PHR Student Blog

Today marks the 100th anniversary of International Women’s Day, a day set aside to celebrate the political, economic, and social achievements of women around the world. To recognize this historic day, PHR is highlighting the enormous challenges we face in addressing mass rape in armed conflicts.

Marking the 100th International Women's Day

This blog post is the first of a series of 10 posts that will chronicle PHR Deputy Director Susannah Sirkin’s recent 13-day trip to Kenya and the Democratic Republic of the Congo (DRC) accompanied by PHR Asylum Network member Dr. Coleen Kivlahan. This diary of their assessment trip seeks to highlight the small — but seminal — achievements of grassroots organizations, women’s rights groups, health professionals, and legal advocates working to serve women and girl survivors of sexual assault in Eastern and Central Africa. The blog series will also underscore the challenges and hurdles that remain.

Kenya Journal

Nairobi, Kenya: How to combat widespread impunity for rape in Central and East Africa, starting here in Kenya? As PHR and other experts have documented for more than a decade, tens of thousands of women and girls have been — and continue to be — sexually assaulted by government soldiers, rebel forces, and civilians, both during and following armed conflict.

A critical problem in addressing this crisis has been the difficulty of prosecuting crimes of sexual violence, to enable survivors to seek justice and to help deter future crimes.

Groups who seek to support survivors’ needs face daunting obstacles: shame, stigma, rejection, lack of political will and poor resources. Perpetrators act with impunity and medical and legal capacity and forensic training required to support prosecutions against these perpetrators are lacking.

We’re here to learn more about this crisis and challenge in Nairobi, and then we’re heading West in a few days to eastern Congo. Dr. Coleen Kivlahan, a veteran PHR doctor, has joined me. She’s a pioneer in setting up SAFE (Sexual Assault Forensic Evaluation) programs in the US, one of our expert asylum evaluators in the DC area, and what’s more, a marathon runner, experienced trainer, and intrepid traveler. I’d go anywhere with her.

Day 1: All over town we see the bold black words on posters, key chains, flyers, wall paintings: Sita Kimya (“I will not keep quiet” in Kiswahili): Say No to Rape — a new awareness or “sensitization” campaign funded by USAID, the US Agency for International Development.

Sita Kimya means 'I Will Not be Quiet!', a rape
awareness campaign funded by USAID

Our aim is to check out the gaps in forensic evaluation — the best practices for health professionals who respond to victims in gathering physical and psychological evidence that can be used in prosecution — and documentation needed to hold perpetrators accountable for this crime. As we know, this all-too-silent crime is suffered by countless women in war as well as in the fragile peace that follows mass violence or armed conflicts. We’re meeting with doctors, lawyers, nurses, police, program administrators, government officials in health and justice, women’s rights activists, and aid workers.

These are travel impressions. The full assessment will come as we pack in our days and peel the onion, since every time we think we understand something, a new layer of complexity reveals itself. Each interview on this trip unravels another set of challenges: policies that seem great versus practices that don’t resemble them at all:

• Standards for treatment of victims and documentation of injuries that exist on paper but are not widely known or understood.
• Confusion about police and/or medical forms required for criminal investigation or evidence.
• Incomplete or inadequate formats for forms.
• Who does what in the investigation and justice systems to prosecute sexual violence?
• What capacities do professionals gathering evidence have and need? Do they have basic equipment?
• Extraordinary people here are making change and pioneering new approaches. Is there the necessary political will to end impunity for rape and serve justice to survivors?

PHR members are invited to attend the Boston Initiative to Advance Human Rights’ sex trafficking film forum event at the Brattle Theater in Cambridge, MA, from December 2 through December 5. The festival, which is the first of its kind, will screen 12 films, which will be followed by panel discussions with filmmakers, academics, and activists.

The film forum will explore the power of film in bringing about a movement to combat commercial sexual exploitation and modern-day slavery. PHR recently blogged about this issue.

