPR),[36] the International Covenant on Economic, Social and Cultural Rights (ICESCR),[37] the African Charter on Human and Peoples’ Rights[38] (all since 1986) as well as the Declaration of Alma Ata(1978).[39] As Sudan is a member of the United Nations, all operations of law enforcement officials in Sudan should comply with relevant international standards, including the Code of Conduct for Law Enforcement Officials (General Assembly resolution 34/169)(1979)[40] and the Basic Principles on the Use of Force and Firearms by Law Enforcement Officials (BPUFF) (1990).[41] Furthermore, the Rome Statute of the International Criminal Court includes imprisonment and other severe deprivations of physical liberty (Article 7.1.e), persecution (Article 7.1.h), enforced disappearance of persons (Article7.1.i), and other inhumane acts (Article 7.1.k) as crimes against humanity punishable by the International Criminal Court (ICC).[42] Although Sudan is not formally a party to the Rome Statute establishing the ICC, the Court may have jurisdiction to investigate and prosecute acts that may amount to crimes against humanity under international criminal law.

Sudan’s National Human Rights Obligations

Sudan’s national laws also establish some basic tenets of civil rights but are deeply problematic in allowing broad powers to military and police security forces.[43] The Interim National Constitution (INC) of the Republic of Sudan (2005) sets out fundamental principles protecting human dignity (Article 28), equality (Article 31), due process (Articles 34 and 35), assembly (Article 40), expression (Article 39), and public health (Articles 19 and 46). Importantly, Article 27(3) of the INC makes international treaties to which Sudan is a party an integral part of the Bill of Rights. Sudan’s Criminal Procedure Code (1991) provides for some rights, but there are no adequate custodial safeguards against arbitrary detention and torture.[44] The rights and safeguards enshrined in these documents have not been effectively implemented in practice. Rather, the National Security Act (2010) effectively promotes impunity for the National Intelligence and Security Service by giving immunity from prosecution for all crimes committed by its personnel in the course of their work.[45] Immunity is conditional and can be lifted by the head of security; but there is virtually no practice to that effect. This immunity provision has been repeatedly criticized by human rights treaty bodies. The NSA also does not guarantee the right to legal representation or medical care nor provide for habeas corpus.[29][33] In practice, Sudan’s national legal rights framework actively facilitates human rights violations and protects perpetrators.

Relevant Legal Standards on Use of Force and Protection of Civilian Rights

With regard to the use of force in law enforcement situations, the BPUFF has set out clear guidelines. They require that security forces shall as far as possible apply nonviolent means before resorting to the use of force. Whenever the lawful use of force is unavoidable to protect civilians from violence or other threats to their safety, health, or livelihood, the authorities should use restraint and act in proportion to the seriousness of the offense. Unequivocally, these weapons are not permitted to disperse peaceful protests for political means. Lethal force may only be used when strictly unavoidable to protect life. The BPUFF principles dictate that exceptional circumstances, such as internal political instability or any other public emergency, may not be invoked to justify any departure from the BPUFF. Furthermore, governments shall ensure that arbitrary or abusive use of force and firearms by law enforcement officials is punished as a criminal offense. Sudan’s Interim Constitution guarantees the rights to peaceful assembly and expression (Articles 39 and 40).

Relevant Legal Standards on the Protection of Medical Care

Specifically related to medical care, doctors and other medical personnel have mandatory ethical obligations to prevent illness and care for the sick and wounded, regardless of political affiliation, race, or religion.[46][47] The World Medical Association’s International Code of Medical Ethics and the Medical Ethics Manual describe the duties of physicians, which include administering emergency care and adhering to principles of non-discrimination.[48] Medical personnel have a duty to care for the sick and wounded, both inside medical facilities and outside facilities, when they respond to public emergencies. They must adhere to principles of nondiscrimination in triaging and caring for the sick and wounded.

Governments, in turn, are required to protect health workers’ independence and support their crucial role in civil society to impartially heal the sick and treat the injured. International law dictates that medical facilities and transports, as well as personnel and patients, be free from any infringements on their rights.[49] Specifically, attacks on or interference in the functioning of medical facilities and transports are strictly prohibited. Medical facilities must be protected from violence, attacks, or any other interference with providing their essential functions.[49][50][51] The sick and wounded are, at a minimum, afforded unhindered and nondiscriminatory access to medical care.[51][52] Furthermore, medical personnel are often particularly visible in society, by their dress and equipment and their obligation to care for the sick and wounded, wherever they may be. Governments may not target or punish those who seek to uphold their internationally recognized responsibilities.[51]

These principles are codified in international human rights instruments (including the ICCPR, ICESCR, and the Declaration of Alma Ata), as well as international manuals on health care principles and codes of ethics. While general principles of protection of medical personnel and facilities, set out in Common Article III of the Geneva Conventions, specifically apply to cases of armed conflict, certain minimum provisions apply at all times. Specifically, provisions that “the wounded and sick shall be collected and cared for” and all persons must “be treated humanely, without any adverse distinction founded on race, color, religion or faith, sex, birth or wealth, or any other similar criteria,” must be upheld according to customary international law, even in times of civil or political unrest without explicit armed conflict.[51] Furthermore, Sudan’s Interim Constitution specifically obliges the government to protect health in Article 19: “The State shall promote public health and guarantee equal access and free primary health care to all citizens.”[53] And in Article 46, Sudan obliges the government to affirmatively provide for health: “The State shall promote public health, establish, rehabilitate,[and] develop basic medical and diagnostic institutions, provide free primary health care and emergency services for all citizens.”[53] Certainly, attacking hospitals and making them harmful to the sick and wounded as well as to the hospital staff would be in clear violation of these principles. Violence against unarmed civilians and the targeting of health workers may also be in breach of international criminal law, subject to investigation by the ICC.[42]

Relevant Law on Torture and Cruel, Inhuman, and Degrading Treatment

Torture and other cruel, inhuman, and degrading treatment or punishment violate human dignity and are absolutely prohibited at all times and under all circumstances. Torture is the intentional infliction of severe mental or physical pain or suffering, by or with the acquiescence of state officials. Sudan ratified the ICCPR in 1986.[36] Article 7 of the ICCPR prohibits both torture and cruel, inhuman, or degrading treatment or punishment. The Human Rights Committee established by the ICCPR has affirmed that no derogation is permitted, even in situations of public emergency, and that no justifications, such as those based on orders from a superior officer, can be invoked to excuse violations.[54] Article 10, paragraph 1, of the ICCPR also states that “All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person.”[36]

Furthermore, the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT)[55] defines and explicitly prohibits torture and other cruel, inhuman, or degrading treatment. Sudan signed the UNCAT in 1986 but it has yet to ratify it more than 30 years later. As part of international customary law, torture is banned regardless of the explicit ratification of the treaty into Sudanese law. Like the ICCPR, the UNCAT states that these prohibitions are absolute; no emergency or exceptional circumstance can justify their use. In the periodic reviews of its human rights record by the UN Human Rights Council, the Sudanese government has been considering recommendations to ratify the UNCAT. In 2017, the government stated that it was taking steps to do so.

