In an opinion piece for Al Jazeera, Rajaie Batniji uncovers the role of medical professionals involved in acts of torture. With a lens to the unrest in Syria, Batniji calls for an international body to identify, monitor, and disqualify those complicit in torture and genocide.

In an opinion piece for Al Jazeera, Rajaie Batniji uncovers the role of medical professionals involved in acts of torture. With a lens to the unrest in Syria, Batniji calls for an international body to identify, monitor, and disqualify those complicit in torture and genocide.

Doctors have a long history of complicity in torture, but the torture of political dissidents holds a privileged place.  In Saddam Hussein's Iraq, surgeons removed the ears of men who failed to report for military service or defected from the army. In the Soviet Union, psychiatrists held political dissidents in mental hospitals with false diagnoses, in order to isolate and punish them. It is in this tradition of medical torture of dissidents that the Syrian healthcare establishment may be heading.

A July 6 report by Amnesty International documents the treatment of Wassim, a 21-year-old protester in the Syrian town of Talkalakh. After an injury from a soldier's bayonet, Wassim was taken to al-Bassel hospital, which had been occupied by Syrian security forces. As he reported: "The nurses, men and women […] swore at me and beat me hard and one female nurse punched me repeatedly with all her strength on my chest. Some were taking off their shoes and slapping me with them. I could hear many voices asking: 'You want freedom, eh?'" The report states he later had his wounds stitched without anesthesia, before being beaten on these wounds by hospital staff.  

Wassim's is not an isolated incident. In May, Reuters documented the case of a protester who had lost sensation in his legs who requested to see a doctor in jail. He told the news agency: "The doctor hit my knees with his legs, and asked: 'There, is it better now?' and then he slapped me". Most pervasively, reports suggest that even when doctors have not been involved in direct abuse, they have falsified the causes of injuries and released information about patients to the Syrian regime's security forces. The result is a public distrust of hospitals, and a clear incentive for injured protestors to avoid the healthcare system. 

The medical torture of political dissidents holds a privileged place because it can be perversely justified. The torture of dissidents may be seen as an act of loyalty to the state. Doctors acting on behalf of the state, such as military doctors, have what is called "dual loyalty" - loyalty to both their patient and a third party.

In addressing the issue of dual loyalty, Physicians for Human Rights has proposed guidelines that physicians not be present when torture takes place, and calls on them to report all human rights violations, especially when they interfere with their loyalty to patients. Like the medical professionals from the US recently implicated in the torture and abuse of prisoners at Guantánamo Bay and Iraq, some Syrian doctors may have valued their contribution to the security of the state more than their adherence to the norms of their profession. 

But, in their pursuit of perceived enemies of the state, have these physicians become enemies of the profession? Doctors involved in torture should be pursued as enemies of medicine: their crimes documented, their professional credentials revoked, and their ability to practice internationally thwarted.

Identifying and disqualifying doctors involved in torture

While it is exceedingly unlikely that Bashar al-Assad, an ophthalmologist, will go back to correcting cataracts in London - where he trained - if his regime is overthrown, other physicians culpable in his regime's torture will seek to continue clinical practice abroad.

Even with continued instability, it is likely that physicians and other elites will seek to emigrate. Could doctors involved in abuse head to Europe, North America or neighbouring Arab countries and continue to operate? How will they be identified? Critically, the majority of Syrian physicians that have not been complicit with abuses must be distinguished from those who have. 

Unfortunately, the medical profession has no method for identifying or punishing doctors complicit in torture. We rely on human rights organisations to provide sporadic documentation of medical torture.

With limited access and competing priorities - such as being able to provide medical care while working in countries where torture occurs - these organisations have a narrow scope for documenting the occurrence of torture. In an excellent Lancet article, Len Rubenstein and Melanie Bittle argue that the World Health Organization is best positioned to play a leading role in documenting attacks on medical functions in conflict, and this should include those attacks committed by physicians.

Among the suggestions put forth by Rubenstein and Bittle are a UN Security Council resolution providing a mandate for the WHO to pursue investigations, and the use of mobile devices for securely and quickly transmitting information about abuse. By documenting medical complicity in torture, we give physicians under incredible pressures incentive to oppose orders from their superiors and the state.