Additional events include an opening night live performance by Tony award-winning actress and humanitarian Sarah Jones, followed by a cocktail hour with hors d’oeuvres by legendary chef Lydia Shire of Scampo, music performance, and a silent auction. On Saturday there will be a book signing with Siddharth Kara, author of Sex Trafficking: Inside the Business of Modern Slavery.

Tickets are available for purchase now. Discounted tickets are available for students, seniors, and non-profits.

Learn more, including film titles and times, at BITAHR’s the official website, and at their Facebook page.
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Medical students during PHR's human rights training, Fall 2008.

Last year, thanks to the dedication of our wonderful PHR intern Margeaux Fischer, a donation of 441 medical textbooks was shipped to the Zimbabwe Association of Doctors for Human Rights (ZADHR), with whom we helped organize a health and human rights training for medical students in 2008.

One of the ways we were able to help satisfy the needs of the students we met was through the donation of these medical texts. Our friends at ZADHR wrote about it in their recent eNewsletter:

ZADHR in conjunction with Physicians for Human Rights (USA) has donated books worth more than US$ 50,000 to the College of Health Sciences at the University of Zimbabwe. The total number of books donated is 441 and of these books 37 have already been selected for the reserve section as they are deemed very important and needs close surveillance on their usage.
ZADHR continues working with Physicians for Human rights in trying to improve access to medical books to medical students in Zimbabwe.
ZADHR would like to continue with such a positive relationships with the College of Health Sciences and they are looking for more ways they can improve access to information and other necessary resources at the College of Health Sciences.

Senior staff from the college examine the donated books.

The ZADHR student leadership PHR trained two years ago have just conducted their own training for 37 students. Norman Matara, one of the leaders, writes:

We have just held a health and human rights where we have trained 37 students in HHR. What was really exciting was that we were the ones who made the presentations, sharing what you have taught us with our young brothers. We still fight for health rights.

Norman Matara (l) and fellow students with donated books.

PHR is proud to  support these students and others around the world. We are in discussions with other US student chapters to see if another book donation drive can be put together. Let us know if you’re interested or can help!

The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.

The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,” is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce. Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the “brain drain” that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.

14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.

The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.

The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.

Every summer, I promise myself that I’ll make the time to time to read the books that I’ve been meaning to get to all year. Whether I’m parked in front of the air conditioning or in the last light of dusk on the porch, there’s just something great about reading that’s not assigned. Summer is my chance to choose what I want to read: something fun, something that will deepen my understanding of the world, or something that will inspire me to return to work with renewed commitment, awareness, and energy. I want to read something that is indulgent, informative, and inspirational.

The PHR National Student Program is busy this summer, expanding and improving the resources available to Chapters. Among other things, we’re creating lists to help you discover new resources and opportunities. In honor of summer reading lists, I wanted to give you a glimpse of our new Recommended Reading list.

Here’s a list of some excellent books, articles, and blog posts that will appear on the Recommended Reading list. Most were suggested by PHR staff and interns. Although Laurie Garrett’s 800-page Betrayal of Trust: The Collapse of Global Public Health might not be everyone’s idea of an ideal beach read, it might be just what you’ve been looking for.

Have a favorite that you didn’t see here? Maybe something that inspired your interest in health or human rights, or offered a new perspective on a topic near and dear to your heart? Post it in the Comments section below, and we might include it in the final version of the Recommended Reading list.

Books

Health and Human Rights: A Reader, Jonathan Mann, Michael A. Grodin, Sofia Gruskin, and George J. Annas.  (1999)

Perspectives on Health and Human Rights, Sofia Gruskin, Michael A. Grodin, George J. Annas, and Stephen P. Marks.  (2005)

These texts are often used in health and human rights courses.  Both are comprehensive anthologies of foundational essays on health and human rights, and examine issues from ethnic cleansing to women’s reproductive rights.