Sudanese national law explicitly bans torture, stating in Article 33 of the Interim National Constitution of the Republic of Sudan (2005) that: “No person shall be subjected to torture or to cruel, inhuman or degrading treatment.”[53]. Of note, Sudanese law left out the term “punishment” to make an exception for Sharia law.

Despite these legal obligations, there is overwhelming evidence that the government of Sudan has been engaging repeatedly in torture.[30][32][35][43][56][57][58][59][60] Over the years, human rights advocates have reported on torture and voiced deep concerns with detention and imprisonment in Sudan, and the UN has highlighted “pervasive” torture and other human rights abuses in Sudan.[29][33][61][62]

Conclusion

“What’s happening in Sudan is a total disaster. There are killings every day. There is no freedom of speech. There is no democracy…. The regime is using all its armed forces to stay in power, and forgetting what’s important, including health and education.”

A Sudanese physician who witnessed attacks on protesters

The findings of this study indicate that the government of Sudan is violating human rights on a massive scale. The National Intelligence and Security Services (NISS) personnel and their adjuncts are using unnecessary and disproportionate force against citizens, targeting medical personnel and facilities, and torturing protesters and medical personnel in detention. Together, these actions violate both national and international laws as well as basic norms of medical ethics and care for the sick and wounded. Despite methodological limitations, these findings provide compelling evidence of ongoing abuses in Sudan.

This study provides evidence that Sudanese security forces have used tear gas, shotgun pellets, and live ammunition to break up peaceful protests and terrorize protesters into leaving the streets. Of note, shotgun pellets are not considered appropriate for crowd control, as they are highly penetrative and indiscriminate and cause significant injury. In 60 cases, as of publication of this report, Sudanese protesters have died as a direct result of what should be safe use of crowd-control weapons. State security forces have beaten and detained hundreds of individuals, both during the protests and in their homes, for speaking out against the government. As one witness stated, “You cannot be safe even inside your home. You cannot imagine what is going on in Sudan unless you live here, it is something very difficult.”

Medical facilities and personnel are both particularly vulnerable and essential during times of social upheaval. They represent a safety net that is obligated to support the community and treat all wounded and sick individuals, regardless of their affiliations; this duty by necessity places medical professionals in the front lines of conflict and human suffering. Physicians and other medical personnel in Sudan have been arrested and detained in the course or exercising their basic civil and human rights: speaking out against government abuse, organizing marches, announcing their willingness to treat all people, and fulfilling their obligations to provide medical care both inside and outside medical facilities. Fifteen of these medical professionals are still detained in unknown conditions. There is concern that Sudan is utilizing a “catch and release” strategy in arresting and detaining medical personnel, abusing them, and then releasing them, only to arrest others. This revolving door of intimidation aims to prevent physicians from participating in the protests or care of protesters, but also serves to decrease vital health care capacity, erode trust in the safety of health institutions, and weaken health systems in the short and long term.

President Omar Hassan Ahmad al-Bashir, the only sitting head of state indicted for war crimes, crimes against humanity, and genocide by the International Criminal Court (in the context of crimes perpetrated in Sudan’s Darfur region), has consistently demonstrated contempt for human rights. For years, evidence of abuses carried out by the security forces, particularly the NISS, at the behest of the president has been reported by numerous human rights groups.[63] Brutal practices of torture, including extreme temperature, solitary confinement, beatings, electric shocking, and psychological torture, are only escalating now. Physicians for Human Rights calls upon President al-Bashir and the Sudanese government to respect the rights and dignity of all Sudanese citizens through an immediate end to both the use of dangerous weapons against protesters and attacks on medical personnel. Sudan must immediately stop its campaign of intimidation, persecution, and torture.

Recommendations

Sudan remains obligated to uphold all human rights treaties to which it is party and to respect the fundamental rights of its citizens. Attacks on its citizens, which erode basic rights and damage health, must stop and those that are responsible must be held accountable.

Physicians for Human Rights calls on the government of Sudan, international bodies, and the United States and other governments to implement the following recommendations without delay:

To President Omar Hassan Ahmad al-Bashir and the Sudanese Government

  • Immediately cease all attacks on and release both medical personnel and peaceful demonstrators who are being held without charge or trial for exercising their fundamental rights.
  • Allow medical personnel to freely fulfil their medical obligations and care for their patients irrespective of their or their patients’ political affiliations.
  • Immediately end torture and ill-treatment of all detainees. Allow for inspections and access to prisoners by families, attorneys, and international observers.
  • End policies of contempt for and criminalization of basic rights and freedoms, including peaceful assembly and freedom of speech, which have been further restricted in the recent emergency orders.
  • Prohibit all forms of violence against peaceful protesters and respect United Nations standards for the use of force, which must always be based on the principles of necessity, proportionality (minimum level of force), legality, and accountability, and enforce these laws.
  • Ensure accountability mechanisms for all those responsible for unnecessary and disproportionate use of force and other human rights violations. Specifically, remove the immunity provisions for the National Intelligence and Security Services in the National Security Act.
  • Form an independent commission of inquiry to investigate extrajudicial killings and hold all perpetrators of violence against medical personnel and/or facilities accountable according to fair and transparent legal procedures.
  • Respect and protect the independence and autonomy of the Sudan Doctors’ Syndicate, Central Committee of Sudan Doctors, Sudanese Professionals Association, and other respected independent organizations for their critical contributions to the health and human rights of Sudanese citizens.
  • Adhere to provisions of Sudanese law that affirm basic human rights principles, including the Bill of Rights of the National Interim Constitution.
  • Extend an open invitation to all UN Special Procedures/UN Special Rapporteurs to visit the country.

