I’m a Muslim woman of color living in diverse New York City, but the part of the city I live in is predominantly conservative. As a visible minority, I have never felt particularly welcomed by some of my neighbors. But up until recently, I was comforted by the fact that if the hostility expressed toward me escalated, I could at least take refuge in the law — that no matter my religion or my skin color or my choice of dress, the protections afforded by the rule of law would provide some measure of safety, or at least accountability.

When kids on their bikes surrounded my car and yelled for my family and me to go back to our country, I felt reassured that the law could provide justice; that I could call the police and seek recourse if I chose to. When a man intentionally drove straight at me while I was walking home, swerving away only at the last minute, I felt reassured that the law would call that a crime, that my concerns would be taken seriously by police and others whom the law instructs to safeguard the public.

What’s more, I work at Physicians for Human Rights (PHR), an organization that uses the power of evidence to fight for justice and accountability. I work with some of the brightest medical and legal minds in the country. They’ve continually inspired me to have faith in the law and in the power of truth.

But the election of Donald Trump changed the equation. Daily, I saw signs that some of his most ardent supporters in my neighborhood felt emboldened — while I felt more and more vulnerable. When I called my local police precinct to inquire about the process to report a hate crime, the operator responded with skepticism. I was no longer sure that the law would protect me from the bigotry I saw growing all around me.

At the time, I believed that while the president might be able to significantly change policies, he could not change the fact that there was a functioning system in this country that would prevent the deterioration of our rights and liberties. No one president alone, I thought, can change the law or the U.S. Constitution.

After hearing about the president’s executive order on immigration and refugees last month, I tried to escape reality in a futile effort of self-preservation. For 48 hours, I avoided social media and news shows and websites. Then, I finally broke down and read the executive order. I didn’t know whether to laugh or cry. It was both absurd and cruel at the same time — and it hit horribly close to home.

I am the daughter of Palestinian refugees. In 1948, when the state of Israel was created, my father was uprooted from his home in Jaffa and forced into a refugee camp. At five years old, he witnessed soldiers killing his classmates and continues to have nightmares until this very day.

I was lucky enough to be born in the United States, not the war-torn battlefield of my parents’ homeland, and today, I work to help people like my father. As a staffer in PHR’s asylum program, I help refugees and immigrants secure evidence of the torture, sexual violence, and other abuse that they suffered in their countries of origin. We match immigration attorneys with doctors and other health professionals from around the country who evaluate the physical and psychological scars of their clients. These evaluations help bolster the client’s case to stay in the United States.

I do this work because the people who flee from war, poverty, and domestic violence deserve the same right to pursue happiness that my family now has. I do this work because the trauma that people like my father have faced deserves to be documented and used to support their claims to seek refuge here.

But it seems the president doesn’t agree. He believes refugees and those fleeing persecution may “engage in acts of bigotry or hatred” — that’s his rationale for turning his back on the promise this country once made to my family: that here in the United States, the law and the rule of law will protect you.

So it leaves me with two options. Give up. Or keep fighting. This executive order will only encourage more attacks against the people on whose behalf I work — people like me. But I will not be intimidated. For all those seeking a safe haven, I’m ready to keep working and keep fighting.

Read the report (pdf)

In a letter to Douglas J. Burgum, governor of North Dakota, and acting Attorney General Dana Boente, PHR voices concerns over reports of excessive use of force by law enforcement toward protestors in the context of the construction of the Dakota Access Pipeline. International standards and U.S. law set clear guidelines for crowd-control tactics, and reports of the indiscriminate use of “less than lethal” weaponry at the construction site are troubling. We have also noted the continued blockage of Backwater Bridge on N.D. Highway 1806, which could affect water protectors’ access to emergency and lifesaving care. We stand by the basic rights of all communities to peaceful protest and assembly and urge immediate, full, and impartial investigations into all allegations of abuse.

Read the full letter here.

Last Friday, on International Holocaust Remembrance Day, many Americans reflected on the lesson of the St. Louis. A passenger liner carrying more than 900 Jewish refugees from Hamburg to Havana in 1939, the St. Louis was turned away from Cuba and from the United States. Its desperate passengers were victims of both anti-Semitism at home and an anti-immigrant, nativist national mood in the countries they hoped would take them in. Forced to return to Europe, more than 200 of the ship’s passengers ultimately died in World War II, a number of them in Hitler’s concentration camps.

