On June 19, the international community marks the International Day for the Elimination of Sexual Violence in Conflict – a day to honor the strength of survivors and recommit to the pursuit of justice and healing. This year’s theme, “The Intergenerational Impact of Sexual Violence” calls global attention to the profound and enduring harm inflicted not only on survivors, but on families, communities, and future generations. 

For over 35 years, Physicians for Human Rights (PHR) has partnered with health workers around the world to confront conflict-related sexual violence. Our work is guided by the understanding that the impacts of violence reverberate across generations, and that justice and healing can begin, often, with a health professional.

A Holistic Model Rooted in Health and Human Rights 

PHR’s work addresses the wide range of impacts of conflict-related sexual violence through a unique model that combines: 

• Rigorous, science-based forensic documentation and research to expose patterns of perpetration of support accountability; 

• Capacity strengthening for medical, legal, law enforcement, and psycho-social professionals to equip them with the tools and skills to response effectively and ethically; 

• Trauma-informed, survivor-centered care that prioritize survivor safety, agency, and healing;  

• Multisectoral networks of professionals who coordinate to support survivors on the pathway to care and justice; and 

•  Strategic advocacy rooted in evidence to advance policy change, promote accountability, uphold legal standards, and improve care for survivors.  

In countries including the Democratic Republic of the Congo (DRC), Ethiopia, Iraq, Kenya, Syria, and Ukraine, PHR works hand-in-hand with frontline health workers who play a critical role in identifying, documenting, and responding to conflict-related sexual violence – often under conditions of instability and extreme resource scarcity. These providers are not only caregivers. They are witnesses, advocates, and essential agents in the fight for accountability. 

Documenting Abuse – and Its Long-Term Impact 

Health workers are often the first to see and identify the physical and psychological consequences of sexual violence, including among children. In conflict settings, those consequences can span a lifetime – shaping survivors’ access to education, health care, livelihood, and social inclusion. 

PHR partners with medical professionals to equip them with the tools to document injuries, collect forensic evidence, and translate clinical observations into court-admissible records. In the DRC, our work with clinicians helped expose the staggering scale of conflict-related sexual violence, including cases involving children – and contributed to landmark convictions, such as the 2017 Kavumu judgment, where children were the targets of brutal sexual violence and the forensic evidence gathered by health professionals in the community played a pivotal role in securing justice for the young survivors and their families. 

Through our award-winning MediCapt app, PHR supports clinicians to securely record and transmit medical evidence of sexual violence to the justice sector to support accountability. More effective than traditional paper forms, MediCapt enables clinicians to capture comprehensive forensic medical evidence to inform investigations, strengthen prosecutions, and improve the likelihood that perpetrators will be held accountable. 

Building Bridges Between Medicine and Justice 

PHR’s capacity development programs foster collaboration among health professionals, law enforcement, lawyers, and judges. In Kenya, DRC, Iraq, Ukraine, and beyond, we’ve helped establish multisectoral networks that ensure survivors receive coordinated, respectful care and support. 

We train providers not only in forensic documentation, but in trauma-informed approaches that recognize the specific needs of young survivors and mitigate the risks of re-traumatization. These trainings are co-developed with local professionals and are continually updated to reflect global best practices in the collection, documentation, preservation, use, and transfer of forensic evidence of sexual violence. 

 We set standards for how professionals can support child survivors. PHR developed, in partnership with a global community of practice,  foundational principles to provide key considerations for professionals to use when developing and implementing consent and assent processes for child survivors of sexual violence that respect children’s right to be heard and evolving capacity within trauma-informed justice and reparation processes. 

By empowering health workers to advocate for survivors and interface effectively with the justice system, PHR helps ensure that healing and accountability can happen in tandem. 

Meeting the Moment: Rising Need, Shrinking Support 

The intergenerational impact of sexual violence underscores the urgency of long-term, systemic solutions. Yet even as needs rise, funding for survivor-centered, evidence-based programs is diminishing. 

PHR is calling for renewed investment in health and justice systems that support survivors – especially children – and hold perpetrators to account. In the midst of a broader erosion of human rights and shrinking support for aid, PHR and our partners are advocating to ensure that the critical funding for survivors of conflict-related sexual violence is secured to enable healing, recovery, and redress. 

Our partnerships on the ground demonstrate what is possible with sufficient support: real impact, scalable models, and a pathway to justice grounded in care. 

A Call to Action: Justice Begins with Health Workers 

This June 19, as we reflect on the enduring harm of sexual violence across generations, we recognize the immense courage and resilience of survivors of all ages and their families and communities who have endured this violence, and we appreciate the immense role of health workers who bear witness, collect evidence, and stand with survivors of all ages to support their justice process and healing journey. Together, we can build a future where no child inherits the trauma of unaddressed violence – and where every survivor’s path to healing begins with care, dignity, and justice. 

This Physicians for Human Rights (PHR) research brief presents key insights from interviews with ten medical and public health experts who support projects across Ethiopia, including in Addis Ababa and Tigray, and data on the impact of the funding cuts across Ethiopia. This brief has a specific focus on Tigray where impacts of regional tensions have exacerbated by cuts to global health aid between February and May 2025. This brief can be used to inform U.S. policymakers, the government of Ethiopia, the international aid community, and global health and human rights leaders of the urgent need to act to restore funding to critical health services.

It’s Time to Go Beyond the Clinic

A letter from Sam Zarifi, JD, PHR executive director

I write this letter shortly after a visit to Kenya, where I gathered with members of the Physicians for Human Rights (PHR) Board of Directors, our staff based in Africa, and some of our many local partners. I returned from this trip more alarmed than I have been in my 25 years of human rights investigations around the globe – and more convinced than ever about the importance of the work we are doing at PHR.

Global civil society – indeed the entire international human rights framework – is under strain like never before. In the United States, the early months of the Trump administration have seen a dizzying onslaught of attacks on rights, health, and the rule of law. The administration is brazenly undermining potential checks on its power, be it from Congress, courts, media, academia, scientific institutions, nonprofits, or protestors.

Expertise – including the expertise of health professionals – is not only met with skepticism, but with outright hostility. Critical scientific, medical, and public health institutions are being intimidated, muzzled, and defunded. The United States is not only withdrawing from but actively undercutting the organizations that form the foundations of the international human rights and global health architecture, from the World Health Organization to the Human Rights Council to the International Criminal Court (ICC).

