The lead-poisoning disaster in Flint, Michigan is more than a shocking public health failure. It is an assault on human rights – a recognition that has been largely absent from most discussions of how and why this could have happened in the advanced industrial democracy of the United States. It is arguably the largest discrete violation of its type since the infamous and grossly unethical Tuskegee syphilis medical study of the last century. The water poisoning in Flint was finally forced into official recognition by a brave and stubborn pediatrician, Dr. Mona Hanna-Attisha, who documented what was really happening to Flint’s vulnerable children and other residents.

There are differences between Flint and Tuskegee, of course. Tuskegee was a deliberately, even cynically, planned trial involving a moderate number of adult African-American men, who were purposely left untreated to suffer the progression of their disease, while falsely told that they were being helped. It was a cruel medical study directed by government public health doctors who violated their professional medical ethics. Flint is the consequence of depraved indifference and layer upon layer of smug, incompetent denial by the state government – more like a slow-moving, long-lasting Tuskegee, with an impact orders of magnitude greater in terms of the numbers of people affected: tens of thousands of particularly vulnerable children and tens of thousands more adolescents and adults.

However, just beneath the surface of these two events is the similarity. All of the men in Tuskegee were African-American, and so were the majority of those exposed to toxic water in Flint. In both events, a particularly despicable form of racism is manifested: a contemptuous disregard for the health of people of color, especially if they are poor and can be dismissed as politically and economically irrelevant.

Every person has the universally-recognized right to the highest attainable standard of physical and mental health – a right callously ignored by the very people tasked with safeguarding these citizens’ wellbeing: their local, state, and federal public health and environmental agencies and their elected representatives. For almost two years, the children of Flint have been exposed to the risk of brain damage – impairing IQ and causing behavioral disorders – that in many cases will prove to be irreversible, and will continue to unfold for years.

Into this swamp of denial stepped Dr. Hanna-Attisha, who carefully reviewed past and current hospital records and documented what was already happening: a doubling and tripling of cases of dangerously elevated levels of lead in children’s blood. She went public with those facts, and, like other citizens of Flint, she was accused of causing hysteria. But she persisted, and won: Flint’s mayor declared a state of emergency over the water issue in December.

Dr. Hanna-Attisha’s work illustrates a truth larger than the Flint case itself. A new and important domain of professional responsibility has emerged for health professionals and medical scientists: the documentation and exposure of human rights and civil rights abuses that violate long-established legal and ethical agreements, and international and domestic laws. Dr. Hanna-Attisha’s efforts are essentially similar to the work of Physicians for Human Rights (PHR) in Syria or other conflict zones, in detention camps and prisons in the United States and abroad, in humanitarian crises, and among asylum seekers.

Such work, and efforts by many other organizations, will be needed in Flint to assure that affected children will receive the careful monitoring, medical care, and intense educational support they may need for many years to come.

But a moral response to the outrage in Flint obliges all of us – not just doctors, bioethicists, and human rights advocates – to act. We must add our voices to calls by the ACLU and other organizations for transparency and accountability for those that caused human damage on this massive scale. We need action now. State authorities must conduct adequate sampling and water testing in the homes where lead pipes are likely to be present, and enforce rigorous inspection, testing, and removal of lead paint in old housing, which is likely the biggest source of chronic lead exposure.

Most important of all, authorities must recognize and address the need for active and ongoing federal supervision. We must assure congressional funding for the essential infrastructure repairs and for ongoing educational, cognitive performance, and remedial support for affected children for the next decade. And we should prevent one last parallel between Tuskegee and Flint from emerging. After Tuskegee, no one ever faced effective criminal prosecution. It remains to be seen whether or not that will happen in Flint.

This post originally appeared on Syria Deeply.

Political wrangling in the lead up to Friday’s U.N.-brokered peace talks has dramatically lowered expectations. But continued inaction at the diplomatic level, writes Elise Baker of Physicians for Human Rights, is a “death sentence” for many Syrians trapped in besieged or remote areas across the country

As world leaders gather in Geneva for the latest round of talks on the Syrian conflict, I can’t help recalling what a Syrian doctor told me a few months ago in Gaziantep, Türkiye.

“Nobody wants to end the conflict in Syria,” he said. “They want to run the conflict in Syria, but not to end it… If I could say something, I would say stop it all. But the world will not listen.”

I find it hard to be optimistic about these talks. While all parties to the negotiations agree in principle on the need for a ceasefire, they have not been willing to make the necessary concessions to achieve one. In the interim, dozens of civilians are killed each day as Russia and Syria increase their assault on opposition-controlled areas. Hospitals, schools and markets are destroyed. Entire towns and cities are demolished. And hundreds of Syrians are forced to flee with their children and few belongings to yet another town, where they will live in yet another abandoned building before it, too, is bombed and they are forced to flee again.