Also last Friday, just hours after releasing a statement pledging “to do everything in my power throughout my Presidency, and my life, to ensure that the forces of evil never again defeat the powers of good,” U.S. President Donald J. Trump signed a sweeping executive order that completely shut down refugee admissions for at least three months, increased the barriers to admission, and instituted a de facto religious preference for refugees that discriminates against Muslims. Before dawn on Saturday, the United States was detaining refugees and documented immigrants in shackles at U.S. airports.

What has swiftly become clear is that President Trump intends to carry out all of his campaign promises: an expanded deportation force, a wall on the southern border, and draconian changes to the treatment of refugees, asylum seekers, and other immigrants. These policies are guided not by national security or common sense, but rather by antipathy towards Muslims and Latinos, fearmongering about “criminal aliens,” and a deep skepticism toward people in need of protection.

With these early policy declarations so in line with the campaign’s ugly and false rhetoric about immigrants and refugees, it’s obvious the next four years will bring immense suffering for millions of immigrants, refugees, displaced people, and their families. As a result, those of us who are able must work even harder in support of truth, evidence, and the fundamental humanity of asylum seekers, refugees, and immigrants of all races and religions.

At Physicians for Human Rights (PHR), we know what refugees and asylum seekers have lived through. We document the horrors of war and persecution. The volunteer health professionals in our Asylum Network conduct evaluations and painstakingly catalogue the physical and psychological scars of asylum seekers in order to provide evidence to asylum courts.

Who are these refugees and asylum seekers? They are families who fled Assad’s barrel bombs in Aleppo. They are Honduran children subjected to extreme violence in their homes and communities. They are Iraqi translators who risked their lives to work with the U.S. military. They are people who have survived some of the most extreme evils on earth, and we must not turn away from them now.

While the Trump Administration asserts that security concerns are at the root of the president’s actions and uses the specter of violence as a weapon against refugees and immigrants, we know that the United States is already quite adept at screening people in the country’s refugee resettlement program – the process takes two to three years and includes multiple security screens by U.S. federal agencies. Refugees are among the most intensely scrutinized immigrants to the United States, and there is no need to choose between security and doing what is right.

Today, a record number of people are displaced from their homes by war and violence – in fact, more people are displaced currently than during the period following the Second World War. The United States must lead when it comes to refugees, not retreat out of fear. The country is strong enough to carefully and securely vet refugees, and compassionate enough to know that it can’t shrink from this duty.

The president’s actions this week present a disturbing picture of the administration’s planned assault on all immigrants, setting out a terrifyingly broad scope of enforcement to limit the right to seek asylum and to undermine the rights of immigrant communities. PHR stands with refugees, we stand with asylum seekers, and we will continue our work to document the human rights violations that lead so many to seek protection in the United States.

This week’s inauguration naturally prompts conversations about the centrality of presidential leadership and power. What kind of powers will the president-elect have, and how will he use them? They’re crucial questions, and the answers can tell us much about how the new president will respect human rights, both inside and outside the United States.

There have been many effective presidents whose approaches to leadership and the use of power have varied widely. Volumes have been written about the subject, but for me — a human rights activist as well as a psychiatrist who advises business and political leaders — what matters most is moral leadership, which emanates directly from the character and values of the leader.

American presidents wield unfathomable power. There is truth to Lord Acton’s famous dictum that “power tends to corrupt, and absolute power corrupts absolutely.” But Robert Caro, the great biographer of U.S. President Lyndon Johnson, offered this wise observation about power that I find even more psychologically useful: “Although the cliché says that power always corrupts, what is seldom said … is that power always reveals.”

Presidential power does not grant presidential impunity. The use of presidential power informed by empathy, fairness, and justice can lead to moral leadership; the abuse of presidential power can lead to tyranny. Two of the most powerful and smart behaviors any U.S. president can exhibit are sorely lacking in the president-elect: judgment and restraint.

Just because he — alas it has so far always been a he — can do virtually anything he wants doesn’t mean that he should do anything he wants. How presidents treat those who are less fortunate, those with whom he disagrees, and those who are different in every possible meaning of the word — that’s the true measure of the leader. The president-elect, who has denigrated Mexicans, mocked the disabled, vilified his opponents, and whipped up hatred has shown plenty of recklessness and little leadership.

