Truth and reconciliation … and justice

HEALTH AND HUMAN RIGHTS

The TRC drew in part on the model of the Chilean commission, but differs from it and other truth commissions because it had the power to Truth and reconciliation . . . and justice offer amnesties to those who perpeSee Commentary page tc tc tc trated abuses. People who believed that they may have committed human should be prosecuted by the internarights violations had to actively seek n July, 1998, the statute for an tional community.2 From Pinochet’s an amnesty, which could only be International Criminal Court was given in circumstances where abuses adopted, and will come into effect 60 coup on Sept 11, 1973, to the end of occurred in the pursuit of political days after the 60th state deposits his dictatorship in 1990, military rule objectives. The TRC’s Amnesty instruments of ratification with the was ruthless and abuses were authoCommittee is continuing with its work UN Secretary General. The court rised or tolerated at the highest levels to decide on applications and may itself will not function until some of government. continue well into 1999. There is contime after that.1 Pinochet only relinquished power Meanwhile, troversy in South Africa as to whether when he was made a life senator and, egregious crimes and human to prosecute those who did not apply thus, immune from prosecution in rights violations remain unpunished for amnesty or to grant a general Chilean courts for human rights violaaround the world. Two recent events amnesty. The TRC also recomtions. One feature of the negotiated reveal the unresolved issues that result mended compensation payments to transition to democracy in 1990 was from periods of systematic human victims of serious abuses or to their that there should rights violations families. be a National and have prompted That doctors took part in the sysTruth and Reconmuch debate about tematic, virtually medicalised torture ciliation Commisreconciliation, justhat occurred in Chilean secret detension to establish the tice, and impunity. tion centres is well known. However, facts about human In London, there was no detailed consideration of rights violations Augusto Pinochet, the role of doctors by the Rettig during the military the former Chilean Commission, although in 1982 the dictatorship.3 This military dictator, Demonstrators in London Chilean Medical Association elected was arrested on Oct commission, estabnew officers, reversed its 1973 pro16, at the request of Spanish judges lished by President Patricio Aylwin Junta position, and in the mid 1980s who are seeking his extradition in conand chaired by Raúl Rettig Guissen, investigated medical collaboration in nection with the torture, murder, disand its successor, the Reparation and human rights abuses, particularly torappearances of Spanish citizens in Reconciliation Corporation, reported ture.5 The TRC report includes a Chile during Pinochet’s 17-year rule. in 1992 and 1996, respectively, and Pinochet’s lawyers successfully argued documented 3197 extrajudicial execuchapter on the role of the health sector before the High Court that his role as tions, disappearances, and deaths during more than 30 years of Head of State rendered him immune under torture. However, no prosecuapartheid. After reviews of the ethical before the courts of a foreign power. tions resulted from the commission, and legal framework of medical pracThe House of Lords ended an appeal although it provided evidence to the tice in South Africa, this chapter hearing on Nov 12 reserving judgcourts and recommended compensaexamines the function of district surment. On Nov 25, in a three-to-two tion to victims and their relatives. geons under apartheid. In a submislandmark ruling, the Law lords While lawyers in London contested sion to the TRC in June, 1997, the announced that Pinochet did not have the case of Pinochet, lawyers for forDepartment of Health noted that immunity and that an extradition mer State President F W De Klerk because district surgeons worked in an hearing could proceed. In the crucial and for the African apartheid culture they judgment, Lord Nicholls of National Congress (ANC) believed it was “normal” Birkenhead declared “International sought to muzzle the not to give black people law has made plain that certain types South African Truth and the same services as of conduct, including torture and Reconciliation Commiswhites. This chapter of the hostage-taking, are not acceptable sion (TRC), as it was TRC report also sumconduct on the part of anyone. This about to publish its marises the Biko case and applies as much to heads of state, or final five-volume report. those of other victims of even more so, as it does to everyone De Klerk obtained an apartheid and cites indielse; the contrary conclusion would interim court order to Desmond Tutu vidual examples of profesmake a mockery of international law”. compel the TRC to sional misconduct by The victims of human rights abuses remove passages that referred to his unnamed doctors. The chapter in Chile during the military dictatorrole in, and responsibility for, human assesses the wide-ranging effects of ship did not benefit from due process, rights violations. There will be a furinstitutionalised racism on the health rights of appeal, and other legal safether court hearing in March, 1999. community and on the false applicaguards—a point made by protesters in The ANC objected to the TRC’s findtion of medical expertise. It also London, Madrid, and Santiago, who ings that it had been responsible for examines military medicine and feaurged the prosecution of Pinochet. human rights violations, but their tures of mental health practice during International calls for the prosecution case failed and on Oct 29 the report the apartheid years. The report as a of the military leaders in Chile have a was handed to President Mandela whole will take time to digest but it is long history. As far back as 1976, the by TRC Chairperson, Desmond a compelling account of systematic, UN Ad-Hoc Working Group on Chile Tutu.4 An additional volume of the racially based oppression that touched concluded that cases of torture comevery sector and every individual in TRC amnesties will be published in mitted by the military government South African society. 1999.

