Major General Antonio Taguba, USA (Ret.) 

Please join Physicians for Human Rights and Retired US Army Major General Antonio Mario Taguba this Tuesday, April 14, 2009, 4:00-6:15 PM for an exciting afternoon of discussion, debate and dialogue on torture by US forces in the war against terror—and how we can hold accountable those who committed these heinous crimes. The discussion will be held at Austin Hall North, Harvard Law School, Cambridge, MA. (Google map, Harvard campus map).

General Taguba is the author of the 2004 Taguba Report, an internal US Army report on detainee abuse at Abu Ghraib prison in Iraq. He has testified before Congress on the issue of detainee abuse, and in the preface of the 2008 Physicians for Human Rights publication Broken Laws, Broken Lives he wrote that

[T]here is no longer any doubt as to whether the [Bush] Administration has committed war crimes. The only question that remains to be answered is whether those who ordered the use of torture will be held to account.

This event is co-sponsored by Physicians for Human Rights, the Human Rights Program at Harvard Law School, Harvard Law Student Advocates for Human Rights, HLS ACLU, and the National Security and Law Association.

For more information on this event, contact Sarah Kalloch at skalloch[at]phrusa[dot]org or 617.301.4200.

Student leaders, Sandra Kiapi (AGHA) and the Minister of Health of Uganda

Last week, over 80 health professional students from Uganda, Rwanda, Kenya, Burundi and the United States gathered together in Kampala for the first East African Health and Human Rights Student Leadership Institute, sponsored by PHR and our local partner, the Action Group for Health, Human Rights, and HIV/AIDS (AGHA). This three-day event was the culmination of months of planning by student leaders, as well as PHR and AGHA staff. Read the blog posts from US students on their experiences in Uganda.

Eleven different training schools—with delegates from medical schools, nursing schools and paramedical programs—were represented at this workshop, a first of its kind in the region. The delegates came together to build their knowledge of human rights, to enhance their skills in advocacy and to share their ideas for building student organizations focused on protecting human rights.

The three days were packed with distinguished speakers (including keynotes by the Minister of Health of Uganda and Honorable Dr. Elioda Tumwesigye) and focused discussions aimed at helping the students understanding how to use human rights principles as they take on their role as future health professional leaders in the region.

As I reflect on the week, there were many highlights—watching the students present on the main health and human rights challenges in their countries; hearing the experiences of current advocates like Sandra Kiapi of AGHA, Miano Munene of HERAF and Dr. Davis Kasheka of FACT; and participating in interactive skills building workshops, which engaged the students and built their knowledge in crucial areas like leadership development, working with the media, power-mapping for their campaign and online organizing and communications.

On the last day, a group of the students worked together to write a resolution from the Leadership Institute which they will all share with their local media, their institutions and their governments. This resolution, which is included at the end of this post, was read aloud to the closing Guest of Honor, AGHA Board of Directors Chair Dr. Margaret Muganwa, who praised the delegates for their impressive work over the course of the three days.

For me, the Student Leadership Institute was much more than just a three-day workshop. It was a symbol of how far we progressed in the past five years through PHR and AGHA's work in Uganda.

When Students for Equity in Healthcare (SEHC)—the medical student organization founded by AGHA and a group of medical students who wanted to get involved in advocacy for human rights—was founded just four years ago, we could only imagine a health professional student human rights movement that spanned four countries across the region. Yet last week, as delegates from each University shared the health and human rights activities taking place on their campuses, it was clear that the concepts of advocacy and human rights have taken hold among students at these universities. PHR, AGHA, HERAF, and FACT Rwanda have all contributed their knowledge and expertise, but the students have really taken the information and the skills provided to them and made this movement their own.

Blending advocacy regarding their own rights and the rights of students with advocacy on behalf of the communities they serve, SEHC and the other student organizations represented in Kampala last week are building the next generation of human rights advocacy in East Africa.