Over the past two decades, I’ve used my expertise to serve as a confidant to a diverse set of leaders, and I am often asked what I believe is the most dangerous trait in leaders. Frankly, there are many, but at the top of my list: the absence of a moral core that informs a leader’s thoughts and behaviors. Also high on my list of dangerous attributes is being impulsive: making decisions too quickly without the benefit of enough reliable information or without thinking through the potential for long term, unintended consequences. Impulsiveness can be dangerous for a corporate leader, catastrophic for a world leader.

Sometimes the best thing to do in what seems like an urgent situation is absolutely nothing in the moment, save for collecting one’s thoughts, gathering the best possible advice, and then being able to take more informed action. Impulsivity in a president, of all people, is terrifying.

There’s one more attribute in this admittedly incomplete list of dangerous leadership behaviors, all of which run counter to that highest form of moral leadership. It’s an attribute I call “pathological certainty.” Pathological certainty is simply the belief that one is always right. I’m not talking about self-confidence or a healthy ego, both of which are important for effective leadership. Rather pathological certainty is an absence of self-doubt, a failure to admit when one is wrong or apologize when one has harmed another, and hostility to taking advice from others with differing points of view.

Instead, real leadership and strength requires an ability to look outside oneself, question assumptions, admit missteps, and look to others for guidance. Those are qualities that make a leader great.

All of us in the human rights world will be closely watching the next president of the United States — as we have watched all presidents — to see what his power reveals about his character. There’s much room for pessimism when it comes to the incoming president. But once in power, as Caro said, we’ll hold our judgment to see what such incredible power reveals about the man and his capacity for moral leadership.

PHR joins 15 other human rights defenders in urging U.S. President Donald Trump to refrain from any executive action that would revive the use of torture or any other abusive interrogation or detention techniques. The law is clear, and enjoys bipartisan understanding and agreement, including among many of President Trump’s nominees, cabinet members, and senior advisors: torture is illegal under U.S. domestic and international law, has been proven ineffective, and stands against U.S. core values. Torture’s consequences are dangerous and enduring, both for those who suffer it, and for those ordered to inflict these heinous practices on others. The United States’ strength rests on its uncompromising values. We stand with the human rights community in refusing to repeat history, which has taught us that when countries sacrifice liberty in the name of security, they lose both. We urge President Trump to retract any intention to revive a torture program.

Read the full statement here.

Overview

Kinetic impact projectiles (KIPs) commonly known as rubber and plastic bullets, are used for crowd-control purposes by law enforcement worldwide in multiples forms and are shot from myriad types of guns and launchers. The findings of a systematic review of global medical literature carried out by Physicians for Human Rights indicate that KIPs cause serious injury, disability, and death. KIPs are inherently inaccurate when fired from afar and therefore can cause unintended injuries to bystanders and strike vulnerable body parts; at close range they are likely to be lethal. Therefore, KIPs are not an appropriate weapon to be used for crowd management and specifically for dispersal purposes.

History

The first kinetic impact projectiles used in protests were sawed-off pieces of broom handles that were shot against rioter in Singapore in the 1880s.The British also developed first wooden, then plastic. polyvinylchloride (PVC) and rubber bullets for use in demonstrations in Northern Ireland. The United States began using rubber and plastic bullets during Vietnam War protests.

How They Work

KIPs work by transferring kinetic energy from a weapon into a person. KIPs are purportedly designed to inflict pain and incapacitate an individual without penetrating the body. In theory, the larger shape and slower speed of KIPs should limit their ability to penetrate the skin or cause deep blunt trauma injury. However, due to their irregular shape and slower speed, KIPs are often inaccurate and therefore can strike vulnerable body parts or unintended targets.

Device Types

Rubber and plastic bullets are solid, spherical, or cylindrical projectiles of variable sizes tired as single shots or in groups of multiple projectiles. Pellets can be made of rubber, plastic, PVC, or a composite including metal.

Bean bag rounds, also known as flexible batons, are synthetic cloth bags filled with small metal pellets that are fit into a cartridge and expand as they travel to create a wide surface area impact.

