Bahrain unrest

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2768 (Published 04 May 2011) Cite this as: BMJ 2011;342:d2768
  1. Richard Sollom, deputy director,
  2. Vince Iacopino, senior medical adviser
  1. 1Physicians for Human Rights, Cambridge, MA 02138, USA
  1. rsollom{at}phrusa.org

Breaches principles of medical neutrality and international law

Thousands of protesters in the small island Kingdom of Bahrain in the Persian Gulf took to the streets calling for government reform in early 2011. The government’s response was brutal and systematic: shoot civilian protesters, detain and torture them, and erase all evidence. On the frontline, treating hundreds of these wounded civilians, doctors had firsthand knowledge of these abuses and suffered from them themselves. Physicians for Human Rights and Médecins Sans Frontières each reported on these attacks against medical personnel, which were the result of their efforts to provide neutral care to wounded pro-democracy demonstrators.

On 22 April a report by Physicians for Human Rights documented violations of well established principles of medical neutrality (box).1

Violations of principles of medical neutrality by the Bahraini authorities1

  • Abducted medical professionals and detained them with no means of communication

  • Attacked ambulances: removed ambulance medics, and forced them to give their uniforms to police who then posed as medics

  • Prevented ambulances from reaching people who needed medical care

  • Blockaded health facilities and obstructed delivery of care

  • Destroyed medical records

  • Militarised the country’s main tertiary care hospital, preventing medical staff and patients from entering or leaving

  • Hunted down patients wounded in protests by searching medical centres and setting up police check points

  • Forcibly discharged patients, detained them, and held them with no means of communication

  • Humiliated, beat, and abused patients while in medical centres

  • Tortured patients to extract false confessions of subversive and illegal activity

The assault on healthcare workers and their patients violates the principle of medical neutrality as well as international law. Medical neutrality ensures the protection of medical personnel, patients, facilities, and transport from attack or interference; unhindered access to medical care and treatment; the humane treatment of all civilians; and non-discriminatory treatment of the injured and sick.2

When countries engage in war or experience civil unrest, the independence of doctors and other medical personnel is often hindered. Although the laws of war protect the sick and wounded in time of armed conflict and oblige doctors to provide them neutral and ethical care,3 these same legal protections are not as clearly articulated in human rights law during civil unrest.4 A doctor’s ethical responsibility during time of peace is identical to that during time of war,5 yet a state’s obligations towards its medical workers under international law in each of these situations are less evident.6

The principle of medical neutrality embodies international medical ethics and is summarised in the Geneva conventions, which set the standard for international humanitarian law, or the laws of war.7 Although international humanitarian law may not apply to the current situation in Bahrain, because it is not an armed conflict, principles of medical neutrality are reinforced in various human rights treaties, which Bahrain has a duty to uphold. International human rights law applies at all times, unlike international humanitarian law, which applies only during armed conflict.8

Major international human rights instruments such as the international covenant on civil and political rights; international covenant on economic, social, and cultural rights; and the convention against torture, all of which the Kingdom of Bahrain has ratified,9 provide a solid foundation on which norms of medical neutrality stand.

The international covenant on civil and political rights, for example, forbids arbitrary arrest and detention,10 and it describes very limited situations in which derogation from this principle is allowed.11 The arbitrary arrest and detention of medical personnel in Bahrain violates this international treaty.

The international covenant on economic, social, and cultural rights summarises the right to health and explicitly calls on governments to provide access to medical care in a non-discriminatory manner for those in need.12 The wilful blocking of medical care to injured Bahraini civilians violates this treaty.

In addition, the convention against torture forbids governments from torturing their citizens and from engaging in acts of cruel, inhuman, and degrading treatment.13 This prohibition on government action relates to all potential victims, including people in need of medical care. Subjecting patients to torture or cruel, inhuman, and degrading treatment is a clear violation of the convention against torture. The recent attacks on Bahraini civilians violate these human rights treaties and place the Kingdom of Bahrain in breach of its international legal obligations.

In addition to violating well founded international human rights law, attacks on medical professionals interfere with their ethical obligations to provide unbiased care to those in need. The World Medical Association’s international code of medical ethics and medical ethics manual describe the duties of doctors, which include administering emergency care and adhering to principles of non-discrimination.14 Governments should not infringe upon the duties of medical professionals and should not target or punish those who seek to uphold these internationally recognised principles.

Violations of medical neutrality will continue in times of war and civil unrest. The international community should tackle such violations by creating a mandate, under the auspices of the United Nations Human Rights Council, for a new thematic special rapporteur on medical neutrality, and through the provision of preventive and remedial protection measures for medical personnel and emergency medical services.


Cite this as: BMJ 2011;342:d2768


  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: they receive grants from the MacArthur Foundation and the Open Society Institute; they both work for Physicians for Human Rights; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed.