This blog post is part of PHR’s Tech & Human Rights Blog Series. The series is meant to highlight the intersection between technology and human rights, and examine the increasing role that technology can play in advancing human rights around the world.

A few months ago, I was fortunate enough to travel to the Democratic Republic of the Congo (DRC) to pilot a new tool in the fight against sexual violence in conflict. In my capacity as the MediCapt project manager, I field tested the mobile application MediCapt v2.0 – a new and improved version of MediCapt – with our clinicians in the DRC. In a nutshell, MediCapt is a concept that emerged from one of the initial field assessments through the Program on Sexual Violence in Conflict Zones at Physicians for Human Rights (PHR); this mobile app digitizes the collection and documentation of sexual violence evidence and preserves it for future court prosecution.

What, in effect, PHR is trying to do is leverage the wide-ranging possibilities of technology to leapfrog certain sectors within these low-resourced communities into the digital age. We have all heard that the possibilities of technology are endless. Mindful of the fact that technology is rights-neutral, we know it has the ability to alleviate some of the burdens placed on these communities. For example, in the DRC, technology can circumvent some of the logistical hurdles faced on the ground in tangible ways. The extreme physical distances that a sexual violence survivor must traverse to seek justice can be daunting as she makes her way from the police station to a health care facility for a proper forensic medical exam; the long, oftentimes solo, journey that the survivor must make can be at great cost to herself, both monetarily as well as physically. The evidence obtained by the health care worker must then make its way from the hospital to the police station, and then to the prosecutor, and ultimately to the courtroom. All the while, the evidence must be able to withstand legal scrutiny of chain of custody – in other words, it must be clear that the evidence has not been altered or tampered with in any manner.

And that’s only the tip of the iceberg in collecting evidence of sexual violence in the DRC. Hospitals and police stations often lack the proper resources to conduct exams and investigations, including the very basics of pen and paper. And if multiple copies of a forensic medical exam record are needed, they are often painstakingly done by hand. Moreover, most hospitals and police stations do not have locked cupboards to securely store evidence making chain of custody even harder to establish. Thus, it is no wonder that many sexual violence cases fail in this region for want of forensic medical evidence.

While certain logistical barriers will remain, MediCapt offers the opportunity to use technology to limit hurdles presented by the poor roads, the long distances between police stations and health centers, the absence of pens and paper, and compromised chain of custody. With PHR providing some basic startup materials – such as hardware like smartphones and printers – clinicians, police officers, prosecutors, and judges will have the resources to properly and efficiently document sexual violence. If we are able to instantaneously document, collect, and preserve forensic medical evidence on a mobile device and use technology to transmit such evidence between medical centers, police stations, and courtrooms, there is a greater likelihood that the evidence will see the light of day in court and will be used to support prosecutions of sexual violence.

Perfecting the paper trail to seek justice has been an ongoing problem in the DRC. MediCapt provides a concrete opportunity to use technology to overcome the gaps that paper presents. While technology is not a panacea to all of the challenges hindering these cases in the DRC, it can offer a significant step forward for survivors of sexual violence in attaining justice.

العربية (Arabic)

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English

Indonesia (Indonesian)

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This forensic brief examines the validity of the use of hymen examinations to determine a women’s “virginity.” Numerous medical studies undertaken in recent decades across multiple countries have demonstrated that there is no factual, scientific, or medical basis for using hymen size, morphology, or integrity to determine whether a woman has experienced vaginal penetration, and therefore the state of her “virginity.” Moreover, evaluations to examine the hymen are often undertaken without the consent of the woman or in a context of duress or threat of force. Such examinations can be psychologically and – in some instances – physically harmful to women and girls. Given that these examinations are medically unnecessary, it is unethical for physicians or health professionals to perform them.

In cultures in which female virginity before marriage is prized, commonly assumed indicators of virginity are an “intact” hymen and blood on the sheets of the marital bed at first intercourse as a result of the hymen being “broken.” Multiple medical and scientific studies have refuted these assumptions and demonstrated that there is no evidence to support these beliefs.

In the brief, we conclude that the examination of the hymen for purposes of determining a woman’s “virginity” has no clinical or scientific value. The use of such examinations within any context attempting to determine a woman’s sexual status is in violation of basic medical and legal standards. Consequently, health professionals requested to perform hymen examinations for purposes of determining a woman’s “virginity” should refuse to do so.

