New beginnings are normally met with optimism and hopes for something better to come. The start of the 112^th Congress, however, provides far less pleasant anticipation for those working to support immigrant survivors of human rights abuses. Health professionals and advocates must maintain their guard and act to ensure that circumstances do not become worse for their patients as the new Congress looks to enact even tighter restrictions on immigration status and care for refugees. A change of leadership in the House of Representatives has brought to prominence both new and old faces. For the next two years, the House Judiciary Committee, which reviews most immigration-related legislation, will be headed by Rep. Lamar Smith of Texas. Rep. Smith is, unfortunately, familiar to advocates for immigrants as he is credited with creating and shepherding to passage the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA). This bill was the source of many of the laws and policies that imperil vulnerable immigrants today. IIRIRA put into place expansive requirements that resulted in mandatory detention for numerous classes of immigrants, including people seeking asylum at the border. Border patrol and immigration enforcement agents were stripped of the discretion they previously had to determine when concerns about an individual’s dangerousness or likelihood of noncompliance merited the expense and trouble of detention. As a result, the use of immigration detention skyrocketed – along with reports of human rights abuses of detainees and government spending on maintaining and defending an unnecessarily punitive and arbitrary system of incarceration. In 1996, the U.S. detained an average of just over 9,000 immigrants each day. By 2009, the average daily immigrant detainee population swelled to 32,000, thanks in large part to Rep. Smith and IIRIRA. By 2009, the U.S. was also defending against several lawsuits regarding medical neglect in detention, such as one filed by the survivors of Francisco Castaneda, who was denied a biopsy for nearly a year, by which time it was too late to save him from dying of penile cancer. Rep. Smith’s IIRIRA was also responsible for the creation of the asylum filing deadline. This provision requires that survivors of persecution file a request for asylum within one year of their arrival in the U.S. Rigid interpretation of the rule has resulted in denial of tens of thousands of legitimate asylum applications from people who were too frightened or traumatized to ask for protection upon arrival, or who were simply unaware of the process and their eligibility for protection. A recent report from Human Rights First tells the stories of several of the deadline’s innocent victims: for example, a Burmese democracy activist was jailed for several years before managing to escape to the U.S. He did not speak English, however, and did not learn about the existence of asylum protection until, years after arriving in the U.S., he happened to meet some other Burmese refugees. The immigration courts believed he would be in danger if returned to Burma, but denied his asylum application solely because it was not filed within one year of his arrival. Though nearly fifteen years of practice has produced clear evidence that the filing deadline results in the forcible return of at-risk immigrants to dangerous conditions, it has proven extremely difficult to amend legislation once enacted, and so the rule remains in place. Rep. Smith will work in concert for the next two years with a newer face: Rep. Steve King of Iowa, who was first elected in 2002, and will chair the House Judiciary Committee’s Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law. In the past several years Rep. King has voiced his disregard for the civil and human rights of immigrants. In June 2010, he endorsed the practice of racial profiling in law enforcement in a House speech about Arizona’s new law empowering local police to enforce immigration laws, saying:

Some claim that the Arizona law will bring about racial discrimination profiling. First let me say, Mr. Speaker, that profiling has always been an important component of legitimate law enforcement…it’s not wrong to use race or other indicators for the sake of identifying those that are violating the law.