The greatest challenge, however, is enforcement, and the punishment of physicians complicit in torture. No international body retains information on professional qualifications. Like most other professions, medicine has proclaimed a need to be self-regulating, yet it has no system in place to disqualify or sanction physicians on a global level (national licensing bodies exist in most countries, but there is little to no international coordination). To this day, investigations continue of Rwandan doctors now practising in Europe and Africa, accused of involvement in the 1994 genocide.

Of course, their crimes were far more widespread than those in Syria today, as doctors oversaw the killing of hundreds of patients and staff in their hospitals, but the challenge of enforcement is nearly identical. Even if medical complicity in torture does not warrant imprisonment, it ought to warrant professional disqualification - and as of yet, no institution or process is in place to disqualify a physician from practising internationally. 

Honouring the heroism of Syrian doctors

Attacks on the healthcare system are common - perhaps inevitable - in modern war, but doctors don't always become complicit. In Bahrain, the Salmaniya medical centre was raided, and its doctors beaten and jailed for treating protesters. In Libya, Misurata hospital came under fire, deterring the sick from seeking care and endangering staff and patients.

Despicable as these attacks are, they have come to be expected as a feature of conflict. Attacks on the healthcare system have been documented in almost all recent conflicts including in Afghanistan, Kosovo, Nepal, Iraq, and the occupied Palestinian territories. In most cases, doctors have acted admirably, and sometimes heroically: seeing the sick in their homes, in secretive and makeshift clinics, risking their lives to provide care. Under oppressive regimes, doctors may be risking their lives just by refusing to be complicit in torture. 

In Syria, a group known as the "Damascus Doctors" has been organising on Facebook to provide hidden clinics in areas of protest, as reported by CNN. These doctors are upholding a tradition of professionalism and protest that existed since at least 1980, when more than 100 healthcare professionals were arrested for striking to demand the lifting of Syria's state of emergency, in place since 1963 (as of 1990, at least 90 of them remained missing). These doctors, like many others who have opposed the regime, were subjected to gruesome physical and psychological torture. 

The overwhelming majority of Syrian physicians have likely been acting heroically. It is in their honour that we should pursue aggressive international efforts to document and disqualify those physicians complicit in torture. This will require emboldened international institutions, cooperation among national licensing bodies, and the courage of doctors, journalists, activists and human rights organisations in documenting and reporting medical torture. 

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the former president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

As Dominique Strauss-Kahn, head of the world’s most powerful financial institution, the International Monetary Fund (IMF), spends a few nights in Rikers Island prison awaiting a hearing, the world is learning a lot about his history of treating women as expendable sex objects. Strauss-Kahn has been charged with rape and forced imprisonment of a 32-year-old Guinean hotel worker at a $3,000-a-night luxury hotel in New York.

While the media dissects the attempted rape of a young African woman and begins to dig out more information about Strauss-Kahn’s past indiscretions, we couldn’t help but see this situation through the feminist lens of the “personal is political.” 

For many in the developing world, the IMF and its draconian policies of structural adjustment have systematically “raped” the earth and the poor and violated the human rights of women. It appears that the personal disregard and disrespect for women demonstrated by the man at the highest levels of leadership within the IMF is quite consistent with the gender bias inherent in the IMF’s institutional policies and practice.

Systematic Violation of Women’s Human Rights

The IMF and the World Bank were established in the aftermath of World War II to promote international trade and monetary cooperation by giving governments loans in times of severe budget crises. Although 184 countries make up the IMF’s membership, only five countries—France, Germany, Japan, Britain, and the United States—control 50 percent of the votes, which are allocated according to each country’s contribution.

The IMF has earned its villainous reputation in the Global South because in exchange for loans, governments must accept a range of austerity measures known as structural adjustment programs (SAPs). A typical IMF package encourages export promotion over local production for local consumption. It also pushes for lower tariffs and cuts in government programs such as welfare and education. Instead of reducing poverty, the trillion dollars of loans issued by the IMF have deepened poverty, especially for women who make up 70 percent of the world’s poor.