The Oath: A Surgeon Under Fire, Khassan Baiev and Ruth Daniloff. Dr. Baiev was caught in the the struggle between Chechnya and Russia. Regardless of their nationality or whether civilian or military, he treated everybody under extraordinarily difficult circumstances.  Considered a traitor to both sides, he was called a “bandit-doctor” (for treating Chechens) and a “pig-doctor” (for treating Russians). For years, PHR has worked to protect Colleagues at Risk – clinicians who are targeted for adhering to their Hippocratic Oath, despite the political situation.

The Spirit Catches You and You Fall Down, Anne Fadiman. Described by various PHR staff as “fantastic,” “riveting,” and “devastating and totally addictive,” this describes the clash of two cultures over a child’s health. Anne Fadiman writes with the insight of an anthropologist and the compassion of a friend. I worked with refugees for years, and I also saw heartbreaking conflict between people who each had a patient’s best interests at heart, but had very different beliefs about illness and health.

Betrayal of Trust: The Collapse of Global Public Health, Laurie Garrett.  As in another of Garrett’s massive tomes, The Coming Plague, Garrett uses investigative reporting to analyze public health preparedness.

The Bone Woman: A Forensic Anthropologist’s Search for Truth in the Mass Graves of Rwanda, Bosnia, Croatia, and Kosovo, Clea Koff. Koff takes the reader inside her life as a forensic anthropologist to see what it’s like to excavate mass graves and build evidence of human rights violations. PHR’s International Forensic Program relies on these skills in Afghanistan, Central America, and elsewhere.

The Dark Side: The Inside Story of How The War on Terror Turned into a War on American Ideals, Jane Mayer. This dramatic narrative reveals the decisions behind the controversial excesses of the war on terror and considers the impact of these choices. For more background and an update, visit PHR’s reports on torture of US detainees.

PHR Reports

From Persecution to Prison: The Health Consequences of Detention for Asylum Seekers. Asylum seekers who come to the U.S. to escape torture, persecution, violence or abuse are often locked up in inhuman conditions. PHR conducted the first systematic and comprehensive study about the impact of detention on asylum seekers’ mental health.

Achieving the MDGs by Investing in Human Resources for Health and The Right to Health and Health Workforce Planning. Access to healthcare depends in large part on the ability and distribution of a country’s health workforce. Investments that sidestep the training, payment and supervision of healthcare workers do not build the overall health system.

Stateless and Starving: Persecuted Rohingya Flee Burma and Starve in Bangladesh. In recent months Bangladeshi authorities have waged an unprecedented campaign of arbitrary arrest, illegal expulsion and forced internment against Burmese refugees. In this emergency report, PHR presents new data and documents dire conditions for these persecuted Rohingya refugees in Bangladesh. PHR’s medical investigators warn that critical levels of acute malnutrition and a surging camp population without access to food aid will cause more deaths from starvation and disease if the humanitarian crisis is not addressed.

Articles

Health and Human Rights is published by the FXB Center for Health and Human Rights at Harvard University. The original editor-in-chief was Jonathan Mann, succeed by Sofia Gruskin and then Paul Farmer, all pioneers in the field. By posing the question, “What is a rights-based approach to health and why should we care?” this issue began a series that dealt with fundamental concepts regarding health as a human right.  Subsequent issues tackle accountability (10:2), participation (11:1), and non-discrimination and equality (11:2). The series concludes with the most recent issue on international assistance and cooperation, edited by Jennifer Leaning, the new FXB director and a former PHR Board member. All material is freely available online.

Health and Human Rights Education in U.S. Schools of Medicine and Public Health: Current Status and Future Challenges, L. Emily Cotter et al.  PHR’s Senior Medical Advisor Vince Iacopino and the other authors evaluated obstacles to health and human rights education at schools of medicine and public health across the country.

Health and Human Rights, Jonathan Mann et al. A close look at the complementary ways that health and human rights define and advance human well-being:

• The Impact of Health Policies, Programs and Practices on Human Rights
• Health Impacts Resulting from Violations of Human Rights
• The Inextricable Linkage Between Health and Human Rights

The Challenge of Global Health, Laurie Garrett. Garrett’s critique of misdirected investment in global health got a strong reaction from the media and the global health establishment. Don’t miss the exchange between Paul Farmer and Laurie Garrett. Although the funding and policy environment has evolved since this was published, it’s a glimpse of a critical moment in global health.