Even worse, in a 2006 House floor speech discussing an expansion of fencing along the U.S.’s southern border, Rep. King equated potential border-crossers with animals, implying that electrifying the border fence would not be a big deal because, “We do that with livestock all the time.”Rep. King was also an enthusiastic supporter of the REAL ID Act of 2005. Among other enforcement-minded provisions, REAL ID expanded application of the “material support to terrorism” ban, which has been overzealously interpreted to bar from the U.S. health professionals who incidentally cared for members of suspect organizations in the course of their everyday practice in hospitals and clinics.Reps. Smith and King can be expected to usher in a new era of harsh immigration enforcement proposals highly likely to result in threats to the health and well-being of vulnerable people and their families. Health professionals of conscience must stand ready to oppose these efforts, and to use their public platform to re-focus the debate on our country’s moral commitment and legal obligation to help people in need of humanitarian assistance. Update: House Judiciary Committee assignments were formally announced on Friday, January 7, 2011, and in a surprise move, new Committee Chairman Rep. Smith chose California Representative Elton Gallegly instead of Rep. Steve King of Iowa to chair the subcommittee concerned with immigration and refugees. It is normal practice to install the former ranking minority member of the committee (in this case, Rep. King) as leader when the balance of power shifts in Congress, and the passing over of Rep. King for the chairmanship is, as Congressional Quarterly reported on Friday, “an indication that GOP House leaders may be concerned that [Rep. King’s] statements could be damaging to the party’s standing.” PHR applauds Republicans’ decision to decline to nominate to a position of influence a member who, like Rep. King, has demonstrated disturbing disregard for the fundamental rights and dignity of immigrants.

In 2010, Physicians for Human Rights investigated alleged human rights violations in Burma’s Chin State. Our report reveals extraordinary levels of state and military violence against civilian populations.

The Chattisgarh Court in India handed down a life sentence to celebrated pediatrician Dr. Binayak Sen, finding him guilty on charges of treason and sedition for alleged support of Maoist rebels. The sentence has shocked family and supporters of this physician who has spent years devoted to public health and the poorest of India's poor. PHR joins in the call for the higher judiciary to hear his appeal promptly, following what is widely viewed as a trial on flimsy evidence and lack of due process.PHR founder and first Executive Director, Dr. Jonathan Fine, who was in Chattisgarh, writes to us:

This afternoon [December 24] Binayak Sen was found guilty on three counts and with two other defendants was sentenced around 3:30 PM India time to life imprisonment. No bail could be arranged today but as soon as possible will be requested of the high court and an appeal will be filed. Meanwhile Binayak Sen is being held in a Raipur prison. Vasu and her husband and I greeted Binayak, his wife, two daughters, his brother and close friends in the courtyard of the trial court immediately before the trial. Only the family was allowed to attend in the courtroom. The verdict was swiftly delivered and the sentence after a brief delay. I talked at length with Binayak and took many photos of him and his family. I must say, and hope not to be thought self-serving, that he was surprised to see me and gave me a big hug. I could not help crying when speaking with his wife before and after the verdict was declared. This is a black day in the history of human rights and we will fight tirelessly to see that he is freed at the earliest possible moment.

PHR urges all supporters to keep working with us to fight this decision on appeal and help free Dr. Sen.

A recent edition of The Lancet Student includes commentary from former PHR board member Dr. Holly Atkinson’s students at Mt. Sinai. The medical students describe the efforts of medical professionals and fellow students to support an innovative bill which is currently proposed in New York State. The bill, which PHR helped to write, is an anti-health professional participation in interrogation bill. PHR will also be introducing similar legislation in Massachusetts next month.The article references PHR’s reports and reviews the known violations, the ethical principles involved, and the range of proposed responses. The full article is available online.

The much-publicized arrest of Wikileaks founder Julian Assange has had the unexpected effect of highlighting laws that criminalize health status related to HIV. Assange is facing rape charges in Sweden for “rape, sexual molestation, and forceful coercion.” These charges were brought after two women allegedly went to Swedish authorities to find Assange and compel him to take an STD test.

As the recent article Underreported: The Link Between Julian Assange and Sweden’s Repressive HIV Law by Housing Works points out, if Assange is HIV positive and had not disclosed this fact, under Sweden’s Communicable Disease Act, he could possibly be prosecuted for exposure and face compulsory isolation, fines or jail time of up to 10 years. It has not been alleged that Assange is HIV positive; however, the charges against him draw attention to Sweden’s counter-productive and repressive HIV criminalization law.

According to the Swedish government the purpose of the law is to “fulfill the population’s need of protection against the spread of communicable diseases.” However, this Act and other laws that punish individuals based on their HIV health status do not serve their intended purpose of protecting the public, but instead provide an incentive to remain ignorant of one’s HIV status, increase stigma, and encourage vulnerable populations like sex workers and drug users to avoid social and health services.

