More than 13,500 asylum seekers remain trapped on the Greek islands in deplorable conditions as winter begins on December 21, 2017. Greece, with support from its European Union partners, should urgently transfer thousands of asylum seekers to the Greek mainland and provide them with adequate accommodation and access to fair and efficient asylum procedures.

Author: Human Rights Watch, Human Rights Watch
Posted: January 1, 1970, 12:00 am

(New York) – The latest revisions to China’s Criminal Law impose up to seven years in prison for “spreading rumors” about disasters, Human Rights Watch said today. The revised law, which took effect November 1, 2015, does not clarify what constitutes a “rumor,” heightening concerns that the provision will be used to curtail freedom of speech, particularly on the Internet.

“The revised Criminal Law adds a potent weapon to the Chinese government’s arsenal of punishments against netizens, including those who simply share information that departs from the official version of events,” said Sophie Richardson, China director at Human Rights Watch. “The authorities are once again criminalizing free speech on the Internet, which has been the Chinese people’s only relatively free avenue for expressing themselves.”

The National People’s Congress Standing Committee approved the addition of a provision to article 291(1) of the Criminal Law (Criminal Law Amendment Act (9)), which states that whoever “fabricates or deliberately spreads on media, including on the Internet, false information regarding dangerous situations, the spread of diseases, disasters and police information, and who seriously disturb social order” would face prison sentences – with a maximum of seven years for those whose rumors result in “serious consequences.” The vagueness of the provision means that individuals doing nothing more than asking questions or reposting information online about reported local disasters could be subject to prosecution.

In the past, the Chinese government has detained netizens who questioned official casualty figures or who had published alternative information about disasters ranging from SARS in 2003 to the Tianjin chemical blast in 2015, under the guise of preventing “rumors.”

The revision was made in the context of a wider effort to rein in online freedom since President Xi Jinping came to power in 2013:

  • In August 2013, the authorities waged a campaign against “online rumors” that included warning Internet users against breaching “seven bottom lines” in their Internet postings, taking into custody the well-known online commentator Charles Xue, and closing popular “public accounts” on the social media platform “WeChat” that report and comment on current affairs;
  • In September 2013, the Supreme People’s Court and the Supreme People’s Procuratorate (the state prosecution) issued a judicial interpretation making the crimes of defamation, creating disturbances, illegal business operations, and extortion applicable to expressions in cyberspace. The first netizen who was criminally prosecuted after this took effect was well-known blogger Qin Huohuo, who was sentenced to three years in prison in April 2014 for allegedly defaming the government and celebrities by questioning whether they were corrupt or engaged in other dishonest behavior;
  • In July and August 2014, authorities suspended popular foreign instant messaging services, including KakaoTalk, claiming the service was being used for “distributing terrorism-related information”;
  • In 2015, government agencies such as the State Internet Information Office issued multiple new directives, including tightening restrictions over the use of usernames and avatars, and requiring writers of online literature in particular to register with their real names;
  • In 2015, the government has also shut down or restricted access to Virtual Private Networks (VPNs), which many users depend on to access content blocked to users inside the country and also help shield user privacy;
  • In March 2015, authorities also deployed a new cyber weapon, the “Great Cannon,” to disrupt the services of GreatFire.org, an organization that works to document China’s censorship and facilitate access to information;
  • In July 2015, the government published a draft cybersecurity law that will requires domestic and foreign Internet companies to increase censorship on the government’s behalf, register users’ real names, localize data, and aid government surveillance; and
  • In August 2015, the government announced that it would station police in major Internet companies to more effectively prevent “spreading rumors” online.
     

Activists in China are regularly prosecuted for speech-related “crimes,” Human Rights Watch said. The best known of these crimes is “inciting subversion,” which carries a maximum of 15 years in prison. But authorities have also used other crimes such as “inciting ethnic hatred,” as in the case of human rights lawyer Pu Zhiqiang, who has been detained since May 2014 for a number of social media posts questioning the government’s policies towards Uighurs and Tibetans.

While providing the public with accurate information during disasters is important, the best way to counter inaccurate information would be to ensure that official information is reliable and transparent, Human Rights Watch said.

Above all, journalists should have unimpeded access to investigate and inform the public about these events, and the wider public should have the freedom to debate and discuss disaster response.

“The casualties of China’s new provision would not be limited to journalists, activists and netizens, but the right of ordinary people and the world to know about crucial developments in China,” Richardson said. “The best way to dispel false rumors would be to allow, not curtail, free expression.”

Posted: January 1, 1970, 12:00 am

Nursing homes across the United States routinely give antipsychotic drugs to residents with dementia to control their behavior, despite regulatory prohibitions on this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics is associated with a nearly doubled risk of death in older people with dementia. 

A year and a half ago in a Texas nursing home, I met an 84-year-old resident with dementia named Felipa Natividad. Her sister, Aurora Suarez, told me that the staff dosed Natividad with Haldol, an antipsychotic drug, to ease the burden of bathing her. “They give my sister medication to sedate her on the days of her shower: Monday, Wednesday, Friday,” Suarez said. “They give her so much she sleeps through the lunch hour and supper.” A review of Natividad’s medical chart confirmed the schedule.

Suarez said she had given her consent to use the drugs because she feared that the staff would not bathe her sister enough if she refused. But when Suarez saw the effect they had, she had second thoughts. She expressed them to the nursing home, but Natividad was taken off the antipsychotics only after she was placed in hospice care. She died a few months after my interview. Her family, seeing her in a reduced state and unable to communicate, wondered whether the drugs had compounded the losses associated with dementia; Suarez thought they contributed to her sister’s decline. “She gets no nourishment,” she told me not long before Natividad died.

The use of antipsychotic drugs as chemical restraints — for staff convenience or to “discipline” a resident — has a long history in nursing homes. In 1975, the Senate released a report, “Drugs in Nursing Homes: Misuse, High Costs, and Kickbacks,” documenting some of the same trends we still see, more than 40 years later. In the past decade, many manufacturers of antipsychotic drugs have faced civil and criminal penalties for misbranding the medications to promote them as appropriate for treating older people with dementia. For more than a decade, the Food and Drug Administration has required manufacturers to place the strongest caution, known as a “black box warning,” on the packaging to advise against the medicines’ use in these patients; such drugs almost double the risk of death for them and have never been approved as safe oreffective for treating symptoms of dementia. Despite the warning, nursing homes still often administer antipsychotic drugs in this manner, sometimes without seeking informed consent first, in violation of federalregulations and human rights norms.

Last year, I visited more than 100 nursing homes across six states as part of Human Rights Watch research on the abuse of antipsychotic drugs in such facilities. Based on government data, we estimate that in an average week, more than 179,000 older people in nursing homes are given antipsychotic drugs without an appropriate diagnosis. The powerful medications were developed to treat schizophrenia, but staff most commonlyadminister them to older people with dementia. Too often, nursing homes use the antipsychotics for their sedative effects rather than to treat a medical problem. It’s true that the prevalence of antipsychotic drugs has declined in recent years, from 1 in 4 nursing home residents without an approved diagnosis in 2012 to 1 in 6 today, but that falsely suggests that a longtime wrong is being righted. Government enforcement of regulations prohibiting the use of the drugs as a chemical restraint or without informed consent remains weak. What’s more, two Trump administration decisions threaten the progress made in curbing the abuse.

These powerful drugs are misused for a variety of reasons, including a misperception by nursing home staff that the medications can help people with dementia; a lack of awareness of their dangers, despite the black box warnings; lack of training in dementia care; and, perhaps most significant, to compensate for understaffing. Nursing homes have been exaggerating levels of nursing and caretaking staff for years, according to an analysis of federal data by Kaiser Health News.

To understand the human toll of the misuse of antipsychotics, in my visits to the nursing homes I interviewed more than 300 people — residents, their families, staff, ombudsmen and doctors, as well as researchers and regulators. In most cases, I did not use their names in my report because they cited a fear of retaliation for speaking openly to me. Human Rights Watch did not identify the individual facilities in its report because the abuse is so pervasive in the industry, and not identifying nursing homes persuaded some staffers to speak with me. Further, the goal was not to expose particular private actors so much as to pressure government officials to enforce minimum health and safety standards for all providers.

Lenora Cline, 88, has lived in a nursing home for years. She has Alzheimer’s disease. Laurel Cline, her daughter, visits her twice a day and assists staff with the care-taking, fearing that otherwise, with the shortage of staff, her mother will not be turned, fed, or changed. She had to persuade the facility to discontinue antipsychotic medications. Before successfully objecting to their use, Ms. Cline said, “Every little thing, they want to put you on psych meds.” Los Angeles, California, August 2017. 

© 2017 Ed Kashi for Human Rights Watch

I found that too often, antipsychotic drugs are administered in harmful, avoidable ways and without the appropriate consent. They are used to control people. Nursing home residents and their family members repeatedly told me they were given these medicines without their knowledge, without awareness of the risks or over their objections. Staff members frankly admitted giving residents these medicines for their own convenience, with some saying they were not aware of an informed-consent policy. Nursing facility staff, pharmacists and medical directors described how doctors commonly prescribed the medications at the request of nursing staff, without even seeing the patients.

[How corporate funding can distort NIH research]

Nursing homes turn to antipsychotic drugs — among other classes of psychotropic medications — because dementia is associated with agitation, irritability, aggression, delusions, wandering, disinhibition and anxiety. While such symptoms are frightening for the people experiencing them and challenging for their caregivers, institutional or otherwise, antipsychotic drugs have not been found to be effective at managing them. In a small number of particularly complex cases, antipsychotic drugs may be appropriate as a last resort. But that is a far cry from how they are used. The American Psychiatric Association concludes that the drugs offer “at best small” potential benefits (such as minimizing the risk of self-harm in people with extreme agitation), while “on the whole, there is consistent evidence that antipsychotics are associated with clinically significant adverse effects, including mortality.”

