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Torture wide spread in China
HEALTH AND HUMAN RIGHTS
Health and human rights
The problems of medical relief agencies ne of the greatest issues faced by relief agencies responding to medical emergencies around the world is how to extricate themselves from the situations in which they find themselves. The problems are usually greater for manmade disasters than for natural ones. Floods do recede, and hurricanes do blow over; the chaos they leave in their wake is tangible, quantifiable, and, at least in immediate health terms, reasonably short lived. It is usually quite easy for an experienced relief agency to determine what must be done and for a donor agency to respond—both knowing that all will be over in about 6 months. The local agencies are set back on their feet and, given a modicum of economic stability, able to cope at about the same level as before the crisis. Relief costs are limited, no dependency created, and a general feeling of satisfaction prevails. But the picture is very different when the chaos is manmade. One of the immediate effects is not only to create a medical emergency but to destroy utterly the health service structures than might contain it in the future. The relief agency is funded to meet the immediate crisis—to control the outbreak of malaria or Lassa fever, to provide basic health care to a mass of displaced people, or restart a collapsed vaccination programme. It does so, and then finds itself immersed in a
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mire of unmet health need for which no help is at hand from local state provision or external donor. The problems are usually compounded by a collapse in basic infrastructure; broken roads and bridges, continued insecurity, a mass of displaced people, interrupted water supplies, defunct schools, and economic mayhem. When the local health provision has been used to an element of cost recovery, this poses even more difficulties. In a recent intervention programme in rural Africa, Merlin found that more than 50% of people could not afford even the tiny amount needed to meet the 10% of drug costs because of an inflation rate of about 1000%. These are the conditions under which Merlin continues to work in the Democratic Republic of Congo; smack between the warring factions in the eastern province of Maniema. With ruined looted health centres and hospitals from which all but a few saintly staff have fled, the only possible policy is to build from the bottom upwards, mobilising and supplementing the few resources that remain. Activities are based on defined measurable indicators which cover as wide a population as can be reached; under-5 mortality, attended deliveries, immunisation cover, health facility use, and all the other measures of a slowly resurgent primary health service. So much of the activities focus on
Torture widespread in China A new report from Amnesty International (AI) shows that torture in China is widespread and systemic, committed in the full range of state institutions, from police stations to “re-education through labour” camps, as well as in people’s homes, workplaces, and in public.1 Those tortured include people in dispute with officials, and alleged criminals. Migrant workers, particularly young women, are frequent victims. Some political activists have been interned in psychiatric institutions as a result of their political acitivities. Many women have been tortured, raped, and sexually abused by police who accuse them of prostitution. Some police detain and torture women in order to extract lists of their clients to blackmail. Alleged prostitutes and clients have died under torture. Those in institutions may also be vulnerable. In July, 1999, a woman wrongly held in a mental institution as a “vagrant” was gang-raped and her family had to pay to have her released. She has so far failed in her attempt to sue the police and the hospital for damages. Others are victims of bureaucratic zeal. Zhou Jiangxiong was detained in May, 1998, by officials at a local birth-control office. They hung him upside down, repeatedly beat him, burned him with cigarette butts, and castrated him. He later died. The 30-year-old farmer from the Hunan province was tortured to death because the officials were trying to make him
THE LANCET • Vol 357 • March 3, 2001
training staff and supplying newly trained staff with the bare essentials to be effective. This has an immediate effect on uptake of health services by the local community to the point that the few remaining staff who have soldiered on with salaries long since unpaid are soon overwhelmed by demand. Naturally they may then begin to look for better opportunities elsewhere. The arrival on any local scene of a vertically organised, donordriven Safe Motherhood or vaccination programme sends shivers of apprehension down the spine; carefully nurtured fragile local structures are suddenly bereft of staff. One of the only two remaining doctors in the Kalima district serving a population of some 150 000 (with a further 22 000 displaced people) has recently left to take up a post with the WHO. More and more agencies, both national and supranational are coming to recognise the problems arising from crisis intervention and to accept the necessity for funding beyond the first few months of immediate need. Welcome though this is, it brings its own problems. The assumption made when setting things to rights, is that they were right before the crisis—efficient, effective, and consistent with basic human rights. This is often not the case, and to attempt otherwise, to set a new template of health provision which specifically involves the com-
reveal the whereabouts of his wife, suspected of being pregnant without permission. Psychiatric hospitalisation is also being used to suppress dissents. On Nov 23, 1999, human rights activist Wang Wanxing was forcibly taken from his home by eight officers to a Beijing psychiatric hospital. His wife was told on an earlier occasion that he was suffering from “political monomania”. However, according to AI’s information, there is no evidence that Wang Wanxing has any form of mental illness. The Chinese Government’s previously stated commitment to end torture is undermined by official directives during periodic anti-crime campaigns and political crackdowns, such as those against the Falun Gong and alleged regional separatists, during which abuses are tolerated if not encouraged. The AI report makes several recommendations to the government including the exclusion from courts all evidence extracted under torture, ending incommunicado and arbitrary detention, ensuring detainees access to lawyers, family, and medical treatment, and instituting an effective complaints mechanism. James Welsh Medical Program, Amnesty International, 1 Easton Street, London WC1X 0DW, UK (e-mail: [email protected]) 1
Amnesty International. Torture—a growing scourge in China—time for action. London: AI, 2001.