To the United Nations, African Union, Arab League,* Organization of Islamic Cooperation, and European Union 

  • Introduce and support a resolution at the United Nations Human Rights Council addressing the current situation in Sudan related to the protests and subsequent human rights violations.
  • Identify suppliers of tear gas, lead pellets, and other crowd-control weapons to Sudanese security forces and make concrete efforts to limit export of these weapons until the government of Sudan has ensured adherence to regulations on their use.
  • Press Sudan to extend an open invitation to the UN Independent Expert on the situation of human rights in the Sudan, the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, the Special Rapporteur on the situation of human rights defenders, and the Special Rapporteur on the rights to freedom of peaceful assembly and of association.
  • Introduce sanctions against identified individuals responsible for extrajudicial killings and/or torture.

*As of this writing, Sudan chairs the presidency of the Council of the Arab League and should be held to account.

To the United States Government 

  • Reintroduce and pass the Medical Neutrality Protection Act (H.R. 2033, 113th Congress), which authorizes accountability mechanisms for governments that attack medical personnel, facilities, transport, or supplies.
  • Pass legislation that would prohibit the export of tear gas or other riot-control items to Sudan until such a time as the Secretary of State certifies that the government of Sudan no longer uses such weapons to repress peaceful dissent.
  • Appoint and confirm a new U.S. Special Envoy for Sudan and South Sudan (a position vacant since January 2017) to more effectively engage with the Sudanese government to advance the international recommendations outlined above.
  • Sanction senior Sudanese officials responsible for gross human rights abuses under the Global Magnitsky Act.

Acknowledgements

This report was written by Physicians for Human Rights (PHR) Medical Expert Rohini J. Haar, MD, MPH, research fellow, Human Rights Center, University of California, Berkeley. Contributions to the research and writing were made by PHR staff, including Maryam Al-Khawaja, Europe director, Vincent Iacopino, MD, PhD, senior medical advisor, Michael Payne, advocacy officer, and Susannah Sirkin, MEd, director of policy.

The report benefitted from review by PHR staff, including DeDe Dunevant, director of communications and Donna McKay, executive director.

Research assistance was provided by Makaila Heifner and Sarah Bakir and open-source data verification was provided by Michael Elsanadi, Brian Perlman, Ceren Fitoz, Haley Willis, Jade Wynn, Kavya Nambiar, Lily Greenberg-Call, Mariya Katsman and Tianyi Ding at the Human Rights Center at the University of California, Berkeley School of Law.

This report benefited from review by PHR Board Member Michele Heisler, MD, MPA, professor of internal medicine and health behavior and health education at the University of Michigan medical school and Lutz Oette, PhD, Director of the Centre for Human Rights Law, SOAS, University of London, UK.

The report was edited by Claudia Rader, MS, PHR senior communications manager. It was prepared for publication by Claudia Rader and Theresa McMackin, PHR communications intern.

PHR is especially indebted to our Sudanese physician colleagues, both in Sudan and abroad, who generously gave their time and efforts to this report, and who are unnamed here to protect their safety. We would especially like to thank our colleagues at the Sudanese American Physicians Association for their invaluable advice and guidance.

Endnotes

[1] J. Henry, “Sudan’s Game of Catch and Release,” Human Rights Watch, February 1, 2019, https://www.hrw.org/news/2019/02/01/sudans-game-catch-and-release.

[2] “‘Why Sudan is shooting medics,’” BBC News, January 18, 2019, https://www.bbc.com/news/world-africa-46921480.   

[3]  “Sudanese forces fire tear gas to break up Omdurman protests,” Reuters, January 10, 2019, https://www.reuters.com/article/us-sudan-protests-casualties/sudanese-forces-fire-tear-gas-to-break-up-omdurman-protests-idUSKCN1P40EI.

[4] M.Osman, “Hospitals attacked in Khartoum, Sudan,” Lancet, January 29, 2019, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30161-8/fulltext.

[5] “Sudan: ‘horrific attack’ on hospital targets injured protesters,” Amnesty International UK, January 10, 2019, https://www.amnesty.org.uk/press-releases/sudan-horrific-attack-hospital-targets-injured-protesters.

[6] R.J. Haar and V. Iacopino, “The Health Consequences of Crowd-Control Weapons,” Physicians for Human Rights, March 1, 2016, https://phr.org/resources/lethal-in-disguise/.

[7] M.Alamin, “Sudan’s Bashir Defies Calls to Step Down as Pressure Mounts,” Bloomberg, January 14, 2019,  https://www.bloomberg.com/news/articles/2019-01-14/sudan-doctors-slam-police-targeting-of-hospitals-during-protests.

[8] P.Rosenberg, “Uprising in Sudan: Does this African nation offer a window of hope onto the future?,” Salon.com, January 27, 2019, https://www.salon.com/2019/01/27/uprising-in-sudan-does-this-african-nation-offer-a-window-of-hope-onto-the-future/.

[9] M.Amin, “Protests rock Sudan’s capital as bread prices soar,” Middle East Eye, January 16, 2018, https://www.middleeasteye.net/news/protests-rock-sudans-capital-bread-prices-soar.

[10] “Sudanese authorities prevent distribution of Al-Jarida newspaper,” Committee to Protect Journalists, June 7, 2018, https://cpj.org/2018/06/sudanese-authorities-prevent-distribution-of-al-ja.php.

[11] D.Walsh, “On Sudan’s Streets, Young Professionals Protest Against an Autocrat,” The New York Times, January 24, 2019, https://www.nytimes.com/2019/01/24/world/africa/sudan-protests-omar-hassan-al-bashir.html.

[12] S.Magdy, “Sudan protesters defy ban on rallies amid crackdown,” AP News, February 26, 2019, https://www.apnews.com/9abd099d651c4fe687150ac2a235165e.

[13] “Sudan doctors’ union says 57 killed in recent protests,” AP News, February 8, 2019, https://www.apnews.com/5775125fac91424594f74fc099b9a642.

[14] “Sudan’s lawmakers approve 6-month state of emergency,” AP News, https://www.apnews.com/a8df62202a864020b41a240a7613f5ac.

[15] D.Walsh, “Facing Protests, Sudan’s Leader Declares Yearlong State of Emergency,” The New York Times, February 22, 2019, https://www.nytimes.com/2019/02/22/world/africa/sudan-bashir-emergency.html.