On paper, federal regulations say that residents have the right to be fully informed of their treatment and to refuse treatment, which should amount to a right to informed consent. But nursing facilities widely ignore the rules, partly because they are rarely held accountable. Reviewing government data from 2014 through mid-2017, Human Rights Watch found that in 97 percent of citations for violations related to antipsychotic drugs, the incidents were determined to have caused “no actual harm” to residents. As a result, in almost no cases did the government impose financial penalties, which correspond to the severity of harm caused by the noncompliance. The prospect of enforcement actions, and the rare sanctions issued, unsurprisingly had little deterrent effect, our analysis found. Nursing homes cited for antipsychotic-drug-related issues did not reduce their rates of drug use any more than facilities not cited.

The way nursing homes obtain or define “informed consent” can also be a factor in the drugs’ misuse. “The use of specific medicines, particularly for somebody with dementia, who lacks the capacity to consent themselves, should require informed consent from their legal representative,” says Jonathan Evans, a former president of the American Medical Directors Association. “But in practice that seldom happens. Not just for that medicine but for any medicine.”

The former administrator of a nursing home in Kansas, who asked to remain anonymous, said: “The facility usually gets informed consent like this: They call you up. They say: ‘X, Y and Z is happening with your mom. This is going to help her.’ Black box warning? It’s best just not to read that. The risks? They gloss over them. They say, ‘That only happens once in a while, and we’ll look for problems.’ We sell it. And, by the way, we already started them on it.”

Despite the limited threat of penalties, many nursing homes have reduced inappropriate use of the drugs in recent years anyway, in response to increased public pressure. By 2012, congressional outrage over the widespread misuse of medications, costing hundreds of millions of Medicare dollars annually, had motivated the Centers for Medicare and Medicaid Services (CMS) to create the National Partnership to Improve Dementia Care in Nursing Homes . While the partnership is only a voluntary initiative offering educational support to train providers, the increased attention has been associated with the reduction in misuse. But it is hard to celebrate the decline when the government elects not to rigorously use the tools it has to protect Americans in nursing homes from irreversible harm.

What’s more, the national reduction may be misleading — and it may not last. First, there’s been a notable uptick in the diagnosis of schizophrenia (a disease that typically develops before age 30) in predominantly elderly nursing home populations. This increase corresponds to the rising pressure on facilities to reduce off-label antipsychotic drug use. There’s no proven link, but the trend does suggest that some homes seek false diagnoses to avoid red flags with the use of these medications. A second concern, recognized by CMS, is that nursing homes are simply replacing this closely watched class of psychotropic medication with other types of sedating drugs with similar health risks.

[Aging is not death. Stop conflating the two.]

Meanwhile, in response to an industry request, the Trump administration in July 2017 changed its guidanceon financial penalties, limiting the instances when inspectors can assess the heaviest fines. The guidance also favors one-time sanctions for harmful noncompliance with the law, rather than a per-day sanction that corresponds to the number of days the harm persists. As a result, in many cases facilities face less-significant consequences for harming residents than they used to. And last November , CMS imposed an 18-month moratorium on Obama-era revisions to some regulations — not updated since 1991 — intended in part to protect residents whose psychotropic medications are prescribed on an “as needed” basis. While it is unclear if those new protections will come into force, it is abundantly clear that this administration’s deregulatory scheme, which it calls “Patients Over Paperwork,” reduces oversight and enforcement in an already dangerously underpoliced industry.

Karla Benkula, daughter of a 75-year-old woman in Kansas, said that when the nursing facility began giving her mother an antipsychotic drug, her mother “would just sit there like this. No personality. Just a zombie.” Laurel Cline, the daughter of an 88-year-old woman in a California nursing home, said she thought the facility used antipsychotic medication to silence people whose symptoms disturbed the staff. Cline said it was obvious that her mother had physiological conditions requiring medical attention. “She would be sitting there, slumped over, mucus everywhere. I would go over and say, ‘She’s sick.’ ” But Cline’s mother wasn’t able to advocate for herself, and Cline had to intervene to demand appropriate medical care for a urinary tract infection, pneumonia and a pulmonary embolism, she said.

“Dementia’s already so hard,” said Ashley Plummer, a licensed practical nurse who works in a Kansas nursing home. “But on top of that, throw [on] a few Seroquels [a common antipsychotic drug], and then you’re just drooling. I mean, it’s taking away even your right to be upset about your disease process. It’s taking away your right to mourn what you’re going through.”

In my interviews, it was disturbing how frequently staff justified administering antipsychotic drugs for “behaviors,” a disconcerting term suggesting that residents could, and should, avoid acting in a disruptive way. A social worker in Texas who used to work in a nursing facility said the underlying issue is that “the nursing homes don’t want behaviors. They want docile.”

Many nursing home staff spoke to me about using antipsychotics to control residents as if it were a perfectly acceptable practice. Others told me that they had become aware that antipsychotic drugs were frequently misused only after the facility’s administration or corporate owners decided to cut down on their use. “It used to be like a death prison here,” a nursing director in a Kansas nursing home told me. “Half our residents were on antipsychotics. Only 10 percent of our residents have a mental illness.” Senior staff at the facility led an effort to reduce the antipsychotic drug rate after receiving financial penalties for administering unnecessary medications and after pressure from the chain’s owners. Another nurse in Kansas said: “We were at 55 percent antipsychotic drug rate before. Now we’re down to only people with a diagnosis [for which the FDA has approved the medications] on the drugs. They have a better quality of life because they’re not sedated.”

[I’m documenting my own Alzheimer’s disease while I still can]

Nursing homes, a mostly for-profit industry, control most aspects of their residents’ lives. Presumably, providers would be more inclined to meet minimum health and safety standards if it cost them dearly not to do so. “In this industry, there is a real cost-benefit analysis,” one long-term-care consultant told me. “If the fine will be $100,000, then they’ll hire the three nurse aides who will cost them about the same amount.”

Antipsychotic drugs may be an appropriate treatment for some people with dementia in nursing homes, but determining that requires a doctor and an informed patient (or proxy). And once told of the significant risks, unlikely benefits and possible alternative treatments — such as behavioral therapy, adjusting routine and environment, or alleviating the source of underlying loneliness, pain, boredom or fear — many people would probably reject the drugs. As one long-term-care pharmacist in Kansas said: “I don’t think antipsychotic drugs are presented well to the family in informed-consent conversations. Because if it were, they’d all reject it.”

An 81-year-old man in a Texas nursing home put it this way to me: “Too many times I’m given too many pills. I can’t even talk. I have a thick tongue when they do that. I ask them not to [give me the antipsychotic drugs]. When I say that, they threaten to remove me from the home. They get me so I can’t think. I don’t want anything to make me change the person I am.”

Hannah Flamm, an immigration lawyer at the Door’s Legal Services Center, reported on the misuse of antipsychotic drugs in nursing homes while she was a fellow at Human Rights Watch.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

A sign which reads “Care instead of Punishment” is held aloft at a protest rally calling for decriminalization of personal drug use, Tbilisi, Georgia, December 10, 2016.

© Yana Korbezelashvili for White Noise Movement

(Tbilisi) – Georgia’s drug laws and their aggressive enforcement is causing severe and unjustifiable harm, Human Rights Watch said in a report released today. Drug prosecutions for consumption and possession often lead to long prison sentences and prohibitive fines against people who have not harmed others, but who acquired small amounts of drugs for personal, recreational use.

The 67-page report, “Harsh Punishment: The Human Toll of Georgia’s Abusive Drug Laws,” describes the impact of overly punitive drug laws and practices on people who use drugs, and on their families. Human Rights Watch documented abusive, mandatory street drug testing, coerced plea bargains, and arbitrary additional punishments, such as stripping people of their driver’s licenses or prohibiting them from working in an array of professions, interfering with their ability to earn a livelihood. Georgia has partially liberalized drug laws, but they remain harsh.

“Every year, Georgian authorities needlessly detain thousands of people, subject them to forced drug tests and funnel them through the criminal justice system, for nothing more than drug consumption or possession for personal use,” said Giorgi Gogia, associate Europe and Central Asia director at Human Rights Watch, and author of the report. “Locking people up for no more than using drugs causes tremendous harm and does nothing to help those who need and want treatment.”

The report is based on more than 85 in-depth interviews with people who have been prosecuted for drug-related crimes, their lawyers and family members, as well as social workers, community organization leaders, government officials, and various advocacy groups and nongovernmental organizations.

In Georgia, first-time illegal drug consumption or possession of a small quantity of drugs for personal use is a misdemeanor. A repeat offense within a year results in criminal liability.

However, Georgian law does not establish a threshold for small quantities of approximately three-quarters of the substances classified as illicit drugs, including those commonly used in Georgia, such as amphetamine, methamphetamine, and desomorphine. Possession of even particles of these substances, including residue in a syringe, automatically qualifies as a large amount, triggering a mandatory minimum five-year prison sentence. Possession of more than one gram is considered a “particularly large amount” and could result in life imprisonment.

In one case, in 2016, police arrested Kote Japaridze, 23, for possession of two grams of the recreational synthetic drug MDMA (“ecstasy”) and charged him with possession of a particularly large quantity of drugs. Facing up to 20 years in prison, Japaridze entered into a plea deal, and a court sentenced him to six years in prison, five of which were suspended. The court also imposed a fine of 25,000 Georgian lari (roughly US$10,800). Japaridze struggles to repay the debt for the fine and has been deprived of his driver’s license and banned from working in certain jobs for five years.

