Physician Accountability Physician Accountability for War Crimesfor War Crimes

Steven H. Miles, MDSteven H. Miles, MD

Professor of Medicine and BioethicsProfessor of Medicine and Bioethics

University of MinnesotaUniversity of MinnesotaNo Conflicts of Interest. No commercial products No Conflicts of Interest. No commercial products

mentioned.mentioned.

Physicians and Torture: a 10 year project.

2004 20122007 2009

MD Accountability•Publications•On-line Database •Testimony & Collaborations

MD Codes (Compilations,

Variations, Harmonization,

Reform)

• Publications (incl screening for

torture)

War on Terror MDs•Book & Publications•On-line Databases •Documentary www.doctorsofthedarkside.com/

2

Nuremburg Nazi Medicine Trial, Nuremburg Nazi Medicine Trial, 1946-19471946-1947

► 23 defendants23 defendants 7 death by hanging 7 death by hanging 9 prison terms, 10 9 prison terms, 10

yrs to life, yrs to life,

7 acquitted7 acquitted. .

United Nations

WMA

19561948 1975 1988 2007

Regulation in Armed Conflict

Declaration of

Geneva

UN Principles Protection of

Persons under Detention

Convention Against Torture, Cruel, Inhuman, and

Degrading Treatment

1984

Declaration of Tokyo Duty of MDs

to Document and

Denounce

No Licenses MDs fleeing

prosecution

1997

Clinical Societies Policies

1980

UN Principles Medical Ethics

1946

Study PopulationStudy Population►Doctors punished for torture or war crimes Doctors punished for torture or war crimes

that occurred after 1972 (date of that occurred after 1972 (date of Amnesty). Amnesty).

► International or national courts, medical International or national courts, medical licensing boards. licensing boards.

►Exclude acquittals but Exclude acquittals but Include physicians found guilty and then Include physicians found guilty and then

excused by amnesties, pardons, etc. excused by amnesties, pardons, etc. ►Not an exhaustive list. Not an exhaustive list.

Some torture doctors give self-incriminating Some torture doctors give self-incriminating testimony in exchange for immunity or testimony in exchange for immunity or amnesty. amnesty.

TortureTorture. . . any act by which . . . any act by which severe pain or sufferingsevere pain or suffering, ,

whether physical or mental, whether physical or mental, is is intentionally inflicted intentionally inflicted on a personon a person by, or at the instigation, consent or acquiescence by, or at the instigation, consent or acquiescence

of a person of a person acting in an official capacityacting in an official capacity. .

It does not include pain or suffering arising only from, It does not include pain or suffering arising only from, inherent in, or incidental to, lawful sanctions.inherent in, or incidental to, lawful sanctions.

► ——UN Convention Against TortureUN Convention Against Torture

(abridged)(abridged)

*US Dept of Justice: Office for Victims of Crime; 2000

Prevalence Of Torture Survivors Prevalence Of Torture Survivors

300,000 persons with Scleroderma in US

400,000 persons with Multiple Sclerosis

500,000 with Parkinson Disease500,000 with Parkinson Disease

500,000 Torture Survivors in US*500,000 Torture Survivors in US*

Prevalence of Torture in Some Prevalence of Torture in Some National or Refugee GroupsNational or Refugee Groups

Bhutan

Tibet

Sudan/SomaliaEthiop/Eritrea

Senegal

S. Leone

Iraq

Afghanistan

Bosnia?

80-100 countries practice torture as policy.

Amnesty International, 2008.Refugees from a given country have a higher torture prevalence than nationals.

Cambodia 75-79 Cohort

Zaire

Zimbabwe

Redface: high but percents are not known.Miles SH. Compiled from multiple sources.

500,000 torture survivors.

Timor

AlgeriaGaza

Torturing regimes need doctors.

• Devise means to minimize scars, including psychosexual torture, (a response to human rights groups surveillance).

• Keep alive those who are supposed to live.

• Conceal the cause of death of those who die.

Half of torture survivors report seeing a physician overseeing their

torture.

Study PopulationStudy Population►Doctors punished for torture or war crimes Doctors punished for torture or war crimes

that occurred after 1972 (date of that occurred after 1972 (date of Amnesty). Amnesty).

► International or national courts, medical International or national courts, medical licensing boards. licensing boards.

►Exclude acquittals but Exclude acquittals but Include physicians found guilty and then Include physicians found guilty and then

excused by amnesties, pardons, etc. excused by amnesties, pardons, etc. ►Not an exhaustive list. Not an exhaustive list.

