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, 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


The Honorable Chuck Grassley 
135 Hart Senate Office Building
Washington, D.C. 20510 

The Honorable Dianne Feinstein
331 Hart Senate Office Building
Washington, D.C. 20510

Dear Chair Grassley and Ranking Member Feinstein: 

We, the undersigned, write to you today to urge you to reject any efforts to reduce the fentanyl and analogue quantities in 21 U.S.C. §§ 841 and 960, or to increase the lengths of these mandatory minimum sentences, as you consider opioid legislation in the committee. We oppose any effort to amend S. 2645, S. 2535, S. 2789, S. 207, S. 2838, or S. 2837 by adding S. 2635, the Ending the Fentanyl Crisis Act of 2018, or any other legislation similar to S. 2635.

We understand and share the deep concern about the opioid overdose crisis and fentanyl in particular. Over 63,000 people died from opioid overdoses in 2016. State opioid overdose death rates range from 6.4 per 100,000 people in Nebraska to 52 per 100,000 in West Virginia.[1] With such startling statistics, it is crucial that Congress pass evidence-based policies that work – and mandatory minimums do not. Lowering the statutory weight thresholds for fentanyl and its analogues, or increasing current penalties, will fail to curb fentanyl supply or demand and will give lengthy, expensive prison sentences to more low-level sellers and individuals who struggle with addiction.

If anything demonstrates the failure of mandatory minimums, it is the opioid overdose crisis. We have had harsh five-, 10-, 20-year, and life without parole mandatory minimum sentences for fentanyl and fentanyl analogues for 30 years, and they did not prevent and have not stopped the manufacture, traffic, or use of these drugs. Reducing fentanyl quantities and applying their lengthy penalties to more people with less drugs will not reverse this. Instead, Congress should invest more resources into alternatives that are proven to reduce drug use, addiction, and overdoses, like effective treatment and overdose prevention programs in our communities.

Making current mandatory penalties harsher will not deter drug trafficking or use or reduce drug supply, either. The Department of Justice’s National Institute of Justice has found that the length and severity of a punishment does not deter crime. Rather, it is the certainty of being caught and swiftly punished that deters criminal behavior.[2] The Pew Charitable Trust released a 50-state report that found no statistically significant relationship between drug sentencing and three key indicators of drug problems: drug use, drug overdoses, and drug arrests.[3] These findings reinforce what we already know: study after study shows that incapacitation does little to slow the drug trade because low-level dealers (the ones who would certainly be impacted if drug thresholds are reduced) are easily replaced. Furthermore, incapacitating suppliers does nothing to curb demand; effective treatment does.

Lowering fentanyl quantities will also produce counterproductive and unintended consequences. First, it may cause some illicit manufacturers to make this drug even more potent and fatal in even smaller quantities – a product no one wants on the streets. Second, it will apply mandatory minimum penalties that Congress intended for major traffickers to low-level drug offenders, people who use drugs, and individuals who struggle with addiction.

The U.S. Sentencing Commission has repeatedly found that current mandatory minimum sentences apply mostly to those who play low-level roles in drug conspiracies, such as mules, couriers, or street-level sellers – and this holds true in fentanyl cases.[4] It is true that a very small amount of fentanyl may prove fatal if misused. Nonetheless, the current fentanyl quantities do seem reasonably targeted at mid-level or major dealers or importers. Reducing fentanyl quantities will misapply mandatory minimums to more low-level sellers and people who use drugs, wasting prison cells and taxpayer resources on people who pose less threat to public safety, are easily replaced in the drug trafficking chain, or need treatment.

Third, smaller fentanyl quantities will punish many people who use drugs and people who struggle with addiction for drugs they may not even be aware they have in their possession. Because fentanyl is usually added to drugs before they get to the streets for sale, street-level sellers or people who use drugs often do not even know that their drugs contain fentanyl. People who use heroin or cocaine and share drugs with friends or sell to support their own addictions may not know that they are sharing drugs laced with fentanyl, but under S. 2635, they would face a five-year mandatory minimum for having a mere two grams of a mixture of a substance containing a detectable amount of fentanyl. A person who unknowingly possesses 1.999 grams of baking soda with 0.001 grams of fentanyl mixed in would face this mandatory minimum sentence. The same five-year mandatory minimum sentence would apply to someone with five grams of 100-percent pure fentanyl. Additionally, fentanyl can be trafficked in many forms, including pills. For example, a 10 milligram dose of hydrocodone weighs approximately 0.65 grams.[5] Using a reduced threshold of two grams, it would take only four hydrocodone pills laced with fentanyl to trigger the five-year mandatory minimum. These results would not be just, cost-effective, or make the public safer.

Congress was wise to pass the Comprehensive Addiction and Recovery Act (CARA) and the Fair Sentencing Act (FSA), a bill that increased drug quantities to more appropriately target the mid- and high-level sellers for whom Congress intended mandatory minimum sentences. Proposals to reduce fentanyl and fentanyl analogue thresholds are antithetical to CARA and the FSA and waste money with no corresponding public safety increase. We understand fully the crisis that our country is currently facing. The rise in drug overdose deaths is not a problem we take lightly. However, we cannot afford to fall back on failed policies of the past as lives continue to be lost to these powerful drugs.

Thank you for your time and consideration. We are happy to provide more assistance to your offices as you consider this important issue.


AIDS Alabama (AL)
Aleph Institute 
American Civil Liberties Union
Blacks in Law Enforcement of America
BOOM!Health (NY)
Broken No More
The Brotherhood/Sister Sol (NY)
Charles Hamilton Houston Institute for Race & Justice, Harvard Law School
Church of Scientology National Affairs Office
Clergy for a New Drug Policy
The Community Health Outreach Work (CHOW) Project (HI)
The Connecticut Bail Fund (CT)
Criminal Justice Policy Foundation
The Daniel Initiative
Due Process Institute
Drug Policy Alliance
Drug Policy Forum of Hawai’i (HI)
Drug Policy Forum of Texas (TX)
Empire State NORML (NY)
Families Against Mandatory Minimums
Friends Committee on National Legislation
GRASP (Grief Recovery After a Substance Passing)
Harm Reduction Coalition
Harm Reduction Michigan (MI)
Health Equity Alliance
Hep Free Hawaii (HI)
Human Rights Watch
Justice Strategies
Karen Garrison, President of Mommieactivist and Sons
Law Enforcement Action Partnership
The Leadership Conference on Civil and Human Rights
Legal Action Center
Life for Pot
Life Foundation (HI)
National African American Drug Policy Coalition, Inc.
National Alliance for Medication Assisted Recovery
National Association of Criminal Defense Lawyers
National Council of Churches
National Immigration Project of the National Lawyers Guild
National Urban League
November Coalition
One Million Americans (CT)
Peer Network of New York (NY)
Project Inform
Protect Families First
Public Justice Center
QC Harm Reduction (IA)
Reentry Central (CT)
Safe Streets Arts Foundation
San Francisco Drug Users Union (CA)
San Francisco Safety and Wellness Coalition (CA)
Sex Workers and Allies Network (CT)
Sonoran Prevention Works (AZ)
St. Ann’s Corner of Harm Reduction (NY)
Students for Sensible Drug Policy
Supernova Women
The Prison Consultants
The Sentencing Project
Tray Johns, Executive Director of Fedfam4life
Treatment Communities of America
Unitarian Universalist Association
Van Jones, President of The Dream Corps
WOLA - Washington Office on Latin America
Witness to Mass Incarceration
Women’s Alliance for Theology, Ethics and Ritual (WATER)
Women Who Never Give Up

cc: Members of the Senate Judiciary Committee

[1] “Drug Overdose Death Data” Center for Disease Control and Prevention.  

[2] “Five Things about Deterrence” National Institute of Justice, May 2016.