“The drugs I bought were for personal use, and yet I am paying dearly for it,” Japaridze told Human Rights Watch.

Every year, police randomly detain thousands of people for coerced drug testing for which fewer than 30 percent test positive. Police use positive test results as evidence for pressing administrative or criminal sanctions. If the person refuses to undergo testing, police can detain them for up to 12 hours in a forensics lab. Georgian law does not give people held for testing the same rights as detainees, such as the right to make a phone call, leaving them vulnerable to ill-treatment by the police, Human Rights Watch said.

Georgian law imposes long, mandatory minimum sentences for drug-related offenses, with a nearly 100 percent conviction rate for these offenses. As a result, a person charged with a drug-related offense often feels there is no other choice than to agree to a plea deal to avoid a long prison term. These plea deals also lead to prohibitive fines, which can financially devastate the accused and his or her family.

In another case Human Rights Watch documented, a family lost their home to pay drug-related criminal fines.

Drug felony convictions also lead to suspension of driver’s licenses and a ban on work in all government positions and educational and medical institutions for periods ranging from 3 to 20 years after release from prison. Such restrictions effectively strip many people of their livelihoods, Human Rights Watch said.

Some of the harsher features of Georgia’s current drug policies and practices were adopted in 2006, and starting in 2012, Georgia’s leadership partially liberalized them. The government reduced criminal penalties for drug possession and consumption. It also adopted a National Strategy and Action Plan to fight drug addiction, which emphasized the importance of public health and prevention of drug use.

Recent constitutional court rulings further liberalized drug policies. Most recently, on July 30, 2018, the court abolished remaining administrative sanctions for marijuana consumption.

The Georgian government offers, free of charge, opioid substitution with Methadone or Suboxone, and short-term detoxification and rehabilitation. Since 2012, the government has significantly increased financial allocations for these programs.

The Georgian authorities should decriminalize personal use and possession of drugs, Human Rights Watch said. This means removing all criminal sanctions for use and possession of drugs for personal use.

“Many people understandably want the government to address the harmful use of drugs, but the most effective way is to focus on public health responses,” Gogia said. “Criminalization and locking people up for using drugs is not an answer.”

Posted: January 1, 1970, 12:00 am

Ibrohim Hamza Tillozoda

© Payom.net

(Almaty) – Tajik authorities should immediately lift a politically motivated travel ban and allow a critically ill child to receive lifesaving medical treatment abroad, Human Rights Watch and the Norwegian Helsinki Committee said today. The 4-year-old boy, Ibrohim Hamza Tillozoda, has life-threatening stage-three testicular cancer that domestic health care was unable to treat.

Ibrohim Hamza is the son of an opposition member, Ruhullo Tillozoda, and the grandson of the opposition leader, Muhiddin Kabiri, the chair of the Islamic Renaissance Party of Tajikistan (IRPT), both of whom fled Tajikistan in 2015 to evade political persecution and are wanted by Tajik authorities. In late 2015, Tajik authorities confiscated the travel documents and birth certificates of Hamza’s mother, Mizhgona, and other family members, preventing them from traveling outside the country.

“Tajik authorities should immediately allow 4-year-old Hamza and his family to leave so he can receive life-saving medical treatment,” said Marius Fossum, Norwegian Helsinki Committee Regional Representative in Central Asia. “President Emomali Rahmon should ensure that the family can travel.”

For several years, Tajik security services have kept the Tillozoda family under close surveillance and placed harsh restrictions on Hamza’s mother, preventing her from getting her passport back.

Earlier this year, doctors in Tajikistan were unable to successfully treat Hamza, who has been suffering from cancer for several years. His family and medical experts believe that treatment abroad remains the only possible way to save his life. Human Rights Watch and the Norwegian Helsinki Committee have learned that an oncological clinic in Turkey is prepared to provide the treatment.

In response to a social media campaign calling on the Tajik government to allow Hamza to travel abroad for medical treatment, Tajik authorities have claimed that the family is free to leave the country at any time. However, in the three years since the security services confiscated the family’s passports and birth certificates, they have continually intimidated and harassed the remaining family members, confiscating their mobile phones and preventing them from making contact with anyone outside their village.

Security services have repeatedly visited the family and accused them of being the relatives of “terrorists” and “enemies of the people.” The security services recently forced Hamza’s mother to tell journalists that she had lost her passport, even though the security services had confiscated the documents.

OVIR, a part of the Internal Affairs Ministry, which is responsible for issuing new travel documents, has taken no meaningful steps to provide the family with alternate travel documents, even as the child’s medical condition has become critical.

Oncologists in Turkey examined available information about the child’s illness, including photographs showing an orange-sized tumor in the boy’s groin area, and estimated on July 25, 2018, that the boy would be at imminent risk of life threatening complications if he doesn’t get adequate health care within days.

Kabiri and Tillozoda were forced into exile when the authorities began a crackdown on the Islamic Renaissance Party of Tajikistan (IRPT) that led to its forced closure in August 2015. A month later, the authorities later accused its leaders, including Kabiri and Tillozoda, of involvement in alleged coup and designated the group a terrorist organization in October. Since then, authorities have arrested hundreds of party members and other peaceful activists on fabricated charges. In many cases, Tajik authorities have confiscated the travel documents of the relatives of exiled dissidents.

Over the past four years, Tajikistan has been undergoing a severe human rights crisis and crackdown on the peaceful opposition, the groups said. In addition to outlawing the opposition party, the government has persecuted peaceful activists and imprisoned hundreds of opposition members and their lawyers. On July 11, a court in northern Tajikistan sentenced an independent journalist, Khayrullo Mirsaidov, to 12 years in prison on charges that appeared to be retaliation for his exposure of government corruption. Government officials routinely target the family members of critics abroad, subjecting them to harassment, threats and intimidation.

“It is morally reprehensible that Tajik authorities appear to be holding a critically ill child hostage to exert pressure on his father and grandfather,” said Steve Swerdlow, Central Asia researcher at Human Rights Watch. “This case should not be about politics, but about a child’s life.”

Posted: January 1, 1970, 12:00 am

A nurse prepares a vaccine to be given to a child in a hospital in Beijing, China on April 13, 2016. 
 
© 2016 Reuters/Damir Sagolj
China’s social media users are in an uproar over a major drug company’s sale of substandard vaccines – most for babies as young as 3-months-old – and the authorities’ persistent failure to regulate the vaccine market properly.

On Sunday, China’s Premier Li Keqiang vowed to “resolutely crack down on … criminal acts that endanger the safety of people’s lives … and severely criticize dereliction of duty in supervision.” The police have since launched an investigation, but for that or any pledge to be meaningful – unlike commitments made following previous vaccine scandals – Li and other leaders should take the following steps:

First, release from incarceration all the lawyers who assisted victims in previous vaccine scandals. From 2006 to 2009, lawyer Tang Jingling represented a group of parents whose children were left permanently disabled after being given problematic meningococcal vaccines. This would require quashing the five-year sentence Tang is currently serving on baseless charges of  “inciting subversion.” Similarly, lawyer Yu Wensheng has languished in a detention center on spurious “subversion” charges. Yu had represented a man who was detained for seeking redress for his daughter, who became seriously ill after being given spoiled vaccine.

Second, stop harassing, detaining, and prosecuting families of victims of faulty vaccines. In July 2015, after being given vaccines at the local government-run epidemic prevention center in Henan province, Wang Nuoyi was diagnosed with a brain injury and other illnesses. In pursuit of justice, her family wrote letters to the government. The authorities responded by detaining Wang’s father for four months in 2017 as well as at least six other members of his family, and prosecuting Wang’s grandmother for “provoking trouble,” which resulted in a two-year prison sentence.

Third, stop punishing journalists for exposing vaccine scandals. In 2010, prominent investigative journalist Wang Keqin was removed from his post at the China Economic Times after the newspaper published his story about mishandled vaccines that led to the deaths of four children in Shanxi province. Amid the current scandal, while netizens are free to condemn the drug company, news articles and social media posts that showed the Chinese government in a critical light continue to be censored.

If Li is serious about transparency and accountability, his government should stop punishing those who endeavor to achieve exactly that.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am
Dr. Brittany Brooks meets with a patient at Open Arms Healthcare Center, a clinic in Jackson, MS, that focuses on alleviating healthcare disparities for underserved populations, with a particular focus on LGBT people. 
© 2018 Nina Robinson / The Verbatim Agency / Getty Images

The Trump administration is considering regulatory changes that would worsen barriers many lesbian, gay, bisexual, and transgender (LGBT) people in the United States face in obtaining health care, Human Rights Watch said in a report released today. The US Department of Health and Human Services (HHS) should reconsider those changes, which would leave LGBT people more vulnerable to discrimination.

The 34-page report, “‘You Don’t Want Second Best’: Anti-LGBT Discrimination in US Health Care,” documents some of the obstacles that LGBT people face when seeking mental and physical healthcare services. Many LGBT people are unable to find services in their area, encounter discrimination or refusals of service in healthcare settings, or delay or forego care because of concerns of mistreatment.

“Discrimination puts LGBT people at heightened risk for a range of health issues, from depression and addiction to cancer and chronic conditions,” said Ryan Thoreson, an LGBT rights researcher at Human Rights Watch. “Instead of treating those disparities as a public health issue, HHS is developing politicized rules that will make them much worse.”

