The Russian Federation’s unconditional support for the regime of Syria’s President Bashar al-Assad hit a new low on Monday, September 16. That afternoon, Russia’s Permanent Representative to the United Nations, Vassily Nebenzia, held a press conference to decry what he declared a sinister “new dimension of warfare” in the Syrian conflict: “disinformation.”

But Nebenzia didn’t spend the hour-long press conference discussing the Assad government’s strategy of denial of war crimes and crimes against humanity perpetrated by Syrian forces and their allies since the conflict began in 2011. And there wasn’t a whisper about Russia’s own use of “theatricality and deception” to cast doubt on war crimes perpetrated in Syria.

Instead, Nebenzia inveighed again allegations of Syrian and Russian forces’ apparently deliberate attacks on health care facilities in Idlib and northwestern Syria since April 2019. Those allegations, according to Nebenzia, constitute a groundless smear campaign by what he described as “unidentified sources” dedicated only to slowing the military offensive by Syrian and Russian military forces in northwestern Syria. Nebenzia is an old hand at this strategy of craven denial in the face of inconvertible facts. Last year, he attempted to rebut well-documented war crimes in the battle for the Damascus suburb of Ghouta as “massive coordinated psychosis,” which was “spread by global media outlets.” 

Nebenzia’s screed was overwhelmingly fact-free and an insult to the hundreds of Syrian civilians – patients, health care workers, and bystanders – killed in attacks on health care infrastructure in Syria over the past eight years. Physicians for Human Rights (PHR) has documented 583 such attacks on at least 350 separate facilities from March 2011 through August 2019, more than ninety percent of them by Syrian and Russian forces.

The Syrian military offensive on Idlib since April, backed by Russian military forces, has inflicted 23 PHR-verified attacks on health care facilities in that region; PHR is in the process of verifying more than two dozen other reported attacks that have occurred there during the same time period. Disturbingly, those facilities were targeted by Syrian and Russian military forces despite the fact that their locational coordinates had been shared with all combatants as part of a UN-brokered “deconfliction” mechanism designed to prevent such attacks.

Nebenzia sought to challenge the veracity of corroborated reports of attacks on health care facilities in northwestern Syria by Syrian and Russian forces. The “evidence” he marshalled in that effort was embarrassingly amateurish: a PowerPoint presentation of random maps that questioned the locational coordinates of declared health care facilities. A photograph of a bombed-out ambulance that he stated – without any visible evidence – had actually been a gun emplacement. And a photograph of a room that could have been taken anywhere in the world that Nebenzia said was of the interior of a hospital that had been falsely reported as destroyed by Syrian and Russian forces.

The most sinister aspect of the Russian ambassador’s presentation was his demonization of the civilian population that Syrian and Russian forces have pounded, in blatant disregard of international humanitarian law, or the rules of war. Northwestern Syria, through Nebenzia’s Russian propaganda lens, is nothing more than a “stronghold of terrorists, shady elements and jihadists.” For Nebenzia, the estimated three million civilians in northwestern Syria are an afterthought in Russia’s obsession with so-called “liberation” of the area through a punitive and unlawful military campaign.

The inconvenient truth for Russia is that PHR has documented a damning critical mass of overwhelming, verified, and factually undeniable evidence that the Syrian government and its allies, including Russia, have made targeting of health care facilities and other civilian infrastructure a deliberate strategy of this brutal eight-year conflict. War crimes have been committed by all sides in the Syrian conflict, but PHR’s meticulous verification process has determined that 91 percent of the attacks on health care facilities have been perpetrated by the Syrian military and its allies. They include a series of airstrikes that hit the Iman Obstetrics and Gynecology Hospital in Orum al-Kubra in Aleppo’s western countryside on August 31 that injured two patients and a hospital staff member and put the facility out of service. 

The elephant in Nebenzia’s press conference room was that the Russians have unconscionable quantities of Syria civilian blood on their hands from their four years of unconditional bankrolling, arming, and equipping of Assad’s war machine and for conducting military operations targeting civilians that may constitute war crimes. The UN Secretary-General’s newly-formed Board of Inquiry to investigate attacks on UN-supported facilities in northwest Syria is a possible opportunity for the UN to decisively challenge the Russian ambassador’sown disinformation campaign with hard facts – but only if the Inquiry identifies responsible parties and the Secretary-General releases its findings publicly. The facts are already out there. It’s the Russian government’s willingness to aid and abet that slaughter and the crimes of Syria’s armed forces that demand investigation and accountability.

Children and young people are at high risk of being recruited into a life of violence, especially when their families and societies do not protect their rights. Indeed, gangs in the Northern Triangle countries of El Salvador, Guatemala, and Honduras forcibly conscript many children who have been abused and abandoned by those who should have cared for them.

Yet when these conscripted children seek to leave gang life and apply for asylum in the United States, the door to safety is shut in their face.  

Two children – Miguel* and Juan* – recently came to the United States under these circumstances. To support their cases for asylum, clinicians in Physicians for Human Rights’ (PHR) Asylum Network conducted forensic evaluations of the children to assess whether their psychological symptoms were consistent with their narratives of persecution. Such an evaluation is a critical part of an asylum seeker’s application for protection.

In order to qualify for U.S. asylum, a person must prove they are persecuted because of their race, religion, nationality, political opinion, or membership in a particular social group. U.S. asylum law has recognized that forcing children to join gangs can constitute persecution which merits consideration for asylum.[1] However, dehumanizing rhetoric – which deems them unworthy due to their former gang affiliation – has made asylum an increasingly dim prospect for these youngsters.

Children like Miguel and Juan do not always choose to become involved with a gang. Sometimes it is the only option to save themselves from abusers or from gang members. When these children try to leave, they are deemed an enemy of the gang. Because local police forces and other state security bodies are often corrupt, or unable or unwilling to step in and protect children from gangs, these youngsters are no longer safe in their home country.

Miguel and Juan’s stories help us to understand why these children deserve protection.