“I returned from this trip more alarmed than I have been in my 25 years of human rights investigations around the globe – and more convinced than ever about the importance of the work we are doing at PHR.”

Seen from abroad, the U.S. government is signaling that rights can be trampled, that kindness is weakness, and that empathy is “suicidal.” As a result, human rights violators around the world are emboldened, from the Russian-occupied territories of Ukraine to the extractive mineral mines in the DRC to the besieged hospitals of Gaza. Combatants continue to use torture and rape as weapons of war in conflicts around the globe. Prohibited weapons as well as crowd-control weapons are deployed with abandon. The global dismantling of the U.S. aid system threatens to roll back the significant public health gains of the last century. And while brave health workers are on the frontlines responding to all these crises and more, they often find themselves in the crosshairs and targeted for fulfilling their oaths.

Against this grim backdrop, how do we keep fighting?

For me, the answer starts with Physicians for Human Rights and our incredible partners. For decades, PHR has confronted some of the most powerful perpetrators around the globe – and won. PHR has found ways to drive progress on some of the most difficult, seemingly intractable crises that humanity faces. And PHR has built a network of clinicians, scientists, lawyers, and advocacy experts that spans all U.S. states and scores of countries across all continents. PHR was built for times like these.

“For decades, PHR has confronted some of the most powerful perpetrators around the globe – and won. PHR has found ways to drive progress on some of the most difficult, seemingly intractable crises that humanity faces. And PHR has built a network of clinicians, scientists, lawyers, and advocacy experts that spans all U.S. states and scores of countries across all continents. PHR was built for times like these.”

Because when disinformation is rife, when society’s most marginalized are attacked, when universal values are called into question, the power of facts, evidence, and truth-telling becomes even more potent. Health professionals have unmatched tools, platforms, and skills to defend not only their patients, but their communities. In moments like these, medical professionals must go beyond the clinic. Now is the time to defend health and human rights inside and outside of health facilities, bringing the clinician’s toolkit to the fight for human rights across the United States and around the world.

I won’t sugar-coat it – everyone who cares about human rights and public health should brace for major tumult in the coming years. But as we set our strategy for the months ahead, it’s helpful to take stock of where we’ve been, the tools at our disposal, and the hard-fought wins we’ve achieved together.

And there were bright spots in the past year. After decades of tyrannical rule and 14 years of large-scale atrocities against civilians, Bashar al-Assad fled Syria and the Syrian people now have a rare opportunity to advance accountability and healing. A new international pandemic treaty was adopted. Despite facing immense attacks and sanctions, the ICC and International Court of Justice continued their independent investigations and prosecutions of some of the most egregious crimes of our time. In the 2024 election, United States voters supported reproductive rights at the state level. PHR played a role in all of these achievements – and many more that you will read about in the inspiring pages ahead. You’ll learn about how our network made a difference from Baton Rouge to Baghdad and from Kinshasa to Kyiv.

In times like these, there is strength in numbers. Autocrats feed on division, isolation, and helplessness. But mass mobilization has been and remains a mighty tool to prevent backsliding and safeguard human rights. And when talented professionals from the medical, scientific, and legal fields come together, there is so much we can do together to protect our communities.

So in this moment when so many are overwhelmed or searching for a way to make a difference, we invite you to join our movement. With your partnership, we can hold the line during these tumultuous times and ultimately drive toward a brighter world, where all rights are fulfilled for all.

Let’s get to work.

It took the rebels just 10 days to topple the Assad regime, whose father and son had ruled Syria brutally for more than five decades. However, rebuilding Syria and fostering national unity will take much longer than the rebels’ rapid takeover. Emerging from decades of dictatorship and a bloody civil conflict, Syria wrestles with multi-generational trauma and inherits a massive legacy of human rights violations, including killings, kidnappings, torture, and enforced disappearances by many perpetrators. United Nations (UN) reports highlight evidence of war crimes committed by all sides during the conflict.

Syria is deeply fractured along ethnic, sectarian, and geographical lines, reflecting divisions entrenched during the war, which has resulted in outbreaks of violence in recent months. Political and military interference by external players with conflicting agendas complicate Syria’s recovery. Widespread corruption, particularly within key institutions like the military, security forces, police, and the judiciary undermines trust in state institutions and the rule of law. Given these challenges, as Syrians are already saying, the country is a prime candidate for transitional justice (TJ) processes. Transitional justice is a set of processes and mechanisms that should not only focus on accountability, but also on addressing the legacy of violations to provide remedies and support the rebuilding of the country on the foundations of peace and justice.  

On May 18, 2025, the Syrian government announced a new National Transitional Justice Commission, tasked with “exposing the truth about the grave violations committed by the former regime and holding those responsible accountable, in coordination with relevant authorities,” according to the Presidential l Decree No.20.

As international justice experts rush to offer Syrians their TJ expertise and services, the Syrians may do well to grasp the opportunity to draw relevant lessons from such experiences around the world—and more importantly from neighboring Iraq—while recognizing key differences between the two situations.

Parallels Between Iraq and Syria

What Iraq experienced after the 2003 fall of the Baath regime shares many similarities with Syria’s current situation. Both nations were ruled by the Baath Party for decades, with authoritarian families and their kin dominating power structures. In Iraq, the Sunni-dominated regime under Saddam Hussein mirrored the Alawite-led regime of the Assads in Syria. Both regimes created extensive paramilitary and security apparatuses to suppress dissent, relying on loyalists willing to use any means to maintain control. The nature and scale of the crimes and oppression committed by both regimes, particularly against dissenters, are similar.

The sociopolitical landscapes of Iraq and Syria are also similarly diverse. Both countries are home to a mix of ethnic and religious groups, including Arabs, Kurds, Sunni and Shia Muslims, Christians, and minorities such as Yazidis, Turkmen, and Assyrians. In Syria, the Druze form an additional minority. Before 2003, Iraq’s Sunni Arabs, despite being less than 20 percent of the population, held power over a diverse society. Similarly, Syria’s Alawites, comprising around 10 percent of the population, had ruled since 1971. The military collapse of both regimes underscores the potential for Syria to face challenges akin to Iraq’s, but with the advantage of learning from its neighbor’s missteps.