Blog posts

The Right to Health: A Conversation with Helen Potts, PhD on the Physicians for Human Rights site. An informative and comprehensive look at the history and meaning of the right to health.

Refugees in America: Faces and Stories Behind the Refugee Protection Act. This post by Erin Hustings, PHR’s Asylum Advocacy Associate, on the PHR blog Health Rights Advocate, offers a personalized look at the refugees who are denied asylum in the United States because of unnecessary obstacles and technicalities.

Two years ago, Kamiar Alaei, MD, and Arash Alaei, MD, were arrested in Iran, just as they were preparing to leave for Mexico to present on their innovative harm reduction work at the XVII International AIDS Conference.

On July 18, the world convenes again for the XVIII International AIDS Conference in Vienna, Austria — but will be short two shining stars. Arash and Kamiar remain in jail today. The Iranian government accused the brothers of using trips to AIDS and public health conferences around the world to “foment a velvet revolution” and sentenced them to years in prison. We say treating AIDS is not a crime.

Friends and colleagues of the Alaeis will be in Vienna spreading the word about their case and advocating for their release, and PHR will be supporting them all the way.

Will you be in Vienna at the AIDS conference? To volunteer with these efforts, email Clint Trout at clintworldwide [at] yahoo [dot] com.

Want to take action to support the Alaeis? Sign our new petition, calling on the government of Iran to free the Alaeis.

Throughout their careers, the Alaeis have promoted public health diplomacy and supported the quest for shared solutions to the world’s shared disease burden. It is an outrage to call this treason. Medical professionals should not be put in prison for doing their jobs. Take action today and stand in solidarity with the Alaeis.

See the Background page at IranFreeTheDocs.org for more information on their case.

Physicians for Human Rights joins numerous international NGOs, including Amnesty International, Human Rights Watch, and Reporters Without Borders, in supporting United4Iran’s Global Day of Action on June 12, 2010. June 12 events will be occurring in over 70 cities around the world. Go to 12June.org for more information.

June 12 marks the one year anniversary of Iran’s disputed election, which was followed by a government crackdown that saw an increase in arbitrary arrests, torture, and politically motivated use of the death penalty. The Global Day of Action calls attention to Prisoners of Conscience in Iran, and demands their unconditional release.

Since last year’s elections, the human rights situation in Iran has only grown worse. PHR continues to highlight the case of Drs. Kamiar and Arash Alaei, Iranian doctors who have been held by Iranian authorities since June 2008. After being imprisoned without charge for six months, the Doctors Alaei were convicted and sentenced for the charges of being in “communications with an enemy government” and “seeking to overthrow the Iranian government.” Kamiar was given a three year prison sentence, while Arash was sentenced to six years.

The Iranian government used the doctors’ travel to international AIDS conferences as a basis for the charge. Iran cannot continue to imprison medical professions for doing their job. By equating public health diplomacy with treason, the Iranian government poses a threat to all Iranians working for scientific knowledge.

Stand with PHR and the international community to tell the world that “Treating AIDS is not a crime.” Visit iranfreethedocs.org for more information on the Alaeis. And on June 12, please help us remember and defend those in Iran jailed for their humanitarian work.

The Obama Administration has initiated a comprehensive review of US landmines policy to decide whether or not the US will join the Mine Ban Treaty. President Obama needs to hear from you about how harmful landmines are to the health and human rights of people worldwide.

Email President Obama today and tell him to join the Mine Ban Treaty.

PHR shared the 1997 Nobel Peace Prize for our work to ban landmines. Since then, 156 countries have signed onto the treaty, which bans the use, trade, production and stockpiling of antipersonnel mines.

However, the US has refused to join. President Obama now has the opportunity to partner with every member of NATO—and every country in the Western Hemisphere, save Cuba—in supporting this critical treaty. Tell him to take action today.