[16] “Sudan Doctors Syndicate: New trends of violence and brutality against civil protestors in Sudan (08.02.2019),” MinBane, February 8, 2019, https://minbane.wordpress.com/2019/02/08/https-wp-me-p1xtjg-8xw-2/.

[17] M.Nashed, “Sudan’s doctors say they are state targets in anti-Bashir protests,” The National, January 21, 2019, https://www.thenational.ae/world/africa/sudan-s-doctors-say-they-are-state-targets-in-anti-bashir-protests-1.816221.

[18] K.Bahri, “Sudanese Doctors Syndicate calls for international support,” RadioDabanga, January 13, 2019, https://www.dabangasudan.org/en/all-news/article/sudanese-doctors-syndicate-calls-for-international-support.

[19] K.Bahri, “Sudan uprising: Youths take to the streets, doctors rally,” RadioDabanga, February 12, 2019, https://www.dabangasudan.org/en/all-news/article/sudan-uprising-youths-take-the-steets-doctors-rally.

[20] “Sudan uprising: Countrywide response to call by Sudanese Professionals Assoc,” Radio Dabanga, February 13, 2019, https://www.dabangasudan.org/en/all-news/article/sudan-uprising-countrywide-response-to-call-by-sudanese-professionals-assoc.

[21] U.S. G. Health and Human Services, “Code of Federal Regulations. Title 45 (Part 46),” 2018.

[22] World Medical Association, “Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects,” 2013.

[23] International Network of Civil Liberties Organizations, “Unhealed Wounds,” 2019, https://www.inclo.net/projects/unhealed-wounds/.

[24] R.J. Haar, V. Iacopino, N. Ranadive, S. D. Weiser, and M. Dandu, “Health impacts of chemical irritants used for crowd control: a systematic review of the injuries and deaths caused by tear gas and pepper spray,” BMC Public Health, vol. 17, no. 1, p. 831, Dec. 2017.

[25] B.Ballantyne, “Medical Management of the Traumatic Consequences of Civil Unrest Incidents,” Toxicological Reviews, September 2006, https://link.springer.com/article/10.2165/00139709-200625030-00003.

[26] “Sudan: Video Footage Shows Extreme Violence, Abuse,” Human Rights Watch, February 10, 2019, https://www.hrw.org/news/2019/02/10/sudan-video-footage-shows-extreme-violence-abuse.

[27] “Sudan protests: Doctor ‘shot dead’ during clashes,” BBC News, January 18, 2019, https://www.bbc.com/news/world-africa-46916169.

[28] “Sudan,”Human Rights Watch, 2019, https://www.hrw.org/africa/sudan.

[29] “Sudan: Reform National Security Law,” Human Rights Watch,  November 6, 2009, https://www.hrw.org/news/2009/11/06/sudan-reform-national-security-law.

[30] L. Oette and M. A. Babiker, Constitution-Making and Human Rights in the Sudans. Routledge, 2018.

[31] L.Oette, Criminal law reform and transitional justice : human rights perspectives for Sudan. Ashgate, 2011.

[32] A. Elzobier, “Op-ed: Will Sudan end torture?,” Amnesty International, April 3, 2018, https://www.amnesty.org/en/latest/news/2018/04/op-ed-will-sudan-end-torture/.

[33] “Sudan: Agents of Fear: The National Security Service in Sudan,” Amnesty International, July 19, 2010, https://www.amnesty.org/en/documents/AFR54/010/2010/en/.

[34] “SUDAN,” Redress, 2019, https://redress.org/sudan/.

[35] Q.D. Young and E. Stover, “Physicians and Human Rights,” JAMA J. Am. Med.Assoc., vol. 264, no. 24, p. 3127, Dec. 1990.

[36] “International Covenant on Civil and Political Rights,” Office of the High Commissioner for Human Rights, 1966.

[37] United Nations, “International Covenant on Civil and Political Rights, State Parties,Treaty Ref. Guid., no. July 1951, pp. 1–9, 2014.

[38] African Commission on Human and People’s Rights, “African Charter on Human and Peoples’ Rights,” 1987.

[39] International Conference on Primary Health Care, “Declaration of Alma-Ata,” Alma-Ata, USSR,1978.

[40] Code of Conduct for Law Enforcement: A/RES/34/169, 1979.

[41] OHCHR, Basic Principles on the Use of Force and Firearms, 1990.

[42] International Criminal Court, “Rome Statute: Elements of Crimes,” The Hague, 2013.

[43] REDRESS and KCHRED, “Criminal Law and Human Rights in Sudan: A Baseline Study,” 2008, https://www.refworld.org/pdfid/5331852e4.pdf.

[44] Republic of Sudan, Criminal Procedure Code, 1991.

[45] Republic of Sudan, National Security Act, Sudan. 2010, p. 29.

[46] M.Ahmed, “Sudan Code of Medical Ethics.”

[47] World Medical Association, “International Code of Medical Ethics,” 2006.

[48] WMA, “International Code of Medical Ethics Duties of Physicians in General,” 1949.

[49] ICRC, “Respecting and Protecting Health Care in Armed Conflicts and in Situations Not Covered by International Humanitarian Law International and Non-International Armed Conflict,” International Committee of the Red Cross, March 31, 2012, https://www.icrc.org/en/document/respecting-and-protecting-health-care-armed-conflicts-and-situations-not-covered.

[50] “Protection of Health Workers, Patients and Facilities in Times of Violence Protection of Health Workers, Patients and Facilities in Times of Violence Center for Public Health and Human Rights 2 Protection of Health Workers, Patients and Facilities in Time,” Johns Hopkins Bloomberg School of Public Health, 2013, https://www.jhsph.edu/research/centers-and-institutes/center-for-public-health-and-human-rights/_pdf/BellagioReport-03192014.pdf.

[51] “Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field,” 1949.

[52] “Human rights and health,” World Health Organization, December 29, 2017, https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health.

[53] G.of Sudan, The Interim National Constitution of the Republic of the Sudan, 2005, p. 122.

[54] “Framework for Communications – V 1 ICCPR Art. 4,” Office of the High Commissioner for Human Rights.

[55] UN General Assembly, Convention against torture and other cruel, inhuman or degrading treatment or punishment, 1984, p. 66.