713
For personal use only. Reproduce with permission from The Lancet Publishing Group.
Health and human rights
The problems of medical relief agencies ne of the greatest issues faced by relief agencies responding to medical emergencies around the world is how to extricate themselves from the situations in which they find themselves. The problems are usually greater for manmade disasters than for natural ones. Floods do recede, and hurricanes do blow over; the chaos they leave in their wake is tangible, quantifiable, and, at least in immediate health terms, reasonably short lived. It is usually quite easy for an experienced relief agency to determine what must be done and for a donor agency to respond—both knowing that all will be over in about 6 months. The local agencies are set back on their feet and, given a modicum of economic stability, able to cope at about the same level as before the crisis. Relief costs are limited, no dependency created, and a general feeling of satisfaction prevails. But the picture is very different when the chaos is manmade. One of the immediate effects is not only to create a medical emergency but to destroy utterly the health service structures than might contain it in the future. The relief agency is funded to meet the immediate crisis—to control the outbreak of malaria or Lassa fever, to provide basic health care to a mass of displaced people, or restart a collapsed vaccination programme. It does so, and then finds itself immersed in a
O
mire of unmet health need for which no help is at hand from local state provision or external donor. The problems are usually compounded by a collapse in basic infrastructure; broken roads and bridges, continued insecurity, a mass of displaced people, interrupted water supplies, defunct schools, and economic mayhem. When the local health provision has been used to an element of cost recovery, this poses even more difficulties. In a recent intervention programme in rural Africa, Merlin found that more than 50% of people could not afford even the tiny amount needed to meet the 10% of drug costs because of an inflation rate of about 1000%. These are the conditions under which Merlin continues to work in the Democratic Republic of Congo; smack between the warring factions in the eastern province of Maniema. With ruined looted health centres and hospitals from which all but a few saintly staff have fled, the only possible policy is to build from the bottom upwards, mobilising and supplementing the few resources that remain. Activities are based on defined measurable indicators which cover as wide a population as can be reached; under-5 mortality, attended deliveries, immunisation cover, health facility use, and all the other measures of a slowly resurgent primary health service. So much of the activities focus on
Torture widespread in China A new report from Amnesty International (AI) shows that torture in China is widespread and systemic, committed in the full range of state institutions, from police stations to “re-education through labour” camps, as well as in people’s homes, workplaces, and in public.1 Those tortured include people in dispute with officials, and alleged criminals. Migrant workers, particularly young women, are frequent victims. Some political activists have been interned in psychiatric institutions as a result of their political acitivities. Many women have been tortured, raped, and sexually abused by police who accuse them of prostitution. Some police detain and torture women in order to extract lists of their clients to blackmail. Alleged prostitutes and clients have died under torture. Those in institutions may also be vulnerable. In July, 1999, a woman wrongly held in a mental institution as a “vagrant” was gang-raped and her family had to pay to have her released. She has so far failed in her attempt to sue the police and the hospital for damages. Others are victims of bureaucratic zeal. Zhou Jiangxiong was detained in May, 1998, by officials at a local birth-control office. They hung him upside down, repeatedly beat him, burned him with cigarette butts, and castrated him. He later died. The 30-year-old farmer from the Hunan province was tortured to death because the officials were trying to make him
THE LANCET • Vol 357 • March 3, 2001
training staff and supplying newly trained staff with the bare essentials to be effective. This has an immediate effect on uptake of health services by the local community to the point that the few remaining staff who have soldiered on with salaries long since unpaid are soon overwhelmed by demand. Naturally they may then begin to look for better opportunities elsewhere. The arrival on any local scene of a vertically organised, donordriven Safe Motherhood or vaccination programme sends shivers of apprehension down the spine; carefully nurtured fragile local structures are suddenly bereft of staff. One of the only two remaining doctors in the Kalima district serving a population of some 150 000 (with a further 22 000 displaced people) has recently left to take up a post with the WHO. More and more agencies, both national and supranational are coming to recognise the problems arising from crisis intervention and to accept the necessity for funding beyond the first few months of immediate need. Welcome though this is, it brings its own problems. The assumption made when setting things to rights, is that they were right before the crisis—efficient, effective, and consistent with basic human rights. This is often not the case, and to attempt otherwise, to set a new template of health provision which specifically involves the com-
reveal the whereabouts of his wife, suspected of being pregnant without permission. Psychiatric hospitalisation is also being used to suppress dissents. On Nov 23, 1999, human rights activist Wang Wanxing was forcibly taken from his home by eight officers to a Beijing psychiatric hospital. His wife was told on an earlier occasion that he was suffering from “political monomania”. However, according to AI’s information, there is no evidence that Wang Wanxing has any form of mental illness. The Chinese Government’s previously stated commitment to end torture is undermined by official directives during periodic anti-crime campaigns and political crackdowns, such as those against the Falun Gong and alleged regional separatists, during which abuses are tolerated if not encouraged. The AI report makes several recommendations to the government including the exclusion from courts all evidence extracted under torture, ending incommunicado and arbitrary detention, ensuring detainees access to lawyers, family, and medical treatment, and instituting an effective complaints mechanism. James Welsh Medical Program, Amnesty International, 1 Easton Street, London WC1X 0DW, UK (e-mail: [email protected]) 1
Amnesty International. Torture—a growing scourge in China—time for action. London: AI, 2001.
713
For personal use only. Reproduce with permission from The Lancet Publishing Group.