[The following is the latest from the Public Committee Against Torture in Israel (PCATI) and Physicians for Human Rights - Israel (PHR) on medical professionals` involvement in mistreatment in Israel.]

Medical Professionals and Torture?  

When we think of doctors, it is often the Hippocratic Oath and its mythical status that comes to mind. We believe that doctors help the sick, standing beside them in times of troubles at any hour of the day or night, remaining loyal to those under their care, and so on. In general, doctors are seen as professionals who can be trusted to do the utmost to bring health to their patients – good people working day and night so that we will be healthier and the world a better place. It may be for this reason that, when they turn their backs to a patient’s distress, the betrayal is exponentially worse. It is for this reason that we must understand what brings medical professionals to avert their gaze in this way, and explore what can encourage them to protect the tortured. 

Apparently, when a patient is helpless and in the custody of the security forces, the focus on his or her well-being oftentimes is weakened and the demands of the security authorities play a significant and inappropriate role in some doctors’ considerations regarding the patient. This report reveals significant evidence arousing the suspicion that many doctors ignore the complaints of their patients; that they allow Israel Security Agency interrogators to use torture; approve the use of forbidden interrogation methods and the ill-treatment of helpless detainees; and conceal information, thereby allowing total impunity for the torturers.  

Unfortunately, there are doctors who do not act in accordance with their ethical obligations when interacting with prisoners – either because they are unaware of these obligations or because they submit to the hierarchy of the security apparatus and the powerful social status it enjoys. What’s more, the very professional associations which are supposed to ensure doctors’ proper behavior in fact allow the perpetuation of the current situation, failing to take even the most minimal steps necessary to end such conduct. They are not sufficiently firm in their effort to bring an end to this behavior and to strengthen the status of medical ethics against the might of outside pressures. 

We are hopeful that this report will help the medical system change its ways and those of the doctors who ignore their ethical obligations. The world will be a better place if the doctors conduct themselves in a moral fashion. 

Introduction

This report deals with the involvement of medical professionals in torture and ill-treatment. Based on a series of testimonies and other evidence, primarily the files of over 100 victims of torture and ill-treatment handled by the Public Committee Against Torture in Israel since 2007, the report demonstrates that medical professionals are frequently involved either actively or passively in torture or ill-treatment. This, of course, contradicts a whole series of ethical and legal obligations to which they are beholden, and is in opposition to the moral duty thrust upon them by their unique status as medical professionals. 

The report consists of five chapters:  

The first chapter deals with the layers of protection enjoyed by torturers. This chapter briefly presents the legal situation which enables the persistence of torture in Israel. It demonstrates how ISA interrogators are wrapped in a number of layers of defense, providing them with full impunity and shielding them from any oversight, trial or punishment. These protections, primarily the law enforcement system which systematically refuses to investigate the conduct of ISA personnel, enable the continued perpetration of torture and ill-treatment in Israel. Medical professionals who interact with the imprisoned, whether they are employed by the Israel Prison Service or are on hospital staff, comprise another layer in this system of protection. They do this by failing to document an injury to which they were a witness, by failing to report such an injury, or by returning victims of torture or ill-treatment to the purview of those who have harmed them. In this way medical professionals also deny victims a crucial piece of evidence which may have been used in their struggle against their abusers, in essence granting authorization for what goes on in the interrogation rooms. Whether through action or silence, all of this occurs with the full support of the medical system which employs them and is entrusted with overseeing their conduct.

The second chapter presents the ethical and legal obligations which apply to doctors and medical professionals who interact with the imprisoned. Medical professionals have a unique societal role, which has led to the creation of ethical rules guiding their work. Over the years, these rules have been anchored in codes entrusted to various professional bodies, both in Israel and internationally. These ethical obligations, which apply to every medical professional, have a special importance when the patients are in custody: they are subjected to the authority of the security forces and the prison service in a manner which does not allow them to care for their own needs. Such situations may present medical professionals with numerous dilemmas arising from their unique role in protecting the rights of the imprisoned. Various bodies in Israel, primarily the Israel Medical Association (hereinafter: IMA), have recognized the unique position of doctors who interact with the imprisoned and the possibility that they will be subjected to the pressures of the security apparatus. Yet the IMA’s ethical guidelines on this matter are, to our deep sorrow, overly vague in asserting the duty of the doctor to the well-being of the patient; they allow the doctor to compromise the patient’s health in the face of the demands of the security apparatus. This chapter further demonstrates that the Penal Code, too, expresses some of the ethical obligations of medical professionals, all the more so when those they are treating those defined under the law as helpless, as are the imprisoned. 