IMF-mandated government cutbacks in social welfare spending have often been achieved by cutting public sector jobs, which disproportionately impact women. Women hold most of the lower-skilled public sector jobs, and they are often the first to be cut. Also, as social programs like caregiving are slashed, women are expected to take on additional domestic responsibilities that further limit their access to education or other jobs.

In exchange for borrowing $5.8 billion from the IMF and World Bank, Tanzania agreed to impose fees for health services, which led to fewer women seeking hospital deliveries or post-natal care and naturally, higher rates of maternal death.  In Zambia, the imposition of SAPs led to a significant drop in girls’ enrollment in schools and a spike in “survival or subsistence sex” as a way for young women to continue their educations.

But IMF’s austerity measures don’t just apply to poor African countries. In 1997, South Korea received $57 billion in loans in exchange for IMF conditionalities that forced the government to introduce “labor market flexibility,” which outlined steps for the government to compress wages, fire “surplus workers,” and cut government spending on programs and infrastructure. When the financial crisis hit, seven Korean women were laid off for every one Korean man. In a sick twist, the Korean government launched a "get your husband energized" campaign encouraging women to support depressed male partners while they cooked, cleaned, and cared for everyone.

Nearly 15 years later, the scenario is grim for South Korean workers, especially women. Of all OECD countries, Koreans work the longest hours: 90% of men and 77% of women work over 40 hours a week.  According to economist Martin Hart-Landsberg, in 2000, 40 percent of Korean workers were irregular workers; by 2008, 60 percent worked in the informal economy. The Korean Women Working Academy reports that today 70 percent of Korean women workers are temporary laborers.

Selling Mother Earth

IMF policies have also raped the earth by dictating that governments privatize the natural resources most people depend on for their survival: water, land, forests, and fisheries. SAPs have also forced developing countries to stop growing staple foods for domestic consumption and instead focus on growing cash crops, like cut flowers and coffee for export to volatile global markets. These policies have destroyed the livelihoods of small-scale subsistence farmers, the majority of whom are women.

“IMF adjustment programs forced poor countries to abandon policies that protected their farmers and their agricultural production and markets,” says Henk Hobbelink of GRAIN, an international organization that promotes sustainable agriculture and biodiversity. "As a result, many countries became dependent on food imports, as local farmers could not compete with the subsidized products from the North. This is one of the main factors in the current food crisis, for which the IMF is directly to blame."

In the Democratic Republic of Congo (DRC), IMF loans have paved the way for the privatization of the country’s mines by transnational corporations and local elites, which has forcibly displaced thousands of Congolese people in a context where women and girls experience obscenely high levels of sexual slavery and rape in the eastern provinces. According to Gender Action, the World Bank and IMF have made loans to the DRC to restructure the mining sector, which translates into laying off tens of thousands of workers, including women and girls who depend on the mining operations for their livelihoods. Furthermore, as the land becomes mined and privatized, women and girls responsible for gathering water and firewood must walk even further, making them more susceptible to violent crimes.

We Are Over It

Women’s rights activists around the globe are consistently dumbfounded by how such violations of women’s bodies are routinely dismissed as minor transgressions. Strauss-Kahn, one of the world’s most powerful politicians whose decisions affected millions across the globe, was known for being a “womanizer” who often forced himself on younger, junior women in subordinate positions where they were vulnerable to his far greater power, influence, and clout. Yet none of his colleagues or fellow Socialist Party members took these reports seriously, colluding in a consensus shared even by his wife that the violation of women’s bodily integrity is not in any sense a genuine violation of human rights.

Why else would the world tolerate the unearthly news that 48 Congolese women are raped every hour with deadening inaction? Eve Ensler speaks for us all when she writes, “I am over a world that could allow, has allowed, continues to allow 400,000 women, 2,300 women, or one woman to be raped anywhere, anytime of any day in the Congo. The women of Congo are over it too.”

