VOLUME 20 ISSUE 1
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Doctors for Human Rights
www.doctorsforhumanrights.org
Company Number 3792515
DHR’s 20th anniversary
Charity Number 1078420
INSIDE THIS ISSUE:
Page 1 - DHR’s 20th anniversary Page 2 - DHR’s 20th anniversary ct’d; DHR at the 12th World Congress on Public Health Page 3. - Shadow report on the UK’s fifth Periodic Report Pages 4 and 5 - Timeline on advocacy campaign on health rights of refused asylum seekers Page 6 - Shadow report on the UK’s fifth Periodic Report ct’d
DHR was launched in 1989 under its former name Physicians for Human Rights–UK as an independent organisation of doctors with a remit to channel the humanity, influence and special skills of medical practitioners into promoting those rights contained within the Univeral Declartion of Human Rights. Once its constitution had been drafted by a steering committee chaired by the former editor of the Lancet, Ian Munro, and approved at its first annual general meeting in November 1990 at Dundee, Professor Derrick Pounder became PHR-UK’s first chair. Within 12 months PHR-UK had reported on three human rights fact finding investigations – into the Kashmiri conflict, the Iraqi occupation of Kuwait following Sadaam Hussien’s invasion, and into continuing discrimation in healthcare in post-aparthied South Africa. Twenty years later PHR-UK’s proud record includes providing two of the only three human rights people to document massacres in Rwanda itself as the 1994 genocide was taking place, and the organisation’s pivotal role lobbying
Page 7- DHR in Geneva Page 8 - AGM and elections; DHR campaigning for human rights education for medical students
for, and contribution to, the UN Committee on Economic, Social and Cultural Right’s General Comment 14 (GC14) published in July 2000. It is difficult to exaggerate the global importance of GC14 in 'unpacking' health rights. Article 12 of the UN International Covenant on Economic, Social and Cultural Rights, as amplified by GC14, is the Magna Carta of health rights. At a stroke GC14 transformed Article 12 from a statement of principle and four general instructions on health preservation as perceived early in the second half of the last century, into a sixty five paragraph document that exhaustively defines states’obligations, health entitlements, and their ethical implementation using human rights principles. Throughout its existence Doctors for Human Rights (as PHR-UK became
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DHR’s 20th anniversary ... continued from page one
The 12th World Congress on Public Health Istanbul, 27 April to 1 May 2009
known in 2004) has focused on both civil and political rights violations (eg genocide, torture, death penalty), as well as economic, social and cultural rights (eg health rights, education, social security) consistent with the 1993 Vienna Declaration and Programme of
In April DHR chair Peter Hall spoke on the right to the highest attainable standard of health at the 12th World Congress on Public Health on Tuesday 28th April.
Action that 'All human rights are universal, indivisible and interdependent and interrelated’.
The presentation, which was entitled 'The right to the highest attainable standard of health: an ethos in search of a profession' was simultaneously translated into Turkish.
This eclectic approach has been vindicated by the findings of the UN Commission on Social Determinants of Health led by one of DHR’s first
There were just under 2,380 participants from 142 countries participating in the World Congress. At any one time twelve scientific sessions were going on at once - apart that is from the rare plenary sessions.
members, Sir Michael Marmot. The 2008 report Closing the gap leave no doubt as to the crucial importance of the conditions of daily life - the circumstances in which people are born, grow, live, work, and age - to health. But there remains much to be done, not least among doctors whose understanding of health rights is sketchy. Many are sceptical of their relevance to healthcare despite their being the ally of good medical practice and scourge of inadequate resources. As the former UN Special Rapporteur on the right to the highest attainable standard of health explained to the UN Human Rights Council in 2007, the right to the highest attainable standard of health is one of the most extensive and
The presentation echoed one of DHR’s three main strategic activities - to encourage the medical profession to adopt the right to the highest attainable standard of health as defined by Article 12 of the International Covenant on Economical, Social and Cultural Rights and General Comment 14 that define states’ obligations, health entitlements, and their ethical implementation using human rights principles. Gratifyingly, although it cannot be claimed as due to DHR’s presentation, at the end of the conference the participants of the 12th World Congress on Public Health unanimosly declared and affirmed the Istanbul Declaration - that health is the first human right.
complex human rights in the international lexicon, and it cannot be realised without health professionals. As Professor Paul Hunt in his 2006 speech to the International Federation of Health and Human Rights Organisations (of which DHR is a member) pointed out, the right to a fair trial would not have become so widely accepted and implemented without the active support of lawyers. “Equally,” he continued “the right to health will not animate health policies and systems without greater support from health professionals. This, it seems to me, is one of our greatest challenges: how to educate more health professionals about the practical utility of human rights”.
