The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.The WHO explains that “a shortage of qualified health workers in remote and rural?areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONSRecommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONSRecommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONSThe WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONSRecommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.As WHO guidelines have been disseminated, an August 14?article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

This week, PHR joins the voices of many thousands of Americans calling on President Obama to keep his promise to the people of Darfur.Displacement, rape, torture and murder of civilians continue in this western region of Sudan. In March 2009, the International Criminal Court issued a warrant for the arrest of Sudan's head of state, President Omar al-Bashir, for war crimes and crimes against humanity. In July of this year, the Court added genocide to the charges. Yet, the Government of Sudan continues to harass and threaten aid workers, journalists and human rights advocates, making it almost impossible to provide humanitarian aid to hundreds of thousands of people in desperate need.Earlier this month, President al-Bashir blocked international assistance to Kalma Camp, one of the largest Internally Displaced Persons camps and temporary home to tens of thousands forced from their homes by the Government of Sudan troops and their proxy Janjaweed militias. Since 2004, PHR has documented in detail the destruction and desperation of the people of Darfur, calling for protection, access to humanitarian assistance and justice.Unless President Obama mobilizes strong pressure now to strengthen the mandate and response of UN peacekeepers in Darfur and exerts additional clear pressures on the Government of Sudan, we will see more bloodshed, death, and suffering.Mr. President, please don't let this happen on your watch!

Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,”?is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda?representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce.?Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the "brain drain" that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example,?it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi's, the crisis is no less dire: in 2008, the study's authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.

Discrimination and the denial of the rights of marginalized populations has been a driving feature of the AIDS pandemic since the disease first surfaced nearly three decades ago. Many have taken valiant steps to combat this discrimination. Last week, the Senate Appropriations Committee took a significant step that will further the struggle for equality through an important directive it issued for the US?President's Emergency Plan for AIDS Relief (PEPFAR).A little background. In this second phase of PEPFAR, the US government and partner countries sign what are called Partnership Frameworks, which establish respective roles and responsibilities in fighting AIDS in these countries. In December 2009, PHR released an analysis of some of the first Partnership Framework agreements and found they were generally quite weak with respect to critical aspects of fighting discrimination against women, people with disabilities, and other marginalized populations. Specifically, the agreements largely neglected the legal and policy reforms required to ensure legal equality for these groups and to enforce the laws that protect their rights. The frameworks also generally failed to address the stigmatization and discrimination that they face within the health sector.?This is despite what genuinely appears to be a strong commitment of the US government, including the Office of the US Global AIDS Coordinator (OGAC), to combat stigma and discrimination.Congress has now instructed that Partnership Framework agreements and other key PEPFAR country planning documents do a better job of fighting discrimination. In its report accompanying its fiscal year 2011 foreign operations appropriations bill, the Senate Appropriations Committee issued a directive to OGAC about how to spend the funds that Congress is appropriating:

The Committee welcomes the emphasis in PEPFAR’s 5-year strategy on addressing stigma and discrimination against most-at-risk populations and violations of the rights of women, and directs OGAC to address the needs for legal and policy reform and the enforcement of such policies in Partnership Frameworks, Partnership Framework Implementation Plans, and Country Operational Plans.

The Committee further required that civil society have a meaningful role in developing these plans—something that had been happening in some countries, but not others.

The Committee also directs OGAC to ensure civil society is fully engaged in developing these frameworks and plans, including most at-risk populations and women’s organizations. The Committee directs OGAC to consult with the Committee on these efforts.

While the struggle for equality continues, we now have one more vehicle to help us.