There are also some key differences between the two situations. One significant distinction between post-2003 Iraq and present-day Syria lies in the nature of the transition of power. In Iraq, the United States-led invasion overthrew Saddam Hussein and transferred authority to opposition groups that had largely remained outside the conflict. In contrast, in Syria, opposition forces who assumed control following the fall of the Assad regime were themselves deeply involved in the decade-long civil war. Another important difference is the role of international involvement. After the fall of Saddam Hussein, Iraq was governed by the United States-led Coalition Provisional Authority (CPA) for over a year. The CPA acted as an occupation authority and made key decisions that shaped Iraq’s political framework and power-sharing arrangements. In Syria, by contrast, opposition groups seized control without the establishment of a formal transitional international authority, instead unilaterally asserting control over political and security institutions

Transitional Justice in Iraq: Lessons Learned

In Iraq, a significant lack of expertise in transitional justice, particularly among Iraqi and Arab-speaking experts, led to, among other things, the absence of a coherent strategy. The steps taken were ad hoc, influenced by exiled Iraqi politicians who failed to assess the perceptions of local Iraqis and by outside powers who accentuated divisions rather than worked to bridge differences. The transitional justice policies heavily relied on punitive measures and compensated specific victim groups without a long-term vision for reconciliation and rebuilding.

Iraq faced numerous issues after the fall of the regime. Apart from the lack of security and stability, the country lacked local capacity and expertise to respond to the massive crimes committed by the Saddam regime. This resulted in a situation where transitional justice was largely shaped by external actors. The outside powers failed to properly understand and assess the challenges that Iraq would face to build peace and reconciliation. By contrast, in Syria the new authorities have been very clear in wanting Syrians to maintain control and lead the process and this is further helped by Syrian actors, inside and outside, who have deep knowledge of the key TJ processes and institutions even while they may lack practical experience in implementing them.

As seen in Iraq, sectarian violence can have a devastating impact on peace and reconciliation efforts. Continued violence not only adds to the number of victims but also complicates any plan or process of transitional justice. The recent outbreaks of violence in Syria’s coastal areas and the south should serve as a warning: the country must act urgently to prevent a descent into chaos.

Iraq’s transitional justice efforts reveal a series of missteps that offer six critical lessons for Syria:

1. Vetting and De-Baathification

Shortly after the fall of Saddam’s regime, the CPA issued orders that disbanded the Iraqi military and removed high-ranking Baath Party members from public service. These measures, known as de-Baathification, were implemented without proper consideration of their long-term consequences. Tens of thousands lost their jobs, creating a massive security vacuum and fostering instability. The process targeted individuals based on rank rather than their actions, fueling resentment and marginalization. De-Baathification became politicized and was, in some instances, used as a tool to unfairly sideline political adversaries and remove them from the political arena.

2. Accountability Measures

The CPA established the Iraqi Special Tribunal to prosecute senior regime figures, including Saddam Hussein, for international crimes such as war crimes, genocide, and crimes against humanity committed by his regime. Iraqi law does not include international crimes.  Although the tribunal was an Iraqi court, it was created by the United States. It heavily relied on the United States, the occupying superpower, which in many ways deterred other international support.

For many Iraqis seeing the former president in the dock answering to a judge was a psychological turning point—at last believing the reign of terror had finally ended. However, from the outset, the tribunal faced challenges, including a lack of security, poor public outreach, and allegations of illegitimacy due to U.S. influence.

Ultimately political expediency overtook the judicial process. Saddam Hussein was convicted and executed after only one trial and one case of criminal behavior. For Iraqis waiting to see him held accountable for many other crimes committed during his period in charge, this was a major disappointment.

3. Reparations

Iraq has established several reparation programs over the years, primarily focused on material compensation. These programs cover a broad range of survivors—not only those affected by the Saddam regime, but also those impacted by the violence that escalated after 2003. In 2006, the government began compensating victims of Saddam Hussein’s regime, including those who were killed, imprisoned, or had lost their jobs and properties. As the conflict evolved, the government expanded the scope of reparations in 2009 to include victims of military operations and terrorist attacks.

These programs have been costly, with at least USD 5 billion disbursed in cash to date. However, they have faced significant challenges, including widespread corruption, limited institutional capacity, and inadequate data collection mechanisms—all of which have contributed to flaws in implementation.

Critics have also pointed to political and sectarian manipulation of these compensation initiatives, with some victim groups being prioritized over others.

In 2021, a dedicated program was established to provide reparations for female survivors of ISIS atrocities—an important, though limited, step toward addressing gender-specific harms, stabilizing regions formally occupied by ISIS, and broadening the scope of transitional justice. It is important for Syria’s transitional justice process to also prioritize gender-specific crimes and the needs of sexual violence survivors, including reparations.

4. Truth-Seeking

Iraq failed to establish a comprehensive truth-seeking mechanism, as policymakers prioritized prosecutions over uncovering the truth. This approach has left victims without an official record of past atrocities nor a broader understanding of why this had been allowed to happen. To ensure non-repetition it is essential to understand the reasons and to put in place the necessary institutional and legal safeguards to prevent recurrence. After 2003, Iraq experienced numerous waves of conflict and upheaval, which led to a reliance on ad-hoc fact-finding committees to investigate specific events and crimes. However, these committees were often neither impartial nor transparent, serving the interests of those who created them rather than prioritizing the investigation, documentation, and dissemination of the truth.

Moreover, these sporadic fact-finding efforts were rarely made public, depriving society of a shared understanding of its history and undermining efforts to promote collective healing and reconciliation.

5. Addressing Missing Persons

Iraq faced significant challenges in dealing with mass graves and missing persons. Iraq has one of the highest rates of missing persons in the world. So far, approximately 221 mass grave sites have been discovered, with around 96 attributed to Saddam’s regime. Arbitrary exhumations by victims’ families and inadequate technical capacity have compromised evidence and hindered justice. Iraq has a law governing mass grave exhumations and in contrast with other measures, the Iraqi institutions dealing with missing persons have, over time, developed significant technical expertise. As such, they are potentially well-positioned to pass on that experience to their Syrian counterparts in building their capacity in this critical area.  