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Shadow report submitted for the UK’s fifth Periodic Report to the International Committee on Economic, Social and Cultural Rights The 2008 shadow health report to the UK’s five yearly Periodic Report was the second submitted by Doctors for Human Rights, albeit on this occasion being a collaborative venture along with Medact, and under the auspices of the Peoples’ Health Movement-UK. DHR’s first was submitted in 2002.
adequate health-care facilities and services. (E/C.12/GBR/5, paras. 302-305).”
In May last year (members may remember) representatives from the three organisations attended the so-called pre-sessional working group meeting in person in Geneva, which always takes place twelve months before the actual Periodic Report. In this way civil society organisations such as DHR can meet with, and present oral evidence to, members of the Committee on Economic, Social and Cultural Rights - and possibly influence the questions the committee then asks the UK Government. The Government then has to reply promptly before the actual Periodic Report is discussed by the to full Committee on Economic, Social and Cultural Rights in front of Government representatives the so called dialogue phase - twelve months later.
“In General Comment 1, the Committee on Economic, Social and Cultural Rights identified seven objectives for states' Periodic Reports. Yet the UK Government's Palais de Wilson, Geneva implementation in 2004 of legislation that de facto denies failed asylum seekers access to free NHS hospital care, at a stroke precludes the UK's Fifth Periodic Report from achieving the three initial objectives.
Much of the Preamble to the full report was written by DHR viz.
Firstly, the Government's violation of the Covenant through retrogressive legislation is clearly inconsistent with conformity with the Covenant. Secondly, the recent appeal by the Department of Health against a judicial review judgment allowing failed asylum seekers access to free NHS hospital care on the basis they are residents, underscores the Government's determination to not ensure everyone's rights under the Covenant are protected. Thirdly, not only does the Fifth Report challenge the Committee's 2002 Concluding Observations over the incorporation of the Covenant into domestic law, but, by introducing the 2004 legislation, the Government inculpates itself further. As UN General Comment 9 advises, the Covenant does not stipulate the method of its implementation into the national legal order, but it does require the method be effective. Given that the government has itself violated the Covenant by discriminating against failed asylum seekers, making non-discrimination justiciable remains the only infallible method. Lastly, the Fifth Report's claims that no retrogressive measures have taken place, and that courts will interpret domestic statutes passed after the date of a treaty as intended to carry out the treaty obligations and not to be inconsistent with them, is manifestly misleading.
The coalition raised three issues with the pre-sessional committee - i) the violation of Iraqis health rights consequent upon the illegal invasion and occupation of Iraq (which the committee refused to accept), ii) the violation of refused asylum seekers access to free NHS healthcare and iii) the government’s failure to educate doctors in economic, social and cultural rights Of the three issues raised by the coalition organisations, only the one on asylum seekers appears to have been adopted by pre-sessional working group - in that it led to the following question addressed to the UK government: “Please provide further information on the implementation of the measures described in the report to reduce the existing inequalities in Drs Judith Cook (Medact) and access to health care, and Peter Hall in Geneva May 2008 to ensure that vulnerable individuals and groups – including persons belonging to racial, ethnic and national minorities, communities living in poor areas, older persons, homeless people, persons with mental disabilities and asylum-seekers and refugees – have equal access to
Further, the Fifth Report largely fails to provide relevant data or benchmarks with which to measure healthcare delivery. The report fails to provide the objective information required to not only evaluate the current health 3
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Advocay between May 2006- April 2007 in the promotion of the right to the highest attainable standard of health
Advocay between May 2007- April 2008 in the promotion of the right to the highest attainable standard of health of refused asylum seekers
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Advocay between May 2008- April 2009 in the promotion of the right to the highest attainable standard of health of refused asylum seekers
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Advocay between May 2009- April 2010 in the promotion of the right to the highest attainable standard of health of refused asylum seekers
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VOLUME 20 ISSUE 1 Shadow report continued from page 5
care system, but also to monitor progressive realisation of the right to the highest attainable standard of health against the UK's Fourth Report, and in the future using the UK’s Sixth Report. Lastly, the consultation over the Fifth Report carried out by the Government with civil society was limited to a small number of nongovernmental organisations that either lacked healthcare expertise or economic, social and cultural human rights expertise. Notably, none of the organisations that have contributed to the present civil society report were consulted by the Government in preparation of its Fifth Report. The failure by the authors of the Fifth Report to engage with the guidelines promulgated by the Committee on Economic, Social and Cultural Rights in General Comment 1, calls into question over the UK's commitment to meet its international human rights treaty obligations. Themes Of the seven chapters within this report, five deal with discrimination in healthcare delivery against people from marginalised groups, and the remaining two chapters document the failure of the Government to introduce education for doctors in economic, social and cultural rights, and the harmful effect privatisation on healthcare delivery. Since 2004, and in defiance of the Committee1s 2002 Concluding Observation 25 and 31, the Government introduced regulations that denied most failed asylum seekers access to free non-emergency hospital treatment which de facto denies them access to hospital care because of their forced destitution under government policy. Further, the Government has discouraged primary care doctors from providing non-emergency treatment for refused asylum seekers and has proposed to withdraw doctors' discretion to treat under the NHS. Thus, health security, one of the core elements of human security, is now denied to a group of people who have already been denied security of residency, and, as a result of government policy, suffer destitution. The Government fails to provide accessible and good quality health care to immigration detainees and fails to protect them from unnecessary morbidity and mortality arising from detention. Pregnant women, including rejected asylum seekers, trafficked women, women whose immigration status is dependent on their husband and undocumented migrants HEALTH IS CONTINGENT UPON RESPECT FOR HUMAN RIGHTS
AUTUNM 2009
are not entitled to free NHS maternity care, putting not only their own health at risk but also that of their unborn child. Evidence shows that, despite improvements in the care of elderly people, age-based discrimination by staff continues to compromises the healthcare of elderly people. Despite a fifth of the population, amongst whom black people are disproportionately affected, experiencing mental illnesses, mental health services lack adequate resources. Worryingly the new Mental Health Act 2007 has broadened the definition of a mental disorder to include people with untreatable personality disorders. This risks adversely affecting the delicate balance between protecting the interests of the patient against the interest of the public. The Government has threatened future health services by accepting long-term contracts with the private sector to fund capital expenditure. This financial commitment puts at risk the future availability, accessibility and quality of NHS health facilities. Furthermore NHS land is threatened if hospitals find they are unable to make payments and have to leave their sites and facilities, because of terms which have given developers the rights to land on which the hospital is built. In 2006 the UN Special Rapporteur on the right to the highest attainable standard of health reported to the Human Rights Council that the realization of the right to the highest attainable standard of health depends upon health professionals enhancing public health and delivering medical care, adding that 'The right to health cannot be realized without health professionals.' Yet three years later, and despite the Committee1s 2002 Concluding Observation 30, the Government has failed to provide education for doctors on Economic, Social and Cultural Rights. In its 2002 Concluding Observations the Committee found no factors to impede the full implementation of the Covenant on Economic, Social and Cultural Rights in the UK. Nevertheless, as our report illustrates, seven years after those Concluding Observations were given, there remain conspicuous failures by the UK government in its implementation of the right to the highest attainable standard of health.“
Stop Press The BMJ has sent for peer review a DHR paper, submitted as an editorial, that criticises the Israeli Occupation, entitled Is continued membership of the WMA by the Israeli Medical Association acceptable? wwww.doctorsforhumanrights.org
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A symposium in Geneva Realizing the Right to Health: Whose Role is it Anyway? In June chair Peter Hall partici-
positively to the common goal of reducing the un-
pated in an international semi-
acceptably high rate of maternal mortality.
nar in Geneva to celebrate the launch of the book Realizing
The issues of HIV and AIDS also featured strongly
the Right to Health, edited by Andrew Clapham and Mary
in the symposium with Professor Mary Crewe,
Robinson, and co‐edited by
Director of the Centre for the Study of AIDS at the University of Pretoria challenging the "enormous
Claire Mahon and Scott Jerbi.
power the medical system has to control the lives of
The book contains forty
of the Centre for the Study of AIDS at the Univer-
chapters by sixty leading health
sity of Pretoria challenging the"enormous power the medical system has to control the lives of people."
people the symposium, with Professor Mary Crewe,
care practitioners, human rights advocates, health officials, and other authorities in the international right to health
The DHR chair was the only person at the seminar to essay a response to
movement.
