Last month, the CIA released more than 50 declassified documents about the illegal torture program it operated after the September 11, 2001 terror attacks. Many of them elaborate on the sheer brutality of the CIA’s practices, including new details about the 2002 death of Gul Rahman, who was beaten and left to die – chained half-naked to the floor – in sub-freezing temperatures at a CIA black site prison in Afghanistan.

But much of the analysis of the documents overlooked a key revelation: the extent to which physicians, physician assistants, nurse practitioners, and psychologists aided and abetted torture. A subset of these documents confirm how the CIA used the participation of medical professionals to give credence to the lie that torture was “safe, legal, and effective.”

Gul Rahman suffered torture under the watchful eye of CIA medical professionals at the Salt Pit prison in Afghanistan from his arrival in August to his death from hypothermia in November 2002. An internal investigation – released as part of this latest cache – shows that medics actually debated what standard of care they were meant to provide Rahman and other prisoners. They eventually called the CIA’s medical office headquarters and were told simply: “The Hippocratic Oath states that if someone is sick, you treat them.”

These instructions were intentionally vague and logically incoherent, given the purpose of the secret prison: to extract information through torture. And the instructions were duly ignored. The available evidence shows that Rahman was brutalized hours before he froze to death. What’s more, health professionals repeatedly signed off on his torture and appalling conditions of confinement and failed to note any health problems, despite regular abuses.

These breaches by health professionals were directly responsible for Rahman’s death. Not surprisingly, the death investigation includes a doctor’s conclusion that Rahman is to be blamed for dying of hypothermia. By throwing away his last meal, he was unable to “provide his body with a source of fuel to keep him warm.” The autopsy summary reads as a final act of medical complicity.

It is a crime, as well as a violation of medical ethics, to facilitate torture and ill-treatment. Any health professional (indeed, any reasonable person) knows that placing human beings in a coffin, subjecting them to freezing temperatures, sexually humiliating them, or drowning them will cause severe physical and mental pain. But CIA health professionals abandoned their ethics and became participants in such acts.

Instead of stopping the program, the CIA’s medical office drafted a list of “guidelines” following Rahman’s death and the continued mistreatment of other detainees. This latest trove of documents includes a 2004 version – almost totally un-redacted for the first time – which essentially provided a clinical blueprint for torture.

The “medical and psychological guidelines” instruct CIA medical personnel to treat detainees, but only to the point where it doesn’t interfere with torture. “Adequate medical care” should be provided, the document says, but “should not undermine the anxiety and dislocation that the various interrogation techniques are designed to foster.” And despite the title, there are virtually no psychological guidelines for assessing the mental harm these torture techniques would inflict.

In an extraordinary display of double-speak, the CIA’s medical office states all health personnel “remain under the professional obligation to do no harm.” It then directly contradicts this central ethical principle of medicine by providing guidance on how to supervise waterboarding, sleep deprivation, confinement, and other forms of torture.

The architects of the CIA’s unlawful program, psychologists James Mitchell and Bruce Jessen, were paid $81 million dollars to design and oversee these practices (and are currently being sued in federal court). Based on their spurious guidance, the CIA told Bush administration lawyers that the torture techniques weren’t expected to produce severe physical or mental pain – an outright lie.

As these new documents reveal, the CIA and complicit medical professionals created a set of contradictory, ethically unsound guidelines not to prevent harm, as they claimed, but to facilitate the commission and cover-up of torture and to mitigate legal risk.

The torture policies of the Bush administration – which so far President Obama has left uninvestigated – are now well known. Accountability is urgently needed. In the process, we cannot ignore the role of health professionals, who violated their ethical and professional duties, and, in doing so, lent a veneer of medical legitimacy to this criminal enterprise. Their crimes, if proven, cannot and should not go unpunished.

The terrifying news of the discovery of the dead bodies of lawyer Willie Kimani, his client Josephat Mwenda, and taxi driver Joseph Muiruri at the beginning of this month sent shock waves through the Kenyan population and the global community. The three disappeared following a court hearing on allegedly trumped-up charges against Josephat Mwenda. The three men were brutally tortured, murdered, and dumped in a river. Police investigators believe their own officers may be to blame.