6. Civil Society Engagement

The role of civil society is crucial in transitional justice—not only in advocacy and promoting accountability and justice, but also in gathering evidence and amplifying the voices of victims. However, this was not the case in Iraq after 2003, despite the massive number of victims and the widespread legacy of human rights violations. Decades of dictatorship and the absence of fundamental freedoms prevented Iraq from developing a robust civil society. This vacuum in the post-2003 period weakened the design and implementation of transitional justice measures.

Recommendations for Syria

To avoid the pitfalls experienced by Iraq, Syrian policymakers and international stakeholders should avoid the Iraqi ad-hoc approach and adopt a comprehensive and inclusive transitional justice strategy. This strategy should involve consultations within all sectors of Syria, and include short-, medium-, and long-term goals supported by data collection—such as public polls—to assess public perceptions and inform resource allocation. Transitional justice in Syria should be based on a victim-centered approach while avoiding retributive justice. The establishment of the National Transitional Justice Commission is a positive step in the transitional justice process. However, while the Commission is mandated to address violations committed by the Assad regime, it will find that it cannot ignore violations committed by all parties to the conflict. The justice component of the transitional justice process should not reflect a “victor’s justice” approach. Instead, the rights and needs of all victims must be addressed equitably and without discrimination.

Truth-Seeking and the Protection of Mass Grave Sites

A national truth-seeking initiative should involve all segments of Syrian society. Given Syria’s long history of violence and abuses, documenting and acknowledging the past is essential for designing effective reparations, promoting accountability, and fostering national unity. Such an initiative must be inclusive and transparent to ensure widespread societal buy-in. Moreover, the right to know the truth should be upheld as a fundamental human right.

As part of truth-seeking efforts, one of the most urgent issues is the protection of mass grave sites. Syrians will need to develop a legal framework to secure and protect mass grave sites. Exhumations should only begin after building national technical capacity and establishing a national entity to take the lead in this area. Nationalizing the process of identifying missing persons is essential to ensuring the collaboration of victims’ families, building trust, and addressing their needs.

Syrians have the advantage of a newly established international mechanism, the Independent Institution on Missing Persons in the Syrian Arab Republic. This institution will help bring expertise and capacity, coordination of international actors and a readiness to work inside Syria in partnership with an impartial and independent national body or bodies. Syrians should seek to benefit to the fullest from this new institution.

Conducting public surveys to understand public attitudes toward peace, justice, and reconciliation have been shown to be a useful way of gathering insights that reflect societal priorities and help shape transitional justice strategies.

Accountability

Syria should develop a comprehensive strategy for accountability for crimes committed over the past few decades. This strategy should reflect the following:

• Defining the threshold for accountability, including which crimes and perpetrators should face prosecution and who may be eligible for other forms of accountability or even pardons, along with the conditions for such exemptions.
• Ensuring the legitimacy of any justice process, it must address crimes committed by all parties to the conflict.
• Assessing the capacity and limitations of the current judicial and law enforcement systems to determine the most effective accountability mechanisms.
• Integrating accountability measures with other pillars of transitional justice, such as truth-seeking, reforms and reparations, to ensure a holistic and survivor-centered approach to justice and reconciliation.

To embark upon this strategy collecting data and mapping crimes and perpetrators to establish a clear record of violations will be an essential step and Syria can benefit from the data-gathering that has been done over many years by Syrian and international civil society organizations. It should also be able to call upon the Independent International Commission of Inquiry that has been gathering data on grave human rights and humanitarian law violations (including war crimes and crimes against humanity) since late 2011.

Syrian and international non-governmental organizations (NGOs) can also assist with data-sharing related to grave human rights violations. For example, Physicians for Human Rights (PHR) has meticulously documented the systematic targeting of Syria hospitals and health care workers during the civil war. This data and other credible sources can be used to inform Syria’s transitional justice efforts to hold perpetrators accountable for attacks on civilians and civilian objects committed during the war.

The prosecutor of the International Criminal Court has already visited Syria and the court may have a variety of useful roles in assisting Syria in its endeavors to deal with past international crimes, but even more importantly will be the strength of the partnership being established between Syria and the International, Impartial and Independent Mechanism that was established in December 2016 to assist “in the investigation and prosecution of crimes under International Law committed in the Syrian Arab Republic since March 2011.”

The national legal and judicial system in Syria should be strengthened to the point where it can effectively address atrocities. It is imperative that all relevant international entities and stakeholders support efforts to build the capacity of Syria’s national institutions.

Institutional Reform

With the dissolution of the Assad regime’s army, security agencies, and Baath Party by the new Syrian authorities, the following issues must be considered in the process of rebuilding the military and security forces and other institutions:

• Vetting vs. Purging: Reforms should prioritize vetting individuals based on their actions and records rather than resorting to wholesale purges. This approach ensures fairness, minimizes disruptions, and preserves institutional functionality. A realistic objective and actionable plan must be established to guide this process. The institutional reform strategy should be forward-looking, emphasizing future resilience while safeguarding against potential abuses.
• Security Sector Reform: Professionalize the military and security forces to eliminate corruption and ensure they protect citizens rather than suppress dissent. Oversight mechanisms are essential to building public trust.

Reparations

Unlike Iraq, Syria may lack the same level of financial resources to effectively address all the needs of survivors, especially after the destruction from the state’s policies during the lengthy internal armed conflict it has endured since early 2011. This will be felt most directly if discussions around compensation or reparations focus only on financial payments to victims. So, it will be important to manage survivors’ expectations to avoid false promises that could inadvertently deepen their suffering.

That said, while Iraq relied heavily on one form of reparations programs (financial compensation) successful reparations programs from around the world and in the Middle East North Africa (MENA) region (Morocco is an example) relied on several types of reparations including but not bound by financial compensations alone. Such programs have included communal programs, symbolic reparations and in some instances an official apology by the new head of state for the harm done to individuals or communities by the state. Programs have also been developed that extend the financial cost of reparations over several years as opposed to incurring the total cost in one year and for example have included subsidies in the health and education spheres for victims’ families and the survivors.

In many ways in a conflict such as the one in Syria, all of Syrian society has been victimized and programs recognizing this will likely help in the process of healing and restoring trust.

Strengthening Civil Society

Civil society organizations as well as survivors and families of victims should be empowered to participate in transitional justice efforts. Their involvement is essential and will enhance public engagement, ensure diverse perspectives, and build community trust. There will likely be differences in experience, knowledge, and perception between civil society activists abroad and also with those who remained inside Syria. That has been the case in many TJ processes around the world.