[56] African Centre For Justice and Peace Studies, “I was electrocuted: Torture in Sudan from 2011-2015,” African Centre for Justice and Peace Studies, Kampala, Uganda, 2015, http://www.acjps.org/wp-content/uploads/2017/05/TORTURE-IN-SUDAN-v4.pdf.

[57] “Sudan: Bring domestic laws in line with the absolute prohibition of torture,” Alkarama Foundation, 2014.

[58] “Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment,” Office of the High Commissioner for Human Rights, 2016.

[59] S.O. A. T. and REDRESS, “National and International Remedies for Torture: A handbook for Sudanese Lawyers,” REDRESS and Sudanese Organization Against Torture,  Khartoum, March 2005, https://redress.org/wp-content/uploads/2018/01/March-05-National-and-International-Remedies-for-Torture.pdf.

[60] S. Mednick, “South Sudan accused of killings, torture, squalor in jails,” APNews, September 4, 2018, https://apnews.com/e33002d756734293b5cb6fb31a45fc95.

[61] Y. Elbagir and M. Bearak, “‘Bashir will not budge:’ Nationwide protests in Sudan take aim at the president,” The Washington Post, January 6, 2019, https://www.washingtonpost.com/world/bashir-will-not-budge-nationwide-protests-in-sudan-take-aim-at-the-president/2019/01/06/550ebf9a-0fac-11e9-8f0c-6f878a26288a_story.html?utm_term=.92884d832964.

[62] “Sudan: UN rights expert voices concern at alleged torture, censorship,” UN News, June 4, 2009, https://news.un.org/en/story/2009/06/302322.

[63]“Sudan: Events of 2018,” Human Rights Watch, https://www.hrw.org/world-report/2019/country-chapters/sudan; “Sudan 2017/2018,” Amnesty International, https://www.amnesty.org/en/countries/africa/sudan/report-sudan/.

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Myanmar Military’s Massacre Denial Complex


This post originally appeared in the Asia Times

“Trust us.” That’s the implicit message in the Myanmar military’s announcement this week of the creation of an “investigation court” to probe the state-backed mass violence targeted at the country’s Muslim Rohingya population in August 2017.

The announcement on the website of the Office of the Commander in Chief of Defense Services describes the court as consisting of three senior military (Tatmadaw) officials tasked to “further scrutinize” the bloodshed of August 2017. It reiterates the military’s long-discredited narrative that all military activity in northern Rakhine state in August 2017 were legitimate operations in response to attacks on police posts allegedly perpetrated by the Arakan Rohingya Salvation Army, a non-state insurgent group.

The military’s motive in forming this so-called investigation court is nothing less than a brazen effort to counter the voluminous evidence compiled by United Nations investigators and international human-rights organizations, including Physicians for Human Rights (PHR), that the Tatmadaw and other security forces organized and executed mass killings and forced relocations of northern Rakhine’s Rohingya community in August 2017. And Tatmadaw officials have reason to be concerned. UN-appointed investigators concluded last August that Myanmar’s state-backed violence against the Rohingya constituted the “gravest” crimes against civilians under international law, including genocide.

And that pool of evidence implicating the Tatmadaw in such crimes just keeps growing. The results of a quantitative survey conducted by PHR of 605 surviving Rohingya community leaders in Bangladesh published this week in The Lancet Planetary Health paints a grim picture of Myanmar security forces deployed in August 2017 to kill and terrorize northern Rakhine’s Rohingya population. The vast majority of respondents identified the Tatmadaw and the official Border Guard Police as the security forces who deployed “military assets, including helicopters, military trucks, and tanks” against defenseless Rohingya men, women and children in August 2017.

This week at the United Nations Human Rights Council in Geneva, Myanmar’s failure to provide meaningful accountability for the abuses of August 2017 will get renewed scrutiny. In a resolution titled “Situation of Human Rights in Myanmar,” the UN “calls upon the Myanmar authorities, in particular the Myanmar military and security forces, to end immediately violence and all violations of international law in Myanmar, in particular in Rakhine, Kachin and Shan states.”

Myanmar’s apparent gambit: that the announcement of a military inquiry into the events of August 2017 will quell international calls for an investigation into that violence and allow Myanmar to return to a ‘business as usual’ setting with the international community

The announcement of the investigation court is the Myanmar authorities’ idea of a solution to this growing international opprobrium about Myanmar’s defiant refusal to allow any meaningful international-standard probe into the slaughter of August 2017 aimed at providing accountability for those abuses. Myanmar’s apparent gambit: that the announcement of a military inquiry into the events of August 2017 will quell international calls for an investigation into that violence and allow Myanmar to return to a “business as usual” setting with the international community.

That’s unlikely. The Tatmadaw’s well-earned reputation for decades of murderous violence targeting Myanmar’s ethnic minorities with utter impunity makes its move to appoint itself as a self-styled impartial investigator into the violence of August 2017 as laughable as it is ironic – particularly since that scorched-earth campaign of mass killings, torture, and sexual violence was for longtime Myanmar observers a matter of brutal deja-vu “on steroids.” The government’s active complicity with the Tatmadaw in resisting accountability for past abuses, including those against the Rohingya in August 2017, render any official Myanmar investigation that does not involve meaningful participation of international investigators, particularly from the UN, a craven exercise in deception.

If the Myanmar authorities are serious about accountability for the violence of August 2017, they can demonstrate that by ending their stonewalling of international probes into the violence. They can start by lifting the prohibition on international organizations seeking to investigate the slaughter of 2017 from accessing the area.

The government should also stop blocking UN Special Rapporteur to Myanmar Yanghee Lee, who is tasked with assessing the human-rights situation in Myanmar, from undertaking a credible, international-standard investigation into the violence of August 2017. In 2017, the government placed restrictions on an official fact-finding mission led by Lee that she described as an “affront to the independence of my mandate as Special Rapporteur.” That December, the government announced it was denying her access to the country, including to Rakhine state.

Myanmar authorities could also signal their sincerity about accountability for those abuses by supporting the work of the UN’s independent mechanism “to collect, consolidate, preserve and analyze evidence of the most serious international crimes and violations of international law committed in Myanmar since 2011.”

Until these restrictions are lifted, expect the Tatmadaw’s “investigation court,” and the long-delayed justice for the Rohingya, to continue to go nowhere fast.

