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Human rights and doctors in Egypt
1085
its effect spread like wild fire, and sick funds refused to pay the vast sums claimed for the drug. Although the heroin "substitute" did not work in a certain percentage of addicts, the conversion of codeine or dihydrocodeine to morphine being dependent on the subjects enzymatic phenotype, there was pressure on doctors to prescribe it. The cases brought to the professional courts were lost and the sick funds had to pay for the drug. Penning et al cannot say whether 2 L of 25% dihydrocodeine a week caused death when taken by one person or whether the prescription was shared. In any case, the monthly consumption of 16 kg pure dihydrocodeine by Augsburg’s pharmacies alone should prompt authorities and physicians to think twice before prescribing dihydrocodeine as a heroin substitute.
Karl H. Kimbel
Human Human
Rights
rights and doctors
in
Egypt
The intimidation and torture of civilians by the Egyptian security forces continues despite well-publicised denials from President Mubarak during his recent meeting with President Clinton. Christopher Bums-Cox and I from Physicians for Human Rights (UK) returned from Cairo on April 11, after a week’s fact-finding investigation into human rights abuses. We had been invited by the Medical Syndicate, the Egyptian doctors’ professional association. Institutionalised ill-treatment of prisoners seems now that the emergency powers of detention without trial have been in operation for more than a generation. Contemporary testimonies from victims and lawyers attest that inhumane practices persist, although the methods of torture have been refined to hinder detection. Safwat Abdel Ghani is the prime defendant in the case of the assassinated former speaker of the People’s Assembly, Dr Rifa’at al-Mahgoub. Last week in court he demonstrated how he had been tortured at arrest, during his transfer and later in prison. "I was suspended over a door from my hands which were tied behind my back, or suspended from the ceiling by the feet, or given electric shocks to my chest and genitals." All 20 of his co-defendants claim to have been tortured. Examinations by forensic doctors confirm that 18 had wounds consistent with their allegations. In a new move the Government has started to try civilians in military courts, whose practices do not meet internationally recognised standards of justice. Al Sharif Hassan Ahmed, along with 7 others tried in absentia, was sentenced to death in Alexandria in December, 1992, by a military court. There is no right of appeal. 5 of the defendants alleged that they were tortured, and forensic reports confirm the presence of wounds consistent with their allegations. There are always several doctors in detention, the figures blipping during "sweeps" such as in the Imbaba district of Cairo in December, 1992, when 700 people were detained. Dr Ali-Ibrahim El-Dewi was a junior surgeon when he was arbitrarily arrested because, he was told, of his beard in July, 1992. At the Lazoughly interrogation centre he was subjected to 20 minutes of electric shocks daily over one week. Dr Ahmed Abda Selim and Dr Mohamed Ahmed Shoeb have been detained for years without trial, while Dr Mahmoud Abdulrahman Mohamed was detained only 2 months ago-and there are others. Last week Dr Magdy Hassannien Morsey was charged with offering an illegal
widespread
because he refused to cooperate over evidence on another patient. The case collapsed once the forensic doctor discovered that the woman had never been pregnant. Prisoners have died because of poor medical care. Detained doctors help when they can but risk reprisals when they intervene. Detailed allegations naming 2 prison doctors as colluding with or supervising torture and 2 forensic doctors as writing biased reports favouring the security forces were passed on to us. Most forensic doctors, however, submit accurate reports despite working for the Ministry of Justice. Last December their collective integrity was rewarded with the accolade Human Rights Personality of the Year presented annually by the Egyptian Organisation of Human Rights. They were forbidden to attend the
abortion
to a woman
falsifying
ceremony.
Two months ago the People’s Assembly passed a new law intended to prevent the 19 professional organisations (syndicates) from being run by small groups of political activists (see Lancet Feb 27, p 549). In recent years the medical, legal, and engineering bodies have elected Islamists (mainstream, not fundamentalists) to their executive committees. The new rules require a threshold percentage turnout of voters to "earn" electoral validity. Failure to reach the threshold triggers judicial control of the syndicate until new elections take place. The imposition of the new law violates international covenants governing non-interference in the affairs of unions, to which Egypt is a party, and has been described by the Egyptian Organisation of Human Rights as a setback for civil rights. Whether the new law will prevent activists from winning elections remains to be seen but for any administration to tamper with an established democratic process because it dislikes the results is disturbing. When the regime is autocratic, is supported by a brutal state security system that the Government cannot or will not control, and is imposing yet another measure curtailing civilian autonomy, then international condemnation should follow. Last week a government spokeswoman denied that there is systematic torture of detainees. "No security personnel has been convicted of torture because none has been satisfactorily identified", she added-a statistic not unrelated to the illegal yet universal practice of blindfolding every prisoner
during questioning. Peter Hall
Conference Legal implications of transsexualism 21 years after Sweden became the first European state to adopt legislation on transsexualism, wide national differences persist on the issue of "gender rights". To some extent, the differences reflect the enigma of whether the profound conviction of belonging to the opposite sex has physical or psychological causes. In the absence of any serious challenge to the view that gender reassignment is a worthwhile and beneficial intervention in carefully screened cases, the three-day conference organised by the Council of Europe, the
International Commission on Civil Status, and the Free University tended to concentrate on legal implications. Only in rare cases have medical practitioners faced criminal prosecution arising from operations, although Geneva law professor Michael Will pointed out that as recently as 1990 a French doctor who operated on a male-to-female patient
its effect spread like wild fire, and sick funds refused to pay the vast sums claimed for the drug. Although the heroin "substitute" did not work in a certain percentage of addicts, the conversion of codeine or dihydrocodeine to morphine being dependent on the subjects enzymatic phenotype, there was pressure on doctors to prescribe it. The cases brought to the professional courts were lost and the sick funds had to pay for the drug. Penning et al cannot say whether 2 L of 25% dihydrocodeine a week caused death when taken by one person or whether the prescription was shared. In any case, the monthly consumption of 16 kg pure dihydrocodeine by Augsburg’s pharmacies alone should prompt authorities and physicians to think twice before prescribing dihydrocodeine as a heroin substitute.