We live in a world where millions of women don’t speak their truth, don’t tell their dark stories, don’t reveal their horror lived every day just because they were born women.  They don’t do it for the same reasons that the women in the Congo articulate – they are tired of not being heard. They are tired of men like Strauss-Kahn, powerful and in suits, believing that they can rape a black woman in a hotel room, just because they feel like it. They are tired of the police not believing them or arresting them for being sex workers. They are tired of hospitals not having rape kits. They are tired of reporting rape and being charged for adultery in Iran, Pakistan, and Saudi Arabia.

Fighting Back

For each one of them, and for those of us who have spent many years investing in the tenacity of women’s movements across the globe, the courage and gumption of the young Guinean immigrant shines like the torch held by Lady Liberty herself. This young woman makes you believe we can change this reality. She refused to be intimidated.  She stood up for herself. She fought to free herself—twice—from the violent grip of the man attacking her. She didn’t care who he was—she knew she was violated and she reported it straight to the hotel staff, who went straight to the New York police, who went straight to JFK to pluck Strauss-Kahn from his first-class Air France seat.

In a world where it often feels as though wealth and power can buy anything, the courage of a young woman and the people who stood by her took our breath away. These stubborn, ethical acts of working class people in New York City reminded us that women have the right to say “no.”  It reminded us that “no” does not mean “yes” as the Yale fraternities would have us believe, and, most importantly that no one, regardless of their position or their gender, should be above the law.  A wise woman judge further drove home the point about how critically important it is to value women’s bodies when she denied Strauss-Kahn bail citing his long history of abusing women.

Strauss-Kahn sits in his Rikers Island cell. It would be a great thing if his trial succeeds in ending the world’s tolerance for those who discriminate and abuse women. We cannot tolerate it one second longer.  We cannot tolerate it at the personal level, we must refuse to condone it at the professional level, and we must challenge it every time it we see it in the policies of global institutions like the International Monetary Fund.

The Center on Democracy, Development, and the Rule of Law (CDDRL) is pleased to announce that undergraduate senior honors student Yihana von Ritter was awarded The Firestone Medal for Excellence in Undergraduate Research for her outstanding thesis examining HIV/AIDS policy in Papua New Guinea. Von Ritter was presented with the award at a ceremony held on June 11 during commencement weekend at Stanford University.

Von Ritter, a political science major, spent the summer of 2010 on the Papua New Guinea island of Karkar, where she performed extensive field research. She interviewed over 40 government officials, medical personnel, religious and civic leaders, youth, and HIV positive individuals. Her thesis entitled "Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea," underscored the fact that while only 1% of Papua New Guinea's adult population is AIDS-infected, a public health crisis is looming if preventative policies are not swiftly adopted.

According to her thesis co-advisor Professor Emeritus David Abernethy, Von Ritter's thesis received the Firestone Medal­--awarded to the top ten percent of honors theses in social science, science, and engineering--for its remarkable combination of social science analysis and informed policy advocacy.

"Von Ritter provides policy-relevant recommendations in her thesis to enhance interagency communication and encourage active government leadership (in Papua New Guinea)," said Abernethy. Von Ritter also worked closely with Francis Fukuyama, FSI senior fellow and CDDRL faculty member, who provided guidance and support during the thesis writing process.

Purun Cheong and Kamil Dada were both recipients of the CDDRL Undergraduate Honors Program "Best Thesis Award" for their outstanding research and policy-relevant scholarship. Cheong, an international relations major, critically evaluated the failed United Nations state-building efforts in East Timor in his thesis, "When the Blind lead: The United Nations in East Timor-Lessons in State Building."

After spending a summer conducting research in Pakistan, Dada, a political science major, wrote "Understanding International Democracy Assistance: A Case Study of Pakistan," a sobering account of democracy assistance to Pakistan. Cheong and Dada were both advised by CDDRL director Larry Diamond.