All parties agree on the need for unhindered humanitarian access to those in need, but one million Syrians continue to live under siege. They go to bed hungry, and outbreaks of flesh-eating diseases go untreated. They hope their children will survive living off one bowl of rice every other day for months on end. But hundreds have not been so lucky. They have starved to death in towns only miles away from food-filled warehouses, where aid sits ready to be delivered. The U.N. says it must deliver aid to all Syrians in need, and the Security Council has authorized U.N. agencies to do so without approval from the Syrian government. Yet these U.N. agencies continue to request permission for such deliveries from the Syrian government, which time after time has ignored or rejected these requests.

Despite the fact that all parties have agreed, in principle, on the need to combat the self-declared Islamic State (ISIS), its members continue to terrorize, imprison, rape, execute, threaten and abuse entire populations. They parade their antics on the Internet for the world to witness and decry. Then they feed off this publicity, garnering more followers who will commit even more atrocities. The United States has spent 18 months and more than $5 billion bombing ISIS, yet the group controls more territory in Syria than it did 18 months ago. Meanwhile, Russia continues to bomb opposition-controlled areas under the pretense that it is fighting terrorism.

As world leaders gather to negotiate ceasefires, humanitarian aid and fighting ISIS, I worry that they have grown too numb to the everyday reality Syrians are forced to live through. I worry that anyone who works on Syria has become inured to this horrifying conflict – the loss of hundreds of thousands of lives to barrel bombs and indiscriminate shelling, to car bombs, starvation and beheadings. But mostly I worry that the politics of stalemate and inaction, which have repeatedly prevented a resolution to the conflict, will stall these peace talks.

I hope these leaders recall the past five years of the Syrian conflict and internalize the incredibly high cost of inaction. I hope negotiators keep in mind the millions of lives that hang in the balance. Millions of Syrians – individuals with families and friends, hopes and careers – could be saved from their current fate of displacement and death if the talks succeed. Millions of Syrians’ lives depend on these talks.

I hope these leaders act with urgency on the principles they tout. If these talks do not succeed, who knows how many more Syrians will be lost to bombs, starvation, and denial of health care? How many millions of refugees will risk their lives seeking safety in an increasingly unwelcoming Europe? How many more agonizing years will Syrians have to endure before politicians again summon the political will to resolve this brutal conflict?

As world leaders gather in Geneva, I hope they understand that for the Syrians who suffer from their inaction, failure of these talks is a death sentence.

This post originally appeared in The Huffington Post.

It’s been just three weeks since the UN Security Council adopted its latest resolution on the conflict in Syria, re-authorizing cross-border delivery routes for humanitarian aid and promising – once again – to take “further measures” if the parties to the conflict do not comply with international humanitarian law.

In these three weeks, the Assad government has systematically ignored this warning. Instead, its forces have continued their relentless violation of international rules of war, among them the requirement to spare civilians, health personnel, and medical facilities.

On December 25, a suspected chemical weapons attack in Moadamiya drove civilians to the local hospital with symptoms consistent with exposure to toxic agents, including difficulty in breathing, bloody frothing at the mouth, muscular contractions, and involuntary urination and defecation. Several patients have died as a result. Local documenters say the missile attack came from the Syrian government-controlled Al Mezzeh airbase.

It’s very likely that this suffering was caused by illegal chemical weapons, but it has not been possible to confirm which toxic agent was responsible, and how it was distributed. There’s a reason for that.

Chemical weapons attacks are notoriously difficult to substantiate. The debris they leave is hard to detect from satellite images. To positively identify a toxic agent, you need to analyze affected blood samples. But in Syria, and in particular in the Damascus suburb where the December attack occurred, the specialized medical equipment needed to conduct these tests is in severely short supply.

What’s more, it is exceedingly difficult to safely deliver blood samples from Moadamiya to health care facilities with the necessary infrastructure. Supplies to adequately preserve samples are virtually non-existent. With health care centers and personnel openly targeted – at least 240 medical facilities have been attacked and 697 medical workers killed in the conflict, primarily by Assad government forces – transporting blood samples has become very dangerous. The combination makes identifying toxic agents near impossible.

Further, government forces have recently turned their sights on border area hospitals in northern Syria that to some extent have served as referential hospitals. Physicians for Human Rights has received multiple reports that health facilities in ‘Azaz and Hraytan, in the suburbs of Aleppo, were hit on December 25 and 26, further debilitating Syria’s already fragile health infrastructure.