All of the delegates left with their work cut out for them, and, as Dr. Muganwa reminded them, their path forward will not always be easy. On the last day, all the delegates started to draft their work plans to bring back to their student organizations on their respective campuses. Although this group of delegates may never meet all together again, the human rights advocacy networks that they are building on their campuses are now linked together through the delegates and through the local human rights organizations that support their work. A true regional student movement was born last week, and all of us from PHR were proud to be a part of it.

East Africa Health and Human Rights Leadership Institute Resolution

Sponsored by: Physicians for Human Rights (PHR-USA), Action Group for Health, Human Rights and HIV/AIDS (AGHA-Uganda), Health Rights Advocacy Forum (HERAF-Kenya), Students for Equity in Health Care (SEHC-Uganda), and Forum of Activists Against Torture (FACT-Rwanda, Burundi)

Preamble

We, health professional students from Burundi, Kenya, Rwanda, and Uganda, convened for the East Africa Health and Human Rights Leadership Institute in Kampala, Uganda on April 2-4, 2009;Being aware of the need to bring together a group of future health professionals to raise awareness of our role in promoting health and human rights on our campuses and in the wider community;Building the foundation for a network of East African health professional students in health and human rights advocacy;Having acquired health and human rights advocacy skills to address critical health rights issues;Identifying health and human rights concerns that affect the future of our countries, important issues that affect health professional students, health care professionals, and fellow citizens;Believing it is essential that health professionals and students ensure that governments deliver on internationally agreed upon commitments to protect health and human rights of all people;Committing ourselves to identifying pressing health professional and student rights and looking forward to working together to protecting these rights.

Resolve to call upon our governments and their partners to work together to ensure that:

1. health professionals and health professional students have freely available vaccinations in order to protect themselves and their patients, including hepatitis B vaccinations, which are cost prohibitive to many health professional students in the East Africa region;
2. essential medicines for diseases including tuberculosis, malaria, and HIV/AIDS are continuously funded and in-stock so that patients can receive timely, accessible, and consistent treatment;
3. health care professional students have access to up-to-date medical guidelines and training as well as reliable access to internet at their institutions for educational purposes;
4. governments upgrade and increase the number of health care facilities, especially in rural and semi-rural areas of our countries;
5. health care professionals have adequate supplies and organized events for frequent, widely available continuing medical education and current standards of good clinical practice;
6. robust short-term and long-term solutions are created and implemented to increase retention of health professionals in our countries, including improved investment in health professional compensation, adequate supplies necessary to good clinical practice, safety protections in the workplace, and continuing education;
7. improved funding and coordination within the health sector, including mechanisms to decrease doctor/nurse to patient ratios and to identify and respond to disease epidemics and the increasing burdens of chronic diseases, such as diabetes mellitus;
8. human rights are included in the curricula for health professional students in all cadres.

Reuters' Randall Mikkelsen reports today that the CIA's Director Leon Panetta says the agency

will decommission the infamous "black sites" where terrorism suspects were interrogated with harsh techniques that included waterboarding.

The article says in a letter to Congress, Panetta reported

'CIA no longer operates detention facilities or black sites and has proposed a plan to decommission the remaining sites. I have directed our Agency personnel to take charge of the decommissioning process and have further directed that the contracts for site security be promptly terminated.'

In July 2008, PHR called for a full trans-Atlantic investigation by Congress and the Parliament of the United Kingdom in the wake of a revelation by TIME magazine that the US covertly used Diego Garcia, a British island off the coast of India, as a top secret CIA detention center. PHR also demanded that the International Committee of the Red Cross (ICRC) be given immediate access to all detainees that may still have been held at "black" site locations.

An editorial in today's New York Times echoes Physicians for Human Rights' repeated call over the last half decade: investigate abuse and hold perpetrators accountable.

Responding to the International Committee of the Red Cross report documenting the involvement of medical personnel in torture and abuse of detainees, the Times concludes:

The report underscores the need to have a full-scale investigation into these abusive practices and into who precisely participated in them. Only then will we know whether indictments or, in the case of physicians, the loss of medical licenses, are warranted.