The release of Ibrahim al-Demestani, a nurse imprisoned by Bahraini authorities, is the latest chapter in the government’s ongoing campaign against health professionals. While his release should be celebrated, al-Demestani should never have been imprisoned and forced to complete a three-year sentence in the first place.

As protests against repressive governments swept across the Middle East and North Africa in 2011, people living in Bahrain launched peaceful protests calling for aysh, hurriya, adala ijtima’ia, karama (bread, freedom, social justice, and dignity). The response was unequivocal: the authorities launched a forceful, bloody crackdown against the largely peaceful protesters.

A key element of this crackdown was the targeting of health professionals. As medics and doctors attempted to provide care for anyone wounded during the protests, the government systematically targeted them with threats, physical abuse, and detention. These attacks went well beyond the protests sites, extending to medical facilities as security forces militarized hospitals. In the 2011 report, Do No Harm, Physicians for Human Rights (PHR) found that doctors were threatened and beaten at Salmaniya hospital, and security forces stole ambulances and posed as medics.

Once the clouds of tear gas cleared and wounded protesters were taken to hospitals or detained by security forces, nearly 100 doctors, nurses, and other health professionals faced charges before military tribunals. Their crime was treating the injured and their conspiracy was working together to save lives. In the end, more than 50 were convicted; some served their full sentences, while others had their sentences reduced or were eventually acquitted. Al-Demestani was one of last two people in the initial group of health professionals who were imprisoned in 2011; the second, Dr. Ali al-Ekri, is still serving his sentence. Dr. Saeed al-Samahiji – who was arrested and convicted in 2014 – also remains in prison.

The health professionals detained in 2011 for fulfilling professional and ethical obligations of treating those in need of medical treatment, regardless of their political affiliation or any aspect of their identity, were deprived due process and fair trial protections.

Unfortunately, the persecution of doctors and nurses is just part of the story. As authorities in Bahrain militarized hospitals, access to health care was effectively off-limits to peaceful protesters. The government ensured that anyone considered a threat would be at risk of arrest, unlawful detention, and/or torture – even while seeking treatment at a hospital.

Furthermore, the careers of those health professionals targeted by the government have been destroyed. Many were stripped of their medical licenses, and many still remain barred from employment. This violates both their freedom of expression and their right to non-discrimination, among other rights. By decimating the ranks of people who serve the medical needs of Bahrainis, the government has also risked destroying the entire health care system.

Which brings us full circle. In Bahrain, the government has designated entire swathes of the population as effectively enemies of the state. Anyone who dares to question the government, dares to fight for human rights, dares to demand democracy is suspect. Protesters took to the streets of Bahrain asking for the fundamental rights due to every human being: freedom, social justice, dignity, and “bread,” representing a cry for basic economic security and opportunity.

Punishing health professionals for upholding the principle of medical neutrality – which calls on governments to refrain from interfering with the duties of medical professionals – and abiding by professional ethics is not confined to Bahrain. The Syrian government also cracked down on peaceful protests and attacked doctors who treated wounded protesters. As the unrest has devolved into conflict in Syria, government forces have systematically attacked hospitals and clinics, and detained, tortured, and killed health professionals.

The U.S. government has been critical of Bashar al-Assad’s government for targeting health care. However, it has been strangely quiet with regard to similar violations committed by the Bahraini government. The difference is that the United States has a close relationship with Bahrain, where the Fifth Fleet of the U.S. Navy maintains its headquarters. Such double standards with regard to respect for international human rights and humanitarian law are unacceptable. Like freedom, justice, and dignity, the independence of health professionals should be universal, and their ability to fulfill their ethical obligations should go unhindered.

The authorities in Bahrain should immediately and unconditionally release the two remaining health professionals – Dr. al-Ekri and Dr. al-Samahiji – who were wrongfully imprisoned; vacate the judgments of those who have already served their sentences; reinstate the credentials of all health professionals who were unlawfully stripped of them; and demilitarize the country’s hospitals.

As a college student, the issue of sexual assault on college campuses resonates deeply with me. During the past year, as campuses around the country have spoken out about sexual assaults, I have seen the same happen at my university. I have watched as many of my peers have courageously spoken out about their own experiences of sexual violence, igniting a campus-wide dialogue that has manifested itself in awareness events, discussions among friends, and even protests. Seemingly overnight, something that was rarely spoken about came to occupy a central place in campus life.