Two upcoming regulatory changes are likely to worsen these barriers, Human Rights Watch said. In January 2018, HHS issued a proposed rule that would broaden existing religious exemptions in healthcare law, giving sweeping discretion to insurers and providers to deny service to patients because of their moral or religious beliefs. In April 2018, the Trump administration announced plans to roll back a regulation that clarifies that federal law prohibits healthcare discrimination based on gender identity. If finalized, these changes would further undermine the limited antidiscrimination protections that currently exist for LGBT people.

Human Rights Watch interviewed 81 people for the report, including providers and individuals who said they had experienced discrimination in healthcare settings.

Existing protections for LGBT people in health care are uneven. In 2016, the Obama administration issued a regulation clarifying that Section 1557 of the Affordable Care Act, which prohibits sex discrimination in health care, also prohibits discrimination against transgender people. Eight states and religious healthcare providers challenged the regulation in court, and the Trump administration has signaled it plans to roll it back.

Protections at the state level are lacking. As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. New Jersey prohibits discrimination based on gender identity but not sexual orientation. In 10 US states, transition-related health care is expressly excluded from Medicaid coverage, limiting options for low-income transgender people.

LGBT people interviewed for the report described difficulty finding hormone replacement therapy, HIV prevention and treatment options, fertility and reproductive services, and even just welcoming primary care services. Judith N., a transgender woman in East Tennessee, said, “I spent years looking for access to therapy and hormones and I just couldn’t find it.”

Others described discriminatory treatment by providers. Trevor L., a gay man in Memphis, recalled an incident when he took an HIV test at his annual checkup in 2016: “and they sat down and started preaching to me – not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, oh, thank you, I’ve been out for 20 years and I think I’m okay. It’s almost like they feel they have the right to tell you that it’s wrong.”

In addition to discrimination, many LGBT people are refused services outright because of their sexual orientation or gender identity. In a nationally representative survey conducted by the Center for American Progress in 2017, 8 percent of lesbian, gay, and bisexual respondents and 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity in the past year. Interviewees described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs  precluded her from evaluating a same-sex couple’s 6-day-old child.

Both providers and LGBT people noted that concerns about discrimination and mistreatment led LGBT people to delay or forego care. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek care they needed because of concern about mistreatment based on gender identity.

Many interviewees expressed concern that laws permitting providers to refuse service on moral or religious grounds would make care even harder to obtain. Persephone Webb, a transgender activist in Knoxville, Tennessee, said that “[i]t tells people who are prone to being bigoted to be a little braver, and a little braver. And we see through this – we know this is an attack on LGBT people.”

Instead of finalizing the proposed changes, HHS should preserve antidiscrimination protections and withdraw sweeping exemptions that put patients at risk, Human Rights Watch said. Lawmakers at the state and federal level should prohibit discrimination in health care on the basis of sexual orientation and gender identity, and should repeal exemptions that allow providers to refuse to serve patients because of their sexual orientation or gender identity.

“When LGBT people seek medical care, the oath to do no harm too often gives way to judgment and discrimination,” Thoreson said. “Lawmakers need to make clear that patients come first, regardless of their sexual orientation or gender identity.”

Posted: January 1, 1970, 12:00 am

(Beirut) – Iraq’s National Security Service (NSS), an Iraqi intelligence agency reporting to Iraq’s prime minister, has acknowledged for the first time that it is detaining individuals for prolonged periods of time, despite not having a clear mandate to do so, Human Rights Watch said today. NSS is holding more than 400 detainees in a detention facility in east Mosul. As of July 4, 2018, 427 men were there, some of whom had been held for more than seven months.

A blank NSS arrest warrant provided to Human Rights Watch. 

© 2018 Private

One person held there briefly in April described horrendous conditions, and said that detainees had no access to lawyers, family visits, or medical care. He described one prisoner dying in April after being tortured for months. Human Rights Watch was granted access to the facility on July 4. The detention conditions appeared improved but remained overcrowded.

“National Security Service officials in Baghdad told us that the intelligence agency has no authority to hold prisoners, but changed their line once we were able to see the prisoners for ourselves,” said Lama Fakih, deputy Middle East director at Human Rights Watch. “Baghdad needs to publicly clarify which authorities have the right to hold and interrogate detainees.”

On April 17 a senior NSS official in Baghdad denied operating any detention facilities and claimed that the agency only holds small numbers of people for up to 48 hours before transferring them to places of formal detention. But researchers were granted access to the facility, where officials said 427 prisoners were being held at the time. A subsequent written response from the Baghdad office confirmed the NSS is holding prisoners in one facility in Mosul, but then proceeded to speak about detention facilities in the plural form. Given the serious contradiction in statements and facts on the ground, the NSS should clarify the number of prisoners it is detaining and the number and location of facilities it is using to detain them. Iraqi authorities should declare the number of detention facilities across Iraq. Judicial authorities should investigate the allegations presented in this report.

On May 16, Human Rights Watch interviewed Faisal Jeber, 47, an archaeologist, who said that on April 3 a group of three Ministry of Interior Intelligence officers in uniform and two armed men in civilian dress, one of who told Jeber he was “from the Prime Minister’s Office” arrested him at an archaeological site in east Mosul, claiming he had no permission to be there and accusing him of illegal excavations at a public heritage site. They first took him to an intelligence office, before turning him over to NSS officers who called a judge to endorse the arrest, Jeber said. Jeber was not given an opportunity to speak to the judge. NSS then brought him to a two-story house next to the NSS office in al-Shurta neighborhood in Mosul. Jeber said that on the ground floor of the house he saw four rooms being used as cells to hold prisoners and estimated that at least 450 prisoners were held with him based on a daily head count.

Jeber said he was taken before an investigative judge at Mosul’s criminal court on April 4, and then returned to the prison for a second night and released the following day pending trial. Upon arrival at the prison, he said guards confiscated his glasses and watch, and other personal items. When he was released, Jeber said guards did not give him his shoes or socks back, sending him out barefoot, and kept his belt, keychain, and headphones.

While Jeber was only held for 48 hours, he said he spoke with six men and one boy detained in the cell with him who told him NSS held them for between four months to two years, some being transferred to several NSS facilities before arriving at this one. Human Rights Watch researchers visited the facility on July 4, and the head of the NSS in Mosul showed them a brand new prison block that had been built next to the house where Jeber had been held. The new facility had three rooms and held 427 adult male prisoners, according to the NSS official. He said they transferred all prisoners under the age of 18 to another facility. He said some had been at the prison for up to seven months.

Another NSS officer who spoke to researchers on condition of anonymity said that some had been held for over one year, having been transferred from Qayyarah to Bartalla and on to Mosul when the detention site opened there seven months ago. The second officer said they had been holding the prisoners in a house next door, but after “pressure from Baghdad,” a few months ago they built the new prison block and transferred the prisoners there to improve conditions. The three rooms were clean, with air-conditioning, but like other prisons in Iraq extremely overcrowded.

The head of the NSS in Mosul said all the prisoners were wanted for ISIS affiliation, and were interrogated before they were either brought before an investigative judge or handed over to another security entity if that entity had the person on one of their “wanted” databases, including the Ministry of Interior’s intelligence branch, or military intelligence. He said they only arrested people after obtaining a warrant, and that all detainees had access to a judge and a lawyer within 24 hours of their arrest. Human Rights Watch did not interview any of the detainees at the facility.

Two Mosul lawyers who defend ISIS suspects said that in their experience, many prisoners are seeing an investigative judge within 24 hours, but have no government-appointed lawyer present then, nor later when the NSS interrogates them further. While the seven detainees told Jeber they had been brought before an investigative judge, none of them had access to a lawyer and they did not know if a lawyer was present to provide them with a defense during their hearing.

Iraq’s Criminal Code of Procedure allows police and “crime scene officers” to detain and interrogate criminal suspects if they have a warrant. It defines crime scene officers broadly, making it impossible to ascertain which forces are included. The NSS head in Mosul said that the NSS was authorized to arrest, hold, and interrogate prisoners.

However, Hamid al-Zerjawi, deputy National Security Service chief, told Human Rights Watch on April 17, that the NSS has no functional detention facilities in the country, and only one facility in Baghdad that is not yet operational. He conceded that the NSS held small numbers of people for up to 24 hours after their arrest at one of their offices, before bringing them before a judge, who could allow them an extra 24 hours of detention, before they needed to transfer the detainee to a formal detention facility. He said the NSS never held any detainee for over 48 hours.

On July 11, the NSS’s Baghdad office responded to Human Rights Watch inquiries into the facility. The written response acknowledged that the NSS is holding detainees at a single facility in Mosul with the consent of the High Judicial Council in Nineveh, that all detainees are held under judicial arrest warrants, see a judge within 24 hours of arrest, and are transferred to Ministry of Justice prisons upon being sentenced. The response did not provide any numbers of detainees nor details into the length of time they are being held at the facility, but stated that detainees are allowed to retain a lawyer, or have one appointed by the court, but added: “most lawyers in the governorate of Nineveh abstain from arguing terrorism cases.” It said there were no detainees under the age of 18.

The Iraqi authorities should publicly clarify which forces have a legal mandate to arrest, hold, and interrogate suspects, and provide a list of all official detention facilities. They should transfer all detainees to prisons run by authorities with a legal mandate to detain people. Such sites should be built to accommodate detainees, and equipped to meet basic international standards, even if this requires transferring the detainees outside of the Nineveh governorate, where Mosul is located. All detainees should have a medical screening upon arrival and be ensured access to medical care. Judges should only order detention in locations, and under the authority of forces, legally authorised to hold detainees, and order the immediate release of detainees or prisoners being held in inhuman or degrading conditions or otherwise detained unlawfully.