An investigation into torture and abuse is not merely supported by both law and medical ethics, it is an imperative. The legal prohibition against torture, which includes attempt, complicity and participation, imposes the duty to investigate alleged abuse. The ethical principles enshrined in the Declaration of Tokyo, adopted by the World Medical Association and the American Medical Association, prohibits participation of physicians in torture and all forms of cruel, inhuman, and degrading treatment. This includes providing "knowledge" to "facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment." It also prohibits the physician's presence when any of these practices take place.

Continued inaction by Congress, the President, health professionals and American citizens makes a mockery of the rule of law, human rights and medical ethics. As evidence mounts and calls for accountability go unheeded, the shroud of torture hangs heavy.

On the eve of World Health Day and just weeks from the fifth anniversary of the Abu Ghraib revelations, a newly-released International Committee of the Red Cross report provides additional evidence documenting violations of medical ethics in detainee abuse, emphasizing the need for a full investigation to restore the ethical foundations of the health professions. Physicians for Human Rights (PHR) has played a leading role condemning the gross violations of core principles of medical ethics by health professionals involved in the ill-treatment of detainees.

The high prestige enjoyed by health professionals is based largely on a perception that they adhere to the highest ethical standards. The actions of a few who have participated in ill-treatment threaten to erode that standing. Will leading health professional associations and the Administration heed the call to defend medical and psychological ethics and preserve the stature of health professionals?

President Obama has taken laudable steps to ensure that the United States upholds the obligations enshrined in domestic and international law prohibiting torture and cruel treatment. He reaffirmed that commitment at a town hall meeting in Strasbourg, France last week, stating the United States "will not torture." The rhetoric is comforting, but only a first step in restoring the rule of law, and international human rights norms and medical ethics.

PHR supports the creation of an independent, non-partisan commission to investigate all aspects of interrogation and detention policy. PHR has also called on the CIA and the Pentagon to undertake an internal investigation of the role of medical and psychological personnel in abuse of detainees. PHR has been privately and publicly involved in efforts to reform policies that continue to allow health professionals to play a role in exploiting detainees.

Until the abusive policies implemented by the Bush administration are fully investigated and overturned, including the role of health professionals in the design of abusive techniques and their role in interrogations, the legacy of torture will continue to cast a dark shadow. Health professional associations and the Administration must officially investigate both the active and passive involvement of medical and psychological personnel in detainee abuse.

Take Action

• Establish a Commission to Investigate US Torture and Hold Health Professionals Accountable (this advocacy action no longer available)

Further Reading

• The Torture Doctors (Harpers)
• Report Outlines Medical Workers' Role in Torture (NY Times)
• Report Calls CIA Detainee Treatment 'Inhuman' (Washington Post)

Is healthcare a right? What is a human right? Why is this important in Africa? Wednesday was spent meeting people who offered different perspectives on these questions and elucidated new ideas for progress in Uganda.

This is a country rife with the denial of basic rights. From a lack of educational opportunities for youth to food insecurity in the rural areas to widespread abductions of children by the Lord's Resistance Army (LRA) in the north—denial of rights is widespread.

In America, we rarely think about human rights, and most of us don't really even know what they are. But here, in Uganda, people are acutely aware of them. The lack of rights is so severe that it affects daily life. Access to food may be a human right, but if the soil is too poor to grow anything, then how can that right be assured? If water sources are running dry due to climate change, then how can the right to water be fulfilled? These are basic life necessities that are lacking in parts of Uganda, and the rights-based approach can empower the people to demand that they have access to these things. It is up to the governing powers, however, to build sustainable systems for delivery of basic rights.

As enshrined in the Universal Declaration of Human Rights of 1948, healthcare is one of those basic human rights. In Uganda, there are so few doctors being trained, and even fewer choose to stay on here after their schooling is over. Brain drain to industrialized nations has crippled this country's ability to effectively respond to the healthcare needs of this country, from basic primary care and obstetrics to a burgeoning HIV/AIDS epidemic. It really falls on the government here to encourage doctors to stay; one way they could do so is by paying them more adequately.