[3] “More Imprisonment Does Not Reduce State Drug Problems,” The Pew Charitable Trust, March 2018.

[4] U.S. Sentencing Comm’n, Public Data Presentation for Synthetic Cathinones, Synthetic Cannabinoids, and Fentanyl and Fentanyl Analogues Amendments (Jan. 2018) (showing that a majority of defendants sentenced for fentanyl offenses are low-level dealers; of the 51 persons convicted of a fentanyl-related offense in FY 2016, 29 served “street-level dealer,” “courier/mule,” and “employee/worker” functions).

[5] “Opinions Are Mixed About Sentencing Laws for Painkiller Trafficking” The Florida Legislature Office of Program Policy Analysis and Government Accountability, January 2012.

Posted: January 1, 1970, 12:00 am

Students receive free condoms at an event organized by the United Nations Population Fund in Metro Manila, July 11, 2014.

© 2014 Reuters

The Philippine Senate passed a bill on Monday that would amend the country’s 20-year-old AIDS law, and which promises to improve the government’s response to the HIV epidemic, the fastest-growing in the Asia-Pacific region. The draft law, which still needs to be harmonized with the version the House of Representatives passed in December, outlines a rights-based response to the epidemic.

The proposed law will provide more resources to the Philippine National AIDS Council, the government’s main policymaking body on HIV/AIDS. It lowers the age young people can be tested for HIV without parental consent from 18 to 15 years. It prohibits discrimination against people with HIV in the workplace and other settings. It makes it unlawful to disclose the HIV status of an individual without their consent. And it makes age-appropriate sex education in schools compulsory.

In short, the draft law is a marked improvement over its antiquated predecessor. But like its predecessor, the measure does not include specific provisions directing the government to promote condom use. This is a big mistake.

An improved official response to the epidemic is crucial. The government itself has declared the HIV epidemic a national emergency. The United Nations program on HIV/AIDS, known as UNAIDS, has determined that over the past six years, the Philippines has had a 140 percent increase in the number of new infections. Low condom use has been identified as the main reason HIV has exploded in the Philippines in the past decade. A 2016 Human Rights Watch report documented the government’s failure to conduct national campaigns to promote condom use. In February, the new UNAIDS country director for the Philippines announced that advocating condom use and comprehensive sex education were key planks in the agency’s strategy.

The failure to make promotion of condom use an official government priority reflects a damaging defeat by the ideological biases of conservative lawmakers and the Catholic Church over proper public health practice. Condoms, when used properly, are scientifically proven to be one of the best methods to prevent HIV transmission. Unless that message is integrated into the new AIDS law – perhaps during the harmonizing of the two congressional versions, or during the drafting of implementing rules and regulations – the struggle to contain the epidemic will get even tougher.

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

May 17, 2018

Office of the United Nations High Commissioner for Human Rights
United Nations Office at Geneva (c/o Zaved Mahmood)
CH 1211 Geneva 10

Re: Report of the Office of the High Commissioner for Human Rights on the implementation of the UNGASS joint commitment to effectively addressing and countering the world drug problem with regard to human rights

To the Office of the High Commissioner for Human Rights:

Thank you for the opportunity to submit our comments to feed into your upcoming report on the implementation of the outcome document of the UN General Assembly Special Session (UNGASS) on Drugs, adopted by the General Assembly in April 2016. We believe that respect for human rights needs to be a central element of national and global drug strategies and that your contribution to the UNGASS is of critical importance. For there to be an effective policy to tackle the world drug problem, there should be a stronger engagement of Geneva health mandate-holders, including the WHO and UNAIDS, together with the human rights expertise of the Human Rights Council, and civil society organizations.

Below, we draw on recent Human Rights Watch work on drug policy issues in several countries to highlight challenges and some progress with the implementation of the UNGASS outcome document.

Re: Operational recommendations on ensuring the availability of and access to controlled substances exclusively for medical and scientific purposes, while preventing their diversion

In its 2016 outcome document, UNGASS called on countries to consider reviewing “unduly restrictive” regulations governing access to controlled substances for medical and scientific purposes. Human Rights Watch has repeatedly documented how needlessly restrictive national drug policies make it difficult for people needing palliative care, pain treatment, and drug treatment to access morphine, methadone, and other medicines.

In 2017, Armenia took significant steps to address the limited availability of palliative care medicines, in line with the UNGASS recommendation. In February, it adopted a national palliative care strategy;[1] in March, it registered two forms of liquid oral morphine, considered by WHO to be fundamental to cancer pain treatment;[2] and in November, it adopted new drug regulations that remove many barriers to access to morphine for patients with pain.

However, many countries have yet to implement the UNGASS recommendation. In Guatemala, for example, Human Rights Watch found that at least 5,000 Guatemalans with cancer and HIV/AIDS live and die in pain per year because they cannot get morphine or other opioid analgesics due to regulatory barriers.[3] To prescribe an opioid analgesic, physicians must use a special prescription pad that only contains 25 scripts and can only be purchased one at a time at one location in the country. Physicians can only prescribe a maximum eight-day supply of morphine. For a longer supply, the physician must issue a second prescription form with a special stamp that they can only buy at one location in Guatemala City. Only 50 to 60 of the 14,000 doctors in Guatemala have special prescription pads, all in Guatemala City. Patients also need to get their prescription authorized in-person by the Ministry of Health, which can only be done at one office in Guatemala City. Only three pharmacies in the country, all in Guatemala City, consistently carry opioid analgesics.

Re: Operational recommendations on drugs and human rights

The 2016 UNGASS outcome document also recommended that states promote “proportionate national sentencing policies, practices and guidelines for drug-related offences”; enhance “access to treatment of drug use disorders for those incarcerated”; and promote effective responses to drug-related crimes that “ensure legal guarantees and due process safeguards.” Yet, our work in the Philippines has found that the government continues to pursue “war on drugs” policies that have resulted in numerous extrajudicial executions. Our work in Georgia has found that the government continues to prioritize arrest and incarceration over human rights and a public health-based approach to drugs.


Since taking office on June 30, 2016, Philippine President Rodrigo Duterte has carried out a “war on drugs” resulting in the deaths of more than 12,000 suspected drug dealers and users by January 2018.[4] The government has attributed an estimated 4,000 killings to the Philippine National Police, and the remainder to “unidentified gunmen.”[5] Media and rights groups investigations have determined that many of these killings were unlawful executions by police or agents of the police acting as “death squads.”[6]

Authorities have likewise used “drug watch lists” not only to target alleged drug suspects but, by releasing these to the media without charges filed in court, also to demonize local politicians they accused – without presenting evidence – of involvement in illegal drugs.[7] So-called “drop boxes” have also been set up in communities and police stations to encourage residents to report alleged drug suspects.[8] These boxes are prone to abuse as anyone can potentially be listed and put at risk.[9]

The government, with China’s assistance, has built so-called “mega rehab centers,” where alleged drug users are arbitrarily detained, ostensibly for drug treatment.[10] It has also initiated a police-run drug rehabilitation program, also detention-based.[11] These programs are not in accordance with internationally accepted standards on drug rehabilitation. More recently, the government has agreed to consider UN-backed programs that are community-based and voluntary.[12]

Poor conditions of detention facilities are also an issue, particularly in police precincts where most of those arrested or surrendered spent a considerable amount of time before being transferred to regular jails for trial or drug rehabilitation facilities.[13]


Georgia’s fight against the use and sale of illicit drugs prioritizes arrest and incarceration over drug prevention and treatment. Georgian authorities aggressively pursue drug prosecutions, which often lead to long sentences and prohibitive fines. People convicted for drug-related felonies often are deprived of several civil rights after they have served their sentences, including the rights to operate motor vehicles and to work in certain professions for certain periods, depriving many of their livelihoods and contributing to further stigmatization of drug users.