When Miguel was nine years old, he decided to move out of the home he shared with his mother, sibling, uncle, grandmother, and various other relatives. Miguel had endured constant verbal and physical abuse by his uncle and could no longer take it. When he informed his mother of his plan, she told Miguel, “the door is open,” further devastating young Miguel. Miguel found himself living on his own, and juggling work and school. At approximately 11 years old, he quit school to focus on bare survival. At 13, a confrontation with his uncle left him shaken and scared. Miguel did the only thing he could at the time – he sought to protect himself from his uncle by joining the gang in his neighborhood. Miguel did what he was told within the gang and got the safety he desired; when his uncle hired hitmen, gang members convinced them to stop pursuing Miguel.

Because local police forces and other state security bodies are often corrupt, or unable or unwilling to step in and protect children from gangs, these youngsters are no longer safe in their home country.

Juan* fell prey to local gangs in El Salvador when he began living with his aunt. Previously, Juan lived with his mother and her boyfriend, but his grandmother took him in to save him from abuse by his mother’s boyfriend. However, in his grandmother’s home, Juan’s uncle beat him, and his uncle’s oldest son sexually abused him. Juan’s grandmother and uncle refused to believe him when he told them of the sexual abuse, which continued for some months. Around the age of 12, Juan finally went to live with an aunt, which he described as a better situation. At his aunt’s house, Juan was frequently visited by an uncle who worked in law enforcement, which often involved investigating gang activity. Because of this relationship, Juan was targeted by gang members and was forced to perform tasks for them, serving as a lookout or delivering money.

Despite the involvement of Miguel and Juan in gang activity, both resisted high-stakes orders by the gangs, even though it placed them in grave danger. When Miguel was ordered to kill his uncle and anyone present at the uncle’s home, he tried to leave but was captured by gang members. Miguel was issued an ultimatum: “kill them or you die.” He knew it would be wrong to kill his uncle’s children or to leave them fatherless, but he also knew that his refusal to follow the gang’s orders made him “a dead man walking.” Thus, he fled from Honduras to the United States to try to save his life. Similarly, Juan left for the United States after he was threatened with death by gang members for his failure to surrender his uncle to the gang. He fears retaliation if forced to return to El Salvador.

The fact that Miguel and Juan were caught up in gang activity should not prevent them from gaining protection in the United States. Both children are remorseful about their prior acts. The PHR clinician who evaluated Miguel noted his desire to change, stating that he asked himself “who he had become?” Miguel expressed horror at his prior behavior and committed to bettering himself. Also, Juan recognizes that the gang activity was wrong and feels “a significant amount of remorse” for his involvement.

PHR’s evaluations of Miguel and Juan indicate that neither of the boys poses a danger to others. Both were involved with gangs at a very young age only because they saw no other option for protection from severe abuse. Nevertheless, they risked their lives in order to break the cycle of violence and reject the gang’s commands. As Miguel’s evaluation explains: “When faced with the possibility of renewed abuse from his uncle, he joined the gang for protection, which led him into illegal activities.” Miguel described his situation prior to moving out at the age of nine: “All I wanted was to be a child, but I was robbed of that.” PHR’s clinician concluded that Miguel’s decision was made because of his precarious situation and was influenced by his suffering from post-traumatic stress disorder and depression due to his abuse and neglect. Miguel’s desire and commitment to change, including his participation in therapy and consistently following his medication treatment plan, were mentioned in the clinician’s report to further illustrate that he should be allowed to remain in an environment where he can fully recover.

The clinician evaluating Juan specifically examined his risk for violence and criminal behavior. The evaluation explains that Juan “demonstrated adequate regard for rules and for the rights of others.” Though he knows that his involvement in gang activity was wrong, he noted that he never became a “full-fledged member” and has no intention of participating in future gang activity. The clinician found that Juan “does not present with major criminogenic risk factors” and deemed his narrative and fear credible.

Taking a trauma-informed approach, it is clear that children like Miguel and Juan need protection and care to recover from their traumatic pasts. They deserve fair access to the U.S. asylum process, and safety while their pleas for protection are being considered.

*Names have been changed.

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[1] It has been stated in case law that forced conscription may constitute persecution when gang conscription occurs on account of a protected ground for asylum. Quiroz Parada v. Sessions, No. 13-73967, 1, 17 (9th Cir. 2018); Lukwago v. Ashcroft, 329 F.3d 157, 170 (3rd Cir. 2003). These children may have been conscripted on account of their membership in a particular social group, potentially defined as “minors in Northern Triangle countries between the ages of 10 and 15 who lack protection due to abuse and neglect by family members charged with their care.” Alternatively, for Juan, gangs targeted him because of his relationship to his uncle; a protected asylum ground of membership in a particular social group based on the nuclear family. These possible grounds for asylum merit, at the very least, a court hearing to decide if the children would fully qualify for asylum under the law.   

Sunday marks the two-year anniversary of the start of a widespread and systematic campaign of mass killings, torture, mutilations and sexual violence by Myanmar security forces targeting the Muslim Rohingya ethnic minority in northern Rakhine province.

That violence resulted in the torching of hundreds of Rohingya villages, killed at least 10,000 Rohingya civilians and prompted approximately 740,000 others to flee for their lives to Cox’s Bazar in neighbouring Bangladesh. The trauma of the violence lives on in profound psychological trauma, wounds from sadistic mutilations and painful long-term disabilities.

Canada led international efforts for accountability for those outrages. In October 2017, Prime Minister Justin Trudeau appointed a Special Envoy to Myanmar. Following the September 2018 release of a damning UN report that implicated the Myanmar military in crimes against humanity and acts of “genocidal intent,” Canada’s Parliament became the world’s first to vote unanimously that the Rohingya were the victims of a genocide.

Canada’s Senate echoed that a month later and also withdrew honorary citizenship to Myanmar’s civilian leader, Aung San Suu Kyi, for being “complicit” in the anti-Rohingya violence.

But for two years, Myanmar’s government has denied those atrocities and stonewalled the international community. Myanmar has forbidden international organizations and observers, including UN Special Rapporteur to Myanmar Yanghee Lee, from accessing Rakhine state.

Efforts to initiate an International Criminal Court (ICC) investigation have been stymied by Myanmar not being a signatory to the Rome Statute. Efforts to trigger an ICC probe via a resolution of the UN Security Council have been blocked by the opposition of Russia and China.

Although the UN has successfully created an independent investigative mechanism to probe Myanmar’s abuses against the Rohingya and the ICC is seeking to overcome legal roadblocks to a Myanmar probe, their necessarily slow and opaque operations in processing evidence and moving toward prosecutions has inadvertently helped bolster the Myanmar government’s denial narrative.

Meanwhile, Myanmar authorities have spent the past two years erasing the sites of mass slaughter of Rohingya in Rakhine. Satellite images have revealed that the locations of former Rohingya villages in Rakhine have been “flattened and scraped by bulldozers.”

The same Myanmar security forces implicated in the atrocities against the Rohingya in Rakhine have continued to perpetrate what Amnesty International has documented an ongoing pattern of violence including “unlawful attacks killing and injuring civilians.” Ignoring that peril, on Aug. 15 the governments of Myanmar and Bangladesh agreed to resume “voluntary” repatriations of Rohingya back to Rakhine.

Canada has a unique opportunity to ensure that Myanmar doesn’t get away with mass murder. On the eve of the second anniversary of that slaughter, Canada can deliver on its stated commitment to accountability by filing a complaint against Myanmar to the International Court of Justice (ICJ) for Myanmar’s violation of the 1948 Convention on the Prevention and Punishment of the Crime of Genocide.

By doing so, Canada can both spur the ICJ to investigate allegations of genocide and pursue reparations for Myanmar’s atrocities against the Rohingya as well as help inspire other foreign governments to file their own ICJ complaints against Myanmar.

The Canadian government can and should also impose individual sanctions, including travel bans and asset freezes, against Myanmar government and military officials — and their family members — implicated in the 2017 violence.

Canada’s Special Envoy to Myanmar, Bob Rae, said in February 2019 that Canada’s commitment to accountability for the Rohingya was unwavering, “Whether it takes a year, two years, five years, 10 years, justice will be done.”

Myanmar is counting on Canada to fail in backing that rhetoric with concrete steps toward justice. Canada’s challenge is to demonstrate that it has the political will to prove Myanmar wrong.

Originally published in The Star on August 23, 2019

Originally published in the Hong Kong Free Press on August 17, 2019

Hong Kong police did something medically dangerous – and patently unlawful – on Sunday night, August 11.

Riot gear-clad officers who had pursued pro-democracy protesters into the Kwai Fong subway station fired multiple barrages of tear gas into the crowded, confined space.

By doing so, they not only subjected the surgical- and gas-mask-wearing protesters to the risks associated with tear gas, they also put untold numbers of commuters in harm’s way by subjecting them – with no prior warning – to what is essentially an attack by a chemical weapon in a tightly confined area.

Physicians for Human Rights is not alone in sounding the warning about the illegality and public safety risks of Hong Kong police misuse of tear gas. On August 13, the Office of the United Nations High Commissioner for Human Rights declared that there was “credible evidence of employing less-lethal weapons such as tear gas in ways that are prohibited by international norms and standards.”

The police deployment of tear gas in the subway station put both protesters and commuters at risk of injury or even death from either the blunt trauma inflicted by the high-velocity cartridges that deliver the gas or the inhalation of the gas itself. That’s because the use of tear gas in any confined space, including a subway station, greatly increases the levels of exposure and, consequently, the quantities of gas that are typically inhaled.

While no evidence has surfaced so far that such injuries resulted from the tear gas attack on Kwai Fong subway station, all protesters and commuters without adequate protective equipment were subjected to tearing and eye pain and were at potential risk of corneal injury, respiratory distress, allergic reactions, and chemical burns.

Moreover, the risk that respiratory distress could progress to potentially fatal lung injury is accentuated in the elderly, children, and individuals with pre-existing cardiac or respiratory disease, such as asthma or emphysema.

The tear gas attack on the Kwai Fong subway station was more than just a willfully reckless use of what is classified as a “non-lethal incapacitating weapon” designed to reduce the need for deployment of lethal firearms in crowd-control situations. It constituted a violation of United Nations international standards on how such weapons can and should be used.

The UN Basic Principles on the Use of Force and Firearms by Law Enforcement Officials stipulate that the use of non-lethal incapacitating weapons such as tear gas requires careful evaluation to ensure that “uninvolved persons” are not endangered by their usage, guidance ignored in the subway station attack.

The Principles also specify that police cannot plead “exceptional circumstances such as internal political instability or any other public emergency” to deviate from ensuring the safest deployment of such weapons.

The police deployment of tear gas in the subway station put both protesters and commuters at risk of injury or even death from either the blunt trauma inflicted by the high-velocity cartridges that deliver the gas or the inhalation of the gas itself.

The Kwai Fong tear gas attack was just the latest in a recent serious escalation in the Hong Kong police’s abuse of this indiscriminate and potentially lethal weapon to disperse protesters.

Although Hong Kong police deployed tear gas during the Umbrella Movement protests that paralyzed large swathes of the city’s business district for two months in 2014, its use has skyrocketed in recent days in an apparent desperate effort to quell intensifying protests by hundreds of thousands of protestors who have flooded Hong Kong’s streets in a tenacious display of defiance to perceived threats to Hong Kong’s rights and freedoms.

Whereas in the two months of the Umbrella Movement protests Hong Kong police deployed a total of 87 tear gas rounds, they fired more than 1,000 tear gas rounds in 14 of 18 city districts between June 9 and August 4 alone. Such an escalation suggests that the police are operating under woeful ignorance or willful disregard of the rules on the safe and lawful use of tear gas in densely populated areas.

We at Physicians for Human Rights (PHR) have documented the impact of such misuse of this chemical agent for decades, including in Bahrain, Egypt, and Kenya. However, the Hong Kong police’s misuse of tear gas bears the most striking and sinister resemblance to the extreme deployment of tear gas by police in South Korea against pro-democracy protesters which PHR documented in 1987.

In that instance, South Korean police often fired tear gas cylinders directly into crowds or into enclosed spaces where people gathered. The tear gas they used – O-chlorobenzylidene malononitrile, commonly referred to as CS gas – is the same chemical formula that Hong Kong police are deploying today.

The injuries sustained by South Korean tear gas victims which PHR documented then – including crushing chest injuries, eye injuries resulting in blindness, and blistering skin burns from direct contact with the chemical – provide an alarming indication of the possible outcomes if Hong Kong police continue to deploy tear gas with wanton disregard for public health.