The heinous murders of Kimani, Mwenda, and Muiruri have garnered significant national and international attention, eliciting outrage across wide swathes of society – lawyers, human rights defenders, and civil society organizations, but also motorcycle taxi riders, taxi drivers, street hawkers, politicians, and the broader citizenry. The public is enraged by the brutal nature of these killings. We are astounded by the audacity of state security agents who turned into assailants when they ought to have been the protectors. Why did the three have to die? Is it a crime to pursue justice in a country that prides itself on upholding the rule of law? And most importantly, will the families of these three young men ever find justice for their loved ones?

This is a story that is, sadly, not new. The Independent Medico-Legal Unit (IMLU), a local non-governmental organization, has documented 64 cases of police killings just between January and April of this year – of these, 53 victims were summarily executed, while 11 died in unclear circumstances. IMLU documented 126 reports of police killings between January and December 2015, including 97 summary executions. Further, barely one week after the somber burials of the three young men, numerous cases of police brutality, killing of civilians, and disappearances following police arrests have been reported in several parts of the country.

This is a story of entrenched impunity in Kenya’s Police Service: for decades, police officers have boldly perpetrated crimes and violations against citizens without fear of punishment or reprisals.

In the horrifying post-election violence that followed 2007’s contested Kenyan presidential election, police officers and state security agents took part in brutalizing the very people they were deployed to protect. Three of their victims, women who were gang-raped by police officers, are among eight survivors who appeared in the High Court in Milimani, Nairobi earlier this week to seek justice from the state for its failure to protect them, and to conduct thorough investigations and prosecutions of the perpetrators.

More than eight years since this dark ordeal and many others like it, not a single police officer has been investigated, apprehended, or held accountable for the sexual abuses that these women suffered. Nor have the survivors been compensated or provided with rehabilitation and other psychosocial assistance.

In 2009, a task force established to investigate cases of sexual violence committed during the post-election period forwarded a list of 66 complaints to the prosecutor’s office, mostly allegations of rape by security officers. The task force suggested that the files be closed for want of evidence, mostly in cases where victims were unable to identify perpetrators or where victims could not present medical or other forms of corroborating forensic evidence. In 2010, the Director of Public Prosecutions directed the police to conduct further investigations into those cases, including an evaluation of available materials that had the potential to form evidentiary basis, such as torn clothes or spent gun cartridges found at crime scenes. However, there has been no public report on the outcome of the task force’s investigations, and six years later it is still not clear whether they resulted in any subsequent prosecutions.

This has been the pattern in many other cases involving police perpetrators: investigations resulting in claims of insufficient evidence, loss of witnesses who in some cases were intimidated or murdered, and/or compromised crime scenes. Other cases have simply gone cold.

As the Police Service insists that these are only a few rogue officers within the service and that the organization as a whole must not be uniformly condemned, one thing is certain: the police’s failure to ensure thorough investigations and prosecution of rogue officers is tantamount to sanctioning police-perpetrated crimes.

The Police Service has laudably, but insufficiently, begun vetting police officers; but accountability is the missing piece, and it requires state investment in proper investigative techniques and witness protection. Above all, it requires political will at the highest levels to demand an end to impunity for police criminality. Justice for Kimani, Mwenda, and Muiruri would be an important start. And accountability for police abuses that took place during the post-election violence period would give Kenya hope that deeper reforms are taking root.