Drug users are vulnerable to police abuse, including ill-treatment and forced drug testing. Police have and use broad powers to stop individuals in the street and compel them to undergo drug testing, so long as there are “sufficient grounds” for assuming they are under the influence of drugs.[14] Police can detain a person who refuses a drug test for up to 12 hours in a forensic lab, during which time they can be deprived of fundamental rights afforded to a detainee in a criminal case.

First-time illegal drug consumption or possession of small quantity for personal use is a misdemeanor offense, but repeated use or possession within a year of a first offense results in criminal liability.[15] Approximately three-quarters of controlled substances – including commonly used substances like amphetamine, methamphetamine, and desomorphine – do not have established thresholds for small and medium quantities.[16] Thus, possession of any amount of those substances automatically qualifies as a large quantity, triggering criminal liability and prison terms ranging from five to eight years. Possession of more than one gram of these substances is considered an “extremely large amount” and can result in life imprisonment.[17]

Georgia imposes mandatory minimum sentences for drug-related offenses. As a result, a person charged with a drug-related offense are essentially compelled to agree to a plea deal to avoid long prison terms.[18] Plea bargaining in drug-related offenses often lead not only to prison sentences but also to prohibitive fines, which can financially devastate the accused and his/her family.


[1] Human Rights Watch, “Armenia Has New Strategy to Help Terminally Ill: Legal Changes Are Next Step to Get Treatment to Those in Need,” October 12, 2017,

[2] Human Rights Watch, “All I can Do Is Cry”: Cancer and the Struggle for Palliative Care in Armenia, July 2015,

[3] Human Rights Watch, “Punishing the Patient”: Ensuring Access to Pain Treatment in Guatemala, May 2017,

[4] Human Rights Watch, “Philippines: Duterte’s ‘Drug War’ Claims 12,000+ Lives,” January 18, 2018,

[5] ABS-CBN News, “Drug war death toll nears 4,000,” says PNP, January 23, 2018,

[6] Reuters, “Duterte’s War: Inside the bloody drug crackdown in the Philippines,” June 2017,

[7] Rappler, “PDEA drug list: More than 200 barangay officials linked to illegal drugs,” April 30, 2018,

[8] Philippine Daily Inquirer, “‘Drop boxes’ help gather intel for Duterte’s drug war,” Jul 30, 2017,

[9] Human Rights Watch, “Deadly Drop Boxes Fuel Philippine’s ‘War on Drugs’,” September 25, 2017,

[10] Human Rights Watch, “Japan: Don’t Fund Abusive Philippine Drug Rehab Services,” May 17, 2017,

[11] ABS-CBN, “PNP chief 'Bato' opens Laguna drug rehab center,” January 14, 2017,

[12] BusinessWorld, “UN offers assistance to Philippines’ rehab program for drug users,” April 3, 2018,

[13] Human Rights Watch, “Philippines' 'War on Drugs' Worsens Jail Miseries,” August 2, 2016,

[14] Police intelligence is considered “sufficient grounds.” See Joint order No1244–No278/n of the Minister of Internal Affairs and of the Minister of Labour, Health and Social Affairs of Georgia “On Approval of Rule of Determination of Administrative Offences Related to Consumption of Narcotic drugs and psychotropic substances”, October 24, 2006.

[15] Article 45 of Administrative Offences Code of Georgia.

[16] Georgian Law on Drugs, Psychotropic Substances, Precursors and Narcological aids, Annex 2. Out of 203 illegal drugs/psychotropic listed by the law, 156 do not have determined small amounts, and amounts enough to start criminal prosecution.

[17] Criminal Code of Georgia, Article 260.

[18] According to data provided by the Georgia’s Supreme Court, 60 percent of all drug-related cases heard by first instant courts in 2016 ended in a plea deal. Letter of Supreme Court of Georgia Np-42-17, February 2, 2017, in response to Human Rights Watch’s request of public information.

Posted: January 1, 1970, 12:00 am

An illustration depicts a transgender woman housed in a men's immigration detention facility.

© 2016 Brian Stauffer for Human Rights Watch

The Trump administration’s decision to change the policy of the federal Bureau of Prisons (BOP) for housing transgender prisoners is dangerous, wrongheaded, and unnecessary.

Because being transgender is a known risk for being sexually victimized in confinement, the Prison Rape Elimination Act (PREA) and Department of Justice guidance issued in 2016 called for individual determinations of housing, program, and other assignments in correctional facilities. That means an individual assessment must be made, taking many factors into account, including the person’s own views about their gender and safety. It also made assigning a transgender prisoner to housing, programs, or other services based solely on their sex assigned at birth a violation of federal law.

But last week, the BOP announced that while it will continue to make these determinations on a case by case basis as is required, “biological sex” will be used as the basis for the initial determination, and transgender prisoners will be assigned to facilities conforming to their gender identity only “in rare cases.”

At highest risk are transgender women who have reported alarming rates of assault in federal and state prisons and local jails: more than 1 in 3 have been sexually victimized according to PREA data. In a national survey of transgender adults, respondents who were incarcerated reported physical and sexual assault rates six to 10 times higher than non-transgender prisoners.

This latest decision is part of a pattern of actions taken by the Trump administration that includes an attempt to ban transgender persons from military service; disavowing protections for transgender persons in both employment and education under the Civil Rights Act of 1964; and green-lighting discrimination in health care by expanding religious and moral objections in health care settings.

As with the change to BOP policy, there is no defensible basis for these decisions. Indeed, Attorney General Jeff Sessions was a leading co-sponsor of PREA when he was in the Senate. BOP’s decision to weaken protections will place transgender people at immediate risk of physical and sexual assault. In light of overwhelming evidence of severe risks in confinement, it should be reversed immediately.

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

An anti-gay rights activist shows a badge during a flash mob organized by gay rights protesters in St. Petersburg May 17, 2012.

©2012 Reuters/Interpress/Valentia Svistunova

Earlier this week, Roskomnadzor, Russia’s federal agency responsible for overseeing online and media content, took steps to shutter ParniPlus, a website raising awareness about the exploding HIV epidemic among men who have sex with men.

The shuttering of ParniPlus marks at least the eighth case of outright censorship under Russia’s 2013 federal “gay propaganda” law that effectively prohibits any positive information about “non-traditional sexual relations” from public discussion.

Children-404, an online group that offers psychological support, advice, and a safe community for lesbian, gay, bisexual and transgender (LGBT) children, has repeatedly been censored and subject to attempts by the government to shut the group down since 2013.

“You can easily imagine a young guy somewhere in a Siberian town for which closed sites [such as] ‘Children 404,’ which have been repeatedly subjected to judicial and other pressure, have become invaluable evidence that he is not a monster and should not be afraid,” ParniPlus administrators wrote.

The purported rationale behind Russia’s “gay propaganda” ban is that portraying same-sex relations as socially acceptable supposedly threatens the intellectual, moral, and mental well-being of children. The law has rightly been condemned by the United Nations Committee on the Rights of the Child, the European Court of Human Rights, the Organization for Security and Co-operation in Europe, and the Council of Europe.

And, ParniPlus leaders point out, their site does more than promote awareness about sexual orientation, gender identity, and human rights; for the past decade, it has “vividly explained about the growing HIV epidemic in Russia every month and tells readers about the need for HIV prevention.”

The head of Moscow’s Federal AIDS Center has called Russia’s HIV epidemic a “national catastrophe,” and prevalence rates among men who have sex with men have increased dramatically in recent years – a trend some leading epidemiologists link closely with the anti-gay propaganda law’s stifling of sexual health information.

Cases like these clearly demonstrate that Russia’s “gay propaganda” law is just a flimsy excuse to discriminate against LGBT people and is abjectly harmful to public health in the process. Factual, positive, and affirming information about sexuality and health is essential for adults and children, including for HIV prevention.