Throwing money at the problem is not the most effective solution in a country that has serious problems with corruption, accountability and rule of law. Uganda has developed a bad reputation for mismanaging aid money, as evidenced by the recent withdrawal of Global Fund for AIDS, TB and Malaria. This has led to increased hesitancy by international donors to give money. As a consequence, there are no drugs left here to treat TB, and this country has the 15 highest disease burden in the world.

Before money can simply be channeled into the system, it must be ensured that an accountable and transparent government exists and is kept in check by the people. Civil society involvement is essential, and that is why all of these human rights groups who we visited on Wednesday exist. People need to know what their rights are and that they must exercise them by voting and holding the government accountable if they want anything to change.

What an amazing day Wednesday was!

We began by visiting Sandra Kiapi at the office of Action Group for Health, Human Rights, and HIV/AIDS (AGHA). AGHA is a NGO that was founded in 2003. They have several advocacy campaigns and community-based research projects that tackle human rights issues as they relate to health, with a specific focus on HIV/AIDS. One of these is the Stop Stock-Outs Campaign. AGHA also continues to promote accountability and transparency in the spending of PEPFAR and Global Fund monies, which has been difficult since the local culture has been to keep budget information away from the public eye.

Sandra had a lot to say about the HIV/AIDS Bill, which currently is in Parliament. She described loop holes, and she said the bill really needed more compelling language to ensure that states provide drugs. The public already pays 30% taxes, and most of them have no other disposable income to afford private healthcare. 30% of Ugandans receive healthcare through religious NGOs. 2-10% of Ugandans receive private healthcare. The other 60% need state assistance—yet the current bill has no provisions for their health services.

I was really excited to talk to Rose, Patricia and Ruth at the Uganda Human Rights Commission, a quasi-governmental body which was established under the Ugandan constitution in 1995. At the beginning, their biggest focus was bringing justice to victims of torture and upholding the rule of law. UHRC also tries to promote the Right to Health by educating both government officials through seminars and the general public through public radio. AGHA and UHRC have worked together on AGHA's Stigma and Discrimination Campaign, for which AGHA trains health professionals and health professional students on health and human rights. Some of the students we'll be meeting in the next few days, leaders in the Students for Equity in Health Care (SEHC), have been active in helping with this work. UHRC and AGHA both work on advocating for health workforce rights on many levels. Currently, there is only 1 health care worker per 22,000 Ugandan people.

UHRC also works on transitional justice and reconciliation, as well as reintegration of LRA child soldiers—all issues that have been incredibly trying for both the Commission and nation in general. I highly recommend watching Uganda Rising and Invisible Children on these issues.

We also met on Wednesday with Julia Spiegel from the ENOUGH Project, a program of the Center for American Progress with a mission to build a permanent constituency to prevent genocide and crimes against humanity. She's been working directly with victims, military and officials in Northern Uganda and the Congo and has been using insight from her research to advocate for high level policy and holistic action to end the LRA's crimes against women, children and the region in general. Check out the ENOUGH Project's Raise Hope for the Congo campaign. For all you Law and Order fans, the Project also helped write a new episode that tells survivors' stories to educate the public and humanize the issue.

We ended by meeting a physician-advocate who does not wait but acts, even when funds or resources are unavailable. He is one of the world's most inspirational pioneers in providing HIV/AIDS treatment for all, Peter Mugyenyi, MD. He was the first person to bring ARV treatment to Africa, and he was involved in the initial planning of PEPFAR. He is the director of the Joint Clinical Research Centre (JCRC), one of the largest PEPFAR funded programs in all of Africa.The JCRC provides HIV care and treatment to over 60,000 patients in both urban and rural Uganda. About twenty percent of these patients are enrolled in the clinical research at the center. JCRC is the smoothest-running, most high-tech clinical, epidemiological and treatment-based research center we had ever seen. It was the first center to test an HIV vaccine in 1998, and the lab continues to study HIV and opportunistic infections in novel ways. Dr. Mugyenyi has about 1,000 patients under his personal care, and he also is Principal Investigator to seven research projects at the institution. He continues to maintain and enroll patients that need care, despite a Uganda PEPFAR mandate to halt the treatment of new patients.

