"A May 22 article on Abu Ghraib in the New York Times states that "much of the evidence of abuse at the prison came from medical documents" and that records and statements "showed doctors and medics reporting to the area of the prison where the abuse occurred several times to stitch wounds, tend to collapsed prisoners or see patients with bruised or reddened genitals."1 According to the article, two doctors who gave a painkiller to a prisoner for a dislocated shoulder and sent him to an outside hospital recognized that the injury was caused by his arms being handcuffed and held over his head for "a long period," but they did not report any suspicions of abuse. A staff sergeant–medic who had seen the prisoner in that position later told investigators that he had instructed a military policeman to free the man but that he did not do so. A nurse, when called to attend to a prisoner who was having a panic attack, saw naked Iraqis in a human pyramid with sandbags over their heads but did not report it until an investigation was held several months later.
A June 10 article in the Washington Post tells of a long-standing policy at the Guantanamo Bay facility whereby military interrogators were given access to the medical records of individual prisoners.2 The policy was maintained despite complaints by the Red Cross that such records "are being used by interrogators to gain information in developing an interrogation plan." A civilian psychiatrist who was part of a medical review team was "disturbed" about not having been told about the practice and said that it would give interrogators "tremendous power" over prisoners.
The USA signed up to the UN Convention of Human Rights. The Convention was created for a reason. As terrorism has become a real threat, the border between good and bad has become blurred and the Convention has been put to one side. Many have turned a blind eye to the medical atrocities in Guantanamo Bay. Thankfully, Barack Obama has finally decided to close it.
Of course, we will never really know what happened there despite investigations. Those who were innocent and yet trapped there will never get their lives back. Only those who have worked in Guantanamo Bay will know the harsh realities of what happened.
The UK has signed up to the UN Convention of Human Rights but as we know it continues to violate the convention on a daily basis. There are reports against the UK but no accountability. The difference is that the UK is better at controlling the media and concealing the human rights abuses that do happen. Indeed, the UK's human rights record according to the European Commission is pretty dire. The UK was criticised in the European Union’s annual report on the state of human rights in the EU (13 January 2003) for the Anti-Terrorism, Crime and Security Act 2001 under which it is possible for non-UK-nationals to be held in indefinite administrative detention without being charged or prosecuted and without access to an appeal in law. It also criticised UK prisons stating that ‘sanitary facilities are far below standard’. The report was drafted by Dutch socialist Joke
Swiebel with the support of the European Parliament’s citizens’ rights committee". More can be read
here.The council of
Europe's Commissioner for Human rights, Alvaro Gil Robles writes a damning report regarding the UK.
The full report can be read
here. The human rights abuses in health and social care is detailed in this
article. A very interesting document called
Human Rights Act - Changing Lives makes fascinating reading.
So there we go, human rights abuses happen in the UK. Our medias focus though is largely on the outside world. We focus on Guantanamo Bay and Zimbabwe. In reality, is the UK any better?
So when we look over the seas at Guantanamo Bay, we need to assess it in context of the human rights violations in our own country
ie the UK.
By 2005, Guantanamo Bay doctors were under severe criticism.
"The UN stated it has evidence that torture has taken place at the prison amid reports that 520 inmates have had mental breakdowns"
The problem of dual loyalty was addressed here "Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and
Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect
detainees' human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism."
The real hero in the UK though is
Dr David Nicholl. "
Dr David Nicholl, MBChB FRCP PhD is a consultant neurologist and honorary senior lecturer at City Hospital Hospital & Queen Elizabeth Hospital, Birmingham and the University of Birmingham, England. He grew up in Belfast, Northern Ireland and has been active as a human rights activist on Guantanamo as a supporter of Amnesty International and Reprieve. He completed the 2005 London marathon dressed in an orange Gitmo suit to raise awareness of the legal issues related to detention without trial".
He
writes"It is interesting to reflect on the guidelines for medical staff treating detainees from the Pentagon [PDF] compared to that of the UK military [PDF]. Nowhere in the Pentagon guidelines does it explicity state that detainees have the right to the same medical care as those of anyone else, under the Geneva convention and UN declarations, as well as a right to confidentiality and informed patient consent. In the case of hunger striking, this is not synonymous with attempted suicide as the Pentagon have attempted to state. Indeed as Dr Reyes commented in 1998 “It is inappropriate to assert, however, that hunger strikers should be placed in the same category as persons intending to commit suicide. This is a simplistic approach to the issue which wrongly reduces it to purely medical terms”.
Finally the recent descriptions of the suicides of 3 inmates at Guantanamo as “a good PR move” and “an act of war” by the US administration clearly shows a complete lack of insight and humanity into the medical aspects. It is vital that the prisoners in Guantanamo are allowed immediate, independent and unfettered access to outside physicians and for these results to be made public (the Red Cross have a long-standing practice of not speaking publicly, and it is not known if they have seen the forcefeeding regime).
