As protests and civil unrest continue across North Africa and the Middle East, reports are emerging of Bahraini and Syrian security forces threatening, assaulting, and arresting protesters seeking medical treatment at hospitals. According to The New York Times, health care workers in Bahrain have been arrested, for protesting but also for treating patients, and security forces are following ambulances, according to witnesses. In one instance, a doctor was allegedly arrested after being photographed while weeping over a protester who had died. Wounded protesters have reportedly been pulled out of the main government hospital in Manama and arrested. Other patients, according to doctors’ testimonies, were tortured by security while under interrogation in the hospital. The NYT charged that the Bahraini hospital “has been converted into an apparatus of state terrorism.” In Syria, HRW has reported that security forces have blocked protesters from entering hospitals and health care workers from treating wounded protesters as well.
Withholding medical treatment is, of course, not a new or novel tactic of intimidation and abuse, and it’s a widespread human rights violation. In South Africa, Amnesty International reported in 2009 that police withheld medical treatment to crime suspects injured by vigilante groups, resulting in at least one death. In the US, the state of Georgia came under scrutiny in December 2010 for a prisoner strike across at least six state prisons. Following the strike, prison reform groups have alleged that guards assaulted two prisoners in retaliation for the strike and then withheld medical care for three weeks. The notion that withholding medical treatment is a human rights violation is also neither new nor novel. Internationally-accepted human rights tenets uphold the right to life and prohibit inhumane treatment. The American Bill of Rights bans “cruel and unusual punishments.” And Article 15 of the third Geneva Convention states free medical care must be provided to prisoners of war.
What interests me, however, is where one begins to draw the line. For example, the prisoners in the Georgia penal system went on strike to protest the poor (and expensive) health care they were receiving while incarcerated, among other reasons. Where do the definitions of “acceptable” inequalities in a health system and “cruel and unusual” diverge?
In one notorious case, it has been estimated that more than 330,000 South Africans died of AIDS and related illnesses due to the government’s refusal to accept and administer ARVs under former President Thabo Mbeki’s AIDS denialist administration. Less dramatic but certainly no less tragic, is the case of those nations that ban opiate-based painkillers. While working in Sierra Leone, I saw cases of advanced cancer that could not be treated in-country due to the lack of basic health infrastructure. And in Sierra Leone, it is virtually impossible to find opiate-based painkillers, like morphine, which meant that people with late-stage cancer and terminal illnesses could not even have their pain managed. Since I’ve left, one health facility in the country has been licensed to administer morphine. Unlike expensive and more complex cancer treatment and screening equipment, morphine is cheap. But even this was not available, due to what one Sierra Leonean hospice founder called “opioid phobia” in 2007.
Beyond that, we have vast economic inequalities that deny citizens the ability to access medical care in established health systems–such as in the United States. When people cannot access medical treatment due to political repression, we are clear that it is wrong. When people cannot access medical treatment due to economic limitations, however, we often turn our heads away. There’s obviously a larger narrative of violence and repression in the case of Syria and Bahrain that makes their version of withholding medical care especially dangerous. But when there is a strong, effective medical system in a country with vibrant liberties and free speech, why are there still people on the outside, pressed against the glass? And why is that acceptable? The difficulties of reconciling economic and health rights with other human rights are clear and have been discussed many times. I am continually fascinated, however, by where we put up the fence between “violation” and “that’s too bad.”