Landmines kill thousands of people a year, with millions more affected by the agricultural, economic and psychological impact of the device. While landmines are a weapon of war, most casualties are civilians: indeed, UNICEF estimates that 30-40% of landmine victims are children. And landmines don’t just kill in conflict zones: there are millions of landmines and unexploded ordinances in more than 80 countries worldwide.

These indiscriminate weapons maim and kill, and destroy families and communities. The US has not used landmines since the 1991 Gulf War; it is time for us to promise never to use them again. Tell Obama to join the Mine Ban Treaty today.

68 Senators co-signed a letter to President Obama in May, showing their support for the Mine Ban Treaty. Now Obama needs to hear from you. Email him today, and ask 6 friends to do the same. PHR members have been advocating to ban landmines for more than 15 years. This is our best chance to join the Mine Ban Treaty in years, and we need your support.

Take action today!

Want to do more? We are asking major US health professional associations to sign a letter to the Administration against the use of landmines. If you have any contacts at health professional associations who might be able to help, please email Gina at gcoplon-newfield[at]phrusa[dot]org.

As you read in our previous landmines blog post, the Obama Administration is reviewing current US landmine policy right now, and will soon decide whether or not the US will join the Mine Ban Treaty. Why should the US join? Check out these compelling facts and see why this is a critical health and human rights issue:

Injury and Death:

• The International Campaign to Ban Landmines (ICBL) estimates that 15,000-20,000 people are maimed or killed by landmines yearly, with millions more affected by the agricultural, economic and psychological impact of the weapon.
• UNICEF estimates that 30-40% of mine victims are children under 15 years old.
• Landmines are responsible for the injury and death of thousands of US and allied troops in all US-fought conflicts since World War II, including dozens in Iraq and Afghanistan. In the 1991 Gulf War, landmines caused 34% of US casualties.
• At the beginning of the 20th century, nearly 80% of landmine victims were military personnel. Today, 90% of landmine victims are civilians.

The Economic and Social Cost:

• The ICBL estimates that there are millions of landmines and other unexploded ordnance in the ground in over 80 countries.
• Landmines cost as little as $3 to produce and up to $1,000 per mine to clear.
• Most kinds of landmines last forever. Mines laid during WWII are still killing and maiming civilians.
• It costs $100 to $3,000 to provide an artificial limb to a landmine survivor. Adults require a prosthesis replacement every two to three years and a child must have a new one every six months to a year.
• Landmines cause environmental damage in the forms of soil degradation, deforestation, and the pollution of water resources with heavy metals. Subsistence farmers are unable to work the land in mined areas.
• Landmines affect all aspects of human life, including the ability of refugees to return home. A report from the United Nations High Commissioner for Refugees (UNHCR) published in 1997 stated that 13.2 million refugees, 4.9 million internally displaced people and 3.3 million returnees were at risk from landmines.

The US and Landmines:

• The United States is one of only 39 countries that have not yet joined the Mine Ban Treaty; in the Western Hemisphere, only the U.S and Cuba are non-signatories.
• The US has the third largest mine arsenal in the world—a stockpile of 11 million Anti-Personnel Landmines (APLs)—despite not using landmines since 1991 or producing them since 1997. Enormous amounts of taxpayer money are used to maintain these weapons.
• The United States is one of only 13 countries that refuse to halt production of APLs.
• The Bush Administration’s landmine policy, announced in February 2004, represented a major rollback of US progress on the landmine issue. The policy increased funding for mines, permitted indefinite US use of self-destructing mines, and refused to phase out long-lived mines until 2010. The Obama Administration has yet to revise the Bush policy.

These indiscriminate weapons maim and kill, and destroy families and communities. President Obama is currently reviewing US landmine policy. We need your voice to tell the President to ban mines now! The US has not used landmines since the 1991 Gulf War. It is time for us to promise never to use them again.

Take action today: email Obama and tell him to join the Mine Ban Treaty!