Tragically, some South Korean tear gas victims developed chronic conditions linked to exposure to tear gas, including deterioration of lung function, new onset asthma, and chronic obstructive pulmonary disease.

The scale of the South Korean police deployment of tear gas – 331,000 cannisters and grenades in a two-month period – dwarfs what we have seen in Hong Kong so far. But the similarity between what we documented in South Korea and what we are seeing in Hong Kong is alarming and requires the Hong Kong police and authorities to immediately curtail both the quantity and location of their use of tear gas to avoid such harmful impacts on Hong Kongers.

The Hong Kong police has for decades staked a claim as “Asia’s finest,” a regional exemplar of professional policing. The police who fired tear gas canisters into the Kwai Fong subway station should have known full well the potentially deadly consequences of their actions. Poor judgment, or worse, reckless disregard for public safety, demands consequences.

The UN Principles stipulate that “arbitrary or abusive use of force” of any kind, including deployment of tear gas, should result in criminal prosecution for police officers responsible for those actions as well as their superior officers if “they did not take all measures in their power to prevent, suppress or report such use.”

The only way to break the Hong Kong police’s dangerous reliance on tear gas is accountability and legal consequences for officers and their superiors who are deploying it in blatantly dangerous and unlawful ways. Until that happens, these kinds of attacks may well continue, with potentially tragic results.

Conversations about the female body, reproductive organs, sexuality, and virginity have dominated cultural discourse for centuries. They have been the subject of works of fiction, Renaissance art, romantic tales, religious missives, feminist theories and counter-theories, historical narratives, political movements, global health initiatives, and of course, scientific articles.

This dialogue often begins with broad philosophical, cultural, and religious concepts, but, when discussing virginity, invariably turns towards biology, specifically a tiny, membranous tissue at the external vaginal opening with no known biological function: the hymen.

Outsized expectations

For centuries, the hymen’s presence or absence has been linked to a presumption of a woman’s virginity, and, by extension, her purity, character, and desirability.

For such a small piece of tissue, the hymen and its perceived state – ‘broken,’ ‘intact,’ ‘dirty,’ – has gained outsized status as the arbiter of virginity, the be-all and end-all evidentiary piece that can determine whether intercourse – with or without consent – has occurred. But can it really do all that?

As explained in our article in last month’s Reproductive Health, the evidence-based answer is an emphatic no. It cannot.

A bit of background

In our article, we reviewed dozens of published studies about the hymen from around the world. Our goal was to create a set of guidelines for clinicians detailing if – and if so, in what situation – a hymen examination could give valuable information in evaluating sexual violence or abuse.

After poring over the literature, we concluded that an examination of the hymen is not an accurate or reliable test of sexual activity, including sexual assault. The reality is that there are many factors that confound whether clinicians can adequately assess changes to the hymen tissue at various stages of the life cycle, including genetic, developmental, endocrine, and external influences.

Little tissue, big world

However, this is not common knowledge among clinicians in certain parts of the world. Many still share the larger public’s unsubstantiated belief that changes in the hymenal tissue’s anatomy are indicative of intercourse or sexual assault, and continue to rely on a hymen examination to offer ‘proof’ of virginity or sexual assault.

Such unfounded perceptions have contributed to the propagation of virginity testing, a practice the World Health Organization (WHO) has condemned as “a violation of the human rights of girls and women.” Virginity testing involves the use of a vaginal examination to evaluate whether or not a woman’s hymen is ‘intact’ in an attempt to ascertain whether a woman has had sexual intercourse.

In societies where the sexual history of girls and women is used as a significant determinant of their societal, familial, and individual status, this can be extremely dangerous.

The adherence to practices like virginity testing inadvertently reinforces gender inequality and further entrenches stereotyped notions of female sexuality. Additionally, the language clinicians often use to describe the hymen in these situations – ‘intact’, ‘broken’ – serves to bolster the dangerous, archaic stereotype about the transformation of a woman and her societal value after intercourse.

Furthermore, the reliance on an unsubstantiated test rather than a woman’s word is not only detrimental to women’s health, safety, and standing in society, but also undermines a woman’s veracity and integrity when it comes to her own sexual history.

Small steps forward

Nevertheless, clinicians are not to be blamed for their lack of knowledge surrounding the subject. Medical school curricula often do not focus on the hymen’s anatomy or outsized role in society. However, there are steps that clinicians can take to improve this situation, which we outline in our article:

1. Avoid relying solely on the status of the hymen in sexual assault examinations and reporting;
2. Help raise awareness of this issue among peers and counterparts in law enforcement and the judicial system;
3. Promote fact-based discussions about the limitations of hymenal examinations with colleagues and health professional students from all specialties that address the sexual and reproductive health of women and girls.

A few parting words

Our article makes it clear that myths about virginity, sex, and basic biology still persist, even among well-educated, well-intentioned clinicians.  When such misconceptions are reinforced by vacuums of reliable information and sexist messages ingrained in tradition, they can have serious consequences for medico-legal processes, and, consequently, for women’s health and well-being.

Understanding the pervasiveness and consequences of myths surrounding women’s reproductive health illustrates that working to dispel these myths and educate the public on these issues is essential to protect the safety and dignity of women and girls around the world.

The hymen should not have this much pressure riding on it. Let’s not give it more attention than it deserves.

Learn the basics about the hymen in PHR’s recent factsheet

Originally published on BioMed Central on July 15, 2019

Photo: Iraqi Yazidi women and children rescued from the Islamic State group waiting to board buses bound for Sinjar in Iraq’s Yazidi heartland. Virginity testing has been widely conducted on Yazidi women and girls who have escaped sexual enslavement by the Islamic State. April, 2019 (DELIL SOULEIMAN/AFP/Getty Images)

This post originally appeared in the Asia Times.

The government of Myanmar reached out late last month to the hundreds of thousands of Rohingya refugees who have taken refuge in the Bangladeshi city of Cox’s Bazar with a seemingly straightforward plea: “Come back home.”