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

Rohingya refugees try to take shelter from torrential rain as they are held by the Border Guard Bangladesh (BGB) after illegally crossing the border, in Teknaf, Bangladesh, August 31, 2017.

© 2017 Reuters
When I last visited the Rohingya refugee camps in Bangladesh at the end of last year, a new sort of everyday life was taking shape. No longer were countless desperate people milling about by the road, on paddy fields, and in public buildings. Instead, I watched refugees line up for plastic, tarpaulin, and bamboo to help construct rows upon rows of shelters.

But these rickety structures won’t be able to withstand the storms and heavy rains of the imminent monsoon season. And as dry earth turns to sludge in the coming weeks and months, there will be danger of both mudslides and disease.

A short but severe storm on Monday portends future disaster. Anxious activists began to call us in the afternoon. One sent a video recorded by 18-year-old Shafiq on his cell phone. The storm ripped into about 900 dwellings, some of which essentially fell apart and blew away.

The head of the International Committee of the Red Cross in Myanmar posted a video on Twitter from Maungdaw town, just across the border from the camps, expressing his concerns: “A reminder about the potential impact of the upcoming monsoon.” The United Nations refugee agency said it was accelerating its delivery of sturdier shelter kits, but the challenge is daunting.

Various UN agencies and humanitarian organizations on the ground in Bangladesh are seeking to address the situation. Their concerted efforts will hopefully get the refugees through this monsoon, but the difficulties they face, including the desire of many to return home to Myanmar when it’s safe to do so, will remain. 

Resolving that issue will require concerted international pressure, including by the UN Security Council, so that Myanmar puts in place the necessary economic, political, and security measures so that the approximately one million Rohingya refugees in Bangladesh and those that remain in Myanmar will be able to one day soon resume their lives in safety and dignity.

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

Doctors in the United States continue to perform medically unnecessary surgeries that can inflict permanent harm on intersex children. 

I testified before California’s senate judiciary committee today to support Senate Concurrent Resolution 110, which supports the autonomy of intersex Californians to decide if and when their bodies get surgically altered. The resolution, authored by Senator Scott Wiener and co-sponsored by interACT Advocates for Intersex Youth and Equality California, says the medical community should establish long-overdue evidence- and rights-based standards of care for children born with atypical sex characteristics.

Intersex children— born with chromosomes, gonads, internal or external sex organs that don’t match typical social expectations of male or female—are born perfectly healthy in most cases. However, since the 1960s, doctors in the US and around the world have routinely performed surgery to “normalize” their bodies, long before they are old enough to decide for themselves whether they want these procedures. The surgery is medically unnecessary, irreversible, often traumatizing, and carries a risk of lifelong harm.

While some surgical intervention is undisputedly medically necessary, some surgeons perform risky cosmetic surgery on intersex children, often before they are even able to talk. The results are often catastrophic and the supposed benefits largely unproven.

A poster by intersex activist Pidgeon Pagonis

© 2017 Human Rights Watch

Resolution 110 in no way seeks to interfere with legitimate medical practice, but rather “to protect children born with variations of sex characteristics from nonconsensual, medically unnecessary surgeries.

Nonetheless, some medical professional associations oppose intersex children’s rights. Some surgeons have proposed deeply problematic amendments to this resolution. These convey the idea that the thousands of intersex children across the state cannot be functioning members of society without cosmetic surgery.

To quote these proposed edits: “It should be considered negligent to not offer to parent’s all options including...surgical reconstruction of their the inherent desire of any responsible parent is that their child be raised as a functioning member of society.”

As I told the senators today, the implicit idea that surgery is often necessary in order for intersex people to be functioning members of society has no factual or scientific basis, and most of the doctors I’ve interviewed on this issue would find it objectionable.

Medically unnecessary surgery on intersex children has been condemned by the World Health Organization, the American Medical Association board of trustees, three former US surgeons-generalPhysicians for Human Rights, the AIS-DSD Support GroupAmnesty InternationalUnited Nations expertsLambda Legal, the ACLU, pediatrics professional bodies, and intersex-led organizations worldwide.

California should join these ranks.

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

This submission focusses on the topics of girls’ right to access a safe abortion, accountability for past abuses against children, and the protection of students, teachers, and schools during time of armed conflict.
Access to Abortion (Articles 2, 6, 14, 16, 24, 37)

Abortion is illegal in Argentina, except in cases of rape or when the life or health of the woman or girl is at risk. But even in such cases, women and girls are sometimes subject to criminal prosecution for seeking abortions, and often have trouble accessing reproductive health services, such as contraception and voluntary sterilization. 

In 2016, the Committee on the Elimination of Discrimination Against Women urged Argentina to legalize abortion not only in cases of rape and risk to the life or health of the pregnant woman but also other circumstances such as incest and when there is a risk of severe fetal impairment. 
In this year’s State of the Union, President Mauricio Macri said that, despite his personal views on the matter, he supported Congress’ inclusion of abortion as an issue to be debated in 2018. 
Human Rights Watch recommends the Committee ask the government of Argentina:
  • What is the government doing to ensure that all adolescent girls and boys, both in and out of school, are provided with, and not denied, accurate and appropriate information on how to protect their health and development and practise healthy behaviors, including information on safe sexual behavior, and accurate information on contraception?
  • During the reporting period, how many arrests and prosecutions have been carried out of either providers or recipients of abortion services?

Human Rights Watch recommends that the Committee:

  • Welcome the statement by President Mauricio Macri as it opens the door to a candid, long-overdue debate.
  • Recommend that Argentina decriminalize abortion in all circumstances and take all necessary steps, both immediate and incremental, to ensure that women and girls have informed and free access to safe and legal abortion services, and postabortion care, as an element of their exercise of their reproductive and other human rights.

Accountability for child abductions and disappearances (Articles 6, 8, 16)

Argentina has made significant progress in identifying children of the disappeared who were illegally taken from their families during the dictatorship and bringing those responsible to justice. As of March 2018, 127 people who were illegally taken from their parents as children during the 1976-1983 dictatorship had been located. Many were reunited with their biological families.
Human Rights Watch recommends that the Committee:

  • Ask the delegation from Argentina to provide updated information on the status of prosecutions and the government’s policies to move forward with the identification of children who were abducted during the dictatorship.
  • Recommend that Argentina prioritizes these prosecutions to avoid unnecessary delays that could undermine the pursuit of justice. 

Protecting Students, Teachers, and Schools During Armed Conflict (Articles 28, 38, 39)

Since 2014, Argentina has taken a leading role in promoting the protection of students, teachers, schools, and universities during times of armed conflict, through its championing of the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict and the Safe Schools Declaration. 
The Guidelines were drawn up with the aim of better protecting schools and universities from use by armed groups for military purposes, and to minimize the negative impact that armed conflict has on students’ safety and education. They provide concrete guidance to states and non-state armed groups for the planning and execution of military operations. They may also serve as a tool for organizations engaged in monitoring, programming, and advocacy related to the conduct of armed conflicts. A draft version of the Guidelines were prepared based on consultations with representatives from governments—including Argentina—as well as militaries, UN agencies, and intergovernmental and nongovernmental organizations. They were finalized through a state-led process headed by Norway and Argentina in December 2014.
The Safe Schools Declaration is an inter-governmental political commitment that was opened for endorsement by countries at an international conference held in Oslo, Norway, on 28 May 2015. The Safe Schools Declaration was developed through consultations with states led by the ministries of foreign affairs of Norway and Argentina between January and May 2015.
In March 2017, Argentina hosted the Second International Safe Schools Conference in Buenos Aires, with representatives from more than 80 countries in attendance. 
Human Rights Watch recommends that the Committee:

  • Commend Argentina for its leadership role on the Safe Schools Declaration and the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict.
  • Encourage Argentina to continue to develop and share examples of its implementation of the Declaration’s commitments with other countries that have endorsed the Safe Schools Declaration and with the Committee as examples of good practice in protecting students, teachers, and schools during armed conflict.
Posted: January 1, 1970, 12:00 am

The maternity ward is show at the newly constructed Kaiser Permanente San Diego Medical Center hospital in San Diego, California , U.S., April 17, 2017.