My fellow students and I were shocked by the prevalence of sexual violence on college campuses nationwide that has come to light. It is estimated that 1 in 5 women and 1 in 16 men will be victims of sexual assault during college. Looking around a large lecture hall and realizing that those statistics are referring to many of your classmates and friends is a very sobering experience. As Sexual Assault Awareness Month comes to an end – marked in April in the United States – I thought it was important to take a deeper look at an issue that profoundly affects those with whom I live and study each day.

The failure of colleges and universities to respond appropriately to this problem is alarming. In both national publications and my own college newspaper, I have seen a trend of universities conducting inadequate investigations and allowing rapists to go unpunished. Even more disturbing are the horror stories of college and university disciplinary processes creating hostile environments for survivors and the trend of victim blaming. Clearly, the very institutions meant to be resources for survivors have in many cases not only failed them, but have further contributed to their traumatization. It is estimated that less than 10 percent of survivors on college campuses report their sexual assault. Though many factors contribute to this low reporting rate, fear of speaking out has been driven in large part by the mishandling of institutional investigations.

My internship with the Program on Sexual Violence in Conflict Zones at Physicians for Human Rights (PHR) has only reinforced my conviction that strengthening institutions is one of the most important ways to combat sexual violence. Though PHR’s work in Kenya and the Democratic Republic of the Congo seeks to address sexual violence in contexts that may seem worlds away from college campuses in the United States, there are some basic lessons that apply regardless of location. For example, it is essential that the institutions that survivors rely on for medical care, personal security, and/or justice know how to appropriately, effectively, and sensitively handle cases of sexual violence. Furthermore, these institutions must refrain from victim blaming, which ultimately reinforces the culture of impunity surrounding sexual violence.

Fortunately, this past year has shown that increased awareness has the ability to bring about accountability. An article published earlier this month by the Huffington Post reported that there are currently 106 colleges and universities under federal investigation for mishandling cases of sexual assault; this is nearly double the number of institutions that were being investigated at the same time last year. Furthermore, many colleges and universities have started taking meaningful steps to establish sexual assault prevention programs and reform their procedures for handling cases. In doing so, more survivors have been empowered to come forward and tell their stories. This Sexual Assault Awareness Month, I challenge you to ask yourself what you can do to help prevent sexual assault, to strengthen the institutions that address it, and to shift the stigma from survivor to perpetrator. Your advocacy and support of survivors has the ability to foster meaningful change.

It is with great sadness that we at Physicians for Human Rights (PHR) pay tribute to Victor Inyanje Kabaka, who died on April 9, 2015, following a tragic car accident. Victor was a principal prosecution counsel at the Office of the Director of Public Prosecutions in Kenya, within the specialized division on sexual and gender-based violence. PHR’s Program on Sexual Violence in Conflict Zones has had the privilege of working with Victor since 2012 and will remember him for his great enthusiasm, passion, and commitment to seeking justice for survivors of sexual violence.

Most recently, Victor joined PHR and multi-sectoral delegations from Kenya and the Democratic Republic of the Congo at a regional roundtable held in Kenya from February 25 to 27, 2015, where participants shared experiences, lessons, and best practices in the collection and management of forensic evidence for the prosecution of crimes of sexual violence. It has been moving to see the outpouring of condolences from the Kenyan and Congolese colleagues who fondly recall Victor’s team spirit, great sense of humor, and cheerfulness. We can all hardly express our shock and sorrow at the untimely death of such a young, valued, and promising member of our network. However, we remain inspired by Victor’s fervor for justice for survivors of sexual violence and will work to amplify our efforts to this end in his memory.

The state-sponsored violence that took place against student demonstrators in Burma this month is a shocking reminder that the country is just beginning its transition to democracy and still has a very long way to go.

Last week, uniformed police officers in Burma attacked an ambulance in the midst of a violent attempt to break up a student demonstration. The attack occurred on the second day of police violence against peaceful student protests, which have been ongoing since last year.

The supervisor of the medics who had been in the ambulance at the time of the attack told Physicians for Human Rights (PHR) that students trying to escape from police officers jumped into the back of the ambulance and closed the door. Police officers responded by forcing the door open, dragging the students out, and beating them with rubber batons. The medics in the ambulance then pulled the students back inside and locked the door. Police proceeded to attack the ambulance with batons, breaking a side mirror and denting the side and front panels of the vehicle. Free Funeral Services Society (FFSS) – the Rangoon-based nonprofit operating the ambulance – took five students suffering head wounds and broken bones to the hospital. They also evacuated one police officer who had heat exhaustion.