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Hospital Bombing Marks Saudi-Emirati-Led Coalition’s Anniversary in Yemen Conflict

The Saudi- and Emirati-led coalition marked the four-year anniversary of its intervention in Yemen this week by bombing yet another hospital on Tuesday, March 26. A missile landed within 50 meters of Kitaf hospital, which is located in a densely populated area of northwest Yemen and is supported by the international organization Save the Children.

The attack killed eight people, including five children, a health worker, and a security guard. It also injured at least eight other people. Helle Thorning-Schmidt, the chief executive of Save the Children International, expressed her dismay given that the attack occurred during the hospital’s busy morning and that the facility’s coordinates had been shared with the Saudi-Emirati-led coalition and therefore should have been explicitly avoided.

Aerial bombardment has been one of the defining features of the Yemen conflict. These assaults have devastated the country’s infrastructure, destroying hospitals, medical centers, aid stations, residential areas, highways, schools, and places of worship. By one estimate, the Saudi- and Emirati-led coalition has conducted over 8,600 air raids, and 31 percent of all targets hit were non-military. The obvious impact of the air raids on the civilian population highlights the disregard by the coalition for international laws concerning the basic rules of war, which exist to protect innocent civilians.

The United Nations Group of Eminent Experts on Yemen 2018 report on the practices of the Saudi-Emirati-led coalition points to its failure to abide by the laws of war, including the principle of distinction (distinguishing between civilian and military targets). Although the coalition has access to no-strike lists and the technical capacity to precisely target its strikes, the UN’s findings call into question the coalition’s willingness to engage in war in accordance with international humanitarian law and raise the grave concern that these attacks on civilians are deliberate in nature.

Physicians for Human Rights (PHR) has been documenting the targeting of health care facilities and the failure of all warring parties to take appropriate measures to shield these facilities from attacks. Over the past year, PHR has independently confirmed more than 23 individual attacks on health facilities. With about 50 percent of hospitals and health facilities in Yemen out of service or functioning partially, each new attack on a functioning facility has a magnified effect on a population whose medical needs have sharply increased since the beginning of the conflict. These attacks, the blocking of humanitarian aid, and the use of starvation as a weapon of war violate medical neutrality and international humanitarian law. These acts constitute war crimes and may amount to crimes against humanity, given their widespread and systematic nature.

Yemen faces the most severe humanitarian catastrophe in the world today, and its medical sector is reeling from the increasing number of conflict causalities, coupled with reduced capacity due to the shortage of medical supplies and the pervasiveness of disease such as cholera. PHR calls on the Saudi-Emirati-led coalition to respect the no-strike lists and to respect hospitals and medical facilities in line with obligations under international humanitarian law and the laws of armed conflict. We further call on all parties to the conflict to immediately cease acts of violence against civilian persons and objects, and to take all possible measures to protect these from the impact of hostilities. All warring parties in Yemen must acknowledge their responsibility for the current crisis and work toward ensuring compliance with international norms.

Photo: Yemen rescue workers search for body parts amid the rubble of a destroyed funeral hall in Sanaa, Yemen in 2016. Mohammed Huwais/AFP/Getty Images

Report

The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System

As the eighth year of the crisis in Syria comes to a close, civilians continue to suffer through a conflict defined by human rights abuses and violations of international humanitarian law. PHR has researched, documented, and mapped widespread and systematic attacks on medical infrastructure in Syria since March 2011. While battlefield developments wound down and the conversation on Syria drifted toward refugee returns and reconstruction, 2018 was marked by phases of extreme violence as the Syrian government consolidated its hold over much of Syria’s territory. Within the shifting landscape of the Syrian conflict, it is more important than ever to maintain focus on past and ongoing crimes and to intensify calls for justice and accountability for the Syrian people.

PHR has corroborated 553 attacks on 348 separate Syrian medical facilities from March 2011 through December 2018.

The Systematic Targeting of Health Facilities

Attacks on health care, in gross violation of humanitarian norms and the Geneva Conventions, have been a distinctive feature of the conflict in Syria since its inception. PHR has documented and mapped 553 attacks on at least 348 separate facilities from March 2011 through December 2018. The reduction in the number of attacks over the past year is a clear reflection of the diminishing intensity of the conflict, which came as a direct result of the Syrian government’s takeover of most opposition-held areas. The systematic targeting of health facilities has been a crucial component of a wider strategy of war employed by the Syrian government and its allies – who are responsible for over 90 percent of attacks – to punish civilians residing in opposition-held territories, destroy their ability to survive, and draw them into government-held areas or drive them out of the country. This strategy of unbridled violence – which in addition to attacks on healthcare has included chemical strikes, sieges, and indiscriminate bombing of predominantly civilian areas – has devastated the civilian population, weakened opposition groups, and translated into direct military gains for the Syrian government.

Graph courtesy of the Lancet-AUB Commission on Syria based on Physicians for Human Rights data

Raining Terror from the Air

Of the total number of documented attacks on health facilities, nearly 73 percent were carried out from the air. Nearly 98 percent of attacks on health facilities perpetrated from the air are attributable to the Syrian government and its ally Russian, which entered the conflict in 2015.

The share of attacks on health facilities from the air has grew from 38 percent of the total in 2012 to 90 percent in 2018. The Syrian government became steadily more reliant on airpower as the conflict evolved. Through their air forces, the Syrian government and Russia extended their strategy of collective punishment deep into opposition-held territory and far beyond hardened front lines. The Syrian government and its allies disabled or destroyed hundreds of facilities through aerial bombardment, leaving countless civilians without access to vital medical services.

A Widespread Assault on Health Care

Attacks on health facilities have been verified in 12 out of Syria’s 14 governorates. Opposition strongholds and heavily contested areas – Aleppo (159), Idlib (123), Hama (40), and Rif Dimashq (84) – bore the brunt of the violence, incurring over 73 percent of all attacks on health facilities documented since 2011. These areas witnessed clear increases in attacks on health care during government military campaigns, and sharp falls in attacks once government control was re-asserted. Aleppo, for example, suffered 54 attacks in 2016, and only nine since its fall to the Syrian government in December of that same year. Idlib, the only remaining opposition stronghold, incurred a total of 123 attacks since 2011 and over a third of all attacks documented in 2018.