© 2017 Reuters

Around the world every single day 800 women and girls die from preventable causes during and after pregnancy. Human Rights Watch has documented some of the root causes of these deathslack of accountability of health professionals to poor quality care to considerable cost barriers to care.

In many countries, this number is dropping. But in the United States – one of the world’s richest countries – it’s rising. Many people would be shocked to learn that at least two women and girls die from pregnancy-related causes each day here. Shamefully, Black women are more than three times as likely to die than white women.

Any pregnancy involves risk – including the woman losing her life. But most pregnant women and their families in the US feel they can rely on the health system.

For Black women, this trust can be hard to muster. Black infants are twice as likely to die as white infants – a disparity the New York Times tells us is greater than in 1850, 15 years before slavery ended.

What is surprising is how little we know about each of these deaths. The United States uses no consistent means to determine what went wrong. Accountability is essential when it comes to your right to the highest attainable standard of health. It entails addressing past grievances, monitoring progress, correcting failures in the healthcare system. It also should reduce disparities when it comes to people accessing health care. But all this starts with answering the simple question, “what went wrong?”

The US Centers for Disease Control is working to support this type of review in states. This is an important first step, even if more work needs to be done.

After knowing what went wrong, the next question to ask is, “what are the solutions?” The Black Mamas Matter Alliance, a Black-women led group that seeks to advance policy grounded in a human rights framework, just launched the inaugural national Black Maternal Health Week. There are many steps needed to end preventable maternal deaths in the US, but this week is an opportunity for local, state, and federal government officials – as well as all stakeholders – to reflect on what a participatory, rights-grounded approach to valuing and saving the lives of Black women and their infants should look like.    

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


Everyone sat on a thatched blanket spread outside under the warm sun, near the tobacco curing barn, with flat farmland, green grass and the occasional tree stretching as far as the eye could see. Admire (not his real name), a tobacco farmer in Zimbabwe, had welcomed the researcher Margaret Wurth and two colleagues onto his property. Admire, together with his wife and their 20-year-old daughter, who both held energetic babies, talked with the researchers about tobacco farming.

When Margaret asked if they had ever heard of the terms nicotine poisoning or Green Tobacco Sickness, or knew what it was, the family said no.

She was horrified, though not surprised – she had heard this again and again from other farmers in Zimbabwe. For the past seven years, Admire had contracted with a company that supplied a major multinational cigarette maker. Tobacco companies have responsibilities to respect human rights in their supply chains, and that includes making sure that farmers know about the dangers of nicotine exposure – particularly for children. Margaret had hoped that in those seven years, someone would have warned Admire.

Tobacco is Zimbabwe’s most valuable export, generating US$933.7 million in 2016. After President Robert Mugabe was forced from office last year, the new president, Emmerson Mnangagwa, said that agriculture will be a key pillar of the government’s plans to revive the economy. However, Human Rights Watch research into conditions on Zimbabwe’s tobacco farms revealed an industry tainted by child labor and confronted by other serious human rights problems.

While Admire’s whole family was warm and welcoming, it was Admire, a slim man with a thin face, who did most of the talking. His wife and daughter, who wore the long, patterned skirts traditional for Zimbabwe’s women, would sometimes chime in. Admire and his wife have five children, the eldest being the daughter who joined the conversation and the youngest their baby girl. Like other children in this community, both their eldest daughter and 17-year-old son started to help with the harvest at around age 14. During our visit, this son was away from the farm, delivering his family’s tobacco to the auction houses in Harare, where it would be weighed and handed over to the company. Admire’s children in grade 6 and grade 7 help their parents and older siblings carry tobacco leaves.

A buyer logs data on the first day of the 2017 tobacco selling season in Harare, Zimbabwe. 

© 2017 AP Photo/Tsvangirayi Mukwazhi

Admire’s children only work when he can’t afford to hire workers—which happens often. But he wishes it were otherwise, he told Margaret “[My kids would] relax, they’d go to school without pain in their bodies,” he said. “At night they’d sleep. They’d have enough time to read books.”

When the family told her they had never heard of nicotine poisoning, Margaret explained the symptoms – nausea, dizziness, headaches – and that it’s caused by nicotine being absorbed into the body through your skin and clothes while handling tobacco. She also explained that this is even more dangerous for children, as nicotine is a toxin that can affect the brain, especially in children, who are still growing and developing.

You could see the realization hit them. “When we’re hanging tobacco, we normally feel weak or vomit, and get a headache and dizziness,” Admire said, explaining that he felt sick while hanging the leaves in the curing barn, a windowless brick building heated by fire, where the tobacco dries. This wasn’t surprising. Nicotine is water-soluble, and when tobacco plants are wet, or workers are sweaty, nicotine dissolves into the moisture and enters the bloodstream more readily. It is places like curing barns – hot, sweaty, enclosed, and surrounded by tobacco – where people get really sick. His 17-year-old son, he added, has also vomited while working with tobacco. Both his wife and daughter had gotten dizzy while harvesting tobacco. “You fall sick, but you don't know what it is,” Admire added.

A child walks between bales of tobacco on an auction floor in Harare, Zimbabwe.  

© 2017 Tsvangirayi Mukwazhi/AP Photo

Margaret told Admire and his family how to avoid nicotine poisoning – something it would have been easy enough for the company to do long ago. Did they have raincoats? Water-resistant gloves? Admire’s family was poor, and the only protective clothing they had was the two pairs of gloves the company had given them (at a cost). She explained that the best way to help someone sick with nicotine poisoning is to get them away from tobacco, and have them bathe and change clothes. She also stressed the need to drink water.

Admire thanked Margaret. “We have never heard that kind of education,” he said.

For farmers like Admire, who make very little money, buying gloves or raincoats is difficult. “We just suffer,” he said, indicating they work without protection.

Admire and other farmers the researchers spoke with get paid once a year, and they often run out of money before their next harvest, leaving them unable to pay their children’s school fees – school in Zimbabwe is not free. Admire is lucky, though. He’s behind in paying the fees, but unlike other farmers we spoke with, he said the school hasn’t sent his children home. “They know I’ll bring the fees after I go to sell [my tobacco],” he said.

Workers sort dried tobacco leaves on a farm outside of Harare, Zimbabwe.

© 2017 Philimon Bulawayo/Reuters

The tobacco companies provide them with tobacco seeds, pesticides, and other things they need – although after the harvest the farmers have to pay the companies back with interest.

He had, of course, signed a detailed contract agreement with the company – a contract that most likely said he agreed to comply with company policies on child labor, handling pesticides, and preventing nicotine poisoning. But like many farmers we spoke with, Admire said he wasn’t given a copy of the contract. Only the companies held the contracts, leaving the farmers vulnerable.

But do you know what Admire did have at home? The company had given him an itemized list of specific chemicals, fertilizers and other necessities for growing tobacco that he received from the company, how much they cost, and how much he would pay for them at the end of the season—with 10 percent interest added. It included the quantity and unit price of each item. Admire understood each line.

In tiny print at the bottom was a reminder that farmers are expected to comply with a requirement of the company’s social responsibility guidelines– specifically on the fuel used in curing barns. Admire said it meant he was not allowed to cut down trees to use for firewood in his curing barn.

A woman sorts dried tobacco leaves in Harare, Zimbabwe while a child sits nearby.