The students were marching from Mandalay to Rangoon to protest a national education law that they believe will curb rights to establish student and teacher unions and will create a more centralized and rigid education system. Demonstrations originally began in November 2014, but in February of this year the students started marching from several universities in central Burma south towards Rangoon. The government issued statements claiming that the students’ safety could not be guaranteed, despite the fact that the government is obligated to ensure that students are protected when they engage in peaceful protests.

About 100 student protesters stopped in Latpadang, Bago Division, when the government agreed to meet with student leaders. When these talked failed, however, and the students tried to resume their march, some 300 police officers blocked them. The standoff continued for several days until March 10, when police officers and plainclothes agitators wearing red armbands attacked students who had sought refuge in homes and a monastery. Police officers pulled students out of these shelters and arrested more than 100 of them under a peaceful assembly law that is often used to jail political activists.

The Burmese government’s passing of a draconian education law, its threats to peaceful student protesters, its employment of hired instigators, and the subsequent use of force against a peaceful gathering – including attacks on medical workers evacuating the injured – are reminiscent of the dictatorship that once ruled the country, indicating that similar repressive elements are still embedded in the current governmental structure.

In recent years, we have seen attacks against health workers around the world, including in Syria, Ukraine, and Gaza, among others. We expect better governance from a country that is supposed to be undergoing a democratic transformation.

The international community must maintain pressure on the Burmese government to respect human rights in the country by both supporting parts of the government that promote these values and condemning those that continue to violate human rights.

It is promising that the Burmese government has said that it will investigate the police's use of force in breaking up the protest. We are awaiting the results of that investigation, which we hope will be independent and transparent.

العربية

It hurts me that my country needs doctors and I left.

I was completing my medical residency at a public hospital when anti-government protests first broke out in Syria. By the end of 2011, government security forces were bringing detained members of the opposition to my hospital for treatment. Members of the security forces would insult and physically attack the medical staff, while also causing chaos by shooting their weapons into the air. In one instance, my colleagues and I were unable to save a severely injured member of the security forces. The soldiers that brought him in threatened that if I was unable to save the man, they would take my life. One of them pointed a machinegun at us and told us to shock the dead man with electricity.

Although I knew that the patient was already dead, I had no choice but to play along and pretend to treat him by using the defibrillator, as requested, and giving him an injection – I knew that if I did not comply, our lives would be in danger. Another security official was more understanding, and eventually convinced the others to let go of the situation. Someone from the hospital’s morgue later told me that the deceased guard had two grenades in his pockets. If we had used a higher level of electricity to shock him, it is likely that the grenades would have detonated, injuring, if not killing, us all.

I saw many detainees in my hospital who appeared to have suffered abuse. One female detainee was brought in to see an obstetrician to get a pregnancy test, and the doctor identified signs of torture on her body; she may have also been raped. I treated another patient with multiple fractures and whose leg and face were swollen from beatings; one of his eyes was bruised to the point that he was unable to open it. Another detainee came in with a high fever, had been repeatedly beaten in the head until he lost consciousness, and was having seizures in the emergency room. I insisted to the security forces that they should leave him at the hospital for treatment, but they refused and took him back to detention – undoubtedly to torture him further – after some superficial treatment.

I distinctly remember an occasion when security forces arrived at the hospital and aggressively forced all the doctors to gather and treat an injured officer. I saw them push one of my colleagues down the stairs and beat him. I only managed to escape by changing out of my scrubs and pretending to be a patient.

Likely because I am a doctor and I treated people on all sides of the conflict, I was on a government wanted list. When my town was attacked by security forces, soldiers came to my house, arrested me, and destroyed my home. They took me to detention, where one of the guards told me, “Just because you are a doctor, don’t think we will treat you with respect.” I was beaten during the interrogation and asked: “Why did you treat the wounded – how many? We need names and locations of the wounded.” I denied treating protesters and convinced the guards that although I was involved in demonstrations, I did not treat any of the demonstrators. The abuse continued throughout my detention – and the guards often mentioned my status as a doctor and tried to force me to tell them how many injured demonstrators I had treated.

At one point, a guard – who had previously beaten me – came to my cell seeking medical consultation. I did my ethical duty and provided him with the medical advice he needed. Even though he insulted me, I felt that he is still weak as a human and that I could defeat him with my ethical values.