Map courtesy of the Lancet-AUB Commission on Syria based on Physicians for Human Rights data

Conclusion and Recommendations

The magnitude, frequency, and distribution of attacks on health care in Syria over the past eight years reveal a widespread and systematic pattern of violations. These attacks rise to the level of war crimes and, in PHR’s assessment, crimes against humanity. PHR calls on the international community to put a stop to these crimes and assure that any resolution to the conflict in Syria carries justice and accountability at its center. PHR calls on:

  • All parties to the conflict in Syria to immediately end attacks on unlawful targets, including civilians, health facilities, and medical personnel;
  • Russia, Turkey, and the United Nations to maintain the de-militarized zone in northwest Syria and prevent military escalation in the area;
  • The United Nations and individual member states to maintain financial, political, and diplomatic support for efforts to document violations of international human rights and humanitarian law and principles, with insistence on justice and accountability for war crimes and crimes against humanity;
  • The United Nations and states supporting a political solution to the Syrian conflict to integrate accountability into efforts to bring the conflict to an end, knowing that sustainable peace can only be built on the foundations of justice.
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Defense Can Be the Best Offense in Protecting Human Rights

Sometimes, success is measured by how firmly you hold the line.

In December 2017, survivors of sexual violence in the Democratic Republic of the Congo (DRC) witnessed a milestone in justice. In a landmark judgment, a mobile court convicted 11 men, including a sitting member of a provincial parliament, of crimes against humanity for raping dozens of young girls in the village of Kavumu, and sent them to prison for life. It was the first ruling of its kind in Congolese history. Physicians for Human Rights (PHR) and our partners were elated that the court held powerful men to account and that the survivors obtained justice.

Just a few months earlier, we had celebrated that the world’s largest organization of psychologists stood up against torture and ill-treatment. The American Psychological Association (APA) reaffirmed its 2015 resolution banning psychologists from participating in national security interrogations and serving at illegal detention sites like Guantánamo Bay. PHR has documented human rights abuses of Guantánamo detainees and exposed how psychologists committed, concealed, and justified torture and abuse of detainees. Since 2005, following the Abu Ghraib scandal, we have relentlessly pushed for a ban on these practices, consistent with the medical ethics of “do no harm.”

But as human rights defenders the world over know, successes seldom go unchallenged. It wasn’t long before both of these landmark victories were contested. The Kavumu verdict was appealed in July 2018, and the APA decision was put to a renewed vote in August 2018 by those seeking a return of military psychologists to Guantánamo.

We in the human rights world fight every day to ensure that our hard-won victories on behalf of victims and survivors are not reversed. Each day we fight to preserve these gains for health and human dignity, and we are careful never to become complacent, even following unambiguous successes. A policy that protects the vulnerable against abuses of power could be adopted today, but summarily revoked tomorrow – sometimes openly, and sometimes in secrecy. Fighting for human rights can sometimes seem like an endless struggle where even as one battle is won, another hard-won gain is eroded.

Given the human rights crises we are witnessing globally and domestically, it has become increasingly evident over the past few years that the human rights movement must embrace an additional metric for defining success: not just moving forward, but securing progress against efforts to move backward; of maintaining gains in the face of escalating disregard for the rule of law, for science, and for evidence. In this shifting paradigm, the tools of law, science, and evidence are even more critical and powerful. Any win must not be taken for granted, but understood as a step forward along the long road that lies ahead.

In July 2018, PHR and our partners exhaled and rejoiced as a DRC appeals court upheld the original Kavumu convictions against lawmaker Frederic Batumike and the militia members he directed. One month later, the APA voted to retain its ban on psychologists at Guantánamo – reinforcing that torture and indefinite detention are unlawful, and that psychologists should have no part in supporting these violations. But any sense of relief is tempered by the knowledge that those indifferent to medical complicity in abuses will not stop.

For every activist who is honored, there is another whose testimony is ignored. For each perpetrator convicted of a war crime, there is another whose massacre is denied. And for each health professional trained to collect forensic evidence, there are many others whose hospitals are bombed. So much of the work done to ensure human rights are upheld is done quietly, and behind the scenes. For this reason, it was especially heartening to see the Nobel Committee award the 2018 Peace Prize to heroes like Nadia Murad, a Yazidi woman and outspoken survivor of sexual violence, and Congolese doctor Denis Mukwege, who treats survivors and who courageously advocates domestically and globally for their meaningful access to justice.

Each of these victories provides inspiration to continue the fight and to ensure that whatever gains are made – whether by a vote, a policy, a resolution, or a ruling – are never reversed, but rather, built upon. They are a constant reminder to human rights activists never to be idle, but to anticipate rollbacks and be ready to fight back with the tools we’ve always used – evidence, facts, and survivors’ testimonies. Because, at the moment, preventing the reversal or rollback of rights is the only way to continue defending established human rights successes.

A version of this article originally appeared on the Oak Foundation’s blog.

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Investment Whitewash for Rohingya Bloodshed

This post originally appeared in the Asia Times

Historic temples. Sandy beaches. Fishing grounds and farmland galore.

This is the idyllic and profitable picture that the government of Myanmar painted last week for potential investors in the country’s troubled Rakhine state. The government sought to allure crowds of potential investors from countries including Japan and South Korea who attended the Rakhine State Investment Fair in the town of Thandwe, with descriptions of Rakhine’s “untapped” investment potential.

What those potential investors didn’t hear was any mention of Rakhine’s Muslim Rohingya ethnic minority population. Or the brutal spree of state-backed violence targeted at Rakhine’s Rohingya population in August 2017 that killed thousands and prompted  720,000 Rohingya to flee to Bangladesh, where they remain to this day.

That omission was no mistake. According to Aung Naing Oo, director general of Myanmar’s Directorate of Investment and Company Administration, the failure to mention the humanitarian catastrophe inflicted on the Rohingya in Rakhine and the Myanmar government’s singular failure to take any meaningful steps toward accountability for those outrages reflect the government’s position that “investment is not political.”

Elsewhere at the fair, Myanmar’s minister for investment and foreign economic relations, Thaung Tun, sought to negate decades of well-documented systematic abuses against the country’s ethnic minorities by touting ethnic diversity as Myanmar’s “great potential” for investors.

That cravenly self-serving government propaganda is as sinister as it is dishonest. And it reflects the role of the Rakhine State Investment Fair as part of a wider government campaign to attempt to paper over the monstrous crimes perpetrated in Rakhine with a veneer of business-as-usual normalcy.