These laws are not unique to Sweden. In the United States thirty-four states and two U.S. territories have HIV-specific criminal statutes that criminalize HIV exposure and transmission, and thirty-six states have reported proceedings in which HIV-positive people have been arrested and/or prosecuted for consensual sex, biting, and spitting. At least eighty such prosecutions have occurred in the last two years alone.

Similarly, laws that criminalize drug users based on their health status as addicts and put prohibitions and penalties on safe drug use result in dramatically increased rates of HIV and other communicable diseases in the drug user population and the community at large, as well as a higher risk of over-dose, and stigma against drug users. The effect is compounded when drug users are incarcerated or institutionalized because of current drug policy. In fact, outside of sub-Saharan Africa injection drug use accounts for one in three new HIV infections.

At the 2010 International Aids Conference in Vienna, Austria, the international scientific community released the Vienna Declaration calling for acknowledgment of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care. Criminalizing people based on health status is not only dangerous to the general public but a violation of an individual’s basic human rights. As Anand Grover, the U.N. Special Rapporteur on the right to health, explained:

The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health, such as widespread implementation of harm-reduction initiatives. The criminalization of drug users does not benefit society and it worsens public health and contributes to serious human rights violations.

Declare your support of evidence-based drug policy and sign the Vienna Declaration today.

The much-publicized arrest of Wikileaks founder Julian Assange has had the unexpected effect of highlighting laws that criminalize health status related to HIV.

Assange is facing rape charges in Sweden for “rape, sexual molestation, and forceful coercion.” These charges were brought after two women allegedly went to Swedish authorities to find Assange and compel him to take an STD test. As the recent article Underreported: The Link Between Julian Assange and Sweden’s Repressive HIV Law by Housing Works points out, if Assange is HIV positive and had not disclosed this fact, under Sweden’s Communicable Disease Act, he could possibly be prosecuted for exposure and face compulsory isolation, fines or jail time of up to 10 years.

It has not been alleged that Assange is HIV positive; however, the charges against him draw attention to Sweden’s counter-productive and repressive HIV criminalization law.

According to the Swedish government the purpose of the law is to “fulfill the population’s need of protection against the spread of communicable diseases.” However, this Act and other laws that punish individuals based on their HIV health status do not serve their intended purpose of protecting the public, but instead provide an incentive to remain ignorant of one’s HIV status, increase stigma, and encourage vulnerable populations like sex workers and drug users to avoid social and health services.

These laws are not unique to Sweden. In the United States thirty-four states and two US territories have HIV-specific criminal statutes that criminalize HIV exposure and transmission, and thirty-six states have reported proceedings in which HIV-positive people have been arrested and/or prosecuted for consensual sex, biting, and spitting. At least eighty such prosecutions have occurred in the last two years alone.

Similarly, laws that criminalize drug users based on their health status as addicts and put prohibitions and penalties on safe drug use result in dramatically increased rates of HIV and other communicable diseases in the drug user population and the community at large, as well as a higher risk of over-dose, and stigma against drug users. The effect is compounded when drug users are incarcerated or institutionalized because of current drug policy. In fact, outside of sub-Saharan Africa injection drug use accounts for one in three new HIV infections.

At the 2010 International Aids Conference in Vienna, Austria, the international scientific community released the Vienna Declaration calling for acknowledgment of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care. Criminalizing people based on health status is not only dangerous to the general public but a violation of an individual’s basic human rights. As Anand Grover, the U.N. Special Rapporteur on the right to health, explained:

The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health, such as widespread implementation of harm-reduction initiatives. The criminalization of drug users does not benefit society and it worsens public health and contributes to serious human rights violations.

Declare your support of evidence-based drug policy and sign the Vienna Declaration today.

