There is not even-handed regulation of doctors worldwide regarding complicity with torture. The case of the Israeli Medical Association serves as a prime example. During the Middle Ages in Europe the practice of torture drew distinction from its association with confessed truth, repentance, and salvation, yet by 1874 Victor Hugo could write that “torture has ceased to exist.” However there has never been any doubt that torture would outlive its obituarists. In 2015 Amnesty International noted that 157 states had ratified the UN Convention of Torture, yet 141 states had used torture in the previous 5 years – this included Western supposedly liberal democracies. Torture is a form of terrorism.
What of doctors and torture? The World Medical Association (WMA), created after World War II following the outrageous ethical abuses of Japanese and German physicians, carries the membership of over 100 national medical associations – from many of the nations implicated by Amnesty. The WMA’s Declaration of Tokyo is the seminal anti-torture manifesto for doctors, forbidding not just direct involvement (“in the room”) but also mandating doctors to speak out, protest and protect the torture victim whenever encountered. There are also UN Special Rapporteurs on Torture supposedly tasked with paying particular attention to medical complicity.
What is the response of a national medical association when there is credible evidence incriminating their own doctors. And do international conventions and declarations forbidding medical complicity with torture, and the organizations set up to regulate these, carry out their mandate effectively and evenhandedly? In a recent paper in the Journal of Medical Ethics I set out two parallel stories: one concerns how far evidence counts in cases which incriminate a Western state with powerful friends; the other describes the experience of trying over years to engage the relevant parties – the national medical association in question, the WMA, UN Rapporteurs, etc. – to get them to do what they were set up to do. [1] I give a blow-by-blow account of convening and running a principled evidence-based appeal launched in 2009, and dedicate the paper to the 725 physicians from 43 countries who gave their names to this endeavour and still do. Our conclusions have been sobering. Mondoweiss Podcast, Episode 21: The changing role of Palestine in Canadian politics
Torture in Israel
Israel is a signatory to the U.N. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT) but evidence of the routine use of torture on Palestinian detainees has long been accumulating in the public domain. In May 1998, a Human Rights Watch report to UNCAT recorded that Israel “continues to use torture and cruel, inhuman or degrading treatment during the interrogation of Palestinian detainees.” The magnitude of Israel’s violations of UNCAT is well known to the Committee, having been extensively documented by UN bodies and international, Israeli and Palestinian human rights organizations. In 2007 B’Tselem, the Israeli Information Center for Human Rights in the Occupied Territories, studied the testimony of 73 Palestinian prisoners gathered since 2005 and concluded that Shin Bet, the Israeli intelligence agency, had inflicted physical and mental abuse amounting to torture on almost all of them. Amnesty briefed UNCAT in September 2008 regarding Israel’s failure to implement the Convention in the Occupied Territories and intensification of measures amounting to torture. In its 2008 Annual Report, the United Against Torture (UAT) Coalition of 14 Palestinian and Israeli human rights organizations, concluded that “the use of torture and ill-treatment by Israeli authorities against Palestinians is both widespread and systematic. The UAT Coalition has observed and recorded evidence of acts, omissions and complicity by agents of the State at all levels, including the army, intelligence service, police, judiciary and other branches of government”. In November 2008 the Public Committee Against Torture in Israel (PCATI) filed a contempt of court motion to the High Court of Justice against the government of Israel and the General Security Service for their responsibility for a policy that granted a priori permits to use torture in interrogations. No Israeli official had ever been charged or sentenced for torture-related crimes. Medical complicity with torture and the Israeli Medical Association (IMA)
In 1993 Amnesty International concluded that Israeli doctors working with the security services, “form part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics”. Amnesty pointed to the implication of statements by Israeli officials (intended to allay concerns about ill-treatment) that detainees were “under constant medical supervision”.
Also in 1993 Amnesty documented the telling example of the Nader Qumsieh case. Five days after his arrest, Qumsieh was brought to a medical center in Be’er Sheva, where a urologist diagnosed a torn scrotum and bleeding. Qumsieh testified that he had been beaten during interrogation and kicked in the testicles. The urologist later received a call from the Israeli military, and as a result wrote a second report which he antedated by two days, without further examination of the patient. In it he recorded that “according to the patient, he fell downstairs two days before he came to the emergency room.” This time his medical findings were recorded as: “superficial haematoma in the scrotal area, which corresponds to local bruises sustained between 2 and 5 days prior to the examination.” The urologist’s original report disappeared from Qumsieh’s medical file.