In the past 10 years, more than 100,000 US children—all of them full-fledged citizens—have suffered the destabilizing effects of losing one or both parents to deportation. According to the American Psychological Association, children who lose a caretaker face notably heightened risk of psychological distress, developmental delay and poor physical health. Thanks to changes in US law that give less consideration than ever before to the health imperative of keeping parents and children together, an estimated 16 million American children who have at least one non-citizen parent are at risk. There is an opportunity to reverse these changes or mitigate their effect by passing the Child Citizen Protection Act, H.R. 182, and the HELP Separated Children Act, S.3522/H.R. 3531; for the time being, however, American families continue to be forced apart in great numbers by our immigration laws.Now, a commission has bolstered the case for legislative reform by finding that the failure to weigh society’s interest in protecting family unity against the government’s interest in deportation violates the US’ human rights treaty obligations. The Inter-American Commission on Human Rights (IACHR), an autonomous organ of the Organization of American States, announced on August 2?its finding that current US deportation policy violates the human right of respect for family life (PDF). The case at hand involved two separate instances in which lawful permanent residents of the US—green card holders, in other words—were deported because of non-violent criminal convictions that had occurred decades earlier. The IACHR found that US policy violated the plaintiffs’ fundamental rights under the American Declaration on the Rights and Duties of Man “by failing to duly consider on an individual basis their rights to family and the best interest of their children.” In deportation proceedings, the men had been given no opportunity to present evidence of their rehabilitation, their family situation or other humanitarian concerns.A recent major study of children who have lived through the deportations of their caretakers found large numbers exhibiting loss of appetite, nightmares, and other disruptions in sleeping and eating patterns; increased crying, fear, anxiety, and clinginess; withdrawal from friends and family; increased aggressive behavior in older children; and developmental and speech delays in younger children. In the longer term, children forcibly separated from their parents are highly susceptible to mental health complications linked to the traumatic effect on brain growth and functioning that can occur when attachment and bonding with caregivers is interrupted. US immigration law must be revised to require a full and fair individualized balancing between the interests of families to remain united and the country’s law enforcement interest in deporting parents and spouses. There are two bills in Congress right now that would help achieve fairness, and better health, for families and children: the Child Citizen Protection Act, and the HELP Separated Children Act.? If enacted, these measures would protect American children by preventing immigration enforcement officers from conducting frightening raids, arrests, or interviews in front of children; by helping parents maintain custody and make arrangements for their children’s care during enforcement actions; and by requiring enforcement officers and courts to take children’s best interests into account when making decisions about detention, transfer between prison facilities, and deportation.Call your Senators and Representative and ask them to stand up for American kids and their need for family unity by sponsoring the Child Citizen Protection Act and HELP Separated Children Act.

Today, October 6, marks the one-year anniversary of Immigration and Customs Enforcement’s (ICE) announcement that it would undertake major reforms of the immigration detention system.?The need for reform was made clear by a report (pdf) issued on this date last year by then-director of the Department of Homeland Security’s (DHS) Office of Detention Policy and Planning, Dr. Dora Schriro.?Among Dr. Schriro’s key findings were that the immigration detention system had grown dramatically over the course of fifteen years to become the largest and most rapidly-expanding system of incarceration in the country.Although most of ICE’s detention facilities were, and are, designed and operated as prisons and jails, the vast majority of immigration detainees were classified as having a low propensity for violence.?As a result, in Dr. Schriro’s estimation, the immigration detention system “impose[s] more restrictions and carr[ies] more costs than are necessary to effectively manage” detainees.?(The New York Times covered this in this article: Report Critical of Scope of Immigration Detention.)Over the past year, Physicians for Human Rights and our colleague organizations have worked with DHS to implement Dr. Schriro’s, and expert health professionals’, recommendations to limit the negative effects of detention on survivors of human rights abuses and other vulnerable immigrants.?Advances have been achieved, yet much more remains to be done.Among the significant accomplishments of the past year is the implementation of a new policy favoring parole for asylum seekers.?Historically, refugees arriving at our borders to request humanitarian protection have been subjected to mandatory detention while their cases were being resolved, which often resulted in incarceration — and declining mental and physical health — lasting a year or more.?Under the new policy, every newly-arriving asylum seeker is afforded an opportunity to request release from detention, which is granted so long as the individual can establish his or her identity, lack of dangerousness, US address upon release, and commitment to appear at his or her Immigration Court hearings.ICE has also made notable progress in ending its relationship with some of its worst-performing detention facilities, and reducing the number of centers nationwide at which immigration detainees are held.?For example, the Varick Street Detention Facility in New York was the object of numerous complaints, including more than fifty grievances (pdf) filed within just one year alleging neglect of medical needs. Detainees at the facility endured inconsistent access to legal assistance, uncomfortably low temperatures, inadequate food, and denial of any outdoor recreation, all in violation of standards that the facility agreed to in its contract with ICE, with complaints dating back to at least the early 1990s. Finally, ICE ended use of the facility for long-term detention at the end of February 2010. In the past year, the number of locations in use by the immigration detention system has declined by more than one hundred, to a current total of about 250.In spite of this past year’s achievements, too many asylum seekers, survivors of violence, immigrants with mental disabilities, and other particularly vulnerable people remain in what is still a massive detention system, oriented towards penal control of its subjects.?Many thousands more have won release from detention only to be referred into restrictive alternatives to detention programs that rely on ankle bracelets, home visits, and other stigmatizing methods that treat immigrants like criminals on community monitoring.On this anniversary of the advent of detention reform, PHR renews its call for changes that are desperately needed to protect the human rights of the most vulnerable newcomers to our country:

• Reduce the unjustified use of detention, which is unavoidably damaging to the mental and physical health of survivors of human rights abuses. Only those immigrants who pose a danger to the community or are likely to abscond from Immigration Court proceedings need be detained — a small fraction of the more than 400,000 individuals who are currently detained on an annual basis. Asylum seekers, torture survivors, immigrants with serious illnesses and medical conditions, pregnant and nursing women, and children should rarely, if ever, be incarcerated in the immigration detention system.
• Design and implement a case-management-based alternative to the detention program that employs education about immigration law and connection to community supports in lieu of constant electronic monitoring and strict control over movements.
• Demonstrate that the US takes its international human rights obligations seriously by ensuring that immigrants who remain in detention are treated with basic dignity and humanity. Harsh penal practices including solitary confinement, shackling, tasering, and strip searches should be used only to mitigate an immediate risk of harm to detainees or others.?Medical screening and classification must be done by licensed health professionals rather than the corps of enforcement officers and detention center guards who currently perform many intake examinations.?All medically-necessary care must be provided in detention, and not subject to the approval — as certain medical orders currently are — of a central reviewing authority composed of officials who never examine or treat detainees.

With the vocal support of health professionals, much more will be accomplished in the coming years, and hundreds of thousands of immigrants will ultimately live healthier, happier, and safer lives.

The promulgation in June of controversial Law 30 (PDF), which weakens unions and potentially limits the right to strike in Panama, triggered mass protests leaving several dead and scores wounded. According to eyewitness accounts, the Panamanian government reportedly sent in 300 National Police to disband several thousand peaceful demonstrators among Bocas Fruit Company union members in Changuinola (Bocas del Toro province) on 8 July 2010. One eyewitness told PHR that the police gave the crowd 30 minutes to clear the streets. Protesters refused, and police began firing into the crowd.Both official and eyewitness accounts confirm police use of various lachrymators (tear gas) and “perdigones” (lead pellets, or bird shot) and that demonstrators retaliated by throwing stones. One eyewitness (a local resident and bystander to the protest) described the indiscriminate use of tear gas and pellet shots, and said the police “fired wherever and at whomever.” He further reported that the police shot him at close range in the eye with bird shot when he entered the street to rescue a three-year old girl. Doctors stated he may be permanently blind in one eye.Official reports (see: AP, “Panama: 2nd banana worker killed in labor protest” and Human Rights Everywhere, “URGENT REVIEW OF EVENTS IN PANAMA: HUMAN RIGHTS VIOLATIONS, THE COUNTRY?S DEMOCRATIC SYSTEM IN SERIOUS CRISIS,” pg. 4 [English – PDF,?Spanish – PDF]) acknowledge two or three deaths and approximately 150 injured. Community members and union leaders affirm ((Urgent Review of Events in Panama, pg4)) a dozen deaths and some 1000 injured. Causes of death remain unknown, and the majority of serious injuries are reportedly from the perdigones fired at close range. PHR received unconfirmed reports that several protesters suffer from permanent vision loss in one or both eyes, although the exact number of such injuries is unknown. PHR is gravely concerned about reports of disappeared persons, which the media has largely neglected.Sources in Panama, who have visited the injured in hospitals, report injuries indicative of bullet wounds, although PHR cannot directly confirm these cases. The Office of the UN High Commissioner for Human Rights released a statement on July 10 that denounced an unnecessary use of force in Bocas del Toro that violates the UN Code of Conduct for Law Enforcement Officials. Ricardo Vargas, Panama Ombudsman, has also criticized forces for aiming perdigones above the waist. Police stated that they were confronted by unexpected force from the protesters. Many of the police are from the same Ng_be-Bugl_ community as the protesters and reportedly felt conflicted in their role.Negotiations have established a 90-day suspension of Law 30 and temporary peace in Bocas del Toro (PDF), but questions remain how the government will deter further conflict.AS PHR recommended in its 1988 report, Panama 1987: Health Consequences of Police and Military Actions ((pg. 28)), we again condemn the use of bird shot and tear gas as a means of crowd control.

Twenty years after the groundbreaking passage of the Americans with Disabilities Act, there has been great progress. Wheelchair-friendly ramps improve access to public buildings, public schools serve many more children with disabilities and many workplaces now accommodate physically and mentally disabled employees. There are hidden places, however, that the principle of equal rights and participation for disabled people has not yet reached. One of the most hidden is the immigration detention system. By failing to provide any consideration or assistance to the mentally disabled, this system violates human rights that are protected by the Covenant on the Rights of People with Disabilities. The US has signed this treaty, but cannot implement it until the Senate ratifies and incorporates it into US law.

Every night the US government detains roughly 32,000 immigrants while it decides their eligibility to remain in the US. While the majority of immigrants are deported or released in a month or two, the most vulnerable can remain in detention for many months or even years.