The authorities should also ensure that there is a clear legal basis for detention, that all detainees have access to legal counsel including during interrogation, and that detainees are moved to facilities accessible to government inspection, independent monitors, relatives, and lawyers, with regular and unimpeded access. The authorities should immediately notify families of the detention of their loved ones and which authority is detaining them and promptly take detainees before a judge to rule on the legality of their detention. They should immediately comply with any order by judges to release detainees.

Children alleged to have committed illegal acts should be treated in accordance with international juvenile justice standards. International law allows authorities to detain children pretrial in limited situations, but only if formally charged with committing a crime, not merely as suspects. The authorities should release all children not yet formally charged.

“Authorities should be doing whatever it takes to make sure that families know where their loved ones are,” Fakih said. “The government should crack down on forces with no legal mandate that are holding detainees for months on end without seeing a judge.”

The Former Detainee’s Account
Faisal Jeber, the archeologist, told Human Rights Watch that the detainees he spoke to said they were being held on suspicion of ISIS affiliation and alleged that during interrogations NSS officers had beaten them with plastic or electrical cables, electrocuted them, beaten the soles of their feet, and hung them with their hands bound behind their backs.

Jeber said that at 3 a.m. on his first night at the prison, an argument broke out between two prisoners in his room. He said two guards came in, took the two men out, and in front of the window Jeber saw each guard beat one of the men with plastic cables and pipes for about 20 minutes, cursing and shouting at them before returning them to the room.

He said that first night in detention he was told that a man had died after being tortured: 

My first night it was the time when we all get to use the bathroom. As we were getting ready to leave our room in a line, we heard voices coming out of the room and it was chaos; the guards were saying someone had died. One prisoner with me said that he had been in the cell with the man who died, and said he was in his thirties, had been at the prison for some time, and had been tortured to the point that he had been half paralyzed.

The NSS July 11 response acknowledged deaths at the prison, stating, “There have been very limited cases of death, which were judicially documented,” without providing any further detail. The response also stated,

 

There has been no use of torture inside detention centers, and no signs of torture or ill-treatment have been found, knowing that there is a department within the NSS that is specialized in these cases if they occur.

Jeber described the conditions in the facility, raising concerns about overcrowding, unhygienic conditions, and unreasonable restrictions on using the bathroom. He said that the room he was held in had a single window and small ventilator and was about 4 by 5 meters:

As I walked in I saw that half the prisoners were standing and the other half sitting because there wasn’t enough room for all of us to sit at the same time. My fellow inmates told me that I was the 79th person in the room. All around me on the walls were plastic bags hanging as well as plastic bottles holding a dark yellow liquid. The prisoners told me that was the only way that I could use the bathroom- urinate into the bottle or defecate into the bag- because the NSS guards only allowed prisoners to use the bathroom once every two days.

He said that at night the prisoners slept in shifts in the scabies-infested room because there was not enough room for all of them to lie down, with some standing until 6 a.m., before it was their turn to lie down with their heads between the legs of other prisoners.

Jeber also raised concerns about the absence of medical care for the detainees. He said that the first night of his detention one man in his cell suffered an epileptic seizure but received no medical attention. Other prisoners told him the guards had said that a doctor would only come if someone died and the body needed to be removed.

The NSS head in Mosul told Human Rights Watch that a representative from the Health Ministry visited there regularly to provide medical assistance, something Human Rights Watch was unable to verify.

The conditions the NSS held Jeber and others in, before the transfer to the new facility, are similar to the dire conditions at other prisons in the towns of Qayyarah and Hammam al-Alil, that Human Rights Watch visited in 2017.

Most of the prisoners Jeber spoke to said they had been able to bribe the guards to allow them to communicate with their families indirectly but none had been allowed a family visit. One gave Jeber his uncle’s phone number. Jeber said, “After I was released I called his uncle, who was surprised that he was still alive and said the family had no news of him since he had disappeared during the Mosul battle in early 2017.” The anonymous officer said that they forbade prisoners to have any visits or contact with their families or the outside world. The NSS July 11 response stated that detainees were only allowed to contact their families after the interrogation period ends.

Jaber believed that there were at least 450 prisoners in the home at the time he was held, because on the two days he was held there he said guards at the facility did a headcount and he overheard them counting at least 450 prisoners.

The NSS response

The NSS officer who spoke to researchers on the condition of anonymity said that officers know some prisoners are innocent. He said the NSS held many of them for months because Nineveh only has one counterterrorism judge hearing cases of detainees held by the NSS, leading to long delays. He said in cases where a defendant does not confess to a crime, the judge needs to order a range of investigations to be carried out by various security actors which also takes a long time to complete.

The NSS head in Mosul stated that the detention site has many prisoners they would like to transfer to other authorities, with a judge’s order, but that there is no room available in other prisons. The prohibition against arbitrary detention is enshrined in Iraq’s constitution and civil code. Under international criminal law, widespread or systematic use of arbitrary detention can be considered a crime against humanity if it is applied as part of a state policy.

Iraq’s penal code says that arbitrary detention is a criminal act if, among other conditions, the person who commits the offense issues a false arrest or detention order, threatens the person with death or torture, and holds the person for more than 15 days.

Posted: January 1, 1970, 12:00 am

Rural residents are being poisoned in Brazil from pesticides sprayed near their homes, schools, and workplaces. Many rural communities fear reprisals from wealthy and politically powerful farmers if they denounce such poisonings or advocate more protective laws and regulations.

Posted: January 1, 1970, 12:00 am

Indonesian authorities are fueling an HIV epidemic through complicity in discrimination against lesbian, gay, bisexual, and transgender (LGBT) people. The government’s failure to halt arbitrary and unlawful raids by police and militant Islamists on private LGBT gatherings has effectively derailed public health outreach efforts to vulnerable populations.

Indonesian authorities are fueling an HIV epidemic through complicity in discrimination against lesbian, gay, bisexual, and transgender (LGBT) people. The government’s failure to halt arbitrary and unlawful raids by police and militant Islamists on private LGBT gatherings has effectively derailed public health outreach efforts to vulnerable populations.

The 70-page report, “‘Scared in Public and Now No Privacy’: Human Rights and Public Health Impacts of Indonesia’s Anti-LGBT Moral Panic,” documents how hateful rhetoric has translated into unlawful action by Indonesian authorities – sometimes in collaboration with militant Islamist groups – against people presumed to be LGBT. Based on in-depth interviews with victims and witnesses, health workers, and activists, this report updates a Human Rights Watch August 2016 report that documented the sharp rise in anti-LGBT attacks and rhetoric in Indonesia that began that year. It examines major incidents between November 2016 and June 2018, and the far-reaching impact of this anti-LGBT “moral panic” on the lives of sexual and gender minorities and the serious consequences for public health in the country.

“The Indonesian government’s failure to address anti-LGBT moral panic is having dire consequences for public health,” said Kyle Knight, LGBT rights researcher at Human Rights Watch and author of the report. “The Indonesian government should recognize that its role in abuses against LGBT people is seriously compromising the country’s response to HIV.”

Beginning in early 2016, politicians, government officials, and state offices issued anti-LGBT statements – calling for everything from criminalization to “cures” for homosexuality, to censorship of information related to LGBT individuals and positive reporting on their activities.

The government’s response to the country’s HIV epidemic in recent decades has helped slow the number of new infections. However, widespread stigma and discrimination against populations at risk of HIV, as well as people living with HIV, has discouraged some HIV-vulnerable populations from accessing prevention and treatment services. As a result, HIV rates among men who have sex with men (MSM) have increased five-fold since 2007 from 5 percent to 25 percent. And while the majority of new HIV infections in Indonesia occur through heterosexual transmission, one-third of new infections occur in MSM.

The anti-LGBT moral panic and unlawful police raids have made public health outreach to the most at-risk populations far more difficult making wider spread of the virus more likely, Human Rights Watch said.

Throughout 2017, Indonesian police raided saunas, night clubs, hotel rooms, hair salons, and private homes on suspicion that LGBT people were inside. In total, police apprehended at least 300 people in 2017 alone because of their presumed sexual orientation and gender identity – a spike from previous years and the highest such number ever recorded in Indonesia.

Nigrat L., a 47-year-old transgender woman outreach worker in Jakarta said, “Violence will always be there – it always has been with us. It’s just part of our lives. It’s normal. We just know it as our bad luck that day, and maybe tomorrow too, or maybe tomorrow will be better.”

The raids sometimes were preceded by police surveillance of social media accounts to discover an event’s location, and at times featured officers marching unclothed detainees in front of the media, public humiliation, and moralizing presentations of condoms as evidence of illegal behavior. Three police raids in 2017 shut down MSM HIV outreach “hot spots,” places where outreach workers would routinely meet and counsel MSM, as well as provide condoms and voluntary HIV tests. In at least two of the well-publicized raids, in Surabaya and West Java, police openly used condoms as evidence in exposing and humiliating MSM detainees in the media.

“It is devastating that these clubs have closed – they were the only places where we could find the community,” said an HIV outreach worker in Jakarta. “Clubs were hot spots for us because we knew that even the discreet guys felt safe about their sexuality inside, so we could do HIV testing and give condoms and they wouldn’t be scared to participate.” Another outreach worker said that “we see more and more MSM waiting to get really sick before they seek help or even ask questions about HIV.”

In December 2017, Indonesia’s constitutional court rejected a petition that had sought to criminalize sex outside of marriage as well as adult consensual same-sex conduct specifically, calling the case “legally unsound” and warning against over-criminalization. Meanwhile beginning in January 2018, versions of the draft Criminal Code that featured troubling proposed provisions on criminalizing consensual sexual relations began circulating through various parliamentary committees. The government representative on the drafting task force has since expressed opposition to outright criminalization of same-sex conduct, but sex outside of marriage remains a criminal offense in the draft.