In late spring 2016, 12-year-old Ola died in Syria. In a place where her death could easily have been caused by barrel bombs, missiles, or mortar fire, she instead suffered a slow and painful death from starvation. This happened because she lived in Madaya, a small town controlled by opposition forces an hour’s drive from Damascus that the Syrian government has besieged since July 2015. A new report released by Physicians for Human Rights (PHR) and the Syrian American Medical Society (SAMS) highlights the harsh conditions faced by Madaya’s 40,000 besieged residents. For a year, the population has been forced to survive on the meager supplies and services available inside the town’s narrow boundaries. With inadequate food stores and medical care, they have suffered from starvation and malnutrition, and succumbed to disease, traumatic injury, and other life-threatening conditions. The population, roughly four times its original size due to internal displacement in the country prior to the siege, is surrounded by 12,000 landmines and 65 checkpoints manned by snipers.

In December 2015, after nearly six months of siege and only one humanitarian aid delivery that included expired food, reports from Madaya appeared in international news outlets, including graphic images of starving children and adults. This prompted a large-scale effort by the United Nations and humanitarian groups to deliver aid and ease the impact of the siege in Madaya. However, of the four humanitarian aid deliveries to Madaya between January and April 2016, none included adequate food and medical supplies to stave off advanced malnutrition and starvation for all of the town’s residents. Syrian government officials only permitted limited quantities and types of food and medicine and stripped out essential aid from convoys, such as kits to treat severe acute childhood malnutrition. UN agencies also failed to deliver some of the aid they promised, including cans of tuna for hundreds of malnourished children suffering from a protein deficiency. These half-measures, lauded by the media and UN officials as progress toward ending the siege, have been far from sufficient to alleviate the immense suffering in Madaya. Now, more than two months since the town last received an aid delivery in late April and more than a month since the International Syria Support Group (ISSG) promised airdrops if government authorities did not grant access to ground convoys, its residents are again on the brink of starvation.

As a result of the tragically inadequate response to Madaya’s needs, Ola and other residents suffering from the effects of starvation found little relief in the aid. When she died in May 2016, Ola became one of at least 86 people who have perished from siege-related causes since the siege on Madaya began – 65 died from malnutrition and starvation, 14 from landmines, six from snipers, and one from a chronic health condition. Almost all 86 could have been saved if they had had access to food, medication, medical equipment, and medical treatment by specialized health workers. But all of those things exist in grossly insufficient numbers in Madaya, and two dentistry students and a veterinarian are left to care for the town’s 40,000 residents. With the siege still firmly in place, the lives of Madaya’s remaining residents hang in the balance, with hundreds suffering the effects of malnutrition, untreated chronic health conditions, infectious diseases, and traumatic injuries.

Dr. Muhammad Darwish was a dentistry student when the conflict broke out. Now he is one of Madaya’s few remaining health care providers. He explains: “What we need in Madaya, and in all besieged areas in Syria, is to lift the siege once and for all. No more beating around the bush and allowing a few convoys in here and there that don’t include medication and with aid that doesn’t even meet the needs of a quarter of the population.”

Madaya is not the only place where siege warfare is being brutally used. Syrian government forces and, to a lesser extent, non-state armed groups are besieging nearly one million people across the country. They have denied deliveries of food, medicine, and other supplies that are indispensable to survival, subjecting entire populations to slow deaths by starvation and lack of health care – actions that constitute war crimes. Yet the only action the UN Security Council and other world leaders have taken is to issue toothless statements decrying the violations.

The death toll will only increase the longer the sieges are in place. The UN Security Council, the ISSG, and UN aid agencies have all failed Syrians again and again by refusing to enforce their resolutions, follow through on their promises, and act according to their humanitarian principles to serve those most in need. It is past time that these agencies and world leaders take concrete action to ensure that civilians starving at the hands of the Syrian government are given a chance to live and are not condemned to die because of politics. The first step they can take is to implement air drops as promised to provide short-term relief to those at risk of starvation.

The Syrian government has besieged Madaya – a small town controlled by opposition forces an hour’s drive from Damascus – trapping residents inside without access to supplies, food, or services outside the town since July 2015, in violation of international humanitarian law.

During the government’s siege, Madaya’s 40,000 residents – roughly four times the town’s original population – have been surrounded by landmines, checkpoints, and snipers, forced to survive on the meager supplies and services available inside the town’s narrow boundaries. With inadequate food stores and medical care, they have suffered from starvation and malnutrition, and succumbed to disease, traumatic injury, and other life-threatening conditions.