Some torture doctors give self-incriminating Some torture doctors give self-incriminating testimony in exchange for immunity or testimony in exchange for immunity or amnesty. amnesty.

Miércoles, 21 de Febrero de 2007 |

Norberto Atilio Bianco cumplió funciones como médico en el Hospital Militar de Campo de Mayo con el grado de capitán del Ejército durante la última dictadura militar. La Justicia lo condenó en 2000 por la apropiación de dos menores de edad, pero en diciembre del año pasado las Abuelas de Plaza de Mayo sumaron a esa denuncia otra por su responsabilidad en los secuestros y desapariciones de los hijos de, por lo menos, 35 mujeres embarazadas que pasaron por Campo de Mayo.

EL PAIS › LA CAUSA CONTRA BIANCO POR LA REPRESION EN CAMPO DE MAYO

Dueño del destino de las embarazadas Comparta esta nota con un amigo

Siluetas de desaparecidos en el predio de Campo de Mayo.“Pudimos revertir el plan macabro”

Google TranslatorGoogle Translator

21 Feb 2007 ... Dueño del destino de las embarazadas. www.pagina12.com.ar/diario/elpais/subnotas/80690-26051-2007-02-21.html -

[ Translate this page ]

Nation> THE CAUSE AGAINST THE REPRESSION IN BIANCO CAMPO DE MAYO OWNER OF THE FATE OF PREGNANT WOMEN     

Norberto Atilio Bianco served as physician at the Hospital Militar de Campo de Mayo with the rank of captain in the Army during the last military dictatorship. Justice sentenced him in 2000 for the appropriation of two minors, but in December last year, the Grandmothers of Plaza de Mayo joined by another claim that its liability in the abductions and disappearances of children of at least 35 pregnant women who went to Campo de Mayo.

Owner of the fate of pregnant women

Wednesday, February 21, 2007

Silhouettes of the missing at the site at Campo de Mayo. "We will reverse the macabre"

Original Spanish text:

La Justicia lo condenó en 2000 por la apropiación de dos menores de edad, pero en diciembre del año pasado las Abuelas de Plaza de Mayo sumaron a esa denuncia otra por su responsabilidad en los secuestros y desapariciones de los hijos de, por lo menos, 35 mujeres embarazadas que pasaron por Campo de Mayo. Contribute a better translation

South Africa

Greece

Sri Lanka

Uruguay

Argentina

Brazil

Chile

Medical BoardDomestic Court

International CourtDied during crim trial

Combinations signify multiple events for one person

Physicians Sanctioned for War Crimes / Torture 1975-2013

Rwanda

Yugoslavia

Sanctioned Hearing Open

UK

Guyana

Bangladesh

Pakistan

14

Italy

Court Martial (one) 1975 Court Martial (one) 1975 The First post-Nuremburg CaseThe First post-Nuremburg Case

► After the Greek After the Greek junta fell, Dr. Dimitri junta fell, Dr. Dimitri Kofas, supervisor of Kofas, supervisor of torture:torture: Court martialed for Court martialed for

dereliction of duty. dereliction of duty. Imprisoned.Imprisoned.

A Separate Issue: MDs who are A Separate Issue: MDs who are Senior Government OfficialsSenior Government Officials

Dr. C BizimunguForeign Minister

Genocide

Dr. B Simic War Presidency

Crim ag Humanity

Dr. M Stakic VP Munc Assembly

Genocide

These physicians acted These physicians acted as senior government as senior government officials, not as clinicians. officials, not as clinicians. There are 10 more.There are 10 more.

MotivationsMotivations►CareerismCareerism►Patriotism/ Patriotism/

Political Political Affiliations.Affiliations.

►National National emergency. emergency.

►CollegialityCollegiality► Orders.Orders.► Fear.Fear.► Personality disorder.Personality disorder.

Amilcar Lobo Amilcar Lobo

Brazil, PsychiatristBrazil, Psychiatrist

““man has used torture and man has used torture and assas-sination for thousands assas-sination for thousands of years and permitted it as of years and permitted it as long as it is socially organized. long as it is socially organized. It is but a moment from the It is but a moment from the InquisitionInquisition’’s torture and s torture and murder of the Jews to the murder of the Jews to the NaziNazi’’s similar actions forty s similar actions forty years ago. This is human years ago. This is human nature; I am not ashamed to nature; I am not ashamed to be part of it.be part of it.”” Lobo A. Lobo A. A Hora do Lobo e a Hora do A Hora do Lobo e a Hora do

CarneiroCarneiro [The Hour of the Wolf and [The Hour of the Wolf and the Hour of the Sheep.]the Hour of the Sheep.]

