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An international minefield
HEALTH AND HUMAN RIGHTS
An international minefield
James Welsh, Adriaan van Es
Two major international agreements, an anniversary, and a truth commission report dominate the human-rights landscape of 1998. In July, an international diplomatic conference in Rome adopted a statute to create the International Criminal Court, which would try crimes against humanity, consolidating the principles embodied in the tribunals on Yugoslavia and Rwanda. In September, the Convention against Landmines was ratified by Burkina Faso, the 40th state to do so, thus enabling it to come into force in March, 1999. And throughout 1998 the 50th anniversary of the Universal Declaration of H u m a n Rights (which fails on 10 December) has prompted renewed interest and debate in ethics teaching and human-rights principles in medicine and promotion of the declaration by health and human-rights organisations. At a national level, the exhaustive inquiry into humanrights violations during the apartheid period in South Africa came to an end in June. Among the many issues examined, the Truth and Reconciliation Commission looked specifically at the role of the health professions in human-rights abuses--a first for such a truth commission. The report was handed to President Mandela on 29 October after last-minute legal appeals by the African National Congress to stop publication failed. The year was also the story of individual doctors: the tragic crash of Swissair 111 on 2 September deprived the human-rights community of Jonathan Mann, whose inspirational role in public health (above all, in AIDS) and in h u m a n rights will be greatly missed. Prisoners of conscience Nguyen Dan Que (Vietnam) and Beko Ransome-Kuti ('Nigeria) were released from gaol following prolonged campaigning by human-rights organisations. Desi Mendoza (Cuba), has been released from prison whilst serving an 8-year sentence for criticism of the official response to a dengue fever outbreak. He is expecting to go into exile in Spain. However, a rare prosecution of a doctor for humanrights violations commenced: a Sudanese doctor working in Scotland was prosecuted for alleged involvement in torture in Sudan; the case continues. Namibia decided to extradite a Rwandan doctor and former political leader to the International Criminal Tribunal on Rwanda in Tanzania. By contrast, the former Bosnian Serb leader and psychiatrist, Dr Karadzic, remained at liberty, beyond the reach of the International Criminal Tribunal on Yugoslavia. The number of prosecutions by the two tribunals remains small. Organisations working with people traumatised by torture campaigned against this abuse on 26 June, the inaugural United Nations day in support of torture victims. A centre for victims of torture in Turkey was closed down by the government just days before the U N Lancet 1998; 352: (suppl IV): 14 Amnesty International, London WCIX 8DJ, UK (J Welsh PhD); International Federation of Health and Human Rights Organizations, 3800 BN Amersfoort, The Netherlands
(Adriaan van Es MD)
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day, although it reopened by the end of June. The incident underlined the case for a U N Special Rapporteur on impartiality and integrity of health professionals, as proposed in 1997 by non-governmental organisations and professional bodies. Campaigners against female genital mutilation took heart from the ruling of Egypt's highest court at the end of 1997 to prohibit the practice. This followed a ban imposed by the Egyptian health minister last year, which was subsequently reversed by a lower court. The West African state of Togo announced in late October that it also was banning female genital manipulation. Reports of an altemative non-mutilating ritual as a rite of passage came from Kenya, although this was one small glimmer of hope in a practice otherwise resistant to reform. China and Guatemala both carried out their first executions by lethal injection in 1998 (with China marketing for transplantation only the organs from those prisoners executed by shooting). The Filippino authorities were scheduled to carry out their first lethal injection execution, of a prisoner convicted of rape, in late 1998. In the coming year we can expect a continued growth in human-rights activism in the health professions, an increase in asylum-related health and welfare concerns, and the continuing need to respond to problems created by war, inter-ethnic tension (at the time of writing the conflict in Kosovo remains unresolved), and poverty. It will be a year in which the interdependence between health and human rights, so effectively articulated by Jonathan Mann, will need to be seriously addressed. Key references for 1998 A m n e s t y I n t e r n a t i o n a l . L e t h a l Injection: T h e Medical Technology of Execution. London: A m n e s t y International, 1998. M a n n J. A I D S and h u m a n rights: where do we go f r o m here? Health a n d H u m a n Rights 1998; 3: 143-49. Rasekh R, B a u e r HM, M a n o s MM, Iacopino V. W o m e n ' s h e a l t h h u m rights in Afghanlstan.JAM-d 1998; 280: 449-55. South African Truth a n d Reconciliation C o m m i s s i o n Final Report, five volumes. Johannesburg: T R C , 1998. W o r l d Health Organlsation. R e p o r t o f the W H O Informal Consultation on Health and H u m a n Rights. Geneva: W H O , 1998. The Lancet • End of year review • Vol 352 • 1998