Through May, at least 86 people have perished from siege-related causes since the siege on Madaya began – 65 from malnutrition and starvation, 14 from landmines, six from snipers, and one from a chronic health condition Almost all 86 could have been saved if they had had access to food, medication, medical equipment, and medical treatment by specialized health workers. But there is grossly insufficient food, medicine, and medical equipment in Madaya and two dentistry students and a veterinarian are left to care for the town’s 40,000 residents. The lives of Madaya’s remaining residents hang in the balance, with hundreds suffering the untreated effects of malnutrition, chronic health conditions, infectious diseases, and traumatic injuries.

Physicians for Human Rights and the Syrian American Medical Society demand that all warring parties in Syria immediately end their deliberate starvation of civilians and blocking of humanitarian aid. Members of the UN Security Council and the International Syria Support Group must demand and guarantee freedom of movement and unimpeded and constant access to all needed humanitarian aid and commercial access for Syria’s besieged population, from food to medical supplies to life-saving services. World leaders must support humanitarian agencies in pursuing every means possible – including airdrops – to deliver life-saving aid and services to everyone in need. Each additional day under siege causes untold suffering to more than one million Syrians and brings them one day closer to death.

The last election in Myanmar (also known as Burma) gave hope to minority groups in the country. After five decades of military rule, the National League for Democracy (NLD), party of Nobel Laureate Aung San Suu Kyi, won a landslide victory in the country’s first truly democratic election since 1990. The election presented an historic opportunity for unity and change.

Unfortunately, positive change has not yet come for the Rohingya minority in the country. Suu Kyi crossed the line of neutrality into a dangerous tone of exclusion earlier this month when she advised the United States to refrain from using the term “Rohingya” because the group is not an officially-recognized minority.

For decades, Myanmar’s Rohingya Muslim minority population has been subjected to such a large number of abuses by the government that the United Nations has deemed them “the most persecuted minority in the world.” Disenfranchised and denied direct representation in Parliament, the Rohingya had been holding out great hope that the NLD could amplify their voice. Yet the NLD has given little indication it is addressing the deteriorating plight of the Rohingya with any urgency. Private diplomacy may be a preferred political approach, but the NLD’s silence is in striking contrast to the outspoken movement that rejects the right of the Rohingya to belong in Myanmar. These anti-Rohingya groups refuse to even acknowledge the term “Rohingya” and instead use “Bengali” – implying that the Rohingya are immigrants from Bangladesh and not a group indigenous to Myanmar. To its credit, the new government appears to have renounced use of the term “Bengali,” while still refusing to use the term “Rohingya.”

U.S. officials should not ignore these developments as they consider shifts in bilateral relations with Myanmar. As we were reminded by Representative Eliot Engel immediately following the election, “Burma’s transition to democracy is not just about what happens on Election Day but about how leaders choose to govern and meet the country’s many challenges regardless of who takes power.”

Many – including Suu Kyi, a known symbol of democracy whom many believe is the only person capable of bringing democracy to Myanmar – cautioned that change will take time. The NLD government was only recently installed, and significant challenges lie ahead. Despite the number of problems facing the new government – civil war, poverty, corruption, dysfunctional bureaucracy – concerns about human rights conditions and violence against ethnic and religious minorities must not be muted. Patience with, and support for, the new government must be delivered with a critical eye, mindful that toxic policies in any sector can quickly metastasize and drive the promise of democracy into collapse.

Neither an historic election nor the NLD can transform Myanmar overnight. Change must ultimately emanate from within communities in cities, towns, rural areas, and ethnic states. But these communities will take their lead from the new government. The NLD needs to show leadership and support the democratic and rights-based values it has represented for decades. If Myanmar has any hope of achieving a real democracy and national reconciliation, it is essential that all groups be recognized and their basic human rights respected.