The third chapter surveys the central ways in which medical professionals become involved in torture and ill-treatment: first, the systematic failure to properly document injuries inflicted upon the victims of torture and ill-treatment. The failure to document is manifested primarily in that descriptions of injuries – when they exist at all – are often extremely laconic; furthermore, there are serious problems with the administration of the Israel Prison Service’s medical files. Second, the failure to report: save one case (which itself raises some serious concerns), we have not encountered any situations where a doctor reported a prisoner’s injury to his or her superiors either in prison or outside it. The guidelines and working procedures on this matter seem to be lacking, as do protections for doctors who would like to report such cases. Third, the return of detainees to the hands of interrogators even after doctors have seen evidence of the harm done to them; this entails a gross violation of the doctors’ obligation to care for their patients’ well-being and to protect them from harm. Fourth, the transferring of medical information to interrogators: the Israeli prison system allows the transfer of medical information from doctors to interrogators by means of a form appearing in a number of the files which reached us. As far as we know, such transferring of information takes place without the consent of the prisoner and thus entails a grave violation of medical confidentiality. Fifth, we have encountered several particularly grave cases in which medical professionals explicitly preferred the requirements of the interrogation over the well-being of the patient. These cases, more than anything else, attest to the organizational conflation of the roles of doctor and interrogator. And finally, even when brought to hospital, an institution ostensibly more independent and less subject to the demands of the security apparatus, the imprisoned encounter the same forbidding walls of silence, the failure to document their injuries and their return to the authority of those who have harmed them. 

The fourth chapter amines how doctors have been held responsible for their actions in various parts of the world and which bodies play a role in holding them accountable. Varying countries have dealt in differing ways with doctors’ cooperation in torture and ill-treatment. In the United States, doctors have gone unpunished despite corroborated evidence of medical professionals condoning, failing to report and misattributing signs of ill-treatment carried out in the context of the “war on terror” at detention centers in Guantanamo Bay and Abu Ghraib. Likewise, medical cooperation with torture was rampant in apartheid South Africa. Though most doctors turned a blind eye, serving as a stamp of approval for systematic police violence, Dr. Wendy Orr chose to appeal to the Supreme Court. She serves as an example of the impact one ‘whistle-blower’ doctor can have on an entire system; nevertheless, the vast majority of complicit doctors went unpunished when apartheid fell.  In the 1970s and 1980s doctors in South American military dictatorships took an often active part in the torture, kidnapping and murder of political opponents of the regimes as part of the CIA’s “Operation Condor”. The vast majority of these remain unpunished, and those punishments meted out were overwhelmingly disciplinary rather than criminal; nevertheless, civil society has played a role in ostracizing these doctors by publishing
information on their crimes.  

The fifth chapter presents the conclusions suggested by the report, which details how the conduct of medical professionals who interact with prisoners does not accord with their ethical and legal obligations. This conduct has grave consequences for prisoners who have fallen victim to torture or ill-treatment: doctors do not serve as effective recourse for the victims’ complaints in real time, preventing them from receiving the protection which they are in such dire need of and which doctors are obliged to provide them. The lack of documentation and the failure to report denies the imprisoned evidence with which they could later pursued justice against their tormenters. The very presence of medical professionals adjacent to the interrogation facilities where torture is carried out grants a certain stamp of approval to the entire system: whether explicitly or tacitly, the authoritative presence of doctors gives an impression of normalcy and propriety. All of this elicits a state of affairs in which, over the course of his interrogation, a detainee under interrogation for security violations does not meet a single individual not identified with the system and its goals. A number of additional professional associations are also responsible for this situation, particularly for the absence of any available channels for reporting, lack of appropriate oversight and punishment, and the lack of protection for medical professionals who would like to act in accord with their obligations. The chapter concludes with a series of recommendations. We are hopeful that these, along with the report itself, will be useful in changing this state of affairs.   

[Click here to read the full Public Committee Against Torture in Israel and Physicians for Human Rights - Israel report.]