After a February visit to Indonesia, the United Nations high commissioner for human rights stated that “LGBTI Indonesians already face increasing stigma, threats and intimidation. … The hateful rhetoric against this community that is being cultivated seemingly for cynical political purposes will only deepen their suffering and create unnecessary divisions.”

“The vitriolic anti-LGBT rhetoric from public officials that began in early 2016 effectively granted social sanction and political cover to violence and discrimination,” Knight said. “To correct its course, the government needs to uphold its commitments to ‘unity in diversity’ by halting and investigating unlawful police raids and ensure discrimination is not enshrined in its laws.”

Posted: January 1, 1970, 12:00 am

Indonesian authorities are fueling an HIV epidemic through complicity in discrimination against lesbian, gay, bisexual, and transgender (LGBT) people. The government’s failure to halt arbitrary and unlawful raids by police and militant Islamists on private LGBT gatherings has effectively derailed public health outreach efforts to vulnerable populations.

The men were nearly identically dressed. Matching fresh crewcuts almost hidden under baseball caps pulled down to shade their eyes, pollution masks covering their faces, and matching dark t-shirts.

You would be forgiven for thinking they were on their way to do something illegal, especially if you spoke with them and realized how on edge they were, nervously looking around and stopping their conversation whenever a security guard on his usual patrols came near.

But these men, who work to prevent HIV in vulnerable populations in Jakarta, Indonesia’s capital, were simply meeting the Human Rights Watch researcher Andreas Harsono and his cameraman for a pre-arranged interview about a new report, “Scared in Public and Now No Privacy,” which looks at the rising anti-LGBT hysteria in Indonesia, and what that means for public health. HIV rates among men who have sex with men in Indonesia have increased five-fold since 2007, from 5 percent to 25 percent. And while the majority of new HIV infections in Indonesia occur through heterosexual transmission, one-third of new infections occur in men who have sex with men.

For over two years now, politicians and government officials in Indonesia have been whipping up the public into an anti-LGBT fury. What started in 2016 as hateful rhetoric has now become violent actions, with raids by police and militant Islamists on places they suspect LGBT people are socializing. This has included raids on everything from gay clubs, to the private homes of suspected lesbians, to waria (transgender women) community events.

The atmosphere of fear and moves to break up safe gathering spaces is having devastating health consequences. HIV outreach workers are struggling to locate the people who need their help – which comes in the form of condom distribution, blood testing, education, and psychological counselling.

The masked men – who asked not to be named to protect their identities – had arranged to meet Harsono outside the now-shuttered T1 nightclub. The men used to work inside and outside the club – giving out condoms and educational pamphlets, and providing some counselling. There was even a mobile clinic where at-risk people could go for blood tests and counselling services.

“It turned out they’d been looking at us from a distance to check us out,” Harsono said. “They had been walking around the area to make sure it was safe.”

They are courageous and persistent.

Andreas Harsono

Indonesia Researcher at Human Rights Watch

When the men eventually approached, they stood out because of their appearance in the business neighborhood where T1 used to be. Harsono took them into a restaurant to shield them. But it was Ramadan, so the two HIV outreach workers did not order food, and the atmosphere remained stressful.

“I was so shocked by their concealed appearance, but of course they were doing it because they were nervous,” Harsono said, adding that it seemed the men were traumatized because hundreds of LGBT people had been arrested in recent raids on nightclubs and in private homes.

“People have been sentenced to 18 to 30 months in prison after being arrested in these raids.”

In 2017, police apprehended at least 300 people perceived to be LGBT – the highest number of such arrests ever recorded in Indonesia. In some cases, if they were carrying condoms, that was used as evidence of homosexuality. That leads people to decide against carrying condoms, which only adds to the HIV epidemic.

When the clubs were open, the outreach workers were easily able to make contact with men at-risk of HIV, but now with the safe spaces shuttered and networks scattered, there are risks of an even bigger spike in HIV rates.

Police officers sit outside a court in Jakarta, Indonesia May 9, 2017.

© 2017 Reuters

The fear the crackdown is causing is palpable. “A security man came by when we were discussing the film shoot, just on his normal rounds, and they were so scared,” Harsono said. “They were terrified he would come over and see them. It says so much about the feeling in Jakarta now.”

The anti-LGBT rhetoric has had a deep impact on society in Indonesia. In a 2016 opinion poll, 26 percent of those interviewed said they didn’t like LGBT people. It was the largest percentage for any group.  By 2017, that number was even higher.

“In February 2016 the minister of defense even said the LGBT movement was more dangerous than nuclear war.”

But despite the shrinking space and the very real risk to their safety and freedom, some outreach workers like the two men Harsono spoke to are still trying to make a difference to communities at-risk of HIV.

“They are turning to social networks and the internet,” Harsono said, “I’m really amazed to see how these workers are adapting. They know that they can be arrested, stopped by the police, stopped by security every time they are seen to be chatting with transgender women, but they are courageous and persistent.”

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Mourners watch as Kian delos Santos, a 17-year-old student who was shot during “anti-drug” operations, is buried in Metro Manila, Philippines, August 26, 2017.

© 2017 Romeo Ranoco/Reuters

Philippine President Rodrigo Duterte’s murderous “war on drugs” may soon place thousands of primary school children in harm’s way.

The Philippine Drug Enforcement Agency (PDEA) announced on Friday that it is seeking the authority from the Dangerous Drugs Board to impose annual surprise drug screening tests on teachers and school children starting from the fourth grade. PDEA has justified the move as an attempt to identify 10-year-old potential drug users so they “can get intervention while they are still young.”

But this proposal, the latest dangerous outgrowth of Duterte’s anti-drug campaign which has already claimed the lives of dozens of children, will place school children at grave risk. It marks a drastic extension of mandatory drug testing already in place for all college students and applicants, and will effectively allow the police to extend their “anti-drug” operations to primary school classrooms. Imposing mandatory drug testing on schoolchildren when Philippine police are committing rampant summary killings of alleged drug users puts countless children in danger for failing a drug test.

The PDEA said that drug test results will be confidential and the Dangerous Drugs Board announced it will negotiate guidelines for the mandatory testing program “to ensure rights of students are protected and their safety is guaranteed.” But the government’s repeated dismissal of the deaths of dozens of children in “drug war” killings by police and unidentified gunmen as “collateral damage” suggests that children’s safety won’t be a top priority.

The mandatory testing of children for drug use raises other human rights concerns as well. Taking a child’s bodily fluids, whether blood or urine, without their consent may violate the right to bodily integrity and constitute arbitrary interference with their privacy and dignity. Depending on how such testing occurs, it could also constitute degrading treatment, and may deter children from attending school or college for reasons unrelated to any potential drug use, depriving them of their right to an education.

The government should provide children with accurate information about the potential risks of drug use, not put them in the crosshairs of a summary killing campaign that has already claimed the lives of more than 12,000 Filipinos.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

An activist waves a rainbow flag in Manhattan, New York, US, February 26, 2017. 

© 2017 Reuters

The American Medical Association (AMA) adopted new policies last week that will position the organization as an advocate for better protections for transgender people in detention, and LGBT-inclusive family leave policies.

My colleagues have investigated paid leave issues in the US. The 1993 Family and Medical Leave Act (FMLA) requires employers to grant up to 12 weeks of unpaid annual leave to allow workers to care for a spouse, child, or parent with a serious health condition, or to care for newly born or adopted children.

Among many other harrowing findings, our 2011 report included interviews with parents whose same-sex spouses were denied even unpaid FMLA leave because employers did not consider the babies of the non-biological parent to be “family” for purposes of their leave policies (in violation of the FMLA). For example, a woman in a same-sex relationship in Arizona whose partner experienced complications after a c-section when delivering twins was denied leave to support her during a prolonged hospital stay.

The 2015 Supreme Court judgment affirming same-sex marriage rights protected married same-sex partners, and some states are now going further by using a “blood or affinity” model, which allows FMLA-equivalent benefits for chosen family, domestic partners, and individuals who are dependent on the employed individual. The AMA’s new policy means physicians will now advocate for such inclusive definitions of family.

The AMA will also support advocacy for transgender people in detention.

In our 2016 report, we documented the ill-treatment of trans women in immigration detention facilities in the US, including placement in cells with men, where they experience disproportionately high rates of sexual assault.

This means the AMA will now advocate for trans people in detention to be placed in facilities in accordance with their gender identity and that those facilities not amount to solitary confinement. It is particularly important given that in May 2018, the Bureau of Prisons announced that “biological sex” will be used as the basis for initial placement determinations, and trans prisoners will be assigned to facilities according to their gender identity only “in rare cases.”

Having the AMA support these LGBT rights issues will boost years of advocacy by community groups. The AMA’s stances on other issues, such as its complete opposition to “conversion” therapy, have made a significant difference by joining the medical community’s voice with that of rights advocates.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Imports sit destroyed in a damaged warehouse at the port in Hodeida city, Yemen.

© November 2016 Kristine Beckerle / Human Rights Watch

(Beirut) – All parties to the conflict in Yemen should minimize civilian harm during military operations against the western port city of Hodeida, Human Rights Watch said today. The Saudi-led coalition, backed by the United States, and Yemeni government-aligned forces, backed by the United Arab Emirates, stepped up attacks on Houthi forces controlling the port in June 2018.