Sponge rounds is a term for projectiles that limit penetration of the projectile into the skin by having a tip or nose that is slightly softer. These include: foam rounds with a hard foam nose or attenuated energy projectiles with a hollow nose.

Pellet rounds are cartridges filled with small lead, steel, or plastic/ rubber pellets that spread out when fired. Metal shot such as buckshot and birdshot are considered crowd- control weapons by some countries.

Pellet rounds are cartridges filled with small lead, steel, or plastic/ rubber pellets that spread out when fired. Metal shot such as buckshot and birdshot are considered crowd-control weapons by some countries.

KIPs can cause bruising of the lungs or heart and penetration into the chest may cause serious, possibly fatal, injuries.

Health Effects

KIPs can cause blunt or penetrative trauma. Penetrative injuries are those that pierce the skin or soft tissue. Blunt injuries are those that cause internal damage without breaking the skin barrier. All projectiles can cause these injuries but projectiles with metal cores (rubber coated metal bullets) or composite metal fragments can cause significantly worse injury.

Eyes: Direct trauma to the eye from KIPs nearly always causes total blindness in that eye, due to rupture of the globe (eyeball) as well as trauma to nearby structures. KIPs can also penetrate through the eye socket and enter the brain, causing brain injury.

Cardiorespiratory System: KIPs can cause bruising of the lungs or heart and penetration into the chest may cause serious, possibly fatal, injuries such as bleeding, pneumothorax, and heart attacks.

Musculoskeletal System: Injuries to the muscles and bones may cause sprains, bruises, and fractures. Deeper injuries can cause permanent damage to the neurovascular structures, leading to amputations or compartment syndrome.

Brain: Blunt trauma to the brain can cause concussions and bruising inside the brain (contusions} as well as different types of bleeding in the brain (intracranial hemorrhage) and skull fractures. KIPs have also been known to penetrate the skull or enter the brain tissue, causing hemorrhage, injury to the spinal cord, and severe brain injury from the foreign body.

Head and Neck: The delicate structures of the face and neck are particularly vulnerable to traumatic injury. The bones of the face and skull, the spinal cord, and the blood vessels in the neck are all close to the skin surface.

Abdominal: Blunt injuries can cause bleeding in the solid organs such as the liver, kidneys, and spleen. Penetrative injuries can also cause bleeding, perforations, and urogenital injuries.

Skin and soft Tissue: KIPs can cause bruising and contusions of the skin and soft tissue, as well as superficial and deep lacerations, some of which may cause muscle or nerve damage as well as bleeding.

Direct trauma to the eye from KIPs always causes total blindness in that eye.

Legality of Use

International human rights law protects the right to freedom of assembly, including the right to hold public or private meetings, marches, processions, demonstrations, and sit-ins.

The state has a duty to protect those exercising their right to peaceful assembly from any type of violence, including violence from law enforcement agents and counter-protesters. As long as the purpose of the assembly is peaceful, incidental violence does not discharge the state from this obligation to protect.

International legal principles require law enforcement agencies to adopt rules and regulations for the use of force within the following parameters:

• The use of force must be minimized, targeted, proportional, and directed at de-escalating violence.
• The use of less than lethal incapacitating weapons must be carefully controlled.
• The deployment of less than lethal incapacitating weapons must occur in a manner that minimizes the risk of endangering uninvolved persons.
• Restraint must be shown in all use of force by law enforcement agents, with a view to minimizing injury and loss of life.

In addition, the state has an obligation to ensure that assistance and medical aid are rendered to any injured or affected persons at the earliest possible moment.

International human rights principles have been violated if the use of less than lethal incapacitating weapons is not adequately regulated, of if the weapons are used in an indiscriminate manner.

Considerations and Policy Recommendations

Indiscriminate KIPs that fire multiple projectiles, such as shotgun pellets, should be prohibited in the context of protests.

KIPs in general are not an appropriate weapon for crowd managements and specifically for dispersal purposes. Most cannot be used effectively and safely against crowds. At close ranges, levels of lethality and patterns of injury of some KIPS become similar to those of live ammunition. At longer ranges, KIPs are inaccurate and indiscriminate. Some KIPs are lethal in close range and ineffective at longer distances which make safe use difficult.