CDDRL congratulates the 2011 graduating class of CDDRL Undergraduate Honors

Students:

Purun Cheong

International Relations

"When the Blind Lead: The United Nations in East Timor- Lessons in State Building"

Kamil Dada

Political Science

"Understanding International Democracy Assistance: A Case study of Pakistan"

Sarah Guerrero

International Relations

"Automation Nation: Electronic Elections, Electoral Governance and Democratic Consolidation in the Philippines"

Ayesha Lalji

International Relations

"Unleashing the Cheetah Generation: How Mobile Banking Enables Access to Capital for the Poor in Developing Countries"

Lauren Swartz

International Relations

"Agribusiness as a Means of Economic Development: Case Studies of Chile and Mexico"

Ann Thompson

History

"The Other Side of the Coin: The US Military and Afghan Women in Contemporary Counterinsurgurgency Operations"

Yihana von Ritter

Political Science

"Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea"

Ari Weiss

International Relations

"Israel: Managing Diversity with Democracy"

 Check out more photos of this event on our Facebook Page: http://www.facebook.com/StanfordCDDRL

The February 10 Liberation Technology seminar titled, Can ICT Improve Clean Water Delivery Systems in Slums? Lessons from Kibera was led by two Stanford students, Katherine Hoffman, M.A. Candidate in International Policy Studies and Global Health together with Sunny Jeon, PhD candidate in Political Science. Hoffman and Jeon presented on the topic of the M-Maji system, a start-up non-profit project that uses mobile phones to empower communities with better information about water availability, price, and quality. M-Maji emerged from the Designing Liberation Technologies course taught at the Stanford d.school, which is dedicated to using mobile phone technology for health improvement in Kibera.  

The M-Maji project was conceived to confront a specific need in one of Africa's largest informal settlements: Nairobi's Kibera slum. Kibera holds about one quarter of Nairobi's population, but lacks a formal water and sanitation system. In short, water in Kibera is scarce, costly, uncertain, and often contaminated. The cost of water can rise up to over $3 per square meter during a shortage, and often takes up 20% of residents' income. Water is uncertain because about 40% of vendors in Kibera do not have access to a constant supply of water, especially since many of the connections that they do use are illegal. Additionally, water is often contaminated because water pipes run through sewer areas and are often plastic, since metal pipes would be taken as scrap. The result of these conditions is that the average person spends about 55 minutes per day looking for water, and about 68% of residents use informal water kiosks to access water.

M-Maji is a mobile platform designed to address problems facing both the seller and buyer of water in Kibera. Sellers report information about water availability and price at their water kiosk, enabling them to attract customers. Meanwhile, buyers access the system to find information about where water is available, at what price and at what level of quality. A third feature of the platform enables complaints and feedback regarding water sources. By coordinating and centralizing water information from multiple sources, M-Maji is designed to empower residents with better information about water availability, price, and quality, which ultimately helps to improve access to clean water.

There are several key reasons why a mobile platform that tackles the information side of the problem may be effective in solving the water problem in Kibera:

1. The water market is distorted, but not coordinated. Also, there is significant variation between neighborhoods.
2. Information asymmetry exists that is not solved by other sources or tools.
3. M-maji is needs-driven.
4. Relative to other interventions, M-Maji is cost-sensitive and low tech.

Although fieldwork conducted by the M-Maji team has indicated great potential for the platform's success, the team has also faced many challenges in implementation. One example stems from the platform's use of USSD sessions. Like SMS, these sessions allow short messages (up to 182 characters) to be exchanged. Users must enter a short code to begin a session, which then lasts about 2 minutes. However, the team has faced significant difficulty in getting mobile operators to allow access to USSD (in Swahili), as well as to negotiate rate agreements with mobile operators. The involvement of gangs and government in the water market introduces another challenges. In some cases, gangs bribe utility people to restrict the supply to push up prices, which may hinder the eventual effectiveness of the M-Maji tool.

Following the formation of a partnership with an important local NGO in Kibera called Umande Trust, M-Maji is moving rapidly into the pilot stage. The team is currently working to carry out a randomized impact evaluation to obtain convincing estimates of M-Maji's cost-effectiveness and impact on water outcomes. With the help of the community partner, the team is running a six-month long pilot on the West side of Kibera. In addition to surveying 1000 households for the baseline survey, the team is also carrying out data collection on water prices and water quality. M-Maji will officially launch in May or June of 2011, and the team will continue to reassess the project to better meet user needs as the results of the pilot become available.