To ensure a broader involvement of civil society, particularly representatives of victims’ groups and different segments of Syria, the new Syrian authorities should establish inclusive consultation mechanisms that engage victims’ groups, women’s organizations, youth representatives, and minority communities in political and transitional processes. The authorities should also guarantee freedom of expression and assembly to allow civil society actors to operate without fear of reprisal.

The Role of Physicians for Human Rights (PHR)

Physicians for Human Rights (PHR) has played a significant role in documenting and collecting evidence of crimes committed in Iraq and Syria, in addition to capacity strengthening support for medical and legal partners in both countries. For example, in Iraq PHR confirmed that the Saddam Hussein regime used chemical weapons—including mustard gas and the sarin nerve agent—against the Kurdish population in the late 1980s. PHR scientists and investigators collected soil samples from the Kurdistan Region and assisted in the exhumation, identification, and determination of probable causes of death of victims found in mass graves. This evidence was later used by the Iraqi High Tribunal in the prosecution of Saddam Hussein and his aides for genocide against the Kurds, and in supporting compensation claims for Kurdish victims.

In Syria, since the start of the conflict in 2011, PHR has documented attacks on health care, including assaults on medical facilities and personnel. Based on this work, PHR has produced numerous reports and compiled substantial evidence of violations of medical neutrality. This documentation should serve as a key resource for any future accountability and reparations initiatives or programs in Syria.

Conclusion

The international community should provide technical and financial assistance to support Syria’s transitional justice process. Lessons from Iraq and other post-conflict settings can help guide these efforts. Syria’s situation remains fragile, and its political and social landscape risks collapsing or backsliding. Sustained international assistance is critical to help the country overcome these challenges.

Syria can benefit from existing international mechanisms and entities that can provide critical assistance, such as the International, Impartial, and Independent Mechanism (IIIM), established by the UN in 2016, and the Independent Institution on Missing Persons in the Syrian Arab Republic (IIMP), established in 2023. The data collected by the Commission of Inquiry (COI), established by the UN Human Rights Council in 2011 to investigate the human rights and humanitarian law violations during the conflict in Syria, is essential for any accountability, truth-seeking, reforms, or reparations programs. The ICC and other international institutions should stand ready to provide additional much needed technical support. 

While Syria lacks financial resources after the destruction wrought by the lengthy civil conflict, it does not lack capable people who can develop and run these TJ programs. In many discussions and debates before and after the December fall of the previous regime, this expertise has been there for all to see. Their actions that lead to the establishment of the IIIM and the IIMP are a testament to these abilities and their resilience. What they may lack today, through no fault of their own, is the practical experience of developing and running such programs. They would do well to now link up with counterparts who have implemented such programs, in the MENA region and beyond, because they can provide crucial assistance in pointing out what worked well, what pitfalls to avoid, and more crucially with the benefit of hindsight to say what they might have done differently.

By learning from Iraq’s experience and implementing a well-thought-out transitional justice strategy, Syria can navigate its post-conflict period more effectively. Although the United States and other countries plan to remove or ease the international sanctions, the new Syrian government should take tangible steps to encourage their full removal. These steps should address the root causes of division and promote inclusive governance that respects the rights of all Syrian factions. Such efforts are essential not only for achieving lasting peace and stability within Syria but also for contributing to regional security.

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Abdulrazzaq Al-Saiedi is an expert in transitional justice and rule of law initiatives in the Middle East and North Africa (MENA) region. He serves as Technical Expert for Physicians for Human Rights (PHR).

Originally published by New York University Center on International Cooperation (CIC).

Photo: Al Hajar al Aswad City, 4 kilometers south of the center of Damascus in the Darayya District of the Rif Dimashq Governorate, Syria. March 21, 2025. Courtesy of New York University.

The first 100 days of U.S. President Donald Trump’s second term have already undermined human rights and access to health care, both in the United States and across the globe. Several executive actions signed by the president target people seeking asylum and other migrants to the United States, while other new policies erode public safety, jeopardize reproductive health, and undermine global health cooperation. Taken together, President Trump’s policy agenda threatens public health and violates fundamental rights.  

As an organization dedicated to the promotion and protection of human rights and health, Physicians for Human Rights (PHR) is alarmed at the dangerous trajectory of these policies. In response PHR will continue to mobilize our networks of clinicians – including nurses, doctors, and psychologists – as well as our expert teams of lawyers, policy and human rights advocates, and researchers to protect the rights of asylum seekers, freedom of expression and peaceful assembly, the right to comprehensive reproductive care, and the right to health, among others. 

Here’s a look at executive actions taken by President Trump in his first 100 days.  

Updated April 28, 2025 

Attacks on Immigrants and Dismantling the Right to Seek Asylum  

President Trump’s 2025 executive actions dismantled immigration and asylum policies and adopted a policy of “deterrence through cruelty.” It is now even more difficult, and in some cases, impossible, for individuals fleeing violence and persecution to seek refuge in the United States, especially those seeking to cross the U.S.-Mexico border.  

With mandatory detention for noncitizens now enshrined in federal law, immigrant communities are facing a sweeping expansion of criminalization and detention. Under these policies, individuals who are merely suspected or arrested for crimes such as burglary, theft, larceny, shoplifting, can be subjected to prolonged detention without individualized assessments of risk or release eligibility. This framework conflates immigration enforcement with criminal punishment, reinforcing a punitive system that disproportionately targets immigrants for detention and deportation, even when they have not been convicted of a crime. 

The Trump administration prepared the Guantánamo Bay prison in Cuba to detain migrants and began to send people to the site infamous for torture and isolation from judicial oversight. Among the 178 migrants held in the prison in February, 51 were nonviolent, “low risk” detainees who lacked criminal records, despite the administration’s claims to only hold the “worst of the worse” at the site. PHR filed an official complaint to the Department of Homeland Security Office of Civil Rights and Civil Liberties (CRCL) – responsible for ensuring that policies and actions by the Department of Homeland Security (DHS) respect civil rights and liberties. The complaint calls for the government to release the names of those detained in order to facilitate contact with attorneys, investigate conditions in the prison, and to ultimately end the use of Guantanamo for immigration detention. CRCL was dismantled less than two weeks later, eliminating a critical safeguard intended to hold DHS accountable for abuses, and increasing the risk of unchecked violations. As of April 22, it is unclear how many migrants remain at the facility.  