PHR’s recent report, “Experiments in Torture,” was selected as one of Discover Magazine’s “Top 100 Stories of 2010.”Ranked at #37, PHR’s work accompanies the recent discovery of an early diagnosis for Alzheimer’s and the BP oil spill as one of the most significant stories of 2010:

Doctors employed by the CIA participated in research and experimentation on prisoners at detainment centers such as Guant?namo Bay, Abu Ghraib, and Bagram air base that included waterboarding, stress positioning, and sleep deprivation, according to a June report from Physicians for Human Rights. The group says doctors violated ethical and legal protections, including the Nuremberg Code and the Common Rule regulating federal research on human subjects.

The full list can be found in the January-February special issue or online now.

PHR salutes his work and calls for his freedom; Dr. Jonathan Fine observes trial

The trial of celebrated Indian pediatrician Binayak Sen, a tireless advocate for the poor and marginalized in India’s Chattisgarh State, ends on Friday, December 24. A judge is expected to deliver a verdict in this widely-watched case that is marked by unsubstantiated allegations and intimidation of human rights advocates.

Dr. Sen with a small patient

PHR and dozens of other human rights and medical organizations have repeatedly called for the release of the doctor who is being tried for alleged conspiracy against the State. Dr. Sen was arrested in 2007, detained for two years, and released on bail in May 2009. In 2008, he was awarded the Jonathan Mann Award for Global Health and Human Rights by the Global Health Council. Sen was unable to attend the ceremony in Washington that year but his wife, Dr. Ilina Sen, received the honor on his behalf.

PHR calls on those involved in the decisions related Dr. Sen’s plight to recognize that the case has involved innuendo and politicized charges from the very beginning. Many following the trial, including Indian journalists for major national newspapers have described the trial as “farcical.”

PHR’s founder and first executive director, Dr. Jonathan Fine, is currently in Chattisgarh and will be in the Court to observe the closing of the case and verdict. Informed observers have repeatedly stated that the arrest and trial of Dr. Sen is an effort by Chattisgarh authorities to vilify and intimidate those who advocate for the poor and marginalized tribal populations in India. Sen has been charged for his alleged involvement with prisoners who are part of the banned Communist or Maoist parties. Chattisgarh has experienced years of violence between armed Maoist groups and Salwa Judum, an armed anti-Maoist movement with suspected state support.

Indian authorities allege that the doctor transferred notes from an imprisoned Maoist leader, Narayan Sanyal, to another Maoist leader, Piyush Guha, arresting Dr. Sen under the Chhattisgarh Special Public Security Act (CSPSA) and the Unlawful Activities (Prevention) Act (UAPA), as the Communist Party of India is banned in Chhattisgarh. Dr. Sen denies these accusations stating that his visits to the prisons were constantly supervised by prison authorities, as required by the Jail Manual. Dr. Suranjan Bhattacharji, Director of the Christian Medical College, speaking of Dr. Sen's case and the violence that has overwhelmed Chhattisgarh stated, "Binayak has always condemned that violence. He has always insisted that violence will not solve any problems. He has been speaking up for poor people. In our country growth and development is not inclusive. He has been trying to remind civil society that we have a responsibility towards all, not some, and that has been an unpopular act."

Dr. Sen is a graduate of the Christian Medical College in Vellore, India. In the early 80's, he worked with iron ore mine workers and their trade union, establishing the Shaheed Hospital which served both mine workers and the local non-mining community in Chattisgarh. In the early 90's, Dr. Sen, along with his wife, Ilina, founded a non-profit health and human rights organization, Rupantar, which trained community health workers and reached dozens of villages. In 2002 Dr. Sen was elected Vice-President of the People's Union for Civil Liberties (PUCL), one of India's leading human rights organizations.

On presenting the Jonathan Mann Award to Dr. Sen in 2008, Dr. Nils Daulaire, then president of the Global Health Council, stated, "He [Dr. Sen] staffed a hospital created by and funded by impoverished mine workers, and he has spent his lifetime educating people about health practices and civil liberties – providing information that has saved lives and improved conditions for thousands of people. His good works need to be recognized as a major contribution to India and global health; he is certainly not a threat to state security."

PHR urges health professionals and their institutions around the world to call for the release of Dr. Sen so that he can return to his remarkable work supporting the poorest of India’s poor.

