Patients as victims

Prevention of access to healthcare by security forces

In November 2018, we wrote to the Foreign Secretary and to the Nicaraguan Embassy to highlight our concerns about interferences with patients’ rights to medical treatment in Nicaragua after learning that physicians had been pressured to prioritise care to specific groups and, in some circumstances to refuse care to anti-government protesters.

The rights of the injured and wounded to appropriate medical treatment are set out in a range of binding international laws, treaties and declarations. The actions of the Nicaraguan security forces in preventing the injured from seeking or receiving treatment are a gross violation of international law.

The letter also raised concerns about interferences with medical impartiality.

 

Further reading

Read our letter to the Nicaraguan Ambassador, Guisell Morales-Echaverry

Prevention of access to healthcare

In August and November 2018, we wrote to the Foreign Secretary, Jeremy Hunt and the Israeli Ambassador to raise concerns about increasingly severe restrictions placed by Israeli authorities on patients seeking to travel outside Gaza to access life-saving treatment.

Since 2007, when Israel imposed a land, air, and sea blockade, Gaza has effectively been closed. As a result, sophisticated diagnostic and therapeutic medical services of the kind required to treat illnesses such as cancer are unavailable. This means patients are often required to travel outside Gaza to access treatment.

According to several recent reports from leading human rights organisations, including Amnesty International, the number of permits for medical travel granted by Israel is at an all-time low. The World Health Organisation (WHO), reports that Israeli authorities approved only 54 per cent of permit requests for those seeking medical appointments outside Gaza, the lowest rate since 2008 when the WHO began collecting figures. The WHO further reported that 54 Palestinians, 46 of whom had cancer, died in 2017 following denial or delay of their permits.

Withholding access to healthcare and treatment contravenes both medical ethics and international law, particularly the right to health as enshrined in the International Covenant on Economic, Social and Cultural Rights (article 12) and Article 25 of the UN Universal Declaration of Human Rights.

 

Further reading

Read our letter to the Foreign Secretary, Jeremy Hunt - February 2019

Read our letter to the Foreign Secretary, Jeremy Hunt - August 2018

BMA condemns the plight of refugees in Calais

On 13 July 2016, Dr Mark Porter, BMA council chair, wrote to the French Ambassador, Sylvie Bermann condemning the recent decision by the French authorities to prevent aid convoys from entering the refugee camp in Calais to deliver basic supplies.

Highlighting the plight of the refugees currently stranded in Calais, Dr Porter called on the French authorities to allow unrestricted access to those organisations who wished to provide aid to this highly vulnerable group of people.

Read Mark Porter's letter to the French Ambassador

Mistreatment of prisoners, prevention of access to healthcare

In August 2018, we wrote to the Iranian Ambassador to express concerns that state-affiliated doctors were involved in facilitating the execution of young prisoners in Iran.

Reports from Amnesty International suggest that four persons had been executed since the beginning of 2014 after being convicted of crimes committed when under the age of 18 and that there are at least 85 other juvenile offenders awaiting execution who had been assessed as juveniles at the time of their crime based on medical maturity assessments.

Iran has ratified the UN Convention on the Rights of the Child, which absolutely prohibits the use of the death penalty in relation to those below the age of 18 at the time they committed the crime. In addition, in February 2017 we wrote to the Iranian Ambassador to raise concerns about the conditions in which detainees are held in Raja’I Shahr Prison in Iran.

According to Amnesty International, detainees at Raja’l Shahr Prison are routinely deprived of access to necessary medical care and treatment.

The Islamic Republic of Iran has ratified the International Covenant on Economic, Social and Cultural Rights and is committed to its provisions, including article 12 recognizing “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. Additionally, Rule 24 of the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) provides that “Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status”.

Read our letter to the Iranian Ambassador, Ayatollah Sadegh Larijani

Anti-homosexuality law in Uganda

The BMA has written to Ugandan President Yoweri Museveni urging him to withdraw new legislation which means that homosexuality now carries a life sentence in Uganda.

Homosexuality was already a crime, with adults found to have had same-sex relationships facing seven years in prison. Under the new law those found guilty of same-sex relationships would automatically be sentenced to life imprisonment.

Punishments have also been extended under the new law to people involved in 'promoting' homosexuality.

Read the BMA's letter to the Ugandan president, Yoweri Museveni

Re-introduction of the death penalty

We wrote to the Vietnam Minister of Health after the country formally reintroduced the death penalty by lethal injection in June 2013. More than 530 people were reportedly under sentence of death in January, with 117 facing imminent execution at the time that lethal injections were reintroduced.

No executions had been carried out in Vietnam since January 2012 following a shortage of lethal injection drugs, although the courts have continued to sentence people to death.

The shortage followed changes made in 2011 to EU regulations on trade in equipment and substances that can be used for capital punishment, torture or other cruel, inhuman or degrading treatment or punishment, which restricted the export of barbiturate anaesthetic agents.

The Vietnam government researched and sourced replacement drugs and the law was changed in May 2013 to allow drugs manufactured domestically to be used in executions.

Vietnam uses the controversial three-drug protocol in executions, which risks excruciating pain for the prisoner if insufficient anaesthetic is administered. As the new Vietnamese law does not specify the particular drugs that are to be used, and the choice of drugs, their quality and constitution is unknown, there is a greater risk of this happening.

Our letter, co-signed by the Danish Medical Association and German Medical Association, called on the Vietnamese health minister, who is a medical doctor, to voice concerns about the three-drug protocol with her government colleagues and to ensure that the Ministry of Health ceases its involvement, as well as the involvement of all medical personnel, in executions.