That offer might have seemed irresistible for those familiar with conditions in the teeming refugee camps in Cox’s Bazar. And the dozens of Rohingya refugees that Physicians for Human Rights has interviewed there over the past two years are almost unanimous in their desire to return to Myanmar. But that desire is offset by what they know about the nature of the government that made that offer. And those refugees have made clear that they’d rather endure the privations of their Bangladeshi refugee camps than risk returning to Myanmar any time soon.

That’s a wise choice. Memories of the catastrophic campaign of widespread and systematic targeted violence by Myanmar security forces against Rohingya in northern Rakhine state beginning on August 25, 2017, are still painfully fresh among the survivors who fled to Bangladesh in fear of their lives. That campaign, executed on the pretext of an anti-terrorist operation aimed at the insurgent Arakan Rohingya Salvation Army, entailed what both Physicians for Human Rights and the United Nations have documented as a catalogue of atrocities against Rohingya civilians including mass killings, rampant sexual violence, torture, mutilation and the torching of hundreds of Rohingya villages.

In the two years since those crimes, the 740,000 Rohingya survivors of that violence who fled to safety in the refugee camps of Cox’s Bazar have watched in dismay as the Myanmar government has defied all international efforts for accountability. The authorities have failed to conduct impartial and independent investigations and have stymied the efforts of the UN and other bodies seeking to do so. A four-member commission formed by the Myanmar government to investigate the alleged crimes announced in December 2018 that it had found no evidence to corroborate the UN’s accusations, an assertion roundly rejected by human-rights groups.

Any lingering hopes among Rohingya refugees that the government was willing and capable of providing meaningful accountability for the bloodshed of late 2017 were dashed with the confirmation this May that the Myanmar military had pardoned the only military personnel successfully prosecuted for their role in the violence: seven soldiersconvicted in April 2018 of killing 10 Rohingya men and boys in the infamous Inn Din village massacre of September 2017.

The Rohingya in the refugee camps are in no hurry to return to Myanmar while their military victimizers roam free with the explicit approval of a government that refuses to utter the word “Rohingya” and continues to justify their mass slaughter as a reasonable response to “terrorist activities.” Recent revelations via analysis of satellite imagery by the Australian Strategic Policy Institute indicate that the Myanmar military has continued its scorched-earth policy by continuing to burn down remaining Rohingya villages in northern Rakhine.

But Rohingya concerns about possible repatriation extend beyond the clear and present dangers posed by an unaccountable military with a proven penchant for ruthless violence against defenseless men, women and children. In 1982, the Myanmar government denied the Rohingya legal recognition by unilaterally stripping them of their citizenship. That citizenship denial  has helped spur a distressingly popular racist narrative in Myanmar that depicts the Rohingya as illegal migrants rather an ethnic minority with a well-documented centuries-long presence in the country.

The government has been adamant in its refusal to restore citizenship rights to Rohingya, instead referring to them as “Bengalis” and offering them so-called “National Verification Cards” rather than national identity documents that specify citizenship. The Myanmar delegation that visited Cox’s Bazar last week made no mention of restoration of Rohingya citizenship rights.

The Myanmar government’s obstinate denial of both accountability for the crimes of 2017 and a guarantee of citizenship raises serious questions about the sincerity of its  repatriation rhetoric. That suggests a calculated strategy by the government to counter growing international opprobrium about the suffering of the Rohingya – and the subsistence and protection costs their care imposes on Bangladesh – on the eve of the two-year anniversary of the mass killing campaign that began in August 2017.

The Myanmar government appears to be gambling that such substance-free overtures on repatriation will help quell some of that criticism and extend indefinitely the status quo of gross impunity for the crimes against the Rohingya.

UN member states have an opportunity take decisive action to prove Myanmar wrong. International efforts toward accountability for Myanmar’s crimes against the Rohingya, such as the United Nations’ independent investigative mechanism and nascent International Criminal Court moves toward establishing its own Myanmar probe, have through their necessarily slow and opaque operations in processing evidence and moving toward prosecutions inadvertently helped bolster the Myanmar government’s denial narrative.

On the eve of the second anniversary of the slaughter of the Rohingya, UN member states can play an instrumental role in countering that narrative and putting the issue of accountability at the center of international engagement with Myanmar by filing complaints to the International Court of Justice for the government’s violation of the 1948 Convention on the Prevention and Punishment of the Crime of Genocide. Such complaints will obligate the ICJ to investigate allegations of genocide and pursue reparations for Myanmar’s atrocities against the Rohingya.

UN member states should also impose individual sanctions, including travel bans and asset freezes, against government and military officials – and their family members – implicated in the 2017 targeted violence against the Rohingya.

It will require the exertion of maximum pressure via all legal and diplomatic channels to compel the Myanmar government to reverse its policy of dual denial of accountability and citizenship necessary for an eventual voluntary, safe and dignified repatriation of the Rohingya refugees now in Bangladesh. Individual UN member states should seize the opportunity to signal to Myanmar that their patience has limits and there will now be meaningful consequences for its intransigence.

العربية

Good morning, Mr. President, and thank you for the opportunity to address the Council regarding attacks on health facilities and personnel, and their impact on civilians in Syria.

Undersecretary-General Lowcock just provided insight into the horrific humanitarian crisis taking place in northwest Syria as we speak here today.

My name is Susannah Sirkin and I am the Director of Policy at Physicians for Human Rights, which is an international non-governmental organization that brings the expertise of science and medicine to the defense of human rights. Our researchers at PHR have been rigorously corroborating, documenting, and reporting on violations in the Syrian conflict for the past eight years.

Since the beginning of the conflict in Syria, the ongoing assault on health care facilities and personnel has been a defining factor – and a deliberate, inhumane, illegal strategy of war. When hospitals are destroyed, the loss is far greater than the buildings. When medical workers are killed, the human toll is not just their lives, but also the exponential number of people who suffer and die without medical treatment.

Our years of meticulously gathered documentation lay bare the blatant disregard for civilian life in the Syria conflict, as revealed in the Syrian government’s repeated attacks since 2011 on health facilities and personnel. The numbers I am about to share with you are an undercounting because we apply a conservative methodology.

• From March 2011 through July 2019, PHR corroborated 578 attacks on at least 350 separate facilities and we documented the killing of 890 medical personnel.

• 521 attacks – 91 percent – were perpetrated by the Syrian government and allied forces (297 by Syrian government forces and 224 by either Russian or Syrian government forces).