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HEALTH AND HUMAN RIGHTS

The Chilean and South African experiences show how the search for truth, reconciliation, and justice is fraught with conflict, and that the resolution of this tension is a major challenge. The prosecution of Pinochet would be a decisive act that would add justice and accountability to the long-term objectives of establishing a just and secure civil society in the period that follows national trauma. The General’s arrest has shown that the social divisions amplified by the

dictatorship in Chile remain—and in South Africa, the slow transition to genuine democracy and effective rule of law has just begun. James Welsh Coordinator, Medical Programme, Amnesty International, 1 Easton Street, London WC1X 8DJ, UK 1

Rome Statute of the International Criminal Court. UN document A/CONF.183/9. July 17, 1998.

2 3

4

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UN document A/31/253. Oct 8, 1976: paragraph 511. Report of the National Truth and Reconciliation Commission, 2 vols. Berryman PE, trans. Notre Dame: Centre for Civil and Human Rights, Notre Dame Law School, 1993. South African Truth and Reconciliation Commission. Final report, 5 vols. Johannesburg: TRC, 1998. Chilean Medical Association. The participation of physicians in torture. In: Stover E. The open secret: torture and the medical profession in Chile. Washington DC: American Association for the Advancement of Science, 1987: 65-78.

Human rights in the USA: land of the free? “The IV line then wiggled a bit, a sign that one of the medical technicians behind a second curtain had inserted the first of three syringes—bringing a chemical that induces unconsciousness—into the line. At the second wiggle, a chemical to stop Wright’s breathing headed for his veins. His chest and stomach heaved deeply, again, again, again, again. Then it stopped. A third wiggle from the intravenous tube brought the final dose into the lethal cocktail, a chemical to stop his heart. Several minutes later, after a doctor watching a heart monitor gave the signal, Wright was declared dead.” 1

n Oct 14, Dwayne Wright became the third juvenile offender known to have been put to death in the world this year.2 All three offenders had a history of learning difficulties and all were executed in the USA. Their killings violated the international ban on the death penalty against those who commit crimes when under the age of 18 years, and were an affront to the Universal Declaration of Human Rights (UDHR). The 50th anniversary of the UDHR is on Dec 10, 1998, and it seems an appropriate time to examine how respect for human rights is faring in the USA—one of the Declaration’s chief architects. Not well, according to Rights for All,3 Amnesty International’s report on the USA and the launch pad for a global campaign that aims to bring US laws and practices into line with the international human rights standards inspired by the UDHR. The execution of juvenile offenders is just one of the many alarm bells rung by Rights for All. The report also highlights widespread cruelty in prisons and, persistent police brutality, and unfair use of the death penalty, with numerous mentally ill inmates among the 3500 prisoners now on death row. In a country with extreme disparities of wealth and power and a continuing racial divide, the poor and members of ethnic minorities bear the brunt of these human rights violations. An increasing emphasis on punishment rather than rehabilitation has led to a deterioration of standards for a prison population that has tripled since 1980 to over 1·7 million inmates, half of whom are African Americans. Women are the fastest-

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growing group of prisoners, numbering 137 000 in 1997. Many incarcerated women have suffered appalling abuses, including sexual abuse such as rape and inadequate health care. Restraints and shackles have been used on pregnant women; in 1996, more than 1000 babies were born in US prisons. Children, too, are being caught up in an ever-widening prison system in the USA, the only country in the world apart from Somalia not to have ratified the Convention on the Rights of the Child. In violation of international standards, over 4000 children are currently held with adult prisoners and are at serious risk of physical and sexual abuse. Children held in juvenile facilities have been subjected to punitive solitary confinement and cruel use of force and restraints, and many of those with mental health problems have been denied adequate services.4 The past 2 years has seen a 75% rise in immigration detainees, over 6000 of whom are held in local jails. Among them are asylum seekers fleeing trauma and persecution in their own countries, only to find themselves treated like criminals in the USA, vulnerable to shackling, strip-searches, physical and verbal abuse, and cut off from outside support. Overcrowding and inadequate resources have contributed to dangerous and inhumane conditions in many detention facilities. Inadequate health care has been repeatedly uncovered, for example, lack of screening for communicable

diseases, failure to refer seriously ill inmates for treatment, and grossly deficient treatment for mentally ill prisoners. The growth of supermaximum security units raises concern for the mental health of 13 000 prisoners who spend up to 24 hours a day isolated in tiny cells, usually with little access to fresh air or daylight. Supermax prisons are part of the trend towards containment, echoed also in the wide range of devices used to control and incapacitate inmates, for example, restraint boards and chairs, chemical sprays, and electroshock weapons. Prisoners with mental illness have been tied to boards for lengthy periods in fourpoint restraints without proper medical authorisation or supervision. One inmate with a history of self-mutilation was shackled to a steel board on a cell floor for 12 weeks in 1995. The restraint chair, frequently used without appropriate medical assessment of the inmate, has been used in circumstances that amount to torture or cruel, inhuman, and degrading treatment. The report cites three recent cases of death after restraint in such chairs for long periods, including one prisoner who died in 1997 after being shackled in a chair for 16 hours. Amnesty International is calling for a national inquiry into the use of the chair, a ban on the easily abused stun belt, and suspension of all other electro-shock devices, pending the outcome of investigations into their use and health risks. Electro-shock weapons and other restraint methods are also used on the 1853