Intended for healthcare professionals

Rapid response to:

Analysis

Clinical care and complicity with torture

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k449 (Published 02 February 2018) Cite this as: BMJ 2018;360:k449

Rapid Response:

Re: Clinical care and complicity with torture

Clinical care and complicity with torture: Israel

Berger et al provide a telling description of the shocking involvement of US health professionals in the torture of detainees (“enhanced interrogation”) after 9/11, adding to the published literature on the active complicity of the American Psychological Association (APA). This has extended to the refusal of the APA to take ethical action against the individual psychologists involved (1).

We support the authors’ call for sanctions against health professionals in collusion with these practices. In this we point to a case of physician complicity with torture for which a mountain of incriminating evidence has accumulated over many years, and which has never been acted on. It is 22 years since Amnesty International concluded that Israeli doctors working with the security services “form 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”. (2) Physicians for Human Rights-Israel (PHRI)/Public Committee Against Torture in Israel have since published exemplary studies, drawing in personal testimonies and often naming the Israeli doctors implicated (3-7). Doctors saw the prisoners at various points before, between, or after episodes of torture (which in one case led to spinal damage and disability), did not take a proper history or write up an honest medical record, made no protest on these men's behalf, and typically prescribed simple analgesia before returning them to their interrogators. Moreover the very presence of doctors as unit members conferred a sense of moral legitimacy to interrogators.

In 2009 an evidence-based appeal on behalf of 725 physicians from 43 countries to the World was submitted to Medical Association (WMA), pointing to the studied refusal of the Israeli Medical Association (IMA), a WMA member, to take action. As PHRI concluded in ‘Doctoring the Evidence, Abandoning the Victim: the Involvement of Medical Professionals in Torture and Ill-treatment in Israel’, “persistently repeated requests calling the IMA’s attention to cases arousing suspicion of doctors’ involvement in torture and cruel or degrading treatment, have not been dealt with substantively” (5). PHRI noted that IMA ethical codes privileged a duty to assist the security services ahead of duty to the patient. This is not consistent with the WMA Declaration of Tokyo, the seminal ethical code for doctors in relation to the practice of torture.

The IMA is a WMA member and at the time the WMA President was the IMA President Yoram Blachar. The WMA refused even to acknowledge our submission, and President Blachar began a libel suit in London against the convenor (DS). It became clear that the WMA would not act against the IMA under any circumstances, and this appears to remain true. Indeed the next WMA President will be IMA President Leonid Eidelman.

In 2016, 71 UK doctors made a fresh submission, with further published evidence, to the then WMA President Sir Michael Marmot, a well-known UK medical academic. He refused to submit it to WMA due process, nor reply to us, but claimed that past investigations had shown that the IMA had not been in ethical breach. Yet no proper investigation has ever occurred - all the evidence points the other way, as the PHRI quote above attests. Marmot’s exoneration of the IMA on behalf of the WMA granted them a propaganda coup widely reported in the Israeli media. He refused three requests by the BMJ for an explanation (8). We also approached the BMA, also an IMA member, but were told they could not assist.

Last December 11 I attended a public meeting at the Battersea Arts Centre at which the commentator Mark Thomas was interviewing Sir Michael Marmot. The event was being filmed. At question time I challenged Marmot about the role he had played in the events above. He responded by telling us all that he had spoken to PHRI who had informed him that they no longer had any medical ethical concerns. When I contacted PHRI they denied saying this, and confirmed that Israeli physicians and the IMA continue to be in breach of the Declaration of Tokyo (9).

We endorse the call by Berger et al that doctors should not allow themselves to be stationed in settings where torture is likely. Indeed PHRI has long noted that torture as state practice in Israel could not continue if doctors were withdrawn from service in interrogation units.

Berger et al do not address the question of the integrity and effectiveness of the WMA in policing medical ethics as commissioned to do when created in 1947 in the light of egregious abuses by German and Japanese doctors in World War 2. We note that others are calling for an overhaul of the WMA, which from the experience we relate above is not fit for purpose (10). The Israel case continues to be a standing reproach to the idea that global regulation of the ethical behaviour of doctors is even-handed and effective. As with the US case, the question is whether those with powerful friends continue to enjoy impunity.

1. Boulanger G. The American Psychological Association: from impunity to shame. Int J of Applied Psychoanalytic Studies 2017. https://doi.org/10.1002/aps.1518.
2. Amnesty International. “Under constant medical supervision”, torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: Amnesty International, 1996.
3. Physicians for Human Rights-Israel. “Ticking Bombs”. Www.stoptorture.org.il/en/node/69.
4. Meyers A, Summerfield D. The campaign about doctors and torture in Israel two years on. BMJ 2011;343:d5223.
5. Public Committee Against Torture in Israel/ Physicians for Human Rights-Israel. Doctoring the Evidence, Abandoning the Victim: the Involvement of Medical Professionals in Torture and Ill-treatment in Israel. stoptorture.org.il 2011.
6. Gulland A. Doctors in Israeli detention facilities are complicit in torture, says report. BMJ 2011;343:d7200.
7. Weishut D. Sexual torture of Palestinian men by Israeli authorities. Reproductive Health Matters doi: 10.1016/j.rhm.2015.11.019.
8. Summerfield D, Burns-Cox C. Sir Michael Marmot, the World Medical Association and medical complicity with torture in Israel. www.bmj.com/content/349/bmj.g4386/rr
9. Ziv H. PHRI. email 7 Jan 2018.
10. Berger D. Time for an overhaul at the WMA. BMJ 2017;357:j1955.

Competing interests: No competing interests

20 March 2018
Derek A Summerfield
Honorary Senior Clinical Lecturer
Chris Burns-Cox
Institute of Psychiatry, Psychology & Neuroscience, King's College
De Crespigny Park, London SE5 8BB