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Aly A. Misha’l MD, FACP
Islamic Hospital, Amman-Jordan
The World Medical Association ( WMA ) was
founded in 1947, as a response to the egregious abuses by
German and Japanese doctors in World War II, and their
unethical participation in research on humans, and torture
of prisoners.
The first task of WMA was the foundation of
ethical codes for the world medical doctors in their
professional conduct in medical practice and research.
Since then, WMA has become the world
authority in bioethical standards.
In 1964, WMA established the (Declaration of
Helsinki) which has become the cornerstone of conduct in
medical practice and research. To this day the Declaration
has proudly stood the test of time as the world policy
statement in bioethical conduct. It has been amended six
times to face evolving medical and research issues, the most
recent amendment has been in October 2008.
Membership in WMA has been open for medical
societies from all parts of the world, many of which have
signed and abided by its covenant.
Since its establishment, WMA’s general
assembly, in collaboration with its ethical bodies,
undertook elections of WMA successive presidents, from among
doctors with distinguished records in adopting sound ethical
standards in their respective national medical associations.
The new extremely disturbing development,
which shocked many doctors from many parts of the world, was
the selection of the Israeli Dr. Yoram Blacher as its new
president, with his shameful record of unethical conduct in
areas of human rights and torture of prisoners.
It is noteworthy that the doctors who
enthusiastically led the worldwide campaign against this
unethical doctor were from among British and other western
professors and medical professionals.
We present this significant account of these
worldwide efforts to condemn Dr. Yoram Blacher selection,
and to strongly demand his dismissal, to safeguard the
distinguished reputation of WMA as a monument for bioethics.
The most informative account is the
presentation by the British pioneer in this campaign, Dr.
Derek Summerfield (derek.summerfield@googlemail.com),
of the UK Medical Committee for Palestine,:
Background Briefing:
Torture and the Israeli Medical Association:
a brief history
Torture in Israel has a long history and there is a mountain
of documentation in the public realm attesting to it, from
both international and regional (Israeli and Palestinian)
human rights
organisations.
In 1993 the existence of a "fitness for interrogation" form
came to light, to be signed by a doctor. Since interrogation
customarily meant torture, the doctors signing these forms
were giving the green light to the interrogators and their
methods and were thus part of the process themselves.
Amnesty International concluded in 1996 that Israeli doctors
working with the security services "formed 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, and others who approached the
Israeli Medical Association (IMA) to urge them to take a
stand, were consistently rebuffed. This too has been the IMA
response to published material in mainstream medical
journals, notable the British Medical Journal and the
Lancet. In reply to one such paper, published in the Lancet
in 1997, the longstanding president of the IMA Dr. Y Blachar
actually justified the use of "moderate physical pressure",
the euphemism in Israel for torture, and declared as such by
the UN Committee Against Torture!.
The moral position and strategic line taken over many years
by the IMA was well captured by a remark made by Professor
Eran Dolev, than IMA Head of Ethics (yes, Ethics!) in an
interview in 1999 with a visiting delegation from the
Medical Foundation for the Care of Victims of Torture,
London. Prof. Dolev stated that "a couple of broken fingers"
during the interrogation of Palestinians were worthwhile for
the information it might garner. When this was published in
the Journal of the Royal Society of Medicine, verified by
those present at the interview, Dr. Blachar defended Prof.
Dolev.
Indeed 2 years earlier, after a human rights conference in
Gaza in 1997, one of us had written to Dolev in his capacity
as Head of Ethics. An Israeli physician had given an account
of a medical colleague who had confessed to her that he had
removed the intravenous drip from the arm of a seriously ill
Palestinian prisoner, and told the man that if he wanted to
live, he should co-operate with his interrogators. Dolev was
asked to investigate but he never replied, even after
reminders.
When an Israeli psychiatrist Dr. Ruchama Marton, publicised
the unethical role that fellow Israeli doctors were playing
in detention centres by labelling seriously mentally ill
Palestinian detainees as "malingerers", and denying them
treatment, the IMA charged her with slander rather than
investigating the allegations.
The titles of 11 Amnesty reports on Israel/OPT between
2002-7 contained the word "torture".
Torture continues to be a state policy in Israel. The
Israeli human rights documentation centre B'Tselem recently
confirmed (April 2007) that almost all Palestinian detainees
suffer physical and mental abuse amounting to torture,
citing the testimonies of 73 men gathered between July 2005
and January 2006. The IMA maintained a studied silence.
No recent firsthand evidence is more telling than that
compiled by the Israeli organization Public Committee
Against Torture (PCATI), entitled '"Ticking Bombs".
Testimonies of Torture Victims in Israel'. Published in May
2007, their report records the detailed testimony of 9
Palestinian men tortured by Israeli security services
between 2004 and 2006.
Here is graphic demonstration of the conclusions published
by Amnesty International in 1996, and over and over again by
other
organisations, that Israeli doctors form an integral and
everyday part of the running of the interrogation suites
whose output is torture. Doctors, several of whom are
actually named, saw the prisoners at various points between
episodes of torture (which in one case led to spinal cord
damage), did not take a proper history, did not protest on
these men's behalf, and typically prescribed simple
analgesia before returning them to their interrogators. They
did not need to ask the prisoners what had happened to them
because they knew perfectly well. It is also remarkable that
doctors in position of authority were directly involved in
several of these cases, and are also named: the Chief
Medical Officer of the Israeli Prison Service, Dr. Alex
Adler; the Chief Medical Officer of Israeli Police Dr. Tzvi
Lankovski; and- most telling of all- no less than the
Chairman of the Ethics board of the Israeli Medical
Association, Professor Avinoam Reches. These accounts carry
the imprimatur of a human rights organization of many years
standing and high reputation. The named doctors have not
demanded a retraction or sued the report's authors in order
to clear their names. When 7 of us published a short account
in the Lancet, the IMA wrote to us to threaten to sue,
though in the same email (which we have retained) they
conceded that Professor Reches had been sent a copy at the
time. Thus the IMA condemned itself out of its own mouth,
since inaction in the face of reputable evidence of torture,
and of doctor's involvement, violates the WMA codes- in
particular the anti-torture Declaration of Tokyo- to which
the IMA is signed up as a member. As the Executive Director
of Physicians for Human Rights-Israel put it in the Lancet
in 2003, the IMA's collusion with torture is part of "its
long tradition of siding with 'national Israeli
considerations' rather than with universal medical ethics".
Amnesty International's briefing to the UN Committee Against
Torture of 30 Sept 2008 concludes as before: "This briefing
focuses on Amnesty International's concerns about Israel's
failure to implement the Convention Against Torture in the
Occupied Palestinian territories (OPT) and the
intensification of measures amounting to cruel, inhuman and
degrading treatment and punishment......."
On 2 Nov 2008, the Public Committee Against Torture in
Israel, in conjunction with the Association for Civil Rights
in Israel, and HaMoked, the Centre for the Defence of the
Individual, PCATI "filed a contempt of court motion to the
High Court of Justice against the government of Israel and
its head, Prime Minster, Ehud Olmert, and against the
General Security Service (GSS) and its head Yuval Diskin,
for their responsibility for a policy that grants a-priori
permits to use torture in interrogations that fundamentally
violate the High Court of Justice decision of September
1999."
The 25 Nov 2008 Annual Report of the United Against Torture
Coalition (UAT), included more than 80 pages of affidavit
material. The Report formed the basis of their submission to
the UN Committee Against Torture in September 2008, pending
the Committee's next review of Israel's compliance with CAT
due in May 2009. The UAT Coalition examined the use of
torture and ill-treatment by the Israeli authorities against
Palestinians from the point of arrest, through interrogation
and detention as well as the use of coerced confessions in
the military courts.
Please note again the surely devastating conclusions of this
Report:
“The UAT Coalition concludes that the use of
torture and ill-treatment by Israeli authorities against
Palestinians is both widespread and systematic. The State is
either unwilling or unable to fulfil its treaty obligations
under CAT. The UAT Coalition has recorded evidence of acts,
omissions and complicity by agents of the State at all
levels, including the army, intelligence service, the
police, the judiciary and other branches of government. The
Coalition is of the view that until this culture of impunity
is addressed the situation is unlikely to improve”.
This, then, is a brief account of torture as state policy in
Israel, and of the shameful and unethical role played over
many years by the IMA and its longstanding President Dr.
Yoram Blachar as part of the culture of impunity to which
the UAT Coalition refers. Those who had cared to examine
this record over many years were nonplussed when Dr. Blachar
became Chair of Council of the World Medical Association in
2003, and are staggered that he now takes the Presidency
itself!
We are challenging Blachar's appointment on the torture
issue specifically, though the other arm of our case against
him and the IMA would be their refusal to hold the Israeli
Government and Defence Force to account for their systematic
violations of the 4th Geneva Convention, specifically those
clauses which guarantee the right of a civilian population
in a conflict zone to unimpeded access to services vital to
life: food, water, health care etc, and which guarantee
health workers, clinics, ambulances etc immunity from
military action. The assault on Gaza in December-January
2008-9 amply and terribly demonstrated what Physicians for
Human Rights Israel (for whom I have the greatest respect)
wrote at the time of the 2002 invasion of the West Bank. "We
believed that the IMA might be able to curb the appalling
deterioration in the attitude of Israeli military forces
towards Palestinian health and rescue services. Yet despite
severe injury to medical personnel and to the ability of
physicians to act in safety to advance their patients'
interests; despite Israeli shells that have fallen on
Palestinian hospitals; despite the killing of medical
personnel on duty- IMA has chosen to remain silent."