The decision to rescind the “Sensitive Locations policy,” previously preventing immigration enforcement in or around hospitals, schools, and places of worship, has already impacted access to health care within our borders. Preliminary findings from a survey of clinicians in PHR’s Asylum Network across the country suggest that the rollback of suck protections has contributed to a pervasive climate of fear. Care providers reported that this fear is already contributing to negative health outcomes among individuals of a broad range of immigration status, including delayed care, missed preventive services, and treatment interruptions. Many note that patients are arriving sicker, with some anticipating more advanced disease presentations, such as late-stage cancers. Children in mixed-status families are especially vulnerable, with parents in some cases refusing essential services like post-surgical rehabilitation due to immigration-related concerns, indicating a broader, long-term public health impact that extends beyond individual patients. 

Over the past 100 days, immigration enforcement agencies have been empowered to detain and expel immigrants without due process and blatant disregard for the judiciary. Nearly 300 people who had attempted to seek asylum in the United States were expelled to Panama via military planes. In response to this, PHR mobilized four physicians and one psychologist to fly to Panama. After being released from detention in Panama and given limited protected status by the Panamanian Government, PHR’s clinicians conducted 27 in-depth medico legal evaluations. The individuals evaluated included a women’s rights advocate and a former military officer who had fought against the Taliban and now faced extreme danger or potential death in Afghanistan; people in Iran who had converted from Islam to Christianity, where such conversions are punishable by imprisonment or even execution, and individuals targeted and threatened with imprisonment because of their sexual orientation. Evidence from these evaluations was prepared by PHR and formed part of an ongoing lawsuit filed by the Global Strategic Litigation Council before the Inter American Commission on Human Rights on behalf individuals expelled from the US and detained in Panama.  

As the government dismantles long-standing protections and accelerates policies designed to deter people from seeking asylum in the United States – and expel those that already have made it into the country – PHR’s 2,000-strong Asylum Network continues to provide pro bono forensic medical evaluations to support ongoing asylum cases. With our partners, PHR will continue to defend the internationally recognized right to seek asylum and advocate for the dignity, health, and safety of immigrants put at risk by punitive U.S. policies. 

If you are a health care provider, please use this guide to navigate the evolving enforcement landscape while upholding your duties as a health care professional, “Health Care and U.S. Immigration Enforcement: What Providers Should Know,” jointly published with the National Immigration Law Center (NILC) 

Read PHR’s statement on Trump’s new executive orders on asylum and immigration, our reaction to the rescinding of the “sensitive locations” policy, and our reaction to the plan to use Guantánamo Bay prison to detain migrants.  

Freezing of International Aid 

The Trump administration’s abrupt and massive cuts to foreign aid imperils millions of people by shuttering USAID. Across the African continent, where the United States had been a leading supporter of life-saving food, medicine, and other vital health services that curbed the spread of HIV as well as other infectious diseases, the sudden slashing of U.S. aid jeopardizes the health of populations already enduring conflict, displacement, and insecurity, including women and children.  

Critically, the shuttering of USAID will dramatically increase the spread of new infections and lead to thousands of unnecessary deaths. According to the World Health Organization (WHO), health systems are already at heightened risk for supply chain collapse and problems with surveillance in at least 18 countries that depended on the United States for 89% of their funding for tuberculosis care. Health studies predict that the loss of USAID funding, without a replacement from other funding sources, could result in 15.2 million addition AIDs deaths, 2.2 million additional deaths from tuberculosis, and 7.9 million additional child deaths from other causes.

PHR shared evidence with the House Foreign Affairs Committee that showed that the DRC faced losses of up to 70% of its foreign aid, rendering hospitals unable to provide critical services and respond to disease outbreaks. Halts in care for survivors of sexual violence come at a particularly critical time. Humanitarian actors reported more than 895 cases of rape in February alone, averaging more than 60 cases a day. PHR also reported that aid cuts threaten to collapse the health system in Ethiopia. USAID funding was critical for supporting water, sanitation, food, and health care needs of internally displaced populations, operation costs for clinics that treat survivors of sexual violence, and programs for distributing HIV medication. 5,000 health care workers were furloughed by the Ethiopian Ministry of Health as of late March. PHR urges the administration to reinstate vital funding for health and human rights sectors, as well as other essential work by our partners and other beneficiaries of U.S. foreign aid.  

Attacks on Reproductive Rights 

Among the first actions taken by President Trump in 2025 was the reinstatement and expansion of the so-called Global Gag Rule, a policy that prohibits organizations that receive U.S. global health assistance from providing legal abortion services or referrals, while also barring advocacy for abortion law reform –  even if it is done with the NGO’s own, non-U.S. funds. By restricting U.S. funding for organizations that provide comprehensive reproductive health services, the Trump administration is threatening the health and rights of millions of individuals of reproductive age, particularly in low- and middle-income countries.  

Meanwhile, here in the United States, President Trump pardoned 23 anti-abortion extremists who attacked abortion clinics and harassed clinicians. The pardons come as anti-abortion officials in states like Louisiana and Texas use the courts to target doctors who mail abortion medications across state lines. The Department of Justice also announced that it is dropping its case against the state of Idaho requiring that hospitals still provide emergency abortion care under the Emergency Medical Treatment & Labor Act (EMTALA). This decision represents a significant break in government policy, which previously ensured that doctors could help pregnant patients suffering from life-threatening conditions before patients were on the brink of death. Funding freezes on Title X by the Department of Health and Human Services (HHS) have targeted clinics that provide affordable birth control, STI testing, and other essential health services, on the grounds that these clinics promote diversity, equity and inclusion. 

PHR recognizes that access to abortion care is part of reproductive rights and justice, whether abroad or here in the United States. PHR’s research with our partners have exposed the unworkability and harms of abortion bans in several U.S. states including Idaho, Oklahoma, Louisiana, and Florida, impacting clinicians and patients alike. We commend state governments like that of New York which are redoubling their commitment to shield health workers in their state from prosecution and other penalties under other state’s bans. We call for an end to the criminalization of abortion care, for both patients and clinicians alike.  