Last week, the state of Texas quietly issued a “child care facility” license to a family detention center in Karnes City, Texas. The license was issued despite the protests of attorneys, health professionals, and former detained individuals. While a temporary injunction now prevents Texas from issuing a similar license to the other family detention facility in the state, both centers remain open and the disgraceful practice of detaining child refugees continues.

Everything we know about detention, particularly indefinite detention, and especially of children, tells us that it is damaging to mental health: it produces surges in suicidal thoughts, depression, anxiety, and sometimes even psychosis. What’s more, the women and children currently held in these family detention centers are particularly vulnerable, having fled some of the most violent places on earth. Many fleeing El Salvador, Guatemala, and Honduras have lived with such a high level of violence and sexual violence that some have never known anything else. Children learn at elementary school age that they could be shot or beheaded and left as a warning by the narco-gangs that rule their cities and neighborhoods. Often, both women and children face pervasive violence in the home, and those who leave home are at risk of labor and sexual exploitation by gangs and traffickers.  

In this context of high levels of organized crime and generalized violence, Central American governments appear helpless at best and implicated at worst. The net result is suffering, and, increasingly, an urgent impetus for flight. So every day, mothers pool resources from family and friends, abandon their homes, and flee north to the United States in an attempt to save their children, and in many cases, themselves. Yet what’s waiting for many in the United States is not safety, but detention. Families are separated, and the fear or anxiety that motivated the flight is heightened in many. Children’s mental and physical health deteriorates alarmingly quickly.

This reality is clear to the volunteer clinicians in Physicians for Human Rights’ (PHR) Asylum Network who conduct pro bono forensic evaluations of asylum seekers. These evaluations are crucial in the documentation of physical and psychological harm from persecution, and can mean the difference between asylum and deportation. But in documenting the cases of detained families, our evaluators see the unique and insidious ways that detention is harming these children: in numerous cases, rather than finding relief, children are withdrawing and growing more fearful and hopeless in the centers. Clinicians describe children deteriorating physically and displaying increasingly inappropriate behavior, including growing violent, withdrawing socially, and trying to breastfeed at advanced ages because they are desperate for comfort.

When you hear the stories of these children, and the circumstances of their detention, this outcome is not surprising. These children have lived through and witnessed horrific violence. One PHR volunteer met with a woman whose child, also detained, had witnessed her mother being repeatedly violated and beaten, and who herself was physically scarred from the violence in her home. Another volunteer documented a case involving a mother who had fled with her child following decades of sexual abuse. Another child had witnessed family members and neighbors murdered.

For many of these children, their mothers are the only adult they have ever trusted, and the person who brought them out of danger, often over a weeks-long or even months-long trip north. However, in the detention centers, the mothers are disempowered and can’t even tell their children when they will be released. The one person the children look to for safety is suddenly terrifyingly helpless. School is not a comfort – just a sea of changing faces as some children are released, some deported, and others join the class after having been captured at the border and detained. Faced with these circumstances, many children are simply falling apart.

Unfortunately, instead of working to end family detention, the Obama administration has worked to entrench the practice in the U.S. immigration system. The administration has continued to award federal contracts to run detention centers to private prison companies, like GEO Group, with abysmal records of abuse and neglect. And now the government is employing a regulatory sleight-of-hand, attempting to license family detention centers as “child care facilities” by fiat as a way to circumvent a federal court ruling that these detention centers are improper places to hold children. The administration has also argued that there is a moral case for jailing children, asserting that detaining and deporting families will deter parents from making the dangerous journey north with their kids. In reality though, it simply means that families will make repeated attempts to reach safety. No matter what deflection techniques the government applies, detention of children remains harmful, and must end.

Americans are right to object to the poor conditions and lack of oversight at family detention centers, and those centers should be properly prepared to provide safe and humane conditions. But there are no regulatory or policy changes that will make detention centers appropriate places for children. Detention, by itself, strips vulnerable children of their last means of emotional security, support, and sense of control, and it is time the federal government stopped this shameful practice.