About 70 percent of Yemen’s aid and commercial imports enter through Hodeida and the nearby Saleef port, providing food, fuel, and medicine that the population needs for survival. To comply with international humanitarian law, or the laws of war, warring parties should take immediate steps to provide safe passage and adequate support to civilians fleeing fighting and facilitate the flow of aid and commercial supplies to the broader population and access by humanitarian agencies.

“The coalition and Houthi forces now fighting for Hodeida have atrocious records abiding by the laws of war,” said Sarah Leah Whitson, Middle East director at Human Rights Watch. “The UN Security Council should urgently warn senior officials on both sides to provide civilians access to desperately needed aid.”

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Up to 600,000 civilians remain in the vicinity of densely populated Hodeida, which the Houthis took over in late 2014. On June 9, the UAE, which has led coalition operations along Yemen’s western coast, informed humanitarian organizations that they had three days to evacuate the city. The United Nations and other humanitarian organizations withdrew many of their staff, but the UN aid chief, Mark Lowcock said, “It is our plan, intention and hope to stay and deliver.”

The parties to the conflict are bound under the laws of war to take all feasible precautions to minimize civilian casualties and damage to civilian structures. Since the coalition began its military campaign in Yemen in March 2015, coalition forces have committed numerous unlawful airstrikes and used inherently indiscriminate cluster munitions. The Houthis have unlawfully carried out indiscriminate missile strikes, used anti-personnel landmines, and deployed children in combat, as have pro-government Yemeni forces.

The UN has referred to Yemen as the world’s worst and largest humanitarian crisis. As of January 2018, at least eight million Yemenis were on the brink of famine, which is linked directly to the armed conflict. Hodeida’s port is the “single most important point of entry for the food and basic supplies needed to prevent famine and a recurrence of a cholera epidemic,” the UN has said.

UN Security Council Resolutions 2140 and 2216 established a sanctions regime that authorizes the Yemen Sanctions Committee to designate those responsible for serious abuses, including obstructing humanitarian assistance, for travel bans and asset freezes. The Security Council should announce that it will impose these penalties on individuals who commit offenses during the Hodeida offensive that meet the sanctions committee’s designation criteria, Human Rights Watch said.

The US became a party to the Yemen conflict soon after fighting began by providing intelligence and refueling for coalition bombing missions. In 2017, the US sent special forces to assist in locating and destroying Houthi caches of ballistic missiles and launch sites, according to the New York Times. The US has also sold thousands of advanced bombs and rockets to Saudi Arabia, which leads the coalition. The US could become complicit in violations of the laws of war by assisting coalition forces during the Hodeida offensive. The United Kingdom, France and other countries have also sold weapons to coalition forces. US and other foreign officials may be exposed to potential legal liability by selling weapons likely to be used in unlawful attacks.

“The battle for Hodeida could have a devastating impact on civilians both in the city and elsewhere in Yemen,” Whitson said. “Both sides need to seek to minimize civilian harm at all times, whether in carrying out attacks or by allowing families to flee to safety.”

A worker is pictured in a government hospital's drug store in Sanaa, Yemen August 16, 2017. 

© 2017 Reuters/Khaled Abdullah

Facilitate Humanitarian Access
Health professionals and humanitarian workers in Yemen have described how parties to the conflict have restricted access to aid and essential goods and the impact on the civilian population. This includes repeatedly failing to abide by laws-of-war requirements to facilitate the delivery of aid to civilians, exacerbating Yemen’s humanitarian crisis.

Further disruption of humanitarian and commercial imports through Hodeida and Saleef will have predictably devastating consequences for civilians, Human Rights Watch said. The inability of essential supplies to reach their final destinations, including to areas under Houthi or Yemeni government control, would also be disastrous.

On June 8, Lise Grande, Yemen’s UN humanitarian coordinator, said: “In a prolonged worst case, we fear that as many as 250,000 people may lose everything – even their lives.… Cutting off imports through Hodeidah for any length of time will put Yemen’s population at extreme, unjustifiable risk.”

The coalition has imposed a naval and air blockade on Yemen since the current conflict began that has severely and disproportionately restricted the flow of food, fuel, and medicine to civilians in violation of international humanitarian law. The coalition closed all of Yemen’s entry points in response to a Houthi missile strike on Saudi’s Riyadh airport on November 4, 2017, keeping Hodeida and Saleef ports closed for several weeks. The closures immediately and predictably exacerbated existing food shortages. The port of Aden in the south, which is controlled by the Yemeni government, does not have the capacity to receive the hundreds of thousands of metric tons of food, fuel, medicine, and other imported goods Yemenis depend on for survival.

Houthi forces have blocked and confiscated food and medical supplies and denied access to civilians in need. They have imposed onerous restrictions on aid workers, interfered with aid delivery, and restricted the movement of ill civilians. The cumulative impact of Houthi obstruction and interference with humanitarian assistance has significantly harmed the civilian population.

Parties to the conflict must facilitate the rapid passage of humanitarian aid for civilians in need and not arbitrarily interfere with it. They must also ensure the freedom of movement of humanitarian workers, which can only be restricted temporarily for reasons of imperative military necessity. Warring parties are also prohibited from carrying out attacks on objects that are indispensable to the civilian population, such as food stores or drinking water installations intended for civilians. The laws of war prohibit using starvation as a method of warfare, and require parties to a conflict not to “provoke [starvation] deliberately” or deliberately cause “the population to suffer hunger, particularly by depriving it of its sources of food or of supplies.”

All parties to the conflict should:

 

  • Take all necessary steps to keep Hodeida and Saleef ports open and operational without interruption to humanitarian and essential commercial goods;
  • Take all necessary steps to ensure that aid and essential commercial imports can be taken in at ports and can be transported to civilians throughout Yemen;
  • Cease targeting, damaging or destroying objects indispensable to the survival of the civilian population; and
  • Ensure the safety and security of humanitarian workers at all times.

 

Provide Safe Passage to Fleeing Civilians

Thousands of civilians have been displaced as fighting moved up Yemen’s western coast. In Aden in February, families displaced from their homes said they fled because they did not trust the warring parties to distinguish between civilians and combatants in their attacks. They described their fear when “the war came” and that the next mortar attack or airstrike would hit their or their neighbors’ homes. Some said that Houthi or UAE-backed fighters had restricted their flight.

A three-story house in Souq al-Hinood, a crowded residential area in Hodeida city, that was hit by an airstrike on the evening of September 21, 2016. A single bomb killed at least 28 civilians, including 8 children.

© 2016 Priyanka Motaparthy / Human Rights Watch

One man, “Talal,” said that after pro-government fighters pushed the Houthis out of Khawka in late 2017, about a dozen Houthi fighters deployed in the woods near his farm. He was worried that coalition forces would attack, but for two weeks the Houthis refused to allow his family to leave. “They said, ‘We will live together or we will die together.’ It was an order,” said Talal. “We heard the sound of airplanes all the time, stuck between the coalition and the Houthis.” His 4-year-old son “would wake up at night, crying, and yell, ‘The airplanes are coming!’” In December, after the Houthis had retreated to the woods, coalition airstrikes hit the family vehicle and their home. Eleven family members, including Talal’s nine children, were at the farm, and his 12-year-old son was severely wounded. They fled on motorbikes to the city of Hays.

Thousands of people displaced from fighting on the western coast have fled to Aden. “Ahmed,” 27, said UAE-backed forces at checkpoints occasionally refused entry to Aden or sought bribes from displaced people. His brother said, “Some of the people who are coming pay at the checkpoint, but it depends where you are from.” People from Houthi areas in the north pay larger bribes, he said. When Ahmed traveled from Taizz to Aden in early 2018, UAE-backed forces held him and a family traveling on the same bus at a checkpoint overnight with nothing to eat – the soldiers took their food and water. The soldiers let Ahmed go in the morning, but the family from the northern city of Saada, whom the soldiers accused of being Houthis, were still being interrogated when he left.

The laws of war require parties to the conflict to take all feasible steps to evacuate civilians from areas of fighting or where fighters are deployed and not to block or impede the evacuation of those wishing to leave. The creation of “humanitarian corridors” and the issuance of effective advance warnings of attack to the civilian population do not relieve attacking forces of their obligation to distinguish at all times between combatants and civilians and to take all feasible precautions to protect civilians.

Deliberately using the presence of civilians to protect military forces from attack is the war crime of “human shielding.”

The parties to the conflict should:

 

  • Remove civilians to the extent feasible from areas in the vicinity of military targets;
  • Allow civilians to flee areas of fighting for safety and to obtain aid; and
  • Never use civilians as “human shields.”

 

Avoid Civilian Casualties and Damaging Civilian Structures
Human Rights Watch and others have documented dozens of indiscriminate or disproportionate airstrikes by coalition forces and missile attacks by the Houthis that have caused thousands of civilian casualties. Coalition airstrikes have killed civilians in attacks on markets, homes, schools, hospitals and mosques. In March, the UN human rights office said that coalition airstrikes caused 61 percent of verified civilian casualties in Yemen.

The coalition has repeatedly hit infrastructure critical to the civilian population, including damaging essential port infrastructure in Hodeida. The coalition has carried out airstrikes using explosive weapons with wide-area effect in densely populated areas, including in Hodeida city.

The coalition has repeatedly pledged to minimize civilian harm in its aerial campaign, but has continued to carry out unlawful attacks. In April, the coalition bombed a wedding in Hajjah, killing 22 civilians and wounding at least another 54, about half of whom were children. As in 23 other apparently unlawful coalition airstrikes that Human Rights Watch has documented, the coalition used a US weapon – a Joint Direct Attack Munition (JDAM) satellite guidance kit.

Houthi and government-aligned forces have carried out indiscriminate artillery attacks that have struck populated neighborhoods, killing and wounding civilians. The Houthis have repeatedly fired artillery indiscriminately into Yemeni cities, including after withdrawing from city centers. They have failed to take all feasible precautions against harming civilians by deploying military forces in civilian facilities – including a school and a civilian detention facility.   

A so-called dual-use object – one that normally has both civilian and military purposes – is a valid military target so long as the expected concrete and direct military advantage from the attack is greater than the anticipated loss of civilian life and property. Any coalition attacks on Hodeida and Saleef port facilities, which serve a military purpose, will need to take into account the extreme importance of those facilities to the civilian population and the anticipated impact of their destruction, Human Rights Watch said.

 

All parties to the conflict should:

 

  • Take all feasible measures to ensure the protection of civilians and civilian objects during military operations;
  • Act to ensure that attacks on military targets do not cause disproportionate harm to civilians and civilian objects;
  • Take all feasible steps, when operating in areas where civilians and combatants are comingled, to minimize the harm to civilians and civilian objects, including by selecting weapons and specific munitions to minimize civilian casualties; and
  • Cease use of munitions with wide-area destructive effect in heavily populated areas.

 

Cease Use of Landmines; Increase Efforts to Clear Explosive Remnants of War

Landmines have killed and maimed civilians, disrupted civilian life, hindered humanitarian access, and prevented civilians’ safe return home in affected areas in Yemen. In any battle for Hodeida, the Houthis, as well as pro-government forces, should not use antipersonnel mines, which pose a threat to civilians long after a conflict ends.

Houthi forces have repeatedly laid antipersonnel, antivehicle, and improvised mines, as they withdrew from areas in Aden, Taizz, Marib and, more recently, along Yemen’s western coast. In February, the Yemen Executive Mine Action Center’s southern branch found antipersonnel mines, antivehicle mines and other types of explosive ordnance, including improvised antipersonnel mines, near the towns of Mokha, Khawka and Hays. One deminer said that, “Areas that have been mined have never been signed [marked with warning signs].” Three years after the Houthis withdrew from Aden, mine survey and clearance operations continue.

Use of antipersonnel landmines violates the laws of war, and those involved are committing war crimes. The indiscriminate use of antivehicle mines and failure to minimize civilian casualties also violate the laws of war. Yemen suffers from a shortage of equipped and trained personnel who can systematically clear landmines and explosive remnants of war.

All parties to the conflict should:

 

  • Cease using antipersonnel mines, destroy any antipersonnel mines in their possession, and appropriately punish those using them;
  • Raise awareness among the displaced about the threat of mines, including improvised mines, and develop capacity to rapidly clear homes and residential areas of mines and remnants of war to facilitate the return of the civilian population; and
  • Direct international assistance to equip, train, and assist clearance personnel to systematically survey, clear, and destroy Yemen’s mines and explosive remnants of war. International donors should provide assistance for landmine victims, including medical care, prosthetics, and ongoing rehabilitation.

 

Ensure that No Children Take Part in Fighting

Houthi forces, pro-government forces, and other armed groups have used child soldiers, an estimated one-third of the fighters in Yemen. By August 2017, the UN had documented 1,702 cases of child recruitment since March 2015, 67 percent of which were attributable to formerly aligned Houthi-Saleh forces. About 100 of the verified cases included recruiting children younger than 15, the recruitment or use of whom is a war crime.

The Houthis have recruited, trained, and deployed children in the current conflict. “Yasser,” 20, said that the fear of forced recruitment drove him and two of his close friends to flee Sanaa in 2017. The Houthis had recruited his younger brother, 15 or 16, who then patrolled neighborhoods, worked at checkpoints, and received training. “He takes our father’s weapon when he goes.” The Houthis provided him with food and qat, but no pay. “He goes with seven of his friends around the same age,” Yasser said. Houthi supporters came to their neighborhood almost daily and talked to young men and boys about becoming fighters.

“Salem,” who was displaced by fighting on the western coast, said that children as young as 13 “were ruling us, they have the guns,” while his family remained in Houthi-controlled Mafraq. His family was first displaced to Houthi-controlled Ibb, but they fled to Aden in early 2018 after a local leader warned them the Houthis might forcibly recruit their children.

The local leader, who was also trying to send his children away to protect them, said the Houthis were going around to people’s homes, asking how many men and boys lived there, and registering names for fighting. Their neighbors said families had to provide either money or a person to fight, often a child: “They paid, or they take the kids, so they paid… They would take people who were 16, 17, if they can carry a weapon.” His relative, “Ali,” 16, said that in December 2017 Houthi men on a truck came to his secondary school. “I saw three Houthis with guns trying to take the kids… some of the kids were crying.” He and his friend scaled the school’s wall and ran away. Salem, Ali and about 70 other members of 13 related families were staying together in an abandoned school in Aden when Human Rights Watch interviewed them.

International law sets 18 as the minimum age for participation in direct hostilities, which includes using children as scouts, couriers, and at checkpoints. Under Yemeni law, 18 is the minimum age for military service.

Forces that capture child soldiers should treat them as victims of rights violations, not simply as captured fighters, and abide by international standards. The Paris Principles on Children Associated with Armed Forces or Armed Groups states: “The release, protection and reintegration of children unlawfully recruited or used must be sought at all times, without condition and must not be dependent on any parallel release or demobilization process for adults.”

All parties to the conflict should:

 

  • Ensure that no children take part in fighting in Hodeida;
  • Clarify to affiliated forces that recruiting children is unlawful even if they are not serving a military function;
  • Appropriately investigate and punish officers who allow children in their units or are responsible for the war crime of recruiting or using children under 15; and
  • Provide former child soldiers all appropriate assistance for their physical and psychological recovery and social reintegration.

 

Investigate Unlawful Attacks

None of the countries that make up the Saudi-led coalition have publicly clarified which alleged unlawful attacks their forces participated in. The investigative body the coalition created in 2016 does not meet international standards and has absolved coalition forces of responsibility in the vast majority of attacks investigated. The coalition has not compensated victims of unlawful strikes or their families, as far as Human Rights Watch has been able to determine.

In response to Human Rights Watch letters in 2016 and 2017, the Houthi-controlled Foreign Affairs Ministry expressed a willingness to investigate reports of landmine use, but not until the conflict ended. Human Rights Watch has not been able to identify any concrete steps the Houthis have taken to investigate potentially unlawful attacks or hold anyone to account for violations.

Countries that are parties to the armed conflict should:

 

  • Impartially and transparently investigate credible reports of alleged violations of the laws of war and make public their findings. Individuals implicated in war crimes should be appropriately prosecuted;
  • Conduct investigations using a full range of tools, including interviews with witnesses, surveillance and targeting videos, and forensic analyses. Public findings should include accountability measures taken against individual personnel, redress provided to victims or their families, and an explanation of the process used;
  • Provide compensation for wrongful civilian deaths, injuries and harm. The coalition should develop effective systems for civilians to file claims for condolence or ex gratia payments and to evaluate the claims; and
  • The US, UK, and France should cease all weapons transfers to Saudi Arabia because of Saudi Arabia’s widespread violations of the laws of war, and weapons transfers to other coalition members that are likely to use them unlawfully.
Posted: January 1, 1970, 12:00 am

A medic looks on during a demonstration near the separation fence with Israel in southern Gaza, May 18, 2018.

© 2018 Reuters

According to the Gaza Ministry of Health, an Israeli sniper fatally shot 21-year-old paramedic Razan al-Najjar inside Gaza near the separation fence on June 1, 2018. According to a medical volunteer with al-Najjar when she was shot, al-Najjar was clearly identifiable as a medical volunteer and aiding injured demonstrators. The Israeli army has said “no shots were deliberately or directly aimed towards her.”

On May 14, 2018, an Israeli sniper shot Dr. Tarek Loubani in the leg near the separation fence. He is one of 25 medical workers and first-responders injured by live fire in demonstrations in Gaza between March 30 and June 2, according to Gaza’s Health Ministry. Loubani wrote that, when shot, he too was clearly identifiable as a doctor, and that most paramedics were wearing bright, fluorescent jackets. He said there were no protests, fire, or smoke in his immediate vicinity, and he and his colleagues were standing still and talking. According to Loubani, one hour later, the paramedic who had rushed to his aid, Musa Abuhassanin, was shot in the chest and killed by Israeli fire while assisting in another rescue.

These shootings take place during an overall health crisis in Gaza, worsened by its decade-long closure by Israel.

The closure, exacerbated by Egypt’s usually sealed border to the south, as well as disputes between the Palestinian Authority and Hamas, has left medical facilities struggling to operate due to severe lack of electricity and shortages of medicines. Hospitals rely on generators to get them through power cuts, but they are prone to malfunction. Israel blocks many critically ill residents from accessing care outside Gaza, leaving them few options but to seek care at overstretched hospitals and clinics in Gaza.

Shooting at medical workers adds further strain to a system already struggling to cope.

Before he was shot, Loubani attended a Human Rights Watch event in Toronto and discussed the humanitarian impact of the decade-long closure. When discussing the bleak situation in Gaza, Loubani was asked if he had hope. He said, “Working in a hospital without electricity, sutures, or supplies, all you can have is hope. Hope that this will, one day, get better.”

Lifting Israel’s closure of Gaza and the accompanying indiscriminate restrictions on the movement of people and goods would mark a major step in that direction. Accountability for serious abuses would be another; the Commission of Inquiry set up by the United Nations Human Rights Council to examine the killings in Gaza should investigate the attacks on medical workers.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am