Ending Bans on “No-Knock” Warrants, Choke Holds, and Militarized Policing 

Another troubling move by the Trump administration  was the reintroduction of federal “no-knock” warrants, which allow law enforcement officers to enter private homes without prior notice or announcement, and an end to the federal ban on the use of choke holds. This move reverses important reforms that sought to end these dangerous practices and increases the risk of deadly confrontations between law enforcement and communities of color. Both the use of no-knock warrants and choke holds have already led to numerous high-profile cases of police violence, often with fatal consequences, and disproportionately impact Black, Latino, and Indigenous communities. 

PHR has documented excessive force used by law enforcement against communities across the United States, including the dangerous and sometimes deadly use of crowd-control weapons. Our work has also helped debunk pseudo-scientific terms with racist origins like “excited delirium”, motivating leading medical associations and multiple U.S. states to ban the term.  

Withdrawal from the World Health Organization and other International Bodies 

Another dangerous action taken by President Trump was to withdraw the United States from the World Health Organization (WHO). This decision directly undermines international health cooperation, weakening global efforts to combat infectious diseases, and limiting access to health care resources in countries that need it most. The United States’ exit from the WHO reduces the ability of health professionals around the world to coordinate responses to health emergencies and threatens the global health infrastructure that has been vital in preventing and managing public health crises. These actions limit the United States’ ability to confront the active outbreaks of avian flu, Ebola, and Marburg virus – threatening the health of people in the United States and abroad alike. PHR has long supported the work of the WHO in promoting universal access to health care and addressing health inequities. PHR has documented how the Trump administration’s previous efforts to distance the United States from international health organizations have had damaging effects on global health, including during emergencies such as the COVID-19 pandemic.  

In February, President Trump signed another Executive Order ending U.S. participation in the United Nations Human Rights Council (UNHRC) and ordered a review of the U.S. relationship with all other international bodies. Unlike the U.S. withdrawal from the UNHRC during the first Trump administration, the U.S. is not currently a Member State of the UNHRC, so its withdrawal will be less immediately disruptive. However, by exiting these multilateral fora, the United States will be abandoning its leadership on the global stage in addressing, mitigating, or shaping human rights and other crises around the world. 

Sanctions Against the International Criminal Court  

In January 2025, President Trump revoked the Biden Administration’s previous order that rescinded the first Trump administration’s sanctions against officials of the International Criminal Court (ICC) in The Hague. In February, the president issued sanctions against individuals and their families who assist the ICC in investigations of citizens of the United States or its allies who are not a state party to the Rome Statute. U.S. Congress is actively considering legislation that would enact new, far-reaching sanctions against the ICC, as well as individuals cooperating with the ICC.  

PHR has long supported the work of the ICC in bringing justice to victims and survivors of atrocities, particularly in places where local justice systems are unable or unwilling to hold perpetrators accountable. PHR has supported case building and evidence sharing on war crimes and other atrocity crimes in countries like the Democratic Republic of Congo, Sudan, Ukraine, and others, The ICC remains a vital part of the global justice infrastructure that helps ensure reparations for victims and survivors of war crimes, crimes against humanity, and genocide. PHR renews its call for the United States to lift any sanctions or penalties against individuals for their work supporting justice and accountability in the international court system and continues its long-standing call on the United States to join the Rome Statute supporting this international court of last resort. 

Looking Ahead

This year, the human rights record of the United States will be the subject of scrutiny before the United Nations Universal Periodic Review (UPR). To support the UPR process, PHR and our partners have submitted our evidence and recomendations on urgent health and human rights developments in the United States. Explore our submissions here. PHR will continue to monitor these developments and advocate for the rights of those most at risk. To stay informed on the ongoing impact of these policies, please subscribe for updates and explore our resources. 

The Universal Periodic Review (UPR) is a groundbreaking United Nations process initiated in 2006 that evaluates the human rights records of all 193 Member States on an equal footing. This year, the human rights record of the United States will be the subject of scrutiny. To help inform the UPR of the United States in November 2025, PHR’s submissions are listed below. 

What is the UPR? As a core mechanism of the Human Rights Council, the UPR fosters global dialogue, encourages countries to address human rights challenges, and promotes the sharing of best practices. Non-governmental organizations (NGOs) like PHR contribute submissions to the UPR process to help share information and shape outcomes, further helping the UPR’s vital role in reporting on and improving human rights conditions worldwide.  

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PHR’s Submission to the Universal Periodic Review of the United States 

PHR’s submission covers the health and human rights impacts of: abortion restrictions on providers and patients in several U.S. states; abuses in U.S. immigration detention facilities, presence of immigration authorities in health care settings, and the erosion of protections for asylum seekers; and the continued use of “excited delirium”, a pseudoscientific term with racist roots that is often used to deny accountability for deaths during interactions with law enforcement. 

Read the submission

Joint Submission on Diminishing Reproductive and Bodily Autonomy in the United States  

Abortion bans in the United States violate the human rights to life, health, privacy, freedom from torture, freedom of movement, non-discrimination, and more. PHR’s joint submission explores this human rights crisis by gathering data from those most impacted. Jointly submitted with partners including: Global Justice Center, Ipas, Guttmacher Institute, Birthmark, Louisiana Abortion Fund, Louisiana Coalition for Reproductive Freedom, ReJAC, Jane’s Due Process, The Afiya Center, and Lift Louisiana. 

 Read the submission

Joint Submission of Coalition of Immigrant Rights Organizations to the United Nations Universal Periodic Review of the United States 

This submission to the Human Rights Council for the 2025 Universal Periodic Review (UPR) of the United States is a joint report from a coalition of 23 United States-based non-profit organizations that defend the human rights of non-citizens. The information presented shows that the United States has failed to meaningfully address Member States’ 2020 UPR recommendations to the United States to remedy human rights violations of non-citizens. Instead, the United States continues to violate the human rights of non-citizens through mass detention, denial of due process, abusive and discriminatory policing, labor exploitation, and suppression of civic space. 

Read the submission

Joint Submission on Excessive Use of Force by Law Enforcement 

The excessive use of force by law enforcement remains a prevalent issue in the United States. In responding to the Black Lives Matter protests of 2020, law enforcement in the United States repeatedly failed to comply with domestic and international standards on the use of less lethal weapons. American companies are involved in the global trade of inherently abusive goods, contrary to international obligations. Government efforts to promote oversight, controls, and accountability remain insufficient to mitigate future violations, and have been undermined by recent policy changes in 2025. This submission, co-authored with Omega Research Foundation, highlights the need for the United States to fulfill its obligations to respect the rights to peaceful assembly and prevent the excessive use of force, as committed to in the last UPR cycle.  

