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Doctors for Human Rights
www.doctorsforhumanrights.org
DHR’s continuing campaign to promote the right to the highest attainable standard of health
Company Number 3792515 Charity Number 1078420
INSIDE THIS ISSUE:
Page 1 - DHR’s continuing campaign on health rights
Over the last twelve months DHR, a leading health and human rights organisation globally, has campaigned to promote the
Page 2 - DHR’s continuing campaign; Professor Paul Hunt; Sir Charles Wheeler
right to the highest attainable standard of health:! advised over, and participated in, the development of a
Page 3. - Medics West Bank Tour and Crimes against Humanity
collaborative shadow health report timed to coincide with the
Pages 4 - Held to ranson in Hebron
Social and Cultural Rights in Geneva in May 2009 - see page 8
Page 5 - Social determinants of health and DHR Page 6 - DHR Inquiry report Page 7- DHR’s objectives; Lancet letters from DHR Page 8 - AGM and elections; DHR in Geneva
UK’s fifth periodic report to the UN Committee on Economic
! continued its long established campaign against the violation of UK refused asylum seekers’ health rights inherent in the denial of their access to free NHS secondary health care ! participated in medical tour of the West Bank over one week in June 2008. The purpose was to update a first hand understanding of security and healthcare realities for Palestinians, and to discuss a proposal regarding Palestinians’ right to their highest attainable standard of health with Physicians for Human Rights Israel - see page 3 !
participated in pivotal seminar at UCL which debated the
suitability of introducing human rights law into the seminal UN report on Social Determinants of Health - see pages 5-6 Shuhada Street used to be the social and economic centre of Hebron, West Bank - see page 4 HEALTH IS CONTINGENT UPON RESPECT FOR HUMAN RIGHTS
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DHR’s campaign to promote health rights ... continued from page one
In 2002, Professor Paul Hunt of Essex University, was appointed as the first UN Special Rapporteur on the Right to Health for a three-year term, that was extended in 2005 into a second three Paul Hunt year term.
! published important letter in Lancet highlighting the importance of accountability in the delivery of the right to the highest attainable standard of health - see page 7 ! participated in a cutting edge seminar at BMA House to mark the end of Paul Hunt’s second three year stint as Special Rapporteur on the right to the highest attainable standard of health, and the start for the new Special Rapportuer, Anand Grover, who is a lawyer from India ! submitted oral evidence to United Nations in Geneva demonstrating that the UK violated Iraqis’ health rights by invading Iraq - see page 8
At the outset he decided the objectives of his mandate were to be: 1. to raise the profile of the right to health as a fundamental human right 2. to clarify what it means
Charles Wheeler
3. and to make it more operational by providing guidance on how to implement it.
To make these challenging objectives more manageable, he decided to focus on two main themes - firstly, poverty and the right to health, and secondly, discrimination and stigma and the right to health. These themes enabled him to give particular attention to those living in poverty, gender issues, racial and ethnic minorities, indigenous peoples, people living with HIV/AIDS, and other vulnerable groups.
DHR was saddened to hear of the death of Sir Charles Wheeler on July 4th, 2008. It was information from the DHR delegation (with whom the BBC generously shared its food during the chaotic aftermath of the 1991 liberation of Kuwait) regarding reprisal torturing of Palestinians by Kuwaitis, that led to Wheeler‘s celebrated ‘on camera’ outing of the Farwanyia Hospital director, Dr Ali.
DHR already knew and admired Professor Hunt as a result of his participation in DHR’s 1998 international health and human rights conference in St Albans. Ten years later it is difficult to conceive that anyone could have achieved more than he has in his two terms. He will be sorely missed.
Under repeated questioning as to why he (Dr Ali) was personally blocking the Newsnight team’s access to a locked hospital ward, he finally confessed:
The newly appointed Special Rapporteur, Anand Grover, is a well-known long-time advocate and activist on HIV and human rights. He is a practising lawyer in the Bombay High Court and the Supreme Court of India.
"If we treated them badly, they deserved it." "Are you," said Wheeler, after a breath, "speaking as a doctor?"