© 2015 Philimon Bulawayo/Reuters

Margaret and her colleagues already knew a lot about this company’s social responsibility guidelines. It was a set of standards used by many of the world’s largest tobacco companies, covering four different areas: crop, environment, facilities, and people. It includes requirements on child labor, labor rights, and health and safety, in line with international standards.

On paper it looks good. But the only information Admire had about this program was a voucher saying he could only use fuel supplied by the company. He had zero materials about health and safety, nothing about protecting the rights of workers on farms, nothing about child labor.

When the researchers asked Admire what the program was, he had no idea. “I’m not understanding,” he said.

Other farmers Margaret spoke with had similar experiences.

Human Rights Watch sent six-page letters to dozens of tobacco companies, describing our research findings and asking questions about their human rights policies and practices. In their responses, many proudly drew attention to the kinds of guidelines Admire and many other farmers like him knew next to nothing about.

“For us, it was so clearly emblematic of the gap between the nice policies the companies post on their websites, and the reality on the ground in tobacco farming communities,” Margaret said.

She wishes companies showed more concern for the health and safety of the farmers and workers, and their families – especially children.

“Can you imagine that every year, your family got sick, you got sick and you don’t know what it is and think it’s inevitable,” Margaret said. “But if you had the right training and information, and better protective equipment, that wouldn’t be the case.”

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

Last week, U.S. Attorney General Jeff Sessions instructed U.S. attorneys to seek the death penalty for drug dealers in all “appropriate” cases. This flies in the face of a decade of bipartisan work in Congress to address the harm caused by drug addiction, and threatens to make federal drug enforcement efforts even more pointlessly cruel than they already are.  

Sessions has spent his first year as attorney general trying to turn back time by repealing significant Obama-era criminal justice reforms. He has moved to limit federal oversight of local law enforcement that was designed to reduce abuses and to encourage prosecutors to charge the most serious offenses possible.

The overdose crisis requires urgent action, but more harsh prosecutions won’t help. Instead of calling for the death penalty, the Trump administration should focus on supporting and implementing proven public health strategies that will save lives, not take them. The Trump planrelies on 20th century attempts to address the overdose problem, invoking concerns of more over-policing in communities of color, greater disproportionate sentencing, and harmful criminalization of drug possession for personal use.

The Centers for Disease Control and Prevention has estimated more than 66,000 died from a drug overdose in 2017. The United States can’t afford to waste its time on tough-on-crime posturing and, instead, needs to focus on measures that have been shown to work. And extensive research has shown that the death penalty does not deter crime.

The death penalty is inhumane, not least because it is inherently irreversible. Most U.S. experts and state governments have recognized that its application has been plagued with arbitrariness, racial disparities and error. The number of executions in the United States, in fact, has dropped to its lowest in 25 years, with fewer death sentences imposed last year than in any year since 1973.

People convicted of drug-related offenses in the United States already suffer massively disproportionate punishment — something President Trump and Attorney General Sessions seem not to appreciate as problematic. Disturbingly, Trump repeatedly has praised the Philippines’ war on drug users, a murderous government-sanctioned campaign that has resulted in more than 12,000 extrajudicial killings in the past two years. Only a few countries, Iran and Saudi Arabia among them, still impose the death penalty for drug crimes.  

The U.S. government and many states had been moving in a more positive and forward-looking direction in recent years, adopting measures that have been shown to work on reducing the harm caused by drug use. Congress has passed a series of bipartisan criminal justice law reforms. The Second Chance Act of 2007 improved programming for prisoners’ re-entry into the community. The Fair Sentencing Act of 2010 reduced the sentencing disparity for the use of crack and powder cocaine, which had imposed disproportionately longer sentences on crack offenders and caused egregious racial disparities in the federal system.

The Comprehensive Addiction and Recovery Act of 2016 improved access to drug treatment and to naloxone, the opioid overdose antidote that has saved tens of thousands of lives. In 2016, Congress also modified the law to make front-line public health and harm reduction services such as syringe exchanges eligible to use federal HIV/hepatitis C prevention dollars.

And in February, the Senate Judiciary Committee, under Chairman Chuck Grassley’s leadership, reported the Sentencing Reform and Corrections Act, S. 1917 (SRCA), out of committee. The SRCA bill seeks to rein in federal mandatory minimum sentencing laws by increasing judicial discretion in sentencing and reducing some mandatory minimums for drug offenses, while also expanding prison reentry programs for eligible prisoners to qualify for early release.  

The massive loss of life in the United States as a result of drug dependence requires a dramatic response. But instead of looking at solutions that have been shown to help, the Trump administration has chosen a response that is cruel and full of dangerously mindless drama — the kind that will make the crisis worse and kill more people in the process.


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

Health and Human Services Secretary Alex Azar participates in a forum called Generation Next at the Eisenhower Executive Office Building in Washington, U.S., March 22, 2018.

© 2018 Reuters

The US should reject a proposed rule that would give healthcare providers sweeping discretion to refuse patients care for religious or moral reasons.

Human Rights Watch has urged the US Secretary of Health and Human Services (HHS), Alex Azar, to discard the proposed rule, which was issued for public comment in January. The rule purports to clarify existing legal protections for religious or moral objectors under federal law. In reality, it would dramatically expand healthcare providers’ ability to turn away patients, without also protecting the rights of those who are refused care.

This would be particularly dangerous for women and lesbian, gay, bisexual, and transgender (LGBT) people, who face widespread discrimination and often lack access to healthcare services.

Carefully designed protections for objectors can protect freedom of religion. The proposed rule, however, falls far short of a rights-respecting approach.

The rule fails to acknowledge the barriers many women and LGBT people face in accessing care, particularly sexual and reproductive healthcare. And while pushing this rule forward, HHS has also weakened access to contraceptive services, removed online resources for lesbian and bisexual women, and announced plans to roll back regulations protecting transgender people.

The rule does not include safeguards to balance and protect patients’ rights, health, and well-being. This lack of safeguards – even for emergency situations – is a stark departure from the approach US law has typically taken, which has sought to ensure that religious and moral objections are balanced against the rights of others.

Given all of this, it is also troubling that the rule would permit a much wider range of people to refuse to provide care for religious or moral reasons – not only doctors, but potentially administrative and technical personnel, insurers, and others as well. Additionally, it would allow religious objectors to refuse to refer individuals to other healthcare providers, or to even give information to refused patients, potentially leaving them in the dark about their treatment options. This compromises their medical care.

Recent Human Rights Watch research has shown how sweeping religious exemptions at the state level have functioned to license discrimination and put LGBT people at risk. HHS can – and should – do better, and it can start by rejecting the proposed rule.

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

Secretary Alex Azar
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue SW., Room 445-G
Washington, DC 20201

RE: Proposed Rule on Protecting Statutory Conscience Rights in Health Care; Delegations of Authority

Dear Secretary Azar,

Human Rights Watch opposes the Proposed Rule on Protecting Statutory Conscience Rights in Health Care; Delegations of Authority (83 Fed. Reg. 3880). The proposed rule would dramatically expand the discretion that religious or moral objectors have to refuse care in healthcare settings without any meaningful safeguards to ensure that the rights and health of others are protected. The rule would function not only as a shield for people asserting objections on religious or moral grounds but also as a sword that permits them to withhold care from women; lesbian, gay, bisexual, and transgender (LGBT) people; and others.

The proposed rule fails to appreciate the significant barriers that women, LGBT people, and others already face when attempting to access health care that meets their needs, and the likelihood that the rule would exacerbate those barriers and prevent people from accessing care. The rule codifies vague, open-ended definitions that would permit unfettered discrimination in healthcare settings. And it breaks from a long tradition of religious or moral exemptions under domestic and international law by providing blanket protection for religious exercise without any mechanism to ensure that the rights and health of others are not jeopardized as a result.