Karl H. Kimbel
Human Human
Rights
rights and doctors
in
Egypt
The intimidation and torture of civilians by the Egyptian security forces continues despite well-publicised denials from President Mubarak during his recent meeting with President Clinton. Christopher Bums-Cox and I from Physicians for Human Rights (UK) returned from Cairo on April 11, after a week’s fact-finding investigation into human rights abuses. We had been invited by the Medical Syndicate, the Egyptian doctors’ professional association. Institutionalised ill-treatment of prisoners seems now that the emergency powers of detention without trial have been in operation for more than a generation. Contemporary testimonies from victims and lawyers attest that inhumane practices persist, although the methods of torture have been refined to hinder detection. Safwat Abdel Ghani is the prime defendant in the case of the assassinated former speaker of the People’s Assembly, Dr Rifa’at al-Mahgoub. Last week in court he demonstrated how he had been tortured at arrest, during his transfer and later in prison. "I was suspended over a door from my hands which were tied behind my back, or suspended from the ceiling by the feet, or given electric shocks to my chest and genitals." All 20 of his co-defendants claim to have been tortured. Examinations by forensic doctors confirm that 18 had wounds consistent with their allegations. In a new move the Government has started to try civilians in military courts, whose practices do not meet internationally recognised standards of justice. Al Sharif Hassan Ahmed, along with 7 others tried in absentia, was sentenced to death in Alexandria in December, 1992, by a military court. There is no right of appeal. 5 of the defendants alleged that they were tortured, and forensic reports confirm the presence of wounds consistent with their allegations. There are always several doctors in detention, the figures blipping during "sweeps" such as in the Imbaba district of Cairo in December, 1992, when 700 people were detained. Dr Ali-Ibrahim El-Dewi was a junior surgeon when he was arbitrarily arrested because, he was told, of his beard in July, 1992. At the Lazoughly interrogation centre he was subjected to 20 minutes of electric shocks daily over one week. Dr Ahmed Abda Selim and Dr Mohamed Ahmed Shoeb have been detained for years without trial, while Dr Mahmoud Abdulrahman Mohamed was detained only 2 months ago-and there are others. Last week Dr Magdy Hassannien Morsey was charged with offering an illegal
widespread
because he refused to cooperate over evidence on another patient. The case collapsed once the forensic doctor discovered that the woman had never been pregnant. Prisoners have died because of poor medical care. Detained doctors help when they can but risk reprisals when they intervene. Detailed allegations naming 2 prison doctors as colluding with or supervising torture and 2 forensic doctors as writing biased reports favouring the security forces were passed on to us. Most forensic doctors, however, submit accurate reports despite working for the Ministry of Justice. Last December their collective integrity was rewarded with the accolade Human Rights Personality of the Year presented annually by the Egyptian Organisation of Human Rights. They were forbidden to attend the
abortion
to a woman
falsifying
ceremony.
Two months ago the People’s Assembly passed a new law intended to prevent the 19 professional organisations (syndicates) from being run by small groups of political activists (see Lancet Feb 27, p 549). In recent years the medical, legal, and engineering bodies have elected Islamists (mainstream, not fundamentalists) to their executive committees. The new rules require a threshold percentage turnout of voters to "earn" electoral validity. Failure to reach the threshold triggers judicial control of the syndicate until new elections take place. The imposition of the new law violates international covenants governing non-interference in the affairs of unions, to which Egypt is a party, and has been described by the Egyptian Organisation of Human Rights as a setback for civil rights. Whether the new law will prevent activists from winning elections remains to be seen but for any administration to tamper with an established democratic process because it dislikes the results is disturbing. When the regime is autocratic, is supported by a brutal state security system that the Government cannot or will not control, and is imposing yet another measure curtailing civilian autonomy, then international condemnation should follow. Last week a government spokeswoman denied that there is systematic torture of detainees. "No security personnel has been convicted of torture because none has been satisfactorily identified", she added-a statistic not unrelated to the illegal yet universal practice of blindfolding every prisoner
during questioning. Peter Hall
Conference Legal implications of transsexualism 21 years after Sweden became the first European state to adopt legislation on transsexualism, wide national differences persist on the issue of "gender rights". To some extent, the differences reflect the enigma of whether the profound conviction of belonging to the opposite sex has physical or psychological causes. In the absence of any serious challenge to the view that gender reassignment is a worthwhile and beneficial intervention in carefully screened cases, the three-day conference organised by the Council of Europe, the
International Commission on Civil Status, and the Free University tended to concentrate on legal implications. Only in rare cases have medical practitioners faced criminal prosecution arising from operations, although Geneva law professor Michael Will pointed out that as recently as 1990 a French doctor who operated on a male-to-female patient