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Medics Tour of West Bank 2008 DHR chair renews his acquaintance with the Occupied Territories ii) the 2004 International Court of Justice judgment Legal Consequences of the Construction of a Wall in the Occupied Palestinian Territory that provided for the first time a court based authentication of the violations of international law by Israel within Palestinian territory, including its findings that:
In 1997 Peter Hall took part in the collaborative investigation conducted by the Dutch Johannes Wier Foundation and Physicians for Human Rights-UK (as DHR was then called). The report, A False Dawn 1997: Palestinian Health and Human Rights Under Siege in the Peace Process, concluded that the Israeli authorities’ disregard of the importance of Palestinian healthcare, evident during their 1967-1994 stewardship of the health system, remained a feature of their policies, particularly on security.
a) the International Covenant on Civil and Political Rights applies to all people over which a Israel has jurisdiction, including the Occupied Territories; b) its finding of the applicability of other conventions that the Israelis have signed to people in the Occupied Territories;
The purpose of participating in this year’s seven day medical tour was to update perceptions of the effect of the occupation on Palestinians’s lives and on their healthcare, and to discuss a project with Physicians for Human Rights-Israel. The project is to assess the feasibility of conceiving the Israeli Occupation of Palestine 1967-2008 as a crime against humanity of Palestinians’ right to the highest attainable standard of health - on the basis that the cumulative damaging effect on health of the systematic violations of Palestinians’ human rights over 41 years amounts to a crime against humanity.
c) its finding that the settlements are illegal d) and its recognition of Palestine as an entity with all the privileges of a state in representation to the court, and its referral to Palestine throughout on a par with Israel as a party to the proceedings iii) the recognition by the Committee on Economic, Social and Cultural Rights, that Israel’s ratification of the Covenant on Economic Social and Cultural Rights applies to the Occupied Territories iv) the recent blockade by Israel of Gaza and the cumulative effect of over 41 years of the increasingly relentless and aggressive occupation of Palestine by Israel
The reasons for considering now to be opportune are the conflation of a number of factors:
v) the cumulative culpability of Israel ignoring Security Council rulings, not least Resolution 242 approved 5 months after the 1967 war, in which the "land for peace" formula which called for the establishment of a just and lasting peace based on Israeli withdrawal from the Occupied Territories in return for an end to belligerency, respect for the sovereignty of all states in the area, and the right to live in peace within secure, recognised boundaries. Many subsequent resolutions, ignored by Israel, have required it to comply with the Geneva Conventions with regard to its responsibilities as an Occupying Power.
i) the August 2008 publication of the final report of the UN Commission on Social Determinants of Health - which provides objective evidence that both the violations of many Economic Social and Cultural Rights, and of many Civil and Political Rights, and of humanitarian law (Geneva Conventions) conspire to violate their right to the highest attainable standard of health. As Professor Marmot, who chaired the UN Commission, said in his 2006 Harveian Oration *, “I shall argue, in this oration, that failing to meet the fundamental human needs of autonomy, empowerment, and human freedom is a potent cause of ill health”. Of all things, violations of human rights are nothing if not a loss of autonomy.
* The Lancet, Volume 368, Issue 9552, Pages 2081 - 2094, 9 December 2006 doi:10.1016/S0140-6736(06)69746-8 [http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(06)69746-8/fulltext] article continues on page 4 .. 3
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Hebron Nothing illustrates the illegal settlement on Palestinian land by Israelis as well as the holding of 35,000 Palestinians in the centre of Hebron to ransom because of the few hundred Jews who live illegally in their midst.
Palestinians have to protect themselves with wire mesh from stones and garbage thrown onto them by the settlers as they walk in the street below - photo June 2008
One main road, Al-Shuhada Street, runs through this area connecting the western to the eastern part of the city. All traffic on this street, where three of the four Israeli settlements in Hebron are located, is tightly controlled by the Israeli Defence Force (IDF).
re-establish a Jewish community in Hebron. They failed to obtain authorisation from the Israeli military administration, but were granted the right to build a settlement on uninhabited land outside the city - Kiryat Arba. A few years later, in the early 1980s, Israelis received government permission to dwell in old houses that used to belong to members of the old Hebronite Jewish community, to re-build parts of the run-down Jewish Quarter and to settle in houses of disputed ownership.
The now virtually deserted Al-Shuhada Street is lined with shuttered Palestinian shops, some spray-painted with Stars of David and the odd bit of Hebrew language graffiti saying "kill Arabs". The restricted access to Palestinians has caused economic collapse of the centre of
Four small Israeli settlements have been established between 1979 and 1984 - in the Qasba, along Al-Shuhada Street and on top of the Tel Rumeida hill, overlooking the Old City. It was nearby in the Ibrahimi Mosque (Cave of the Patriarchs) that at 5 am on February 25th, 1994, Dr. Baruch Kappel Goldstein, an American born Israeli physician, shot and killed 29 Muslims at prayer and wounded up to another 150. After being subdued, Goldstein was beaten to death by survivors. Israeli extremists continue to pay homage at his grave in the nearby Jewish settlement of Kiryat Arba, where a marble plaque reads: "To the holy Baruch Goldstein, who gave his life for the Jewish people, the Torah and the nation of Israel."
Al-Shuhada Street in June 2008 - at the far end of the street (not shown) lies an IDF check point, where an armoured vehicle is parked which periodically drives up and down the street
Hebron and driven many out of the area. Hebron is the only West Bank City in which a number of Israelis have settled. In 1968, a group of Israelis occupied a small hotel in Hebron, expressing their intention to 4 HEALTH IS CONTINGENT UPON RESPECT FOR HUMAN RIGHTS
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Doctor for Human Rights and social determinants of health Professor Sir Michael Marmot - one of DHR’s earliest members - has headed a pivotal UN investigation into social determinants of health. The report was published in August 2008 under the exhortative title Closing the gap in a Generation - health equity through action on social determinants.
Internationally acclaimed, Professor Marmot is Vice President of the Academia Europaea, a Foreign Associate Member of the Institute of Medicine, as well as having been chair of the Commission on Social Determinants of Health set up by the World Health Organization in 2005 The report, which has been three years in the making, vindicates the health and human rights community’s conviction that respect for human rights is essential to the promotion and maintenance of health, by providing an objective evidence base that demonstrates the influence of social determinants on health. Its publication will inevitably stimulate renewed efforts to reverse social deprivation, the development of more health and human rights departments at medical schools and universities, and renewed campaigning for respect for human rights.
Bernie Hamilton’s widow being a manager within UCL’s Department of Primary Care and Population Sciences. Professor Marmot, who only hours before had got off the plane from a Commission meeting in New Orleans, began the seminar by describing how shocked he had been at the inequalities suffered by black people, exposed by Hurricane Katrina. In his 2007 Lancet article Achieving health equity Sir Michael had explained that a “central aim of the Commission on Social Determinants of Health was to assemble the evidence, particularly of what will make a difference, to lay the basis for action to reduce inequalities in health within and between countries”.
If there is one disappointment, it is that the report favours terms such as ‘social justice‘, ‘inequities in health‘, and ‘avoidable health inequalities‘ - and eschews the conceptualising of social deprivation in terms of violations of human rights. In November 2007 Professor Marmot chaired a collaborative seminar between the University College London’s Faculty of Law, and its Department of Primary Care and Population Sciences. He had invited his UCL academic lawyer colleagues to discuss whether it would be useful to introduce human rights law into the report as a potential strategy by which to reverse deprivations of social norms.
Having asked the participants to make the case for or against invoking human rights law as a means by which to eliminate the malign influence of adverse social factors, a lively discussion took place. Perhaps predictably, given the absence of international lawyers, Peter Hall was one of the few to champion the importance of human rights. As he explained, not only does the International Covenant on Economic, Social and Cultural Rights encompass many of the rights so relevant to adverse social factors, but also - a fact of which the Professor admitted he had been unaware - over four in every five countries worldwide have ratified the
Peter Hall, chair of DHR, managed to participate in the seminar by dint of, coincidentally,
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continued from page 5 - DHR and the social determinants of health ...
DHR’s submission to UK healthcare inquiry
Covenant and are therefore obliged to respect it. At another stage in the discussion, the DHR chairman made a case for Professor Marmot meeting with the UN Special Rapporteur on the right to the highest attainable standard of health, but Sir Michael explained he had already done so. Later the Special Rapporteur confirmed that he had spent the best part of a meal they shared trying to persuade Sir Michael of the validity of human rights as a vehicle with which to change unfavourable social determinants.
The report of the UK inquiry into healthcare for people with learning disability concluded that they are indeed discriminated against. It had been ordered in response to Mencap’s Death by indifference report, which recounts the stories of six people with a learning disability who appeared to have died unnecessarily while in NHS care.
In concluding the two hour seminar, during which it had become increasingly apparent that Sir Michael knew more about human rights than most participants, he recalled that he started off some years previously as sceptical about relevance of human rights to reversing social determinants of poor health, but latterly he been become more persuaded that there may be a case - hence the discussion.
DHR submitted a 26 page comprehensive report* that concluded with the recommendation that the post of a community based specialist physical healthcare physician for people with learning disability (analogous to community paediatricians, and to learning disability psychiatrists) be created.
Nine months on, and the report is published without reference to human rights. And in fact, on reflection, it maybe a more effective report for being free of any potentially divisive and distracting promotion in support of human rights. Inevitably, an analysis from the health and human rights community that demonstrates how to use human rights law to reverse social determinants of ill health will soon follow.
The inquiry found the health system to have been indifferent to people with learning disability’s special needs as vulnerable individuals, and that there had been “appalling examples of discrimination, abuse, and neglect across the range of health services”. Recommendations included the creation of a learning disabilities Public Health Observatory, supplemented by a confidential inquiry into premature deaths. The absence of a new healthcare speciality physician post represents a valuable opportunity lost. * http://phall.members.gn.apc.org/HlthcrPWLDfinred.pdf HEALTH IS CONTINGENT UPON RESPECT FOR HUMAN RIGHTS
The UN Commission report concludes “Acknowledging that there is a problem, and ensuring that health inequity is measured – within countries and globally – is a vital platform for action. National governments and international organizations, supported by WHO, should set up national and global health equity surveillance systems for routine monitoring of health inequity and the social determinants of health and should evaluate the health equity impact of policy and action”. 6 wwww.doctorsforhumanrights.org
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DHR publications in the medical journals 2007-8
DHR 2008 strategy
Torture - the December 15th 2007 edition
DHR’s current grand strategy remains
of the Lancet included a letter written by
threefold:- to encourage the medical
former DHR executive committee member Chris-Burns Cox, co-signed
profession to adopt health rights as an
by Peter Hall as chair of
ethos; to campaign for the creation of
DHR. The letter dealt with
crimes against humanity for economic,
military doctors and torture,
social and cultural rights (as distinct from
and finished with a demand
already existing crimes against humanity
that military doctors are
for civil and political rights) - that includes
made aware of their respon-
the right to the highest attainable standard
sibilities over the prevention, investigation and
of health; and to redevelop and update
reporting of the torture of detainees. (doi:10.1016
DHR’s medicine and human rights
S0140-6736(07)61853-4). http://www.thelancet.com/journals/lancet/article/PIIS0140-67 36(07)61853-4/fulltext
modular course in order to facilitate education for doctors and medical students
The right to the highest attainable standard of health - a second letter, in the Lancet of 27th Sept 2008, praises editor Richard Horton’s
and how using General Comment 14 to define
April address at the Royal Society of Medicine
governments' responsibilities allows human
to mark the NHS’s 60th anniversary. It was
rights activists and health professionals alike to
later published, in enhanced form, in the 28th
hold governments to account.
June Lancet as a Viewpoint. The DHR letter
It appears that
characterises Horton’s article as seminal because of the way he links the NHS to the
Richard Horton’s
right to the highest attainable standard of
paper is one of the
health. Importantly it takes the opportunity
first fruits resulting from a briefing
remind readers that rights oblige governments’
given by the Special
accountability to respect, protect and fulfil health rights. It listed five accountability
Rapporteur to the
mechanisms - judicial, quasi-judicial,
Lancet editorial
administrative, political, and social.
staff earlier this year. (doi:10.1016/S0140-6736(08)61480-4) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (08)60956-3/fulltext
The letter finished by explaining what the right to the highest attainable standard of health is,
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The election of DHR committee members
AGM 2008 Saturday 6th December 2 pm at the
This year DHR continues the election cycle as described in the Newsletter prior to the 2000 AGM.
3, Merrow Dene 76 Epsom Rd, Guildford GU1 2BX
This year the executive committee officers 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.
Guildford
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
The UK’s violation of Iraqis right to the highest attainable standard of health In May 2008 DHR was in Geneva presenting oral evidence intended to persuade the UN Committee which monitors each governments’ observation of the International Covenant on Economic, Social and Cultural Rights, that the UK violated Iraqis’ health rights by dint of illegally invading Iraq (violation of UN Chapter), and violating international humanitarian law (war crimes under the Geneva Conventions) as a result of allowing the country to descend into chaos because they failed to prepare for the aftermath of the invasion. [paras 39, 9, 50-52 of General Comment 14] The attempt proved unsuccessful because the Committee disputed the applicability of the Covenant extraterritorially - a position at variance with the Committee’s implacable assertion that Israel’s obligations under the same Covenant apply in the Occupied Territories. On the other hand, one can understand the Committee preferring to avoid becoming the only UN organ to tacitly accept the Iraq war was illegal and that the UK violated the law of armed conflict (which is jurisprudentially distinct from international human rights law). It might have led to the Committee, whose role is to adjudicate on matters economic, social and cultural, losing credibility with member States for associating itself with a controversial issue that falls outside its remit. 8 HEALTH IS CONTINGENT UPON RESPECT FOR HUMAN RIGHTS
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