Read the submission

The woman seated facing me smiled briefly as she recalled her work in Afghanistan with a nongovernmental organization that supported women’s voting rights. This was before the Taliban takeover in 2021 – before her organization’s offices were ransacked and directors imprisoned, before her town’s mayor warned that she was on a list of women wanted by the Taliban, before she fled her home to hide with relatives. Despite going into hiding in Afghanistan, a group of men found her, beat and raped her, warning they would return to imprison and kill her. With financial support from her relatives, she fled Afghanistan and made her way to the United States-Mexico border with the goal of requesting asylum and joining her family members in California.

Earlier that same day, a woman who had converted from Islam to Christianity in Iran told me that after her religious conversion was publicly revealed, she fled Iran to avoid imprisonment and possible execution for what the Islamic regime considers a severe crime.

The day before, an Afghani military colonel who had fought with U.S. forces against the Taliban described his fear of execution if forced to return to Afghanistan. And a Cameroonian English-speaking teacher had recounted her detention and torture after being labeled as a “separatist” by government officials for her peaceful campaigning against discrimination targeting English-speaking people in Cameroon.

These heart-wrenching accounts are among many that were relayed to me at a school-turned-shelter in Panama City last month, where scores of people who were expelled from the United States to Panama had taken refuge after they had been released from detention in Panama.

Yet, these evaluations in Panama were unlike any I had ever conducted before.

A group of lawyers who had filed a petition to the Inter-American Commission on Human Rights against the government of Panama for its treatment of individuals expelled from the United States had asked me and three other clinicians from Physicians for Human Rights (PHR) to come to Panama City in mid-March 2025. We conducted evaluations of 29 of approximately 300 people from countries such as China, Russia, Eritrea, Cameroon, Afghanistan, and Iran. Upon arriving at the U.S. southern border, they had been detained in U.S. detention centers and in mid-February 2025, were forced onto military planes from the United States to Panama without being told where they were going. In Panama, they had been further detained in abhorrent conditions and held incommunicado for several weeks, until they were subsequently released with temporary protected status for 30 days after the petition had been filed.

Within days of the filing of the petition, 108 of those expelled from the United States were released from detention and given a temporary permit allowing them to remain in Panama. The group of lawyers and human rights activists then helped them find temporary shelter after the government abandoned them in the capital.

The lawyers’ request for us was to focus on physical and psychological effects of the treatment by U.S. and Panamanian officials, as well as their fear of returning to their country of origin. And indeed, their accounts of their treatment by U.S. and Panamanian officials were harrowing. 

We heard about their desperate attempts to explain to U.S. immigration officials why they had a credible fear of returning to their countries and wished to seek asylum, only to be silenced, denied the chance to speak, and offered no translators. U.S. immigration officials confiscated their cell phones, and most of those we evaluated reported not being allowed to call family, friends, or request a lawyer; they were only given their phones back when finally released many weeks later from detention in Panama. One woman described being treated as “less than animals” by U.S. immigration officials.

Most of those we evaluated reported not being allowed to call family, friends, or request a lawyer; they were only given their phones back when finally released many weeks later from detention in Panama. One woman described being treated as “less than animals” by U.S. immigration officials.

In the United States, when they were taken by bus to military planes they were not told where they were going. While detained in Panama, most were still not permitted to contact family or friends. Many described even more vicious insults and abuse from the Panamanian officials guarding them, being told that they were criminals who had no rights, that they had to voluntarily agree to return to their countries or be forced to under military guard, and that they should not bother trying to apply for asylum in Panama as they would never receive it.

The people we met who remained at the large school gymnasium run by the Catholic organization Fe y Alegría as shelter were terrified about their futures. Others had agreed weeks before to be flown back to their countries of origin – the only option being offered at the time – but those we evaluated reported fear of persecution and even death if returned to their homes. They continued to resist being forced to return to their countries. Many shared feeling emotionally exhausted from being asked to repeatedly recount their experiences in United States and Panamanian detention without knowing what will happen to them next.

As clinicians, we could offer each of them concrete assistance. In our medical-legal evaluations, we could fully document their accounts of what they had experienced in their countries and subsequent psychological and physical sequelae. We could ensure that they each received a copy of their own report so they would have it if they were offered the opportunity to apply for asylum. Evidence shows that these medical-legal affidavits can significantly increase the likelihood of being granted asylum compared to cases without such affidavits.

We have now completed all medical-legal affidavits and shared them with each person we evaluated for their records. The findings of our evaluations will be submitted to the Inter-American Commission on Human Rights to support efforts to seek justice for the human rights violations and health harms from the U.S. expulsion and Panamanian detention of these individuals.

But it is still unclear what will happen to them. With the United States effectively ending the availability of asylum at the southern border, it is also unclear whether more groups of people seeking to migrate to or seek asylum in the United States will continue to be expelled without any due process to countries like Panama, Costa Rica – or even worse, to be disappeared and imprisoned in brutal El Salvador prisons like the groups of Venezuelans expelled by the Trump administration.

…It also unclear whether more groups of people seeking to migrate to or seek asylum in the United States will continue to be expelled without any due process to countries like Panama, Costa Rica – or even worse, to be disappeared and imprisoned in brutal El Salvador prisons like the groups of Venezuelans expelled by the Trump administration.

I hope our medical-legal documentation will help provide effective evidence for the collective lawsuit and for each of these individuals’ efforts to find legal protection in a safe country. Despite the Trump administration’s ongoing attacks on people who flee torture and ill-treatment to seek safety in the United States, PHR will continue to advocate for a humane and rights-respecting asylum system.

Meanwhile, even now from thousands of miles away in my home in Michigan, the words of the courageous Afghani women’s voting rights activist echo through my head:

“My dream was to build a better society for all in Afghanistan. I know I can’t do that now. But I still dream of helping improve conditions for women somewhere. I know I can make a contribution. I am being treated like a criminal with nothing to offer. But I refuse to give up hope. I know I have so much to give. I do.”