Direct trauma to the eye from KIPs always causes total blindness in that eye. Some types of KIPs are able to provide a less lethal and accurate alternative. Deployment of those KIPs should be restricted to circumstances where a threat to life or a threat of serious injury exists and where all other means to protect lives are inapplicable.

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Produced jointly by Physicians for Human Rights (PHR) and the International Network of Civil Liberties Organizations (INCLO)

Overview

Chemical irritants (CIs), commonly known as tear gas and pepper spray, are used for crowd-control purposes by law enforcement worldwide. While the public perception may be that CIs cause minimal, transient harm, the findings of a systematic review of medical literature carried out by Physicians for Human Rights identify troubling levels of morbidity and even instances of death caused by these weapons. CIs are inherently indiscriminate and therefore the risk of exposing bystanders and individuals other than the intended targets, including vulnerable people, is high.

History

The most common CIs are Agent CS, Agent OC and its synthetic form, PAVA. Agent CS was developed in the 1920s in the United States and introduced as a military weapon. It became a frequently used weapon in the second half of the 20th century and was famously deployed by the U.S. military in the Vietnam War. Agent OC was also developed by the United States and originally used as a deterrent against wild animals (and by the U.S. Postal Service against dogs). Agent OC became a law enforcement weapon in the late 1980s. CIs are banned for use in warfare but are permitted for law enforcement purposes by the Chemical Weapons Convention (1993).

How They Work

CIs are potent sensory irritants that cause pain and inflammation via multiple mechanisms. These agents work on pain and temperature receptors (TRPV1) to cause sensations of burning and severe pain. Since OC is an oil, even small concentrations of it can penetrate skin and enter mucous membranes, causing severe and prolonged (20-90 minutes) discomfort.

Device Types

• Grenade and canister. This method of deployment produces a cloud of chemicals, usually within 60 seconds. It is indiscriminate by nature, and can spread to unintended targets and bystanders. Gas canisters are sometimes deliberately misused as projectile weapons fired directly at protesters at close range.
• Spray. Aerosolized streams of irritants can be sprayed at distances of 2.4-3.6 meters in one to two second bursts, allowing for potentially higher doses of the chemical agent to directly strike targeted people or groups.
• Other systems. CIs can also be dissolved in water to be used in water cannons, or fire hoses or contained as a powder inside a thin-coated spherical projectile (similar to paint inside a paintball).

Direct impact by the canisters and grenades carrying tear gas can cause significant blunt trauma and death.

Health Effects

CIs can cause injuries to many different body systems, depending on the exposure times, concentrations, the ability of the exposed person to leave the area, and prior medial conditions of vulnerabilities.

• Eyes. Irritation of the conjunctiva and cornea produces tearing, uncontrollable eyelid spasms, redness, and pain. The severe spasms can cause the lids to close tightly and produce temporary blindness. Vision can become blurry. These injuries may lead to corneal burns, abrasions, lacerations, and blindness.
• Respiratory system. CIs cause inflammation of the airways and pain. Coughing, difficulty breathing and bronchorrhea are common. The smooth muscle of the respiratory tract may contract, resulting in airway closure and difficulty breathing. Individuals with preexisting respiratory disease may be more sensitive to these agents, even at low concentrations. Exposure may precipitate attacks of respiratory distress resulting in hypoxia, respiratory arrest, and death.
• Skin. CIs cause a burning sensation to the skin as well as redness, itching or allergic reactions. Erythema (redness of the skin) usually begins several minutes after contact and can least for minutes or days after the injury. Blistering and burns of the skin as well as allergic skin reactions may also occur.
• Psychological. The physical symptoms of CIs often result in disorientation and agitation, which can lead to a state of fear, anxiety and panic. In some instances of prolonged and repeated exposure to CIs in protest settings, symptoms of post-traumatic stress disorder have been documented.
• Cardiovascular. CIs can cause increases in heart rate and blood pressure. Preexisting heart conditions may pose combined effects of increased heart rate and blood pressure, and hypoxia from respiratory distress may result in heart attack and possibly death.
• Oral and gastrointestinal mucosa. Irritation of the nose produces a burning sensation, inflammation, rhinorrhea and sneezing. In the mouth and gastrointestinal tract, exposure to CIs can cause pain, excessive salivation, and nausea and vomiting. Excessive vomiting and the toxicity of the agent can cause blood vessel ruptures and persistent pain.
• Effects on pregnancy and the fetus. There are some case reports to suggest adverse effects of CIs on the fetus. Animal models indicate that miscarriages and fetal abnormalities can occur after exposure to CIs. There is insufficient population data to verify a causal link in humans, but there are case reports of miscarriage and teratogenic effects on the fetus secondary to exposure to high concentrations of CIs.

