Human rights abuses common in southern Iraq between 1991 and 2003

03/18/04

Nearly half of the households surveyed in southern Iraq report that human rights abuses occurred among household members between 1991 and 2003, according to a study in the March 24/31 issue of The Journal of the American Medical Association (JAMA).

Although human rights abuses have been reported in Iraq, the full scope of these abuses has not been well documented, according to background information in the article.

Lynn L. Amowitz, M.D., M.S.P.H., M.Sc., of the Physicians for Human Rights, Boston, and colleagues conducted a study to assess the nature and scope of human rights abuses in southern Iraq since 1991 and to examine Iraqi views on women's health and human rights. The study consisted of a survey of 1,991 Iraqi men and women, representing 16,520 household members in three major cities in southern Iraq. The survey was conducted in July 2003, using structured questionnaires.

Respondents averaged 38 years of age, and were mostly of Arab ethnicity (99.7 percent) and Muslim Shi'a (96.7 percent). "Overall, 47 percent of those interviewed reported 1 or more of the following abuses among themselves and household members since 1991: torture, killings, disappearance, forced [military service], beating, gunshot wounds, kidnappings, being held hostage, and ear amputation, among others. Seventy percent of abuses were reputed to have occurred in homes. Baath party regime-affiliated groups were identified most often (95 percent) as the perpetrators of the abuses; 53 percent of the abuses occurred between 1991 and 1993, following the Shi'a uprising, and another 30 percent between 2000 and the first 6 months of 2003," the authors write.

"Education and work opportunities for women were both highly supported by men and women. However, men were significantly less supportive than women of these rights and of women's civil and political rights. Half of respondents agreed that there were reasons to restrict women's educational opportunities (53 percent) and work opportunities (50 percent) outside the home at the present time. Both men and women were less likely to support women's rights to associate with persons of their choosing and to be able to move about in public without restrictions," the researchers write. The authors also found that more than half of both men and women agreed that a man had a right to beat his wife if she did not obey him.

Respondents support an Iraqi society that protects and promotes human rights, but neither men nor women support a full range of human rights for women.

(JAMA. 2004;291:1471-1479. Available post-embargo at JAMA.com)

Editor's Note: The survey was made possible by a grant from the John D. and Catherine T. MacArthur Foundation.

IRAQI PHYSICIANS REPORT ON PHYSICIAN PARTICIPATION IN HUMAN RIGHTS ABUSES

About half of Iraqi physicians surveyed indicate that some physicians have participated in a variety of human rights abuses in Iraq, including physical mutilation and falsification of reports regarding torture, according to a study in the March 24/31 issue of JAMA.

According to background information in the article, although the participation of physicians in human rights abuses in Iraq during the Baath regime has been documented, Iraqi physicians have not, to the authors' knowledge, been surveyed about their own experiences and views on physician involvement.

Chen Reis, J.D., M.P.H., of the Physicians for Human Rights, Boston, and colleagues conducted a survey of physicians in southern Iraq to assess patterns and practices of physician participation in human rights abuses and identified factors that facilitated physician participation in these abuses.

The study consisted of a self-administered survey in June and July, 2003, of 98 physicians and semistructured interviews of hospital directors and physicians in 3 major hospitals with general surgical units in 2 cities in southern Iraq. The majority of participants were male (88 percent) and Shi'a Muslims (97 percent). Respondents had an average of 6.8 years in practice.

"A total of 71 percent of respondents reported that torture was a problem to an extreme extent in Iraq since 1988. The proportion of respondents indicating that, since 1988, their physician peers as a group were extremely or quite a bit involved in human rights abuses included 50 percent for nontherapeutic amputation of ears as a form of punishment, 49 percent for falsification of medical-legal reports of torture, and 32 percent for falsification of death certificates. Few respondents (range, n=2 to 6) reported participation in abuses themselves.

"More than half (52 percent) of respondents indicated that physicians did not willingly participate in these abuses; 93 percent reported that the Iraqi paramilitary force Fedayeen Saddam was responsible for initiating physician complicity. Fear of harm to oneself or family members was a common explanation for complicity. Respondents reported that physicians who refused to participate in abuses faced consequences including loss of job, imprisonment, torture, and disappearance," the researchers write.

Measures suggested to prevent physician involvement in future abuses included ensuring the independence of physicians from state authorities, legal provisions to ensure effective monitoring, punitive sanctions for physicians who commit abuses, and increasing human rights and ethics education of physicians.

(JAMA. 2004;291:1480-1486. Available post-embargo at JAMA.com)

Editor's Note: This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation.

EDITORIAL: MEDICAL ETHICS SUBORNED BY TYRANNY AND WAR

In an accompanying editorial, Edmund D. Pellegrino, M.D., of the Center for Clinical Bioethics, Georgetown University Medical Center, Washington, D.C., examines the studies on human rights abuses in Iraq in this week's JAMA.

"The central problem in the case of Iraqi physicians who have engaged in torture and other abuses is the active and passive collusion of the profession with patriotic and defensive measures justified in the interest of the nation, one's career, or personal safety," he writes. "The study by Reis et al shows again that national and international medical associations must examine more closely the implications of becoming instruments of anything other than the healing purposes for which the profession is ordained."

Concerning the study by Amowitz et al, "Given these findings, it may not be surprising that some Iraqi physicians were acclimated and relatively insensitive to the moral implications of violence, especially against purported enemies of the Baath regime. Both of the articles on human rights abuses in Iraq published in this issue of THE JOURNAL alert the world to the continuing violation of the most fundamental human rights. Even though the United Nations declaration is now 50 years old, it risks becoming little more than a pious and self-righteous travesty if an orderly yet firm international means for enforcement is not found," he concludes.

(JAMA. 2004;291:1505-1506. Available post-embargo at JAMA.com)

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