  1. Women and LGBT People Already Face Barriers to Care

Under Executive Order 13563, the Department of Health and Human Services may only propose a rule where it has made a reasoned determination that the rule’s benefits outweigh its costs and it is tailored to impose “the least burden on society.”[1] However, the proposed rule fails to incorporate an understanding of the barriers that women and LGBT people already face in accessing care and the ways in which the proposed rule could exacerbate health disparities.

Women face significant barriers in access to health care, particularly reproductive health services. Despite significant increases in the number of women with health insurance as a result of the Affordable Care Act, women are less likely than men to be insured through an employer and more likely to be insured as a dependent of another family member.[2] This leaves women more vulnerable to a loss of insurance if they become widowed or divorced, or if their spouses lose insurance. One in ten women have no health insurance, and uninsured women have poorer access to care and lower rates of use of important preventative services, such as mammograms, pap smears, and contraceptive services.[3] Low-income women, women of color, and immigrant women are at greatest risk of being uninsured.[4] An estimated 1.1 million women in states that have not expanded Medicaid under the Affordable Care Act fall into the “coverage gap” between being eligible for Medicaid and qualifying for subsidies for private insurance. Another 1.5 million undocumented women are uninsured and ineligible for either Medicaid or private insurance coverage.[5]

For women who do have health insurance, the Affordable Care Act prohibits discrimination by healthcare and insurance providers on the basis of sex, and requires coverage for key women’s health services, such as preventative screenings for breast and cervical cancer, contraception, maternity care, and breastfeeding support services.[6] The proposed rule fails to indicate how the anti-discrimination and substantive coverage provisions of the ACA would be balanced against claims for religious or moral exemptions. This creates a dangerous ambiguity that could undermine the ACA’s anti-discrimination provisions.

There are also significant challenges in access to constitutionally-protected abortion services, particularly for low-income women and women of color. Poor women are five times more likely than higher income women to have an unintended pregnancy, and rates of unintended pregnancy among women of color are more than twice the rates for white women; the federal ban on funding for Medicaid coverage for abortions contributes significantly to these disparities.[7] Current US law provides extensive grounds for religious and conscience-based objection to abortion and abortion related services, including the Church Amendment, the Coats-Snowe Amendment, the Weldon Amendment, the Medicaid or Medicare Conscience Protections, and the Affordable Care Act Conscience and Religious Exemption Laws.[8] Rule proponents have produced no compelling evidence of the necessity of supplementing these provisions. Furthermore, the proposed rule may risk further limiting access to abortion services and exacerbate existing racial and socio-economic health disparities. It does not appear that these possible harms have been seriously considered in formulating the rule.

LGBT people also face significant disparities in access to health care, with LGBT individuals twice as likely to be uninsured than their non-LGBT counterparts.[9] Moreover, discrimination in healthcare settings is problematic; in 2010, more than half of LGBT people surveyed by Lambda Legal reported a discriminatory experience while seeking healthcare services.[10] Transgender individuals in particular experience high levels of discrimination. In a 2017 survey, nearly 1 in 3 reported denial of health care on the basis of their gender identity.[11]

Congress has not enacted explicit federal non-discrimination protections for LGBT people, and fewer than half of the states offer such protection. In this environment, broad and vaguely worded religious exemption laws threaten to increase discrimination on the basis of sexual orientation and gender identity. In numerous states that have recently passed religious exemption laws without adequate protection against discrimination, Human Rights Watch has documented discriminatory denials of health care and services to LGBT people.[12] According to Lambda Legal: “In the health care field, where patients are especially vulnerable, religion-based harassment and refusals of medically necessary care have been a persistent, profoundly harmful problem.”[13] People living with HIV also continue to face discrimination in healthcare settings; as recently as December 2017 the Department of Justice reached a settlement under the Americans with Disabilities Act against a surgeon in Ohio who refused care on the basis of the claimant’s HIV status.[14] In many of the countries where HHS implements global HIV/AIDS programs, many of the patients served already face numerous barriers to care, including a broad and harmful refusal provision contained within the statute governing such programs.[15] The proposed rule lacks consideration of existing anti-LGBT and HIV-related discrimination in health care and contains no mechanism for avoiding or reducing potential harm.

The complaints received by the Office of Civil Rights (OCR) suggest that civil rights violations in health care are far more common than religious liberty violations. Between November 2016 and January 2018, OCR received 34 complaints alleging violations of federal laws permitting religious refusals; from the fall of 2016 to the fall of 2017, OCR received more than 30,000 complaints alleging HIPAA or civil rights violations.[16] While Human Rights Watch recognizes that violations of religious freedom are a significant and valid concern, HHS has not demonstrated that existing safeguards are insufficient to protect religious objectors; that the benefits of broader exemptions outweigh the costs they will impose; or that the proposed rule is tailored to impose the least burden on society.

As detailed below, Human Rights Watch believes the proposed rule would embolden providers to discriminate against women, LGBT people, and others based on their religious beliefs. Worse, it would do so at a time when HHS has weakened access to contraceptive services under the Affordable Care Act (ACA);[17] removed online resources for lesbian and bisexual women;[18] and intends to roll back protections for transgender people under Section 1557 of the ACA.[19]

  1. The Proposed Rule Represents a Troubling Expansion of the Scope of Religious and Moral Exemptions

While the proposed rule purports to clarify federal law, it redefines key terms in ways that would significantly broaden the scope of religious and moral exemptions. In the absence of any protections that might mitigate harm, these redefinitions risk greatly exacerbating the discrimination and barriers to access women and LGBT people already experience. Among the definitions that give cause for concern are the following:

  • The proposed rule broadens the definition of the term “entity” to encompass the definition of “person” in 1 U.S.C. 1, which includes “corporations, companies, associations, firms, partnerships, societies, and joint stock companies, as well as individuals.”[20]
  • The proposed rule broadens the definition of the term “health care entity” with an illustrative, non-exhaustive list of providers, leaving little clarity about the scope of the exemptions that could be claimed under the proposed rule and providing little guidance for providers and patients alike.[21]
  • The proposed rule broadens what it means to “assist in the performance of” a healthcare service, permitting anyone with an “articulable connection” to the healthcare service they consider objectionable – instead of a “direct connection” – to decline to participate. The expanded definition would allow objectors, including administrative or technical personnel, to refuse to perform a task because they can identify some connection, no matter how attenuated, to a service they consider objectionable.[22] For example, a hospital room scheduler could refuse to book a room or a technician could refuse to clean surgical instruments for procedures they consider objectionable.
  • The proposed rule allows exemptions from a broad range of referral requirements, defining “referral” or “refer for” to include the provision of basic information about a healthcare service, activity, or procedure.[23]

At the same time, the proposed rule does not define key terms like “religious beliefs,” “moral convictions,” or “moral or religious grounds.” This gives objectors virtually unfettered discretion to couch any refusal in moral or religious terms.

These drastic expansions of existing law could come at a cost to patients, and the rule fails to consider this. Human Rights Watch research has documented how recent religious exemptions jeopardize the health of women and LGBT people.[24] In some instances, these exemptions are invoked to justify discrimination and refuse service to individuals seeking care. Even before refusals occur, however, sweeping religious or moral exemptions put women and LGBT people on notice that they may be turned away or discriminated against, deterring them from seeking care at all.

  1. The Proposed Rule Lacks Safeguards to Protect Patients

The prevalence of discrimination against women and LGBT people in health care and the sheer breadth of the proposed rule put the rights of patients at risk. These harms are exacerbated by the lack of safeguards in the proposed rule, which breaks from the US’ traditional approach towards religious exemptions.

The proposed rule fails to account for the adverse impact that religious or moral refusals may have on the state’s interests or the rights of others – something that has generally been a core element of religious and moral exemptions under US law.