Each of the attacks on a functioning health facility is a war crime. Taken together, these assaults constitute crimes against humanity. The widespread and systematic destruction of health facilities and the killing of hundreds of doctors, nurses, pharmacists, and paramedics by Syria and its Russian allies has the apparent aim to “break people’s spirits,” as one Syrian doctor put it in the powerful new documentary For Sama.

This repeated tactic of terror turns places of safety and life into danger zones and death traps.

For years, the UN Secretary-General has routinely shared these data with the Security Council. They have been publicized to the world again and again. Yet, appallingly, these crimes continue to be committed with utter impunity.

In Aleppo, PHR has documented 161 attacks on health facilities, with 54 in the year 2016 alone. Hospital attacks then by Syria with its Russian allies forced tens of thousands of civilians into flight, and literally killed patients who were stripped of life-saving care.

And now, three years later, the world is watching, silently, the same escalation of brutality in Idlib and northwestern Syria that could result in the worst humanitarian crisis of the 21st century.

On the 29th of April this year, the Syrian government and Russia started their military escalation targeting Idlib and northern Hama. Since then, PHR has received reports of 46 attacks on health care facilities; so far, using PHR’s rigorous methodology, we have confirmed 16 of them and are still counting.

OCHA has estimated that between May and July 15, the number of newly internally displaced people who are trapped in this so-called demilitarized area has reached 500,000, bringing the total to at least 1.3 million. Many of the families now in Idlib have already been displaced four, five, or more times throughout the relentless waves of violence in the Syrian conflict. People in Idlib have nowhere else to go.

Many of the health facilities in this area have been forced out of service. But shockingly, we see that agreements coordinated by the UN to notify all parties of the locations of health facilities, intended as a strategy to protect them, have been violated again and again.

The Syrian and Russian governments know the exact location of most health facilities, and yet they continue targeting them. The courageous remaining medical workers are providing life-saving care while being bombed, and doctors tell us that hospitals, which should be the safest places in Idlib, are the exact opposite. They are targets.

At least 14 facilities have been hit, according to SAMS (Syrian American Medical Society), in spite of having shared their coordinates with belligerents through OCHA’s so-called de-confliction mechanism. PHR has documented attacks on the Saraqeb Primary Healthcare Center and the Ma’aret al-Nouman Central Hospital, both on July 10. And they had shared their coordinates. Three surgical units were attacked on the same day early in May. And the list goes on.

In 2016 when the UN Security Council passed Resolution 2286 on protecting health in conflict, then-Secretary-General Ban Ki-moon stated: “When so-called surgical strikes are hitting surgical wards, something is deeply wrong. Even wars have rules. The Council and member states must do more than condemn such attacks,” he added. “They must use every ounce of influence to press parties to respect their obligations.”

Your current collective inaction is a clear derogation of your responsibility to protect.

Governments failed to heed all the warnings of this criminal strategy of war, which has devastated all manner of infrastructure, community, and culture. Civilians in Syria have been let down by the Security Council’s failure to act, by individual governments who were in positions to stop the carnage, and sadly, by UN agencies hamstrung by rules that have enabled the perpetrators to flout the most basic humanitarian agreements with zero consequence.

We are calling on Syria and Russia to immediately stop attacks on hospitals and other vital civilian infrastructure. And we are calling on all parties to the conflict to cease violence against civilians.

We are urging the UN Secretary-General to launch an immediate investigation into attacks on health facilities and personnel in Idlib, northern Hama, and western Aleppo, and on the failure of the deconfliction mechanism. All parties must cooperate fully and ensure unimpeded access to investigators.

To all governments, everyone in this room, and to people of conscience everywhere: We are calling on you to do everything in your power to end the slaughter and to protect the civilians cornered in Syria. The continued failure of the UN Security Council to end impunity for these crimes is a blight on the credibility of this body to carry out its core mandate. Continued inaction sends a message of abandonment and erosion of humanitarian law not only to those in Syria, but to all people subjected to war crimes and crimes against humanity.

Thank you for the opportunity to address you today. I’d like to add that we at Physicians for Human Rights offer a special tribute to Syrian health professionals, to those still alive and providing care under fire, to those who were forced to flee, and to all those who gave up their lives for their bravery and commitment to save lives.

Hello, and thank you for inviting me to speak today.

My name is Amy Cohen and I am a child and family psychiatrist who has devoted most of my career to addressing the psychological needs of vulnerable and traumatized children. Over the past year, I have mostly worked with newly migrated children and families at the border, with parents separated from their children at Port Isabel, and as a mental health and, sometimes, medical consultant to Flores Settlement Agreement counsel. In this last capacity, I have visited Office of Refugee Resettlement (ORR) facilities, interviewed many children, poured over thousands of pages of records, and worked with the Special Master tasked by the Flores court judge to have independent oversight of children in custody. I have, in this, gotten a rare look inside an otherwise very opaque system of detention which now holds about 14,000 migrant children.

Today I will ask you to look beyond the border and to listen to what we are doing to the tens of thousands of children currently in government detention. I will ask that you embrace the full and true picture, which shows that this “crisis” is, in many ways, manufactured. The atrocities we are seeing in places like Clint and Ursula are not – as some would have us believe – the consequence of a migrant “surge,” but rather of U.S. policies and procedures which result in the unnecessary, protracted, and damaging detention of children who belong instead with family, with sponsors, and in communities.

Let us first dispel the notion that these children are coming as the pawns of adults who wish to use them to exploit “loopholes” through our immigration laws. As outlined in detail by the most recent report from Physicians for Human Rights, these children are coming because of the terrifying, life-threatening conditions they face in their home countries, where their local agencies of government can’t or won’t protect them. These children are exposed to and endangered by violence in their schools, on the streets, in their homes. They and their families risk the perils of the journey they undertake to this country in order to save their lives.

These children arrive at our border already vulnerable. We know that the effects of trauma are treatable. But we also know that these effects multiply, amplify, and are less amenable to treatment the more trauma these children endure.

Unfortunately, our policies of removing these children from their family and subjecting them to protracted detention pile trauma upon trauma. The results can be devastating.