Legality of Use

International human rights law protects the right to freedom of assembly, including the right to hold public or private meetings, marches, processions, demonstrations, and sit-ins.

The state has a duty to protect those exercising their right to peaceful assembly from any type of violence, including violence from law enforcement agents and counter-protesters. As long as the purpose of the assembly is peaceful, incidental violence does not discharge the state from this obligation to protect.

International legal principles require law enforcement agencies to adopt rules and regulations for the use of force within the following parameters:

• The use of force must be minimized, targeted, proportional, and directed at de-escalating violence.
• The use of less than lethal incapacitating weapons must be carefully controlled.
• The deployment of less than lethal incapacitating weapons must occur in a manner that minimizes the risk of endangering uninvolved persons.
• Restraint must be shown in all use of force by law enforcement agents, with a view to minimizing injury and loss of life.

In addition, the state has an obligation to ensure that assistance and medical aid are rendered to any injured or affected persons at the earliest possible moment.

International human rights principles have been violated if the use of less than lethal incapacitating weapons is not adequately regulated, of if the weapons are used in an indiscriminate manner. Since CIs are inherently indiscriminate, the legality of their use is questionable.

The physical symptoms of chemical irritants often result in disorientation and agitation, which can lead to a state of fear, anxiety, and panic.

Considerations and Policy Recommendations

• CIs, when deployed using canisters or grenades, are indiscriminate by nature. Caution should be used during deployment to stop the effect from spreading to unintended targets and bystanders.
• Firing multiple canisters in the same spot or firing repeatedly must be avoided, as this can cause serious injury or even death.
• Contextual factors must always be considered before making a decision to deploy indiscriminate CIs: geographical nature of the deployment site, wind patterns and temperature, or the existence of hospitals, schools, or dense uninvolved populations in the vicinity.
• Firing grenades or canisters containing CIs into closed paces or open spaces where there is no safe egress must be prohibited.
• Mixing more than one chemical agent or dissolving the agent into the liquid used in water cannons should be prohibited.
• Firing gas canisters or grenades directly into a crowd or towards individuals must be prohibited.

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Produced jointly by Physicians for Human Rights (PHR) and the International Network of Civil Liberties Organizations (INCLO)

Seventy years ago this month, an American military tribunal initiated the first of 12 criminal cases against Nazi doctors for committing war crimes and crimes against humanity in the name of medical science. Held in Nuremberg, the trials charged doctors for their participation in murder, torture, and other atrocities, including experimenting on prisoners and killing those the Nazis deemed “unworthy of life,” including people with mental and physical disabilities.

As a psychiatrist and the child of Holocaust survivors, I struggle to fathom how a doctor — sworn to “do no harm” — could inflict such incredible pain and suffering on another human being. And yet we know today that in the post-9/11 period, doctors and other health professionals were instrumental in designing and implementing the U.S. torture program that destroyed thousands of lives and has undermined the moral standing the United States assumed in the postwar period.

In the wake of World War II, those responsible for some of the war’s worst crimes were tried before the International Military Tribunals for Germany, known as the Nuremburg Trials, and the Far East, known as the Tokyo Trials. The U.S. government was the leader in pushing for justice, recognizing the importance of a full accounting of the crimes, justice and reparation for the victims, and accountability of those responsible.

In fact, the seeds of modern research ethics and human rights protections, including the Nuremberg Code banning nonconsensual medical experimentation and the conventions against genocide and torture, were first sowed in these years after the war. As people like my parents emerged from the camps, these international compacts were meant as a promise: the horrors you and your families endured must never happen again. And the perpetrators will be held accountable for their crimes.

But after 9/11, something shifted. Using national security as an excuse, the United States broke the promises it had made to uphold human rights — and instead engaged in a secret, illegal torture program. And even after President Obama banned the worst of the torture practices upon assuming office, none of those who designed or implemented that program have been held accountable for their crimes.