Meeting with activists from these organizations gave me a lot to think about and process. These organizations deal with tremendous obstacles in creating sustainable change and fighting for the rights of people that are often poor and powerless. Yet, they trudge on, knowing that, though change does not come over night, progress does. These are not people that will wait for better conditions to begin fighting for human rights. They just do it.

(Cross-posted on the PHR Student Blog)

A man dies in immigration detention; isn't this old news?

But the NY Times article on the almost forgotten death of Pakistani immigrant Ahmed Tanveer provides important insight — particularly for what reporter Nina Bernstein doesn't say directly.

The process that lead to discovery of Mr. Tanveer's death was not set in motion by Mr. Tanveer's family, nor his lawyer (he didn't seem to have one), nor New Jersey authorities, who apparently didn't investigate. Mr. Tanveer would still be forgotten if not for one woman, Jean Blum — a refugee from Nazi Europe who was outraged and saddened when detainees were shuttled off to Monmouth County Prison. She set out to do what a "civilian" could do — write to immigration detainees and make sure they weren't forgotten. Her ongoing contact with Monmouth detainees made her the person to whom Mr. Tanveer's cell-mate turned when tragedy struck.

"I am very, very aware of the issues that involve displaced people," said Ms. Blum, 73, who was a child when she and her parents, Polish Jews, fled the Nazis. "I could not turn my back, because that is my history."

It bears repeating that many other sick and dying immigration detainees need advocates with conscience:

As Congress and the news media brought new scrutiny to the issue, several detention deaths have highlighted problems with medical care and accountability.

The secrecy and brokenness of ICE detention will only be fixed when "Jean Blums" across the country — you and I, in every state and county — are watching detention centers, sharing what they know in places like this blog, and demanding action. All contact with detention centers helps make them more transparent and less able to hide flaws.

This is one of many ways that PHR Asylum Network members contribute: By traveling to detention centers to do forensic evaluations for asylum seekers, they show prisons as well as detainees that the outside world is watching.

And now that we're paying attention, how about asking how Ahmed Tanveer came to die a detainee in Monmouth County Jail? It probably will never be known:

Even now, most questions about Mr. Tanveer are unanswered, including just who he was and why he had been detained.

Chances are that Mr. Tanveer, like the majority of immigration detainees, had never been in custody before — no criminal background, no problems with the law. Maybe he feared returning to Pakistan, or was one of many immigrants working in New York to send funds home to his family.

Why does the government keep detaining these people until deportation cases are decided? Immigration and Customs Enforcement's own records show that the cost is extreme, and that there are other ways to make sure that people show up for deportation. As the AP recently revealed:

Based on the amount budgeted for this fiscal year, US taxpayers will pay about $141 a night — the equivalent of a decent hotel room — for each immigrant detained, even though paroling them on ankle monitors — at a budgeted average daily cost of $13 — has an almost perfect compliance rate, according to ICE's own stats.

Let's all be Jean Blums, tell what we see, and demand better from our government. ICE can do the right thing, right now. In keeping with the memory of Mr. Tanveer and others like him, why are they waiting?

We were on the road for quite a while on Tuesday.

Lyantonde is a rural district about three or four hours driving distance southwest from Kampala. Looking out the window, I caught a glimpse of what life for ordinary Africans might be like.

I don't really know what I expected; all of the imagery that I had conjured up about the continent before I came here were basically cliches from movies. I didn't expect people talking in clicks, wielding poison-tipped darts or looking like Libyan terrorists boarding our bus.

The Ugandan countryside is plush and green, it is extremely iconic without being strikingly beautiful. Unlike other parts of Africa, the soil here is fertile, and there are thousands of trees sprouting tropical fruits such as bananas and passion fruit. Along the highway are people gathered in little communities, often sitting in front of small shops.

All the shops are painted vivid colors, like bright purple, that don't mix very well with the surrounding environment and appear this way to advertise for SIM cards companies. If there were a dominant industry here, it would be cell phone credits. It seems like every single person in the city or in the countryside sells airtime. I don't know if this is a good thing or not, but it sure was evident as we passed by thousands of storefronts doused in neon paint.