How many war crimes does the Assad government need to commit for the UN Security Council to take more decisive action?

Some might say the December 2015 resolution did effect change. Last week, the Assad government agreed to allow humanitarian aid into Madaya, a rural area close to the Lebanese border where a six-month siege has caused countless deaths and unspeakable suffering. This aid is supposed to arrive today. Survivors, driven to starvation by their own government, report being reduced to eating leaves, insects, even their pets – and having to depend on a veterinarian and a carpenter for health care and surgery.

However, the very fact that the Assad government is in a position to allow or deny humanitarian aid is because it is using besiegement as a weapon of war – in direct contravention of UN Security Council directives and the Geneva Conventions. In fact, the limited ceasefire agreement between Syrian government and opposition forces last year should, in principle, have brought humanitarian aid to Madaya months ago. Moreover, under international humanitarian law, organizations providing aid must have unfettered access to Madaya and the dozens of other besieged areas throughout Syria, with or without Assad’s express permission.

It has been nearly five years, 300,000 deaths, and four million refugees since the Security Council first called on the Syrian authorities to respect their obligations under international law. The three weeks since the latest Security Council resolution show the Assad government has no intention of doing so.

Whatever solution Syrian peace talks may arrive at, world leaders must immediately focus on protecting civilians and improving conditions on the ground. Without concrete action to reduce the suffering of Syrian civilians, another UN Security Council resolution on this conflict will appear as empty as so many other New Year’s resolutions.

This post originally appeared in The Huffington Post.

Fourteen years ago, the U.S. government opened Guantánamo Bay detention facility in an effort to create a place beyond the reach of the law and the Constitution — a place where the absolute prohibition against torture and ill-treatment could be violated with impunity.

Today, the consequences of that pernicious move are being felt in every corner of the United States.

Our readiness to endorse the use of torture at CIA “black sites,” including one at Guantánamo, has fundamentally undermined the legitimacy of our police and other security forces. More ominously, it has created a divided world where those we perceive as “other” can be killed by law enforcers, harassed, deported or refused safe haven — while the rest of us look the other way, confident that these wrongs will never happen to us.

Investigating crimes is hard, difficult work. A permissive attitude toward torture opens the door for law enforcers to extract coerced confessions without actually solving any crimes. It de-skills those who need to learn how to actually conduct legitimate criminal investigations and interrogations. Ultimately, it scars them by severing them from their own humanity — and from ours.

U.S. law enforcement agencies have abandoned the rigor of evidence-based and rights-respecting investigations, rooted in the principle of “innocent until proven guilty,” in favor of a system based on profiling and denial of rights. Anyone who has ever experienced profiling — whether on the basis of race or ethnicity, gender identity or national origin — knows how arbitrary and capricious these practices are.

Guantánamo Bay detention center has been a rights-free purgatory for hundreds of men — many of whom are there for no reason other than that someone wanted to collect a bounty from U.S. forces, or because they were in the wrong place at the wrong time. Investigators did not have to bring charges or release the detainees, who were presumed guilty and burdened with the impossibility of proving their innocence. In the absence of any actual evidence, their national origin, religious beliefs and mode of dress all were offered as proof of their guilt.

These heinous practices feed a rot that lies at the heart of abusive, ineffective and self-defeating police and security services. And they have enabled a national discourse in which entire groups can be vilified and dehumanized because they are seen as “other.”

The impossible-to-ignore trend of police killing unarmed black men and boys speaks to this point. Michael Brown, Eric Garner, Dontre Hamilton, and 12-year-old Tamir Rice — to name just a few — were all killed by police in situations that had no justifiable reason for a violent end. The construction of black men and boys as presumptively criminal means that even the most benign behavior will be construed as threatening and may be used to justify their death at the hands of the police.

Similarly, the rush to paint all immigrants, including asylum seekers, from countries of the Middle East, North Africa and South Asia as potential terrorists points not just to a lack of compassion and empathy, but also to the failure of police and security forces to make evidence-based assessments of individuals who may be a threat.

Families fleeing violence in Central America are being held in abysmal detention facilities as the government races to deport them before they have even had an opportunity to make the case of a well-founded fear of persecution and seek asylum in our country. This is yet another example of sweeping judgments being made against those who are perceived as “other” in the name of protecting those who are privileged.

This brings us to how we lost our humanity by failing to reject torture, the narrative of fear, and all its consequences. The victims — whether they are detainees in Guantánamo Bay, asylum seekers on our southern border, or black men in our communities — will never be able to trust those in authority again. Meanwhile, the people whom our government employs in law enforcement and security roles are paying the moral and psychological price of having brutalized and dehumanized others. But all of us are also dehumanized by remaining passive when the government undermines dignity and rights.