An international minefield
James Welsh, Adriaan van Es
Two major international agreements, an anniversary, and a truth commission report dominate the human-rights landscape of 1998. In July, an international diplomatic conference in Rome adopted a statute to create the International Criminal Court, which would try crimes against humanity, consolidating the principles embodied in the tribunals on Yugoslavia and Rwanda. In September, the Convention against Landmines was ratified by Burkina Faso, the 40th state to do so, thus enabling it to come into force in March, 1999. And throughout 1998 the 50th anniversary of the Universal Declaration of H u m a n Rights (which fails on 10 December) has prompted renewed interest and debate in ethics teaching and human-rights principles in medicine and promotion of the declaration by health and human-rights organisations. At a national level, the exhaustive inquiry into humanrights violations during the apartheid period in South Africa came to an end in June. Among the many issues examined, the Truth and Reconciliation Commission looked specifically at the role of the health professions in human-rights abuses--a first for such a truth commission. The report was handed to President Mandela on 29 October after last-minute legal appeals by the African National Congress to stop publication failed. The year was also the story of individual doctors: the tragic crash of Swissair 111 on 2 September deprived the human-rights community of Jonathan Mann, whose inspirational role in public health (above all, in AIDS) and in h u m a n rights will be greatly missed. Prisoners of conscience Nguyen Dan Que (Vietnam) and Beko Ransome-Kuti ('Nigeria) were released from gaol following prolonged campaigning by human-rights organisations. Desi Mendoza (Cuba), has been released from prison whilst serving an 8-year sentence for criticism of the official response to a dengue fever outbreak. He is expecting to go into exile in Spain. However, a rare prosecution of a doctor for humanrights violations commenced: a Sudanese doctor working in Scotland was prosecuted for alleged involvement in torture in Sudan; the case continues. Namibia decided to extradite a Rwandan doctor and former political leader to the International Criminal Tribunal on Rwanda in Tanzania. By contrast, the former Bosnian Serb leader and psychiatrist, Dr Karadzic, remained at liberty, beyond the reach of the International Criminal Tribunal on Yugoslavia. The number of prosecutions by the two tribunals remains small. Organisations working with people traumatised by torture campaigned against this abuse on 26 June, the inaugural United Nations day in support of torture victims. A centre for victims of torture in Turkey was closed down by the government just days before the U N Lancet 1998; 352: (suppl IV): 14 Amnesty International, London WCIX 8DJ, UK (J Welsh PhD); International Federation of Health and Human Rights Organizations, 3800 BN Amersfoort, The Netherlands
(Adriaan van Es MD)
srvl4
day, although it reopened by the end of June. The incident underlined the case for a U N Special Rapporteur on impartiality and integrity of health professionals, as proposed in 1997 by non-governmental organisations and professional bodies. Campaigners against female genital mutilation took heart from the ruling of Egypt's highest court at the end of 1997 to prohibit the practice. This followed a ban imposed by the Egyptian health minister last year, which was subsequently reversed by a lower court. The West African state of Togo announced in late October that it also was banning female genital manipulation. Reports of an altemative non-mutilating ritual as a rite of passage came from Kenya, although this was one small glimmer of hope in a practice otherwise resistant to reform. China and Guatemala both carried out their first executions by lethal injection in 1998 (with China marketing for transplantation only the organs from those prisoners executed by shooting). The Filippino authorities were scheduled to carry out their first lethal injection execution, of a prisoner convicted of rape, in late 1998. In the coming year we can expect a continued growth in human-rights activism in the health professions, an increase in asylum-related health and welfare concerns, and the continuing need to respond to problems created by war, inter-ethnic tension (at the time of writing the conflict in Kosovo remains unresolved), and poverty. It will be a year in which the interdependence between health and human rights, so effectively articulated by Jonathan Mann, will need to be seriously addressed. Key references for 1998 A m n e s t y I n t e r n a t i o n a l . L e t h a l Injection: T h e Medical Technology of Execution. London: A m n e s t y International, 1998. M a n n J. A I D S and h u m a n rights: where do we go f r o m here? Health a n d H u m a n Rights 1998; 3: 143-49. Rasekh R, B a u e r HM, M a n o s MM, Iacopino V. W o m e n ' s h e a l t h h u m rights in Afghanlstan.JAM-d 1998; 280: 449-55. South African Truth a n d Reconciliation C o m m i s s i o n Final Report, five volumes. Johannesburg: T R C , 1998. W o r l d Health Organlsation. R e p o r t o f the W H O Informal Consultation on Health and H u m a n Rights. Geneva: W H O , 1998. The Lancet • End of year review • Vol 352 • 1998