The U.S. government’s failure to pursue justice stands in sharp contrast to its undisputed leadership in promoting justice and accountability for the victims of World War II and its support for the UN Declaration of Human Rights, which captured the vision of a world in which people live free from fear and want.

Instead, the U.S. government is now using every tool at its disposal to prevent the victims of torture from accessing justice and a complete accounting of their suffering while in U.S. custody — from the hell of the CIA’s “Dark Prison” black site in Afghanistan to the Kafkaesque world of Guantánamo.

Perhaps nothing is more a betrayal of the spirit of Nuremberg than the willingness of American medical and health professionals to torture detainees and the ongoing cover-up of such crimes. Health professionals were involved in the torture program from the beginning, including two psychologists who undertook experiments in torture on detainees to “test” its effectiveness. For a fee of $81 million, psychologists James Mitchell and Bruce Jessen helped subvert medical ethics and, in the process, ruined lives.

Instead of being held accountable for his actions, James Mitchell is on a book tour attempting to reargue that techniques like waterboarding aren’t torture — despite the fact that the United States convicted several Japanese soldiers for waterboarding U.S. prisoners after World War II. Waterboarding is torture and torture is a crime, one that destroys the very fabric of a rights-respecting society.

With a president-elect poised to take office and threatening to bring back waterboarding “and much worse,” it is crucial that the current administration act now to preserve and declassify all the evidence of these crimes committed by the CIA and the U.S. military, including those committed by health professionals who breached their ethical duties. It’s an absolutely necessary step for the United States to begin to regain its moral authority in the world.

After the war, the U.S. government didn’t try to shield its eyes from atrocities. Rather, during the Doctors Trial, the Unites States was willing to look perpetrators in the face and reckon with the past. It’s time to reassume the mantle of leadership and not shy away from the truth. We owe it to all the victims of warfare and atrocities.

This post originally appeared on The Huffington Post.

The brutality visited on Aleppo in recent weeks has shown the world that Syrian President Bashar al-Assad has no scruples about killing his own people and destroying one of the world’s once-great cities. According to the United Nations, as Syrian forces closed in on eastern Aleppo, they executed dozens of civilians on sight, including women and children. Reports of men and boys being rounded up have families wondering what horrors await their loved ones.

But it’s a brutality that has been clear all along to those of us who’ve watched Assad and his allies engage in a seemingly limitless campaign to annihilate Syria’s health care infrastructure and personnel over the past five years. There have been at least 400 attacks on medical facilities in Syria since 2011. The intentional campaign of striking hospitals, emergency clinics, maternity wards, and pediatric units has shown that Assad and his principal backer, Russian President Vladimir Putin, have absolutely zero regard for international law and the longstanding prohibition against attacking medical workers and facilities during wartime.

In Syria, attacking hospitals has become an ominous “new normal” of sorts, a signature of this conflict and likely conflicts to come. And though such attacks violate not just international law but repeated UN Security Council resolutions, the international community has failed to stop them. There has been plenty of rhetoric, plenty of attempts to name and shame, and yet our governments and the international bodies with a duty to maintain peace and security abdicated their responsibilities. This shame will endure for generations.

Crimes like the systematic destruction of hospitals are called crimes against humanity because in their barbarity, they violate our common understanding of what it should mean to be human. We are all victims of such atrocities, because as those international norms and standards wither, all of us may someday find ourselves seeking refuge or fleeing a conflict and will find no sanctuary. It’s a thought that should terrify us all.

One morning just a few weeks ago, the two of us discussed the desperation that we in the medical and human rights communities feel about the situation in Syria. Our governments had let us down; we felt entirely helpless. So we decided to act. We imagined the People’s Convoy, a crowd-funded effort supported by private citizens, to send a message of solidarity and provide much-needed medical aid to those who are now suffering even more intensely in the wake of Aleppo’s fall.

Laden with nebulizers, scales, examination tables, stethoscopes, and feeding bottle sterilizers, the convoy is now working its way across Europe. Once the supplies reach the Syrian border, our partners who routinely make aid deliveries into Syria will use them to establish a children’s clinic capable of serving 60,000 patients. It’s meant to support both those who are suffering but also the valiant doctors who’ve risked their own lives to save others. A genuine citizen action.

But the convoy is also meant to send a message: we do not accept the new normal of attacks on hospitals. And it’s also an expression of support for the doctors, nurses, medics, and other health professionals inside Syria are the heroes of a conflict where heroics are in short supply. Medical students have become specialists by dint of their own ingenuity and a smartphone. Nurses and medics have logged all-night shifts knowing that if they rest, others might die. They have lived up to the highest ideals of the health professions by providing care without fear or favor.

And they’ve died because of it. At least 768 medical professionals in Syria have been killed since 2011. In 2012, the Syrian parliament passed a law banning any assistance to opposition forces, including medical care, and branding those who violated the law as terrorists. This law is an affront to the longstanding norms and treaties protecting medical care in conflict. The People’s Convoy is meant as a message to our medical colleagues that we support their work no matter who they treat.

It’s unclear what will happen next in Syria or what fresh new horrors await those who’ve escaped Aleppo and other towns under siege. But the conflict will inevitably end. That’s when the world will reach another moment of reckoning: will we allow the war criminals who attacked the heart and soul of Syria’s health care system to get away with it, or will we hold those who’ve violated international laws and compacts accountable for their crimes?

Dr. Rola Hallam is the founder and CEO of CanDo.

Dr. Katherine McKenzie, director of the Yale Center for Asylum Medicine, contributed the medical evaluation that helped Congolese torture survivor Paulin Mukubayi Kalonji gain asylum in 2013. | Physicians for Human Rights

This post originally appeared on The BMJ.

I saw the first asylum seeker around ten years ago in my clinic. He came from a country with an autocratic president against whom he had peacefully protested. The government would not accept dissent from its citizens and they arrested, detained, and tortured him. He was released, but he was told that he would be killed for any future real or perceived opposition. He fled to the United States for safety, and eventually presented to my office for a medical forensic exam to document the scars of his torture.

In the intervening years I have encountered many people who have experienced human rights abuses in different forms. A woman who wanted to attend church in a non-Christian country and was attacked each time she tried. A man who lived with his male lover; they were beaten nearly to death when they went to a bar together. A woman whose husband began to abuse her regularly soon after they married. The police force refused to intervene when she sought protection as they stated this was a “family matter.” A woman who was forced against her will as a young girl to undergo female genital cutting. These individuals are seeking for themselves the rights I am fortunate to enjoy daily. They want to live in a country where they can protest against a government without fear of torture, worship as they desire, live safely in intimate relationships, love the person they want.

Physicians have unique skills to contribute to asylum seekers; they can use their medical training to document the physical and psychological scars of torture and ill-treatment. Although emotionally challenging, the work offers the rewards that attract doctors to the practice of medicine in the first place. We hear stories, we lay on hands, we use our expertise to help. And medical exams can significantly increase the likelihood that asylum will be granted.^[1]

Providing refuge to those fleeing danger or injustice has historical precedent, and societies have been offering safe haven for millennia. In the twentieth century the Universal Declaration of Human Rights was adopted by the United Nations and member states.^[2] Many countries have laws protecting these universal human rights and provide a process for those in danger to seek asylum.

Much of the discussion surrounding refugees and asylum seekers involves the vetting process, and to be sure this issue is not a small one. But physicians are not required to determine whether a person is a security risk. In fact, rigorous background checks are performed on all asylum seekers. The physician’s role is to approach each person individually and assess whether their exam findings corroborate the story they tell.

A president was elected in the US this month who has stated his strong opposition to refugees and asylum seekers. Irrespective of the election results, a record number of people remain globally displaced.^[3] Now more than ever, over 65 million women, men, and children need protection; this fact has not changed despite the new political landscape.

As a physician dedicated to supporting refugees and asylum seekers, I will continue to vote for candidates who advocate for them. But political change may be a long way off, so this week I will again have the privilege of entering the exam room with someone who came to this country to be free from persecution, and if their story is credible, my exam will help that person live a safer life.

Katherine McKenzie is a physician on the faculty of the Yale School of Medicine, and has been the director of the Yale Center for Asylum Medicine since 2007.

Competing interests: None declared. 

References:

1. Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health 2008; 10(1): 7-15.
2. Universal declaration of human rights. United Nations; 1948.
3. Office of the United Nations High Commissioner for R. Forced displacement in 2015. 2016.