(
End of Dr. Summerfield presentation ).
And now
we
come to the letter sent to the Chairman of the WMA Council,
Secretary General and to the Director of Ethics.
The letter was signed by Professor Alan Meyers from Boston
University School of Medicine – USA, and signed by a list of
(724) doctors from all over the world:
Dear WMA Council Chair Dr. Edward Hill and the Council
We the undersigned 725 physicians represent both academic
medicine (114 professors) and clinical practice in 43
countries. A matter of grave concern to us, and a threat to
the public reputation of the World Medical Association, has
brought us together in this perhaps unprecedented medical
initiative. We wish to publicly protest and appeal against
the recent appointment of Dr. Yoram Blachar, longstanding
President of the Israeli Medical Association, as President
of the World Medical Association. We believe that his
Presidency makes a mockery of the principles on which the
WMA was founded in 1947, which was as a response to
egregious abuses by German and Japanese doctors in World War
Two.
The WMA's own Declaration of Tokyo (1975) specifies that
"physicians shall not countenance, condone or participate in
the practice of torture or other forms of cruel, inhuman or
degrading procedures, and in all situations, including armed
conflict and civil conflict". The WMA Annual General
Assembly of 2007 made it clear that inaction was not an
option, stating that "this is the first time the WMA has
explicitly obliged doctors to document cases of torture of
which they become aware. The absence of documenting and
denouncing such acts might be considered as a form of
tolerance and of non-assistance to the victims".(1)
There are still more recent calls from authoritative
academic sources for the international medical community to
go much further in actively allying itself with efforts to
suppress mistreatment of prisoners.(2)
Amnesty International concluded as long ago
as 1996 that Israeli doctors working with the security
services "formed 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".(3)
Dr. Blachar, already IMA President, took no action.
Amnesty's briefing to the UN Committee against Torture in
September 2008 "focuses on Amnesty International's
(continuing) concerns about Israel's failure to implement
the Convention against Torture in the Occupied Palestinian
Territories and the intensification of measures amounting to
cruel, inhuman and degrading treatment and punishment".(4)
A well publicised report in 2007 by the Public Committee
Against Torture in Israel (PCATI), based on the detailed
testimony of 9 Palestinian men tortured between 2004 and
2006, gives a graphic demonstration of the extent to which
Israeli doctors continue to form an integral and everyday
part of the running of interrogation suites whose output is
torture.(5) The IMA have conceded that they were
aware of this report, but did nothing. More recently, at a
meeting on December 10, 2008 in Tel Aviv, with Dr. Blachar
presiding only weeks after his inauguration as WMA
President, Physicians for Human Rights Israel again sought
(unsuccessfully) to get the IMA to face this report and all
the other evidence in the public domain.
In its 2008 annual report to the UN Committee against
Torture, the UAT Coalition, a coalition of 14 Israeli and
Palestinian human rights organisations, concluded that
"since the Committee last reviewed Israel, the practice of
torture and ill treatment has continued unabated. The UAT
Coalition wishes to inform the Committee that in its opinion
the use of torture and ill treatment by Israeli authorities
against Palestinians is both widespread and systematic. The
UAT Coalition has recorded evidence of acts, omissions and
complicity by agents of the State at all levels....until
this culture of impunity is addressed this situation is
unlikely to improve".(6)
In November 2008, 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 grants a-priori permits to use torture in
interrogations. The IMA have never challenged torture as
state policy in Israel.
Dr. Blachar went as far as to justify the use in Israel of
"moderate physical pressure" (condemned as torture by the UN
Committee Against Torture) in the fourth paragraph of a
letter published in the international medical journal, The
Lancet, in 1997 (7). This surely unprecedented
action by the president of a national medical association
has not been disowned, and renders him unfit for the office
of WMA President. In the age of evidence-based medicine, his
rejection of the documentary record has been unprofessional
and frequently contemptuous. On the British Medical Journal
(BMJ) website he dismissed a BMJ paper on health and human
rights in the Occupied Palestinian Territories- which cited
Amnesty, Johns Hopkins University, the International Court
of Justice, a UN Rapporteur and Physicians for Human Rights
Israel- as "the lies and filth he spews and "reminiscent of
some of the worst forms of anti-Semitism ever espoused"(8)
Indeed Dr. Blachar has made statements which were untrue,
and which he must have known were untrue, on at least 10
occasions in the Lancet and the BMJ in the past decade.(9)
Given that these 2 international medical journals are
amongst the world's most prestigious and influential, this
is an intended corruption of the public record.
IMA membership of WMA appears to have been a fig leaf: The
IMA website pays lip service to medical ethics, but Dr.
Blachar has overseen a studied failure to take the actions
mandated by the Declaration of Tokyo.