The terrible toll exacted on children when separated from their parents is the most extreme trauma that a child can endure. It often results in something we call “toxic stress” – a condition which impacts many systems of the body, the brain, and the mind, and can lead to irreversible damage, even early death.

But when you think “separation” think not only of the separation from a parent, but also separation from whomever serves as a child’s anchor to safety and stability. For the thousands of children who arrive here in the care of grandparents, aunts, uncles, siblings, and who are taken from those guardians – these children, too, experience the dire consequences of toxic stress.

Another form of separation is experienced by those children who arrive truly “unaccompanied,” but bearing a name and phone number of a relative ready and willing to receive them. Their protracted detention, along with delays and denials in being united with their families, can be devastating.

And then there is the detrimental impact of ORR detention itself.

We have been keeping children detained for longer and longer periods. We must understand that it is for this reason – and not some “surge” at the border – that the system has swelled and backed up. We are taking these children, detaining them, and then failing to let them go in a timely fashion. And this is what is clogging the system.

The average length of stay for children in ORR facilities has been, since 2017, two to three times the average length of stay during the Obama administration. Do the math: if you keep children twice as long you will, in effect, have twice as many children in your facility.

And ORR facilities are bad places for kids. Anyone who imagines them to be “summer camps” is ignorant of the experience of children there. Kept away from the nurturance of loving family, forbidden to interact with peers in age-appropriate ways, restricted from engaging in activities which are essential to their growth and development, locked in with no agency to impact even what food they eat or, sometimes, what clothes they wear, let alone the more essential elements of their lives – children do poorly when kept in these rigid institutional facilities.

Beyond the ravages of institutionalization in general, there are specific issues with ORR facilities which make them dangerous places for children. We have all read the reports of sexual and physical abuse, educational inadequacy, and inadequate staff often inexperienced or poorly trained in caring for this population. Additional stressors exist for the many indigenous children whose inability to communicate with staff or peers leaves them isolated and marginalized.

Medical neglect is one major issue which has been documented in two facilities in New Jersey but is evident in many more. An eight-year-old I’ve worked with suffered an accident at an ORR facility in Texas which caused leg pain so severe that he needed a wheelchair. It was five days before he received medical attention, six days before he saw an orthopedist. He was diagnosed with a fracture of the femur. This fracture had transected the growth plate, meaning that negligent care could result in permanent deformity of that leg, impeding his ability to run, jump or even walk. We routinely hear stories like these about children with medical complaints who receive no attention or follow up.

Personnel in these facilities are not equipped to deal with the psychological and behavioral symptoms of trauma and are quick to refer these children to be medicated or hospitalized. Time and again, children whose behavior deteriorates due to the twin assaults of separation trauma and institutionalization are given improper psychiatric diagnoses, administered medication, unnecessarily hospitalized, and often transferred to increasingly restrictive environments.

Early this year, the Flores counsel team discovered that the government had been hiding that children were being sent to “treatment centers” off the grid. At one such place in Arkansas, children were assigned to therapists who spoke no Spanish. All the children interviewed were mystified as to why they’d been sent to this facility. All were being medicated, most with multiple psychotropic agents which produced side effects. None had been examined by a child psychiatrist and none knew the names or purposes of their medications.

The process of getting these kids released from detention and into the care of families is itself draconian, involving several layers of agencies which do not communicate with each other, with the proposed sponsor, or with the child. The burden is routinely placed on caregivers, and even parents to prove that they are worthy of caring for their children, with no counterbalancing appreciation for the cost of ongoing detention. Indeed, one Federal Field Specialist whose task was to approve or deny releases openly admitted that she herself nearly never meets with children, never speaks with sponsors, and does not in any way consider length of stay in her decisions about release.

What sort of things are parents and others subjected to before being permitted to bring home their own child? One mother’s 14-year-old daughter was in an ORR facility in a distant state. For weeks, the child had been complaining about vision problems with painful and swollen eyes, but the facility had refused to get her seen by an eye doctor. The mother – anxious to care for her child’s medical needs – quickly submitted all required paperwork, but was then presented with an escalating list of demands for more paperwork. Not until the mother produced her elder daughter’s summer school transcripts was she finally permitted to bring her child home and get her the care she needed.

Another parent who’d undergone cancer treatment was told that she must produce a doctor’s note showing that she was cancer free before she could get her child back. In other cases, parents and other relatives may be told that their child must have a room of their own and cannot share even with a same-sex sibling. This despite the fact that all children in ORR custody are in shared rooms.

Decisions denying the release of children from the hardships of detention are inconsistent, often arbitrary, and in no way comport with the manner in which such decisions would be made by social service agencies.

ORR has at various times imposed new rules which they claim are designed to keep children from harm, but which are not consistent with any evidence or data. About 20 percent of the 14,000 children in ORR custody are without the option of being placed with family. But ORR has forbidden placement with non-related sponsors, leaving these children stranded in indefinite detention.

How broken is this system? Those children crammed into windowless rooms, sitting in filth, sleeping on concrete slabs at places like Clint, could not leave, even if their own parents arrived to take them home, with all identifying paperwork in hand.

There is currently no consistent professional oversight of the treatment of these vulnerable children in government custody. ORR, CBP, and ICE are opaque agencies, closed off from evaluation by independent child welfare groups, revealing little about what goes on in their facilities, refusing true inspections by almost anyone other than those mandated by the Flores agreement, and even then, imposing limits on those inspections. For this and many other reasons, the Flores Agreement – now under attack – must be protected. While its provisions must be updated and codified, it is the only instrument currently able to mandate any oversight of these facilities and to protect these vulnerable children.

Congress needs a far more robust mechanism to provide the information necessary to inform policy. I would hope to see an independent commission with free and unfettered access to these facilities, one with interdisciplinary expertise which could provide oversight, reporting back to Congress on its findings and studying the impact of current policy on the lives of these children and families.

It has become trite, perhaps, but it is nonetheless true from a medical, developmental, and psychological standpoint: children do indeed belong with families. Their growth and development, the health of their current and future relationships, of their prospects educationally and vocationally all rest squarely on that familial bond on which every child relies. And children belong in communities, where they can not only gain from the stimulation and experience of community fellowship but can learn to give back and to be a contributing member to the larger family of others.