IMA President Yoram Blachar defended Israeli practices in a Lancet letter in 1997. He wrote that “the guidelines on interrogation recommend only that ‘moderate physical pressure’ be sanctioned. Even this is restricted to cases defined in terms of a ‘ticking bomb’”. Yet in 1994 UNCAT had reiterated that “moderate physical pressure” was indeed torture, and also outlawed the ‘ticking bomb’ justification. Here a president of a national medical association was defending torture in the pages of a famous medical journal. In November 1999 the then Head of Ethics of the IMA Eran Dolev was interviewed by a delegation from the London-based Medical Foundation for the Care of Victims of Torture (where I was then the principal psychiatrist). During the interview he stated that “a couple of broken fingers” during the interrogation of Palestinians was a price worth paying for information. When I quoted this in the Journal of Royal Society of Medicine (JRSM) in 2001, IMA President Blachar castigated this in JRSM as “lies and vilification” and threatened to sue me. The four delegation members responded in JRSM by affirming that this was exactly what Professor Dolev had said.
In 2007 PCATI published “Ticking Bombs”, the detailed testimony of nine Palestinian men tortured between 2004 and 2006, painting a graphic picture of how Israeli doctors formed an integral part of the running of interrogation units whose output included torture. They alleged that doctors, several of whom were named, saw the prisoners at various points before, between or after experiences of torture (which in one case led to spinal damage and disability), did not take a proper history, made no protest on these men’s behalf as the Declaration of Tokyo demands, and typically prescribed simple analgesia before returning them to their interrogators. Several cases had allegedly been known to the Chief Medical Officers of the Israeli Prison Service and Police Service.
Following repeated requests by PCATI, the IMA eventually agreed to investigate “Ticking Bombs”. Professor Avinoam Reches, Chairman of the IMA Ethics Board, sent a 14 line letter dated 9 March 2009 back to PCATI to report the outcome. The investigation had amounted to phone calls to a few of the named doctors, all of whom denied involvement, and no examination of the relevant medical files. Reches concluded that there was no evidence, “other than the word of the prisoners”. What kind of investigation discounts victim testimonies at the outset? When six UK doctors wrote about “Ticking Bombs” in the Lancet in 2007, the IMA threatened to sue.
The British Medical Association (BMA) is a WMA member and I drew the issue to the attention of the BMA as early as 1997. I was asking them to take the matter up at the WMA, as they were entitled to do. I sent the same material to the then WMA Secretary General Delon Human in 2001, who defended the IMA largely on the grounds that they had ratified the Declaration of Tokyo. In 2005 Edwin Borman, Chair of the BMA International Committee, wrote to me to say they “sought to engage constructively with our Israeli colleagues” and would not be “partisan”.
In now preparing a formal international appeal to the WMA, we were aware that campaigning about human rights issues in Israel-Palestine is qualitatively different from human rights work elsewhere. Publications deemed critical of Israel often evoke vitriolic and ad hominem attacks upon writer and medical journal – though little engagement with the cited evidence base. There are calls for journal editors to be disciplined or dismissed. In response to a BMJ paper of mine in 2004, Yoram Blachar, IMA President as well as then WMA Chair of Council (the political head of the WMA), posted a bmj.com Rapid Response stating that “the lies and hatred he spews are reminiscent of some of the worst forms of anti-semitism ever espoused.” Yet the paper was based on work by a UN Rapporteur, the International Court of Justice, Amnesty International, Johns Hopkins and Al Quds Universities, Physicians for Human Rights Israel (PHRI), and the Palestinian Environmental NGOs Network. The same paper produced nearly 1,000 hostile emails sent directly to the editor Kamran Abbasi, mostly crude, abusive and with recurrent reference to antisemitism, some threatening violence against the editor or his family and myself. In 2007 the Royal Society of Medicine were pressured by pro-Israel doctors into withdrawing an invitation to me to speak at a conference on religion, spirituality and mental health.
In May 2009 725 doctors, including 115 professors, from 43 countries (235 from UK) made a joint appeal to WMA Chair of Council Edward Hill from USA. I was convenor and Professor Alan Meyers of Boston University and Jewish Voice for Peace USA, was lead signatory. We attached a detailed dossier of evidence as above and requested that it be distributed to all Council members (these are geographically scattered around the world and only convene yearly). The WMA is mandated to ensure that its member associations do not breach WMA codes like the Declaration of Tokyo. We asked the Council to investigate the IMA’s ethical track record in the light of the evidence, and thus to review the probity of their recent appointment of IMA President Yoram Blachar as WMA President. We had public support from Professors Noam Chomsky and Norman Finkelstein in the USA, and from Dr Wendy Orr in South Africa. Orr had been working as a medical officer for the District Surgeon in Port Elizabeth in the 1980s and blew the whistle on torture and the complicity of state doctors in cases she saw- her ethical duty under the Declaration of Tokyo.
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