Outside of the medical aspects, I would concur with President Bush in his October 2005 statement that “Each individual is presumed innocent and entitled to due process and a fair trial” . However, I believe he was referring to his colleague Scooter Libby rather than the individuals being held in Guantanamo. No-one should be beyond either the law or appropriate ethical treatment"
He also ran a
petition in 2006. David's work has been admirable. He also writes extremely well in his
Stirrer Columns. I occasionally disagree with some of his material but that is probably because I think David lives in a consultants environment. Living in one of those often makes you view the world from a limited perspective. Nevertheless, credit to him, he is one of the most outspoken and admired doctors in the UK and we need more doctors like him.
Anyhow, when we apply the same principles of justice and fairness enshrined by the International Conventions to Ward 87, we note that most authorities would say that the UN Convention on Human Rights were irrelevant.
When we ask ourselves how many doctors ever campaigned for human rights in the
NHS, you will probably end up with very few. Probably a
hand full. The fact remains you have to be male,
caucasian and senior to be taken seriously in the UK. Multicultural England is simply a debate in the Guardian newspapers :). When we then ask ourselves - what of the UK being the country with the highest death rate in Europe? We would be assured that each clinician in the UK walks away ignoring these basic statistics. It simply does not sit well to acknowledge these issues and perhaps the UK is allergic to its own flaws being pointed out to them.
The status in Guantanamo Bay was not dissimilar to that on Ward 87. Guantanamo Bay though has the image worthy of international news.
When we consider David
Nicholl, a consultant, a upright citizen, a human rights campaigner, you will find that David would support Guantanamo Bay but there would be something in his upbringing or his medical culture that would stop him from supporting junior
whistleblowers or any ward like Ward 87. His mindset much like that of his colleagues would stand back before supporting any
whistleblower because in the end he is aware that sticking his neck out too far will result in it being chopped by
GMC Towers or any other organisation in the
NHS. He is not dissimilar to other consultants who would all campaign to support human rights abuses abroad but would never raise the human rights abuses that happen in their own country - the UK.
David
Nicholl writes naively on
whistleblowing. We differ on the subject. That is probably because I have problems accepting the views of someone who has relatively little experience of
whistleblowing at a maximum level.
I really don't blame him because most consultants have no idea what
whistleblowing involves. He writes "
Whingeing is one thing, but being sued for libel doesn’t do anyone". No
whistleblower can be sued for libel. The case law is very clear on this issue.
Whistleblowing is a qualified and protected act. Even if the
whistleblower turns out to be wrong in the end, the law provides them with ultimate protection if the concerns were raised in good faith.
He states "
make sure you are 100% sure of your facts". No
whistleblower has access to 100 percent of the facts because no
whistleblower can have access to ALL documentation. If you waited for 100 percent of the facts, no one could ever
whistleblow :).
He then goes on to say "
if the problem is still ongoing and is risking patients, and you haven’t had a proper reply following the above, you are duty bound to go to the press in my view". He fails to tell the world that the General Medical Council regularly collects press cuttings [ Investigation Manual 2008] and will conduct any inquiry they wish without informing the doctor [ Rule 4 Fitness to Practise 2004]. For a man who holds a senior position to advise such recklessly on
whistleblowing is interesting.
Nicholls then fails to mention that in the event
whistleblowers are subject to
GMC investigation - and many are, he won't be there to back them up and neither will his colleagues. Dr Peter
Wilmshurst, cardiologist testifies to this phenomena of " reversing an investigation on the
whistleblower". I certainly know and have the documentation that the
GMC conducted a covert enquiry for 2 years. I wasn't even made aware of this investigation. To assume that this only happens to me is probably naive. Dr Grumble will tell the world that its not only me this happens to. It happens to everyone. I just happened to be clever enough to make a subject access request under the Data Protection Act and catch the
GMC red handed.
I believe consultants often have a hazy and dreamy outlook on the
whistleblowing issue and assume the system has changed.
Nicholl fails to point out the issues raised in both the
Shipman Inquiry as well as the
Bristol Inquiry. They were serious issues about the backlash faced by each and every
whistleblower in the UK. The system hasn't improved because consultants haven't improved.
Nicholls fails to mention one important issue, the
Health Commission now has a
whistleblowing protocol and concerns can be reported directly to them. I would suggest never
whistleblowing until you have gained the maximum support of your seniors, colleagues etc. I mean serious backing on paper not some " yes, we will back you anonymously".
As it is often impossible for
whistleblowers to achieve that, raising concerns on your own is probably one of the most dangerous things you can do.
It is therefore unsafe for any junior doctor to raise concerns internally or through the media no matter what the public expects. I believe doctors should remember that the public won't be there when you have to face the music. The public won't be there to
thankyou, your consultants won't be there to protect you. You will have to face the music on your own. If you are ready to fight the backlash then get ready to
whistleblow and you have to remember, if you are a junior doctor, you start with no credibility so you end up with less than no credibility.
Liz Miller will always state, never fight a battle you cannot finish. You have got to be ready, to stand on your own, fight on your own and learn not to give a damn about those colleagues who will sit in judgment of you.
The media are unpredictable, government driven and every effort will be in force to ensure you as a
whistleblower are silenced. This is not to be underestimated at all. If you think Guantanamo Bay is a dangerous place, just try living a life post
whistleblowing.
I would say a Guantanamo Bay inmate probably has more people fighting for him or her than a
whistleblower does in the UK.