Antoni P., a green card holder diagnosed with bipolar and personality disorders, has been stuck in immigration detention for an unbelievable ten years, according to a new report released this past Sunday by Human Rights Watch (HRW) and the ACLU. His plight is not uncommon: Juan Antonio Franco suffers from mental retardation so severe that he cannot tell his age, read a clock or dial phone numbers. An Immigration Judge closed his case almost five years ago after finding him incompetent to take part in proceedings, but Mr. Franco was never given a hearing to determine whether continuing detention was appropriate or whether bond could be granted; instead, immigration authorities were content to let him sit in detention, in limbo and forgotten, for years. Thankfully, the ACLU of Southern California took up his case and was finally able to win his release earlier this year.

As the HRW/ACLU report shows, the rights of the disabled are compromised throughout the immigration enforcement system, from apprehension all the way to deportation. Unlike in criminal prosecutions, where liberty is similarly at stake, immigration courts do not systematically identify mentally disabled immigrants, appoint lawyers to protect their best interests or provide treatment and restore competency so people can understand their cases. Immigration judges who suspend proceedings out of concern for the rights of disabled and incompetent immigrants are given no direction about how to proceed or where to send immigrants. Enforcement officers and detention center staff are ill-equipped and under-funded to manage and treat the mentally disabled immigrants who are in their care.

The results have been horrific: disabled US citizens who could not defend themselves were mistakenly deported and could not be located by their US families for months; a man so disassociated from reality he believed his family had given him the state of Texas was deported despite having a credible claim to asylum; a schizophrenic detainee was forcibly medicated in court.

The Convention on the Rights of People with Disabilities (CRPD) mandates respect for the dignity of disabled people, non-discrimination and full participation of the disabled everywhere, including immigration courts and detention centers. Friday, July 30 marks the one-year anniversary of the US’s signature of the CRPD. Now, the treaty must be ratified and incorporated into US law by the Senate. There has never been a more appropriate or critical time to take that step. Learn about the plight of mentally disabled non-citizens in immigration proceedings: you can read some of their stories here, here, and here. Call on your Senators to support ratification of the CRPD. Don’t let the many immigrants in the same position as Antoni P. and Juan Antonio Franco spend another year in detention.

The International AIDS Conference is taking place this week in Vienna, Austria. The theme of the Conference is “Rights Here, Right Now” and a major focus is on the exploding epidemic in nearby Eastern Europe fueled by injecting drug use.PHR joined with hundreds of other organizations in endorsing The Vienna Declaration—the official declaration of the Conference—which was released at the Conference launch.

The Vienna Declaration is a scientific statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies.

PHR has been a leader in advocating for the United States Government’s adoption and implementation of health policies that are evidence-based, practical, rights-based and appropriate for injecting and other drug users. The Vienna Declaration is right in line with this focus. It outlines how drug policies based largely on law enforcement are harmful to public health while failing to control illicit drug use.The Declaration states that

The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed.

PHR is pleased to see the increased awareness and support for evidence-based drug policies. We are hopeful that momentum from the Conference will result in meaningful policy change and progress toward the right to health.

Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting. However, reorienting drug policies towards evidence-based approaches that respect, protect and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction intervention.

PHR will continue to be a leader in advocating for these policies as well as monitoring their implementation and their impact on improving the health of injecting and other drug users.Endorsements are still being collected; visit the Vienna Declaration website to show your support.

Two years ago, Kamiar Alaei, MD, and Arash Alaei, MD, were arrested in Iran, just as they were preparing to leave for Mexico to present on their innovative harm reduction work at the XVII International AIDS Conference.On July 18, the world convenes again for the XVIII International AIDS Conference in Vienna, Austria—but will be short two shining stars. Arash and Kamiar remain in jail today. The Iranian government accused the brothers of using trips to AIDS and public health conferences around the world to “foment a velvet revolution” and sentenced them to years in prison. We say treating AIDS is not a crime.Friends and colleagues of the Alaeis will be in Vienna spreading the word about their case and advocating for their release, and PHR will be supporting them all the way.Will you be in Vienna at the AIDS conference? To volunteer with these efforts, email Clint Trout at clintworldwide [at] yahoo [dot] com.Want to take action to support the Alaeis? Sign our new petition, calling on the government of Iran to free the Alaeis.Throughout their careers, the Alaeis have promoted public health diplomacy and supported the quest for shared solutions to the world’s shared disease burden. It is an outrage to call this treason. Medical professionals should not be put in prison for doing their jobs. Take action today and stand in solidarity with the Alaeis.See the Background page at IranFreeTheDocs.org for more information on their case.