Today’s Journal of the American Medical Association (JAMA) includes an article from Eric Friedman, PHR consultant, and Eli Adashi, MD, PHR Board member. A portion of the piece, The Right to Health as the Unheralded Narrative of Health Care Reform, is available online for free.Learn more about PHR’s Global Health Action Campaign, which works with health professionals, students, and concerned citizens to advocate for effective, well-funded, integrated health systems that are equitable and accessible to all.

Ms. R came to the US from her home country in central Africa where, in her early teenage years, she was subjected to a horrifying sexual initiation ritual. Even though she was little more than a child at the time, Ms. R endured repeated insertion of extremely hot items into her vagina as well as forced sex with a stranger. Many years later, as an adult, Ms. R continued to suffer chronic pain as a result of these experiences, as well as the persistent ill effects of psychological trauma. But, recently, with the help of Physicians for Human Rights’ Asylum Network, which documented the forensic evidence of her injuries, Ms. R took a significant step down the path to healing when she was granted asylum.

Ms. R is just one of millions of refugees who have received safe haven in the United States with the assistance, support, and leadership of the office of the United Nations High Commissioner for Refugees (UNHCR). This year — December 14, 2010 — marks the 60th anniversary of the founding of UNHCR, and of the beginning of coordinated international humanitarian protections.

UNHCR, a two-time recipient of the Nobel Peace Prize, has done critical work fleshing out the practical meaning of major international treaties on refugee protection and holding nations accountable for the commitments they have made by adhering to these treaties. The agency is a leader in calling for the end of detention of asylum seekers, and it has spotlighted many other similar concerns for the rights of refugees in its advocacy with governments. UNHCR’s work and influence extend far beyond policymaking circles. The agency is often the first line of assistance to vulnerable migrants, providing food, water, counseling and cultural integration services, and much more. UNHCR staff register refugees, and secure permanent refuge to those who cannot return home.

In 2009, UNHCR served more than 34 million people around the world. By comparison, the US has, in recent years, resettled 60,000 to 70,000 refugees identified by UNHCR annually, and has granted asylum to 20,000 to 25,000 people a year. Our country’s assistance to vulnerable migrants is just a drop in the bucket of need, and demonstrates the vital importance of coordinated and comprehensive international efforts.

UNHCR will mark its anniversary this year by asking governments around the world to make new pledges to refugee protection. To demonstrate our national commitment to survivors of human rights abuses, the Obama Administration should consider responding to UNHCR’s call with the following commitments:

• Eliminate the rule that asylum seekers must request protection within one year of their arrival in the US. There are numerous legitimate reasons why traumatized people do not come forward immediately, from lack of knowledge of the asylum system and their own eligibility to the after-effects of PTSD. The filing deadline results in thousands of denials that put refugees back in harm’s way.
• Re-examine the scope of what is considered “material support to terrorists,” so that innocent victims are no longer barred from protection in the US. Thousands of refugees are currently in legal limbo because of an over-broad reading of the ban on immigration status for anyone who has supported terrorist activities. The government’s extreme interpretation of the law has affected, for example, health professionals who have treated a member of a terrorist organization merely out of duty to practice medical neutrality. The US must limit application of the terrorism-support ban to those who have intentionally acted to further illegal and harmful terrorist activities.
• Eliminate detention of asylum seekers. As PHR’s study From Persecution to Prison has shown, treating asylum applicants like criminals is mentally and physically devastating to them. Unless the government can show that an asylum seeker is a danger to the community or unlikely to appear for immigration court hearings, there is no justification for incarcerating survivors of human rights abuses who are seeking protection under the law.
• Ratify treaties recognizing and protecting the rights of women and children. The US holds itself out as a strong defender of human rights, yet we are one of only seven UN member-nations that have not fully ratified the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and one of only two who have declined to ratify the Convention on the Rights of the Child (CRC). These failures are both shocking and embarrassing. It is long past time for the US to make a public international commitment to women’s and children’s human rights.

The non-profit organization USA for UNHCR recently launched an effort called the Blue Key Campaign to generate American support and funding for UNHCR in its anniversary year. Learn more and declare your support for this agency’s vital work.