I know that I was detained in part because I am a doctor. An interrogator threatened to take away my medical license if I did not confess to taking part in protests and treating injured demonstrators; they also demanded my cooperation in providing information on patients in the future. I didn’t concede to the conditions of that ultimatum, but I was forced to sign a blank piece of paper – likely to be used for a false confession. Eventually, I was taken to court and released after about eight days of detention and abuse.

I believe that the reason Syrian security forces deliberately attacked medical personnel at the beginning of the conflict was in order to prevent protesters from receiving medical care. Many of my medical colleagues were, like me, targeted and intimidated in an attempt to obtain the names of demonstrators. Moreover, meddling by security forces deterred injured demonstrators from seeking medical treatment at hospitals. Protesters recognized early on that security forces were collecting names at hospitals and would target those who had been injured while participating in protests.

There is now a terrible rift between people who have stayed in Syria and doctors who have fled. While the opposition was grateful to those doctors who upheld doctor-patient confidentiality and withheld patient names from security officials, I know they were also upset with doctors who left Syria. Some members of the opposition made general threats about what they might do to the doctors who may later return. As one of the doctors who eventually fled, I have a lot of guilt and can’t help feeling that I have abandoned my people and my colleagues. I am a doctor. They need me. It hurts me that my country needs doctors and I left.

While at one time I dreamt of a modern and democratic Syria, now my greatest hope is simply that we may see an end to the injustice of people being tortured and killed in my country.

*The author’s name has been changed for security purposes.

This post originally appeared in The Huffington Post.

As we approach International Women's Day and reflect on the goals of our Program on Sexual Violence in Conflict Zones, we at Physicians for Human Rights sometimes feel like we are swimming against an inexorable tide of denial and temporizing attitudes. We are repeatedly told that claims of rape in conflict are exaggerated, that the victims do not want to speak about the violence because they would rather put it behind them, and that it's nearly impossible to prove the crime of sexual violence. We have heard it all.

But the failure of investigators, prosecutors, and courts to seek justice for the victims has significant consequences. Remember the women held in sexual slavery by the Japanese military during World War II? The International Military Tribunal for the Far East did not investigate these cases, which involved as many as 200,000 Asian women. At a war crimes tribunal held in Tokyo in 2000, 66 women survivors of sexual slavery from Burma, China, Guam, Indonesia, Malaysia, North Korea, the Philippines, South Korea, and Taiwan, among others, described their lives of shame, rejection, and persistent physical and mental health problems and the struggle to keep their sanity as the world rewrote their experiences out of the historical record.

At the International Criminal Court (ICC), there is a danger that the same erasure and denial is being imposed on victims of sexual violence in the Democratic Republic of Congo. In the Lubanga case — the first case to be decided by the ICC — the prosecutor failed to bring charges of sexual enslavement and rape against Thomas Lubanga, a Congolese warlord charged with recruiting and using child soldiers, even as victims and witnesses included sexual violence as part of their testimony. Lubanga was ultimately convicted of war crimes for conscripting and enlisting children and using them to participate actively in hostilities, but when the court issued its judgment, the judges explicitly noted the prosecutor's failure to include charges of sexual violence despite the overwhelming evidence.

Earlier this week, in another blow to these survivors, the ICC's appeals chamber rejected inclusion of victims of sexual and gender-based violence in the design of the reparations order.

Justice is again being denied to the victims of sexual violence. And because the ICC failed to capture the full range of victims who suffered from Lubanga's crimes, the survivors will now be deprived appropriate reparations that would ensure them psychological and physical health care, access to programs for reintegration into their communities, and access to other rehabilitation assistance.

It is horrific to be targeted for sexual violence in any context. To be targeted in conflict is to be used as a sacrificial pawn to sow fear in communities — fear compounded by shame that may tear apart the lives of the victims, their families, and their communities. Justice matters, because in acknowledging the harm and demanding accountability for the perpetrators, a community is taking its first step in repairing that harm. Justice denied prolongs the pain and exacerbates suffering. History matters, because when we fail to confront our history, we are too often doomed to repeat it.

There is no excuse for courts to fail the victims of sexual violence. As Physicians for Human Rights has demonstrated in its work in eastern Congo, doctors, nurses, police investigators, prosecutors, and judges can work together to support evidence-based prosecutions for crimes of sexual violence.

The ICC should know better. The ICC should do better.