The increase in migration of children to our borders is the consequence of terrible circumstances in their home countries: circumstances which must be addressed in those countries of origin. But until they are, can we not agree that children running for their lives deserve our care and a chance to heal and grow? That policies which seek to harm these children – that are entirely contrary to all that we know about what is in their best interest – are simply not who we are or should be? That these policies demean us all and reduce our standing in the world? Surely as doctors and legislators, as human beings, we must be able to come together on this.

PHR has been at the U.S.-Mexico border, interviewing children, families and other asylum seekers to document the medical and psychological trauma caused by U.S. policy and Department of Homeland Security mismanagement. And what we’ve found makes it clear: It’s beyond time to end all policies that lead to the detention and separation of children. Our video, produced in partnership with MoveOn, explains why no child belongs in detention. The United States knows how to do this right, and yet the administration made an elective decision to traumatize children. 

“Don’t forget the power of your voice. It does have impact.”

Dr. Scott Allen

Read more in our report, “You Will Never See Your Child Again”: The Persistent Psychological Effects of Family Separation

On the eve of the second anniversary of the August 2017 campaign of extreme violence by Myanmar security forces against Rohingya civilians in northern Rakhine state, the experiences of “Chesa” and Chit” (not their real names) recall the brutality of that campaign.

“Chesa,” a 60-year-old Rohingya woman, and “Chit,” her 20-year-old daughter, were interviewed by Physicians for Human Rights (PHR) investigators in Cox’s Bazar, Bangladesh last year and recounted how, in September 2017, security forces entered their village and forced Chit’s 20-year-old pregnant cousin and her husband into a field. They killed the husband immediately and then raped the cousin, after which they mutilated her breasts with a knife and killed her.

Those horrors are emblematic of a vicious, widespread, and systematic targeting of the Muslim Rohingya population in northern Rakhine state by Myanmar security forces in a weeks-long orgy of violence that began on August 25, 2017. That’s when security forces attacked hundreds of Rohingya villages, massacring thousands of their residents and burning their homes to the ground. As of January 2019, the violence and ongoing abuses had killed at least 10,000 Rohingya civilians and prompted approximately 740,000 others to flee for their lives to Cox’s Bazar in neighboring Bangladesh, where they remain.

Of 114 Rohingya survivors interviewed by PHR during four separate field investigations to Cox’s Bazar in 2017 and 2018, 11 (9.6 percent) said that they had been the subject of some kind of deliberate bodily mutilation or had witnessed Myanmar security forces mutilating others. The victims of those mutilations suggest that the security forces intentionally targeted women and girls – particularly those who were pregnant – with mutilations of their breasts, genitals, or other body parts, often while or after they were raped. But men, including religious or community leaders, were also targets for mutilation or decapitation. Due to the deeply brutal and stigmatizing nature of injuries like genital mutilation – and the fact that PHR did not ask specific questions about this kind of violence – they are likely underreported.

PHR’s findings on sexual violence and mutilation of Rohingya civilians by Myanmar security forces are consistent with documentation by the United Nations Fact-Finding Mission (FFM). In September 2018, the FFM reported that Myanmar security forces used sexual violence – often including gang rape – on a mass scale against Rohingya women and girls. That report concluded that rape and other forms of gender-based violence “were used as a form of torture, to terrorize the community and as a tactic of war.” The Myanmar government rejected the report’s findings as “false allegations,” and, to date, has failed to conduct impartial or independent investigations into these events or allow the UN or other bodies to do so.

The UN report also noted the widespread use of sexual violence, including genital and other bodily mutilation, which served Myanmar security forces as a tool “akin to branding.” A September 2018 United States State Department report on the targeted violence against the Rohingya documented that 10 percent of the 1,024 Rohingya surveyed for the report stated that they had witnessed mutilations of Rohingya citizens, including “the cutting and spreading of entrails, severed limbs or hands/feet, pulling out nails or burning beards and genitals to force a confession, or being burned alive.”

Those atrocities come as no surprise to long-time foreign observers of the activities of the Myanmar military, or Tatmadaw. The Tatmadaw has long been synonymous with perpetrating with impunity egregious human rights abuses against the country’s ethnic minorities as part of a “culture of recreational sadism within the Burmese Army that has defined their counter-insurgency practice for decades.” The Tatmadaw is not alone in committing such abuses. Security forces and combatants have long used mutilation as a tactic of terror in conflicts in areas including Colombia, Haiti, Liberia, and Sierra Leone. Bodily mutilation carries immediate and long-term effects on targeted populations by inflicting fear, shame, and humiliation on both victims and witnesses to such brutality. On the individual level, these intentional injuries, targeted at civilians, can have profound physiological and psychological effects on both victims and witnesses.

The medical consequences of mutilations are devastating. The intentional mutilation and amputation of body parts outside of a medical facility, without anesthesia, and using non-sterile tools, such as knives and machetes, can cause severe pain, bleeding, hemorrhagic shock, and death. It can also cause infection, possibly leading to gangrene and sepsis (disseminated infection). Studies on the mental health consequences of civilian-targeted, traumatic conflict-related injuries have shown significantly higher rates of post-traumatic stress disorder, anxiety, and depression than in the general population. A compounding factor is the general lack of access to rehabilitation, pain relief, and mental health services in refugee settings and in low-income countries, such as Bangladesh and Myanmar.

The mutilation of the genitalia and other reproductive organs of both males and females should not be confused with harmful culturally-bound or ceremonial practices, such as male circumcision or female genital mutilation or cutting (FGM/C), but should be regarded as a deliberate attempt to maim, shame, and humiliate. Beyond the immediate risk of bleeding, pain, and infection, such sadistic actions can also affect future fertility of both men and women, and thus can be interpreted as actions meant to send a message about reproduction and procreation of a specific ethnic group.

The widespread and systematic use of bodily mutilation by Myanmar security forces against Rohingya civilians constitutes a crime against humanity. PHR supports recommendations by the UN Fact-Finding Mission to refer Myanmar to the International Criminal Court or an ad hoc criminal tribunal to further investigate these crimes. Among the victims who should not be forgotten: those who were subjected to or witnessed mutilations, the brutal result of which will remain seared into their memories and onto their bodies for years to come.