After about four hours of contemplating this, and of feeling every speed bump and pothole that the road had to offer, I was ready to jump out of the minivan and meet some of the people we had kept passing by. Lyantonde district is where AIDS was first discovered in Africa—initially called "slim disease" because it made people very skinny and frail before they died.

Now, about 30 years later, the region has made a lot of progress toward diagnosing and treating this disease. Central to those efforts in this region is Fred Katumba, MD, the head of Lyantonde District Hospital. This facility is depressingly bare-bones for the the approximately 250 patiens seen there each day. Yet it offers many services such as obstetrics, gynecology, general medicine, basic surgery, pediatrics, infectious disease and specialized HIV/AIDS patient care.The hospital is really a collection of a few old buildings with hundreds of people waiting inside and outside, either to receive care or to visit their loved ones. Inside the hospital there is one small ward for each service and patients lie on cast-iron beds often doubling up with others or in very close distance of one another. Family members who are attending to the patients make a bed on the floor below the patient and are responsible for feeding the patient and buying the necessary supplies and medications. Those without caretakers have a difficult time getting the care they need. Though this is barely a hospital and has almost no infrastructure to speak of.

Yet Dr. Katumba has transformed this into one of the best HIV/AIDS treatment facilities in the country. People come from all over to seek care here, because the program inclues a high degree of follow-up and treatment success rate. Dr. Katumba has recruited community health workers who go to patients' homes and help to ensure their medications are taken regularly. Family members may also assume this role—the idea being that when a patient has a sponsor or partner in their treatment plan, they will be more encouraged to keep with their medication regimen.

Dr. Katumba also has a great patient education program with guidance and counseling to teach patients about their disease and why it is important to remain on ARVs consistently. Another unique program that he has started focuses on commercial sex workers, who frequent Lyantonde because it is a hub of long-distance trucking traffic. He has addressed stigma head-on with this program, by sending healthcare workers into the workplaces of commercial sex workers to test and treat them for HIV and STDs. This program has proven very successful and is actually well-received by the community. Dr. Katumba has made a lot of strides in addressing stigma about HIV/AIDS in his community with the very limited resources that he has to work with.

The countryside is overrun by commercialism, and people are moving out to cities, yet the people I met were friendly and motivated to help change things for the better. It is inspiring to see Dr. Katumba has make postive things happen through being a powerful advocate for his patients—something we can all aspire to!

(For more on the visit to Lyantonde Hospital, see Mona Singh's post on the PHR Student Blog.)

UPDATE: The Kerry-Lugar amendment has passed by unanimous consent! Thank you for your calls!

Last week, the Senate Budget Committee cut President Obama's FY10 International Affairs Budget request by $4 billion. The International Affairs budget funds critical global health programs like PEPFAR and supports humanitarian aid to Darfur, as well as other needed development and diplomatic programming world-wide.

Please ask the Senate to fully fund the International Affairs Budget for Fiscal Year 2010 in order to prevent drastic cuts in US foreign aid funding.

Senators John Kerry (D-MA) and Richard Lugar (R-IN) are introducing an amendment to return the International Affairs budget to the level requested by the President.

Take Action

• Call the Senate switchboard: 202-224-3121
• Ask for your Senator's office
• Use the sample script below to encourage your Senator to be a champion for global health and development:

I am calling to encourage Senator XXXX to support the Kerry-Lugar amendment, which would restore the $4 billion cut to the FY10 International Affairs Budget. This budget funds global AIDS programs and humanitarian aid to war torn regions like Darfur, as well as critical development and diplomatic initiatives that will save live and improve America's relations with the rest of the world. I hope Senator XXXX will co-sponsor the Kerry-Lugar Amendment so the US can keep its promises to the people of the world who need it most. We need to robustly fund PEPFAR, humanitarian aid for Darfur and other key programs which fall under the International Affairs budget.

Continue reading “Foreign Aid Funding At Risk: Call Your Senators Today!”