Ceartas urges Irish Medical Council not to accredit Bahrain facility linked to rights abuses
Gearoid O Cuinn is Co-Director of Ceartas - Irish Lawyers for Human Rights. He is currently an Academic Fellow at Lancaster University Law School where his research focuses on human rights law, public health law and the intersection of law, science and technology.
Ceartas has submitted its report ‘Human Rights Standards and the Accreditation of RCSI-Bahrain’ to the Irish Medical Council highlighting past and on-going violations of rights within hospital facilities in Bahrain. News of this submission featured in The Lancet, the BBC and the Irish Times and the Ceartas News Release.
The proximity of the Royal College of Surgeons in Ireland (RCSI) to human rights violations committed by the Bahraini authorities have presented numerous challenges for this medical institution. A constituent college of RCSI, the RCSI-Medical University of Bahrain (RCSI-Bahrain) relies on the public hospital system of Bahrain for the education, training and professional development of its students. However these sites have also been the scene of the Government’s militarized response to pro-democracy protests. When a student in Bahrain graduates from ‘Medical University Bahrain’ he or she is awarded with Irish qualifications from the Royal College of Surgeons in Ireland (RCSI) and the National University of Ireland. As an Irish degree awarding body the RCSI-Bahrain must also be monitored and accredited by Ireland’s Medical Council. Since 2010, when the first cohort of medical students graduated from RCSI-Bahrain, the Medical Council indicated they would conduct an obligatory site visit. Such inspections include, not only the education facilities, but also the affiliated hospitals where students receive a significant proportion of their training. As Ceartas aims to use legal actions to effect positive human rights change from Ireland we have published a submission to help ensure that human rights issues are factored into the Medical Council's upcoming accreditation of RCSI-Bahrain.
'Arab Spring' Protests
On 14 February 2011, the Bahraini people began months of peaceful protests, calling for free speech, democracy and human rights. The Bahraini Government’s response to the renewed wave of pro-reform protests was brutal and uncompromising. An independent review would later confirm the shooting dead of unarmed peaceful protesters and the widespread use of torture against detainees which, in several cases, lead to death. Since this time protests have consistently been met with overwhelming non-lethal force, including the enthusiastic and indiscriminate use of chemical gases and bird shot.
Many of the human rights abuses documented in Bahrain over the last two years involved medical personnel and medical facilities, public and private, utilized by RCSI-Bahrain. Some RCSI-trained medical staff were tortured and imprisoned for treating protesters. Many have lost their jobs and one Irish trained doctor, Dr. Ali Al-Ekri, is currently serving a five year prison sentence. His colleagues and others maintain he was targeted for speaking out. Two years on it appears that ill-treatment is not likely to be inflicted on medical staff. If they dissent they are more likely to be denied access to public or private practice which would have a devastating impact on their livelihoods. There have also been reports that at least 30 RCSI-Bahrain students were denied work placements on the basis of their religion.
For injured protesters and other victims of the security forces the situation is grim. While live fire is still used over-whelming non-lethal force against protesters and the indiscriminate use of tear gas on predominantly Shia villages is now the norm. Medical staff regularly encounter persons with blunt force trauma from tear gas canisters, bird shot injuries and severe breathing complications. Treating an injured protester is not a cost neutral exercise in Bahrain.First doctors have been given explicit orders to report on protesters, or they must wait for them to be cleared for treatment by police. When they do they risk exposing the injured to torture and ill-treatment in police custody and, in the longer term, imprisonment for exercising their right to freedom of expression. Should the doctor decide to not report they themselves risk prosecution. It’s an ethical dead-end.
Many, including those who are not protesters, fear seeking treatment while pregnant women who have suffered miscarriages following indiscriminate tear gas exposure have reportedly been denied access to their medical records. Ultimately doctors are plugged into this repressive mechanism at the cost of their own neutrality. In a context where doctors fear speaking out serious questions arise as to how the Medical Council can even begin to properly assess the suitability of the sites of clinical tuition used by RCSI-Bahrain.
International Standards in Medical Education
As an Irish degree awarding programme RCSI-Bahrain must live up to international standards used by the Medical Council, those of the World Federation for Medical Education (WFME). These demand that the locations for clinical tuition are safe appropriate and able to deliver training in the core competencies of medicine, including medical ethics. Furthermore, as a public body the Medical Council has specific human rights obligations requiring that relevant human rights concerns are taken into account. Section 3(1) of Ireland’s ECHR Act, 2003 places a statutory duty on ‘organs of the State’ to ‘perform its functions in a manner compatible with the State's obligations’. As our report explains human rights standards intersect with the WFME Standards and offer an important interpretative framework when applies even when the Medical Council operates outside of Irish territory. Should the Medical Council choose to approve of the RCSI-Bahrain affiliated hospitals this could also imply the legitimization of the acts of torture and other human rights abuses and the circumstances which facilitated them.
Waiting for reforms?
There is a risk that the issue of RCSI-Bahrain's accreditation will be passed from one elected Medical Council to another. Decisive action is needed in conjunction with other relevant bodies such as the National University or Ireland and the Higher Education Authority. Otherwise the implication is that Ireland will continue to give its seal of approval by awarding degrees obtained in a discriminatory and dysfunctional medical system.
To date, minimal reforms from Bahrain's government have failed to ensure respect for the rights of medical staff and patients and protests continue to be violently suppressed. From our assessment it is difficult to conclude that the government of Bahrain is committed to reforms necessary to address this crisis within its medical system. Otherwise it would have let the UN Special Rapporteur on Torture, Juan Mendez, enter the country to conduct an investigation. In March 2013, the president of RCSI-Bahrain, Prof. Tom Collins, attempted to organise a multi-stakeholder conference on ‘Medical ethics and dilemmas in situations of political discord or violence’ in association with Médecins Sans Frontières. Before the event could take place it was obstructed by Bahrain’s monarchy. As a result Prof. Collins tendered his resignation. Dr Bart Janssens, MSF director of operations said “we are forced to conclude that today in Bahrain it is not possible for medical professionals and international impartial participants to have a conversation about medical ethics.” Ceartas has learned from MSF that is still denied access to Bahrain, as is the case with many other reputable humanitarian organisations and journalists.
Robust reforms are needed if Bahrain's hospital facilities are to live up to Irish standards and therefore robust action is needed by the Irish Medical Council. The only solution, based on our assessment of international legal standards, is to deny accreditation until such time as appropriate changes are made.
We welcome contributions which might further our understanding of ways in which the protection of human rights and the promotion of accountability can be achieved through legal action or other non-traditional approaches, for example, through the use of soft law mechanisms. If you are interested in contributing to our blog, please contact our blog editor Michelle Farrell, Lecturer in Law, University of Liverpool, firstname.lastname@example.org