It is time to say, “Not in my name.” It is time to say no to torture. It is time to cast away the political rhetoric of vilification and dehumanization.

It is time to examine our behavior and attitudes over the last 14 years to understand what we have created — through acts of commission and omission. We — the people of the United States — must seize this moment to reclaim the principles of dignity and equality and reject fear and exclusion.

This month marks the 14th anniversary of the opening of Guantánamo Bay detention center, the most visible symbol of U.S. torture and injustice around the world. President Barack Obama acknowledged this when he ordered the prison closed on his second day in office, calling it a “sad chapter in American history.”

Unfortunately, Guantánamo is still open – and so is this sad chapter.

One hundred and five men remain at the prison, most held a decade or longer without being charged with any crime. Many have been tortured and abused by the United States and its allies. All have been denied the full protection of the Geneva Conventions and the U.S. Constitution – their lives and rights forfeited to the United States’ contempt for its human rights obligations.

In the wake of the Paris terror attacks, America is once again grappling with security concerns in an intense climate of fear. An all-too-familiar rhetoric has resurged about compromising laws and values for “safety.” On Guantánamo’s anniversary, there is no better time to reflect on what policies based on fear have already cost us.

The military prison was opened in 2002 as a place to detain and interrogate terror suspects outside the protection of domestic and international law. Detainees were tortured with “enhanced interrogation techniques” such as waterboarding, sleep deprivation, prolonged isolation, sensory deprivation, and stress positions.

These techniques, developed by CIA psychologists, were calculated to bring about the complete psychological destruction of human beings and were carried out at CIA “black sites” and military prisons, including Guantánamo. The torture was monitored by physicians and psychologists, who shared medical data with interrogators to better exploit detainees.

Many victims of the CIA torture program were eventually sent to Guantánamo. And while the military no longer interrogates Guantánamo detainees, cruelty persists in the form of indefinite detention, force-feeding, and medical neglect.

Abd Al-Rahim al-Nashiri’s story is illustrative. Accused of planning the 2000 bombing of the USS Cole, al-Nashiri was tortured at several CIA black sites, including one at Guantánamo. The summary of the Senate’s 2014 report on the CIA torture program – one of the few declassified accounts of his abuse – details rectal feeding, mock execution, and threats with a gun and a drill.

Today, al-Nashiri is held in near total isolation at Guantánamo. He suffers severe, untreated psychological trauma as the result of this torture. Dr. Sondra Crosby, an independent physician who evaluated al-Nashiri, diagnosed him with complex post-traumatic stress disorder, with “somatic complaints, nightmares, hypervigilance, flashbacks, numbing, and a host of other symptoms.” The CIA accomplished its goal of reducing al-Nashiri to a state of “learned helplessness” – that is, of inflicting psychological harm so severe it produced lasting mental illness.

Al-Nashiri is the unusual Guantánamo detainee actually facing prosecution. But years of detention have taken a dire health toll on all the men:

• Tariq Ba Odah, a Yemeni detained since 2002, has been on hunger strike for years. Despite twice-daily force-feedings, he has dropped from 160 lbs to a skeletal 74 lbs.
• Tariq al Sawah, an Egyptian detained since 2002, doubled from 200 to 400 lbs, largely due to Guantánamo interrogators who used food as an instrument to exploit his psychological vulnerabilities.
• Asim Thabit Abdullah al-Khalaq, a Yemeni detained since 2002, died of chronic kidney failure six months after being resettled in Kazakhstan in 2014.

Guantánamo has been called a “psychological scar on our national values.” It has profoundly harmed the minds and bodies of detainees. It has corrupted the health professionals who enabled abuses and violated their ethical duty to “do no harm.” It has served as a propaganda tool for terrorists and undermined our counterterrorism efforts. And it has degraded our collective respect for human rights and the rule of law.

It is time for us to take responsibility for these mistakes and the people we’ve harmed. President Obama must end indefinite detention by ensuring all Guantánamo detainees are prosecuted in federal courts, or safely repatriated or resettled. Relevant federal agencies must review the Senate torture report summary, and the full report must be declassified. The Justice Department must investigate and prosecute all those responsible for torture. Finally, the United States must provide torture victims with truth, justice, reparations, and redress, including medical and psychological rehabilitation.

For this sad chapter in American history to end, there must be accountability for all the human rights violations committed in the name of national security. The discourse of fear must not distract us from the truth: the human cost of Guantánamo is borne by us all.