The Myanmar government’s apparent gambit is that if it turns a deaf ear long enough to the international opprobrium about the slaughter of the Rohingya and the humanitarian crisis of the refugee camps in neighboring Bangladesh, foreign investor interest in Rakhine’s oil and gas, agriculture, and fishing sectors will inevitably help mute the calls for accountability.

The Myanmar government’s apparent gambit is that if it turns a deaf ear long enough to the international opprobrium about the slaughter of the Rohingya and the humanitarian crisis of the refugee camps in neighboring Bangladesh, foreign investor interest in Rakhine’s oil and gas, agriculture, and fishing sectors will inevitably help mute the calls for accountability.

Indeed, while Myanmar has rolled out the red carpet for foreign investors to Rakhine, it has forbidden international organizations seeking to investigate the slaughter of 2017 from accessing the area. Most notably, the government has blocked UN Special Rapporteur to Myanmar Yanghee Lee, who is tasked with assessing the human-rights situation in Myanmar.

In 2017, the government placed restrictions on an official fact-finding mission led by Lee that she described as an “affront to the independence of my mandate as Special Rapporteur.” That December, it announced it was denying her access to the country, including to Rakhine state.

In June last year, the government announced the creation of an “independent commission of inquiry” to investigate further allegations of human-rights abuses in Rakhine state. Given Myanmar’s limited past efforts on justice and accountability, there are reasonable grounds for concern about whether these investigations will be carried out effectively or in accordance with credible international standards.

Those efforts dovetail with moves by the Myanmar government and security forces to erase the sites of mass slaughter of Rohingya in Rakhine. Over the past two years, satellite images have revealed that the locations of former Rohingya villages in Rakhine have been “flattened and scraped by bulldozers.” In what appears to be a blatant form of post-conflict elimination of physical remnants left behind by the dead or fled Rohingya,  those villages have been replaced by facilities for the security forces as well as hundreds of new homes built for mostly Buddhist residents from other areas of Rakhine.

Potential foreign investors who attended the Rakhine State Investment Fair should be under no illusions about the grim recent history of Rakhine state and the horrors that the Myanmar military inflicted on its Rohingya population. UN-appointed investigators concluded last August that Myanmar’s state-backed violence against the Rohingya constituted the “gravest” crimes against civilians under international law, including genocide.

Investigations by Physicians for Human Rights over the past two years put a tragic human face to that UN assessment and provide scientific objectivity in refuting the government’s repeated denials. In 2018, PHR surveyed leaders from 604 Rohingya hamlets in Rakhine state encompassing more than 916,000 people. The findings, coupled with in-depth interviews and forensic medical examinations of Rohingya survivors, point to a widespread and systematic pattern of targeted violence – including rapes and killings of women, men and children.

The Rakhine State Investment Fair reflects the Myanmar government’s desperation to change the narrative of its security forces’ well-documented role in the targeted killings of the Rohingya and their harrowing journey to safety in Bangladesh. It is a cynical official attempt to parry international demands for accountability with the prospect of financial profit.

Foreign governments and foreign investors alike should dismiss such craven cover-up efforts by the Myanmar government and make clear that normal diplomatic and economic relations hinge on respecting human rights and ensuring accountability in Rakhine, not undermining it.

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International Justice Closes in on Syria’s State-backed Killers

On Tuesday, February 19, nine Syrian survivors of torture filed a criminal complaint in Stockholm, Sweden, against 25 senior Syrian government intelligence officials. That complaint is the latest in a series of similar moves in countries – including France, Germany, Austria, and other European countries – aimed at rendering accountability for actions by the Syrian government that may constitute war crimes and crimes against humanity.

The abuses that the nine plaintiffs in Stockholm allegedly endured illustrate the Syrian government’s savage zero-tolerance approach toward perceived dissidents. According to the European Center for Constitutional and Human Rights (ECCHR), the plaintiffs were arrested on separate occasions between 2011 and 2015 and subsequently subjected to torture by agents of four of Syria’s five intelligence branches. The plaintiffs’ allegations include illegal abduction, rape, torture, war crimes, and crimes against humanity – patterns of abuse that have been extensively documented by human rights monitoring organizations, including Physicians for Human Rights (PHR).

The motion in Sweden comes on the heels of an unprecedented accountability milestone in a grinding eight-year conflict that has been characterized by gross violations of human rights and international law. Until recently, these violations have taken place in a context of utter impunity. But on February 13, German and French officials arrested one former high-ranking Syrian intelligence official and two of his subordinates on suspicion of torture and crimes against humanity. The arrests ended the complete failure of the international community to hold perpetrators of these vicious crimes to account. Those arrests, together with criminal complaints filed and warrants issued over the past year, have sparked renewed hope in the prospect for justice. This despite coming at a particularly hopeless moment in the crisis – when the Syrian government’s apparent military victory has all but cemented its reign of impunity.

Syria presents a particularly complicated context for accountability, primarily because the party responsible for perpetrating the majority of crimes – the Syrian government – remains in power. The international criminal justice system has not yet determined a way to address this problem. Because Syria is not a party to the Rome Statute, the International Criminal Court which it established is not authorized to investigate crimes in Syria without a referral by the United Nations Security Council. Russia and China have blocked attempts at such a referral.

In the absence of large-scale international options, the struggle against impunity has begun in countries outside Syria, where survivors, legal advocates, and judicial institutions are employing universal jurisdiction to launch investigations and prosecutions of those responsible for war crimes and crimes against humanity. We have seen this taking shape in Sweden, France, Germany, Austria, and other European countries. A similar example of efforts toward justice in national courts outside Syria involves the case of Colvin v. Syrian Arab Republic, prosecuted in the United States.

Since the early days of the conflict in Syria, PHR has conducted painstaking research to document violations of international humanitarian law, including war crimes and crimes against humanity, while advocating for justice. To date, PHR has confirmed 550 attacks on health facilities and the killing of more than 890 medical professionals. Our recently updated map provides a snapshot of the intentionality and scale of the assault on health care in Syria, while giving users the ability to zoom in on the details and documentation of each verified attack.

In a landscape fraught with political and procedural obstacles, avenues to justice must be pursued at every opportunity. The seeds of justice are sown where circumstances allow, but justice cannot flourish without the immense efforts of those dedicated to the ideal of accountability: victims and witnesses who courageously give testimony; human rights organizations that conduct research, advocate, and litigate; and government authorities that assume their responsibilities to investigate the most heinous crimes and prosecute those responsible.