Governments Shelter Torture DoctorsGovernments Shelter Torture Doctors

► Amnesties/Excuse crimes committed under Amnesties/Excuse crimes committed under orders.orders.

► Require military courts to screen cases. Require military courts to screen cases.

► Block access to records, military testimony. Block access to records, military testimony.

► Exempt military MDs from license Exempt military MDs from license punishments.punishments.

► Establish government medical associations Establish government medical associations to supersede civilian medical societies. to supersede civilian medical societies.

► Let delicensed MDs work in military Let delicensed MDs work in military hospitals.hospitals.

Types of Hearings as of Types of Hearings as of 2010s2010s

In Progress N=18

Sanctioned N=57

Medical Associations Precede Court Actions (court involvement is often second action against an MD)

Courts vs. Medical License Courts vs. Medical License BrdsBrds

►Crimes Crimes Murder (incl. false Murder (incl. false

death certificates)death certificates) Kidnapping Kidnapping ““TortureTorture”” rarely rarely

indicted because not indicted because not codified. codified.

► SanctionsSanctions ImprisonmentImprisonment Damages to Damages to

survivorssurvivors Revoke pensionsRevoke pensions

►Ethics Ethics ViolationsViolations National codesNational codes Declaration of TokyoDeclaration of Tokyo Hippocratic OathHippocratic Oath

► SanctionsSanctions Suspend licenseSuspend license Revoke licenses Revoke licenses CensureCensure Revoke awards.Revoke awards. Remove from Office.Remove from Office.

20

Denouncing of Physicians

Clinic

Home

Camilo Azar SabaSuspended for six months by the Medical Association for torture of prisoners at barracks of Centro Nacional de Información. Involved in case of Federico Santibanez. Address: Alto Las Condes, ubicada en Avenida Kennedy 9001, piso 7, Mall Alto Las Condes. Phone: 6366666 Web

A Schematic History of A Schematic History of SanctionsSanctions

Torturing regime

Medical Associations

Create new med assnsEmploy sanctioned MDs

In gov hospitals

Civil society

Political affinities

Build supportfor sanctions

Med Assn Sanctions

Med Ethics Awakening

Courts

Court Sanctions

Compile evidenceResistance

Obstruct complaintsAmnesty, PardonsDestroy Evidence

Intimidation

Courts

MDs Sanctioned for TortureMDs Sanctioned for Torture

Few allegations proceed to Few allegations proceed to sanctions.sanctions.

Brazil110 Allegations

10 SanctionsChile

80 Allegations

Argentina200+ Allegations

22 Sanctions

12 Sanctions

National Stages of MD Sanctions for National Stages of MD Sanctions for TortureTorture

Stage IV: Systems for sanction-ing MDs for abetting torture.

Argentina, Brazil, Chile, Italy, Rwanda, Uruguay.

Stage III: Punished a symbolic MD. Greece, India, Pakistan, South Africa, Sri Lanka, UK.

Stage II: Condemn complicity in principle but no punishments of MDs. Egypt, US, Philippines, Venezuela, Uzbekistan…

Stage I: Suppress discussion of MD complicity with torture.

China, North Korea, Syria

Stage I

Stage II

IIIIII Stage IVStage IV

Doctors and TortureDoctors and Torture

Doctors are essential to torturing regimes.

• help minimize scars, • keep alive those who are supposed to live,• conceal the cause of death of those who die.

Doctors are essential to resistance to torture.

• stewards of norms against prisoner abuse (Declaration of Tokyo).• detect torture.• physicians are allied with civil dissent and testimony re torture. • Pressure other MDs to report and resist torture.

Half of torture survivors

report that a MD

supervised the torture.

Health Professions Council of Health Professions Council of South Africa: South Africa:

Matter of W.J. Basson MDMatter of W.J. Basson MD

2828

Slides available on requestSlides available on requestMiles001@umn.eduMiles001@umn.edu

Miles SH, Alencar A, Crock BN. Miles SH, Alencar A, Crock BN. Sanctions against physicians for Sanctions against physicians for war crimes: A work in progress. war crimes: A work in progress.

Paper is available at IRCT.ORG.Paper is available at IRCT.ORG.