We conclude that under Dr. Blachar's leadership the IMA made
a decision on political grounds years ago to turn a blind
eye to torture in Israel and the institutionalised
involvement of doctors. This stance continues with Dr.
Blachar as WMA President. On an issue that goes to the heart
of the moral authority of the profession, Dr. Blachar has
offered shameful ethical leadership to doctors in Israel and
worldwide.
It could scarcely be more scandalous that he now assumes the
Presidency of the official international body overseeing
medical ethics. This appointment will seriously damage the
public reputation of the WMA and its work, and risks making
it a laughing stock. We call upon the WMA Council to oblige
Dr. Blachar to step down as a matter of priority.
Since the WMA is mandated to ensure that its member
associations conform to its codes, we also request an
investigation into the IMA record highlighted above.
In view of the public importance of this issue, we are
copying our letter and supporting documentation to
international medical journals and mainstream newspapers for
coverage.
We hope to hear from you and the WMA Council as soon as
possible please.
Yours sincerely,
Professor Alan Meyers (afmeyers@bu.edu)
and 724 other physicians from: United Kingdom, Canada, USA,
Lebanon, Egypt, Israel, Jordan, Italy, South Africa, Norway,
Occupied Palestinian Territories, Malaysia, Switzerland,
Algeria, Iraq, Eire, Spain, Australia, India, New Zealand,
Germany, France, Sweden, Pakistan, Tunisia, Morocco, Saudi
Arabia, Greece, Libya, Turkey, Bahrain, Belgium, Peru,
Syria, Qatar, Nigeria, Czech Republic, Zambia, Denmark,
Dubai, Kuwait, Argentina.
(
Full signatory list was attached )
References
1. World Medical Association. Doctors urged to document
cases of torture. Press Release 8 Oct 2007.
2. Miles S, Freedman A. Medical ethics and torture: revising
the Declaration of Tokyo. Lancet 2009: 373:344-48.
3. Amnesty International. "Under constant medical
supervision",torture, ill-treatment and the health
professions in Israel and the Occupied Territories. London.
Amnesty International. MDE 15/37/96. 1996.
4. Amnesty International. Israel/OPT. Briefing to the
Committee Against Torture. MDE 15/040/2008. 2008.
5. Public Committee Against Torture in Israel. Ticking
Bombs testimonies of torture victims in Israel. PCATI 2007.
6. Defence for Children International. Palestine Section.
UAT Report: Torture and ill-treatment in Israel and the OPT.
2008.
7. Blachar Y. The truth about Israeli medical ethics.
Lancet 1997;350:1247. (see also pdf attachment).
8. Blachar Y. Response from the Israeli Medical
Association. Rapid Responses,
bmj.com, 15
December 2004.
9. Untrue statements by Dr. Blachar in the British Medical
Journal and the Lancet:
§
Blachar Y. BMJ 1996;
313:630. "...the association (IMA) has done its utmost to
ensure that Israeli physicians neither directly nor
indirectly participate in any acts of torture".
§
Blachar Y. BMJ 2003;
327:1107. "..a collusion of doctors and torture that does
not exist".
§
Blachar Y. BMJ 2005;
330:254-5. ".. neither the IMA nor WMA is willing to give
credence to the half-truths and untruths".
Blachar Y. BMJ 2005; 331;699. (re torture etc) "..the IMA
looks into any claims brought to our attention".
§
Dyer O. BMJ 2007;
334:871 (quoting Blachar) ".. the IMA has on many occasions
denounced the use of torture and any involvement by
physicians in torture".
More such statements as Rapid Responses at
bmj.com <http://bmj.com/>.
Blachar Y. Lancet 1996; 348:1748. (Re Amnesty report on
torture in Israel) "..our organisation endeavours to ensure
that Israeli physicians neither directly nor indirectly
participate in any acts of torture".
§
Blachar Y. Lancet
1997; 350:1247. "..the IMA has frequently and unequivocally
denounced the use of torture". (In 4th para of same letter
he defends moderate physical pressure, condemned as torture
by UN Committee on Torture!)
§
Blachar Y. Lancet
2001; 361:425." torture is abhorrent and the IMA in no way
endorses it".
§
Blachar Y. Lancet
2003; 361:1827. "..the IMA has also contacted the Ministry
of Health to ensure reportage of ethical problems
encountered in the course of treatments or any instances of
unethical treatment of patients".
§
Blachar Y. Lancet
2003; 362:252. (re torture) "..IMA has always made it clear
that doctors are not to be involved in such acts..to the
best of our knowledge, Israeli doctors have not taken part
or assisted in such acts".
§
Blachar Y. Lancet
2003; 362:1675. (re Doctors in Conflict) "..I object
strenuously to your implication that I would deviate from a
universally accepted code of medical ethics.. the IMA has
been working for years to ensure that human and medical
rights in the territories are maintained".
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