Mary Robinson’s question as to why health professionals are so resistant to the notion of a right to the highest
The chapters address various aspects of book's eight core topics: the human rights perspective on health, prioritising women's health, the right to health in
attainable standard of health. Peter Hall prefaced his remarks by point-
emergencies, people and groups at risk, key health
ing out he was not the best equipped
challenges, multilateral institutions and responses,
to defend the medical profession, given DHR’s trenchant criticism of the BMA’s silence over the
the role of health care practitioners, and strengthening health care systems
violations of refused asylum health rights.
A discussion panel led by
The first point he made was that conservatism in
Mrs Robinson explored a
healthcare practice is safer for patients than a
range of healthcare and
penchant for following fashions. The second was that if doctors are required to take on board
human right issues, not least the recent landmark resolu-
human rights in healthcare they need to see its
tion on maternal mortality
applicability to their medical practice. The third and
and morbidity adopted on Iain Byrne, Mary Crewe and Mary Robinson
perhaps most convincing point, was to explain that
June 17th by the UN Human
expecting doctors to fully engage with the right to the highest attainable standard of health requires a
Rights Council. The resolution recognises that a human rights perspective in
culture change (not to say Pauline conversion)
international and national responses to maternal
amounting to a change in the way doctors peceive
mortality and morbidity could contribute
their patients. 7
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AGM 2009 Saturday 12th December at 2 pm 3, Merrow Dene 76 Epsom Rd, Guildford GU1 2BX 4
Guildford
The election of DHR committee members This year DHR continues the election cycle as described in the Newsletter prior to the 2000 AGM. This year the chair and honorary secretary will be elected Members can vote in the Members’ Ballot by attending the AGM and voting, or by postal vote, arriving at 91 Harlech Rd, Abbots Langley WD5 OBE not later than three days prior to the AGM. Nominees names must arrive not later than three days prior to the AGM to include: a. written notice of a members nomination signed by one other member of DHR b. a written agreement to serve in such office if appointed signed by the nominated member elected
DHR’s submission to the GMC on human rights education Earlier this year the GMC consulted the profession over proposals for the new GMC document Tomorrow’s Doctors – Outcomes and standards for undergraduate medical education. In March DHR submitted a paper entitled Submission to the GMC on education for Tomorrow’s Doctors with the running title The right to the highest attainable standard of health should be taught within the Core Undergraduate Medical Curriculum. One of reports the DHR paper highlighted as evidence was that of the Parliamentary Joint Committee on Human Rights into healthcare for people with learning disability. QUOTE – In the course of our recent inquiries on the treatment of asylum seekers and the human rights of older people in healthcare, we have raised our concerns about the lack of respect afforded to the human rights of the some of the most marginalised and vulnerable members of our society. In the course of this inquiry, these concerns have intensified. The evidence reveals that adults with learning disabilities continue to face a high level of prejudice and discrimination, ranging from patronising behaviour to criminal assaults – UNQUOTE As the DHR paper pointed out, in Valuing People Now, which was published in January 2009 as the Government response to the Michael Inquiry recommendations, the authors declaim that people with learning disabilities have the same human rights as everyone else - rather missing the point that human rights are designed primarily for the disempowered, not those who can look after themselves. Nonetheless Valuing People Now is an exceptionally important document, not least because it uses the term human rights no less than fifty four times in 149 pages, and constituting as it does a declaration of intent that healthcare workers must respect human rights - or else. In the event Tomorrow’s Doctors – Outcomes and standards for undergraduate medical education published this September makes no direct mention of human rights but on page 26 (under the heading The doctor as a health professional) there is the requirement to “Recognise the rights and the equal value of all people and how opportunities for some people may be restricted by others’ perceptions”.
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