Under international law, religious freedom protections have distinguished between the freedom of religious belief, which is inviolable, and the freedom of religious exercise, which may be limited when it infringes upon the rights of others or the state’s interests. While federal law frequently collapses the distinction between religious belief and religious exercise, exemptions have typically contained some mechanism to balance protections for conscience with the state’s interests, including its protection of the rights of other people.[25] The proposed rule not only fails to distinguish between belief and exercise, but does not give any explicit weight whatsoever to the rights of others or state interests.

In addition, the proposed rule does not include safeguards to minimize the harm inflicted on those who are denied service or turned away. It does not require healthcare facilities to ensure that, when a provider has an objection, a non-objecting provider is available to offer the service in their stead. It does not require healthcare facilities to refer patients to another healthcare facility where they can obtain the treatment or services they seek or provide information about their options.

  1. Rights at Stake
  1. Right to Health

Under international law, everyone has the right “to the enjoyment of the highest attainable standard of physical and mental health” without discrimination on the basis of sex, age, or other prohibited grounds.[26] The right to health is also inextricably linked to provisions on the right to life and the right to non-discrimination that are included in the International Covenant on Civil and Political Rights (ICCPR), which the US has ratified.[27]

The Committee on Economic, Social and Cultural Rights, the body charged with interpreting and monitoring the implementation of the ICESCR, has identified four essential components to the right to health: availability, accessibility, acceptability and quality.[28] Even though the US is not a party to the ICESCR, the Committee’s interpretation represents a useful and authoritative guide to the steps governments should take to realize and protect the right to health and other human rights. The proposed rule will reduce the availability and accessibility of healthcare services, particularly sexual and reproductive healthcare services, in communities across the US.

Sexual and reproductive health and rights are addressed specifically in a number of international treaties and other authoritative sources.[29] Article 12 of the Convention on the Elimination of Discrimination Against Women (CEDAW) provides that “[s]tates parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services […].”[30] The US has signed, but not ratified, CEDAW. The CEDAW Committee in its General Recommendation 24 affirmed states parties’ obligation to respect women’s access to reproductive health services and to “refrain from obstructing action taken by women in pursuit of their health goals.”[31] As with the ICESCR, even though the US is not a party to CEDAW, the Committee’s interpretation represents a useful and authoritative guide to the steps governments should take to realize and protect the range of human rights addressed under the Convention.

  1. Right to Information

The right to information is set forth in numerous human rights treaties.[32] CEDAW asserts that states should provide women “[t]he same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights.”[33] The ICESCR obliges state parties to provide complete and accurate information necessary for the protection and promotion of rights, including the right to health.[34] Furthermore, the CESCR Committee in its General Comment 14 has stated that the right to health includes the right to health-related education and information, including on sexual and reproductive health.[35] The CEDAW Committee has also noted that, under article 10(h) of CEDAW, women must have access to information about contraceptive measures, sex education and family-planning services in order to make informed decisions.[36]

The proposed rule expands existing protections to allow providers to decline to provide information they deem morally or religiously objectionable to their patients, while doing nothing to ensure that those patients have reliable alternative routes to secure that information. Denying medically accurate information to patients leaves them in the dark about their treatment options and prevents them from making an informed choice about which options to pursue.

  1. The Right to Non-Discrimination

Non-discrimination is a central principle of international human rights law.[37] As a party to the ICCPR, the US is obligated to guarantee effective protection against discrimination, including discrimination based on sex, sexual orientation, and gender identity.[38] CEDAW mandates that state parties take action to “eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to healthcare services.”[39]

The UN Human Rights Committee, which provides authoritative guidance on the ICCPR, has clarified that the freedom of thought, conscience, and religion does not protect religiously motivated discrimination against women, or racial and religious minorities.[40] It has urged states considering restrictions on the manifestation of religion or belief to “proceed from the need to protect all rights guaranteed under the Covenant, including the right to equality and non-discrimination.”[41]

As Human Rights Watch has documented, recent religious exemptions at the state level have emboldened service providers to discriminate against women and LGBT people. Indeed, there is substantial evidence that permitting such discrimination is the primary motivation for some of these exemptions.[42] By granting virtually unfettered discretion to religious objectors who refuse to meet the healthcare needs of women and LGBT people – and declining to provide any safeguards to mitigate the harm that such refusals inflict – the proposed rule likely fails to satisfy the US’s obligations under international law.

  1. Conclusion

While religious freedom is an important human right, the proposed rule fails to advance that right in a responsible and rights-respecting manner. It fails to appreciate the effectiveness of existing protections for conscience and the worrying prevalence of discrimination against women and LGBT people in the United States. It broadens existing protections for conscience in ways that jeopardize access to healthcare and risk exacerbating discrimination and mistreatment against women and LGBT people. It gives little to no regard to those whose rights are jeopardized by blanket religious exemptions and breaks with a long tradition of religious exemptions that seek to ensure that the rights of all are respected. In these ways, it jeopardizes the right to health, the right to information, and the principle of non-discrimination under international law. For all of these reasons, Human Rights Watch calls on HHS to reject the proposed rule.


Amanda Klasing
Senior Researcher, Women’s Rights Division
Human Rights Watch

Megan McLemore
Senior Researcher, Health and Human Rights Division
Human Rights Watch

Ryan Thoreson
Researcher, LGBT Rights Program
Human Rights Watch


[1] Improving Regulation and Regulatory Review, Executive Order 13563 (Jan. 18, 2011), (accessed March 26, 2018).

[2] Henry J. Kaiser Family Foundation, “Women’s Health Insurance Coverage,” (accessed March 26, 2018).

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] Usha Ranji, Alina Salganicoff, Laurie Sobel & Caroline Rosenzweig, “Ten Ways That the House American Health Care Act Could Affect Women,” Henry J. Kaiser Family Foundation, May 8, 2017, (accessed March 26, 2018).

[7] American Public Health Association, “Restricted Access to Abortion Violates Human Rights, Precludes Reproductive Justice, and Demands Public Health Intervention,” November 3, 2015, (accessed March 26, 2018).

[8] 42 USC 300-a(7); 42 USC 238(n); Consolidated Appropriations Act, 2017, Pub. L. 115-31, Div. H, Tit. V, sec. 507(d); 42 U.S.C. 18023(c)(2)(A)(i)-(iii), (b)(1)(A) and (b)(4); 42 U.S.C. 1395w-22(j)(3)(B) and 1396u-2(b)(3)(B).

[9] Kellan Baker and Laura E. Durso, “Why Repealing the Affordable Care Act is Bad Medicine for LGBT Communities,” Center for American Progress, March 22, 2017, (accessed March 26, 2017).

[10] Lambda Legal, When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV, 2010, (accessed March 26, 2018).

[11] Shabab Ahmed Mirza & Caitlin Rooney, “Discrimination Prevents LGBTQ People from Accessing Health Care,” Center for American Progress, January 18, 2018, (accessed March 26, 2018).

[12] Human Rights Watch, “All We Want is Equality”: Religious Exemptions and Discrimination against LGBT People in the United States, February 19, 2018,

[13] Lambda Legal, “Trump Administration Plan to Expand Religious Refusal Rights of Health Professionals: Legal Issues and Concerns,” (accessed March 26, 2018).

[14] Settlement Agreement between the United States of America and Advanced Plastic Surgery Solutions under the Americans with Disabilities Act, December 6, 2017, (accessed March 26, 2018).

[15] See Henry J. Kaiser Family Foundation, “The Mexico City Policy: An Explainer,” June 1, 2017, (accessed March 26, 2018).

[16] US Department of Health and Human Services, “FY 2019 Budget in Brief,” February 19, 2018, (accessed March 26, 2018) p. 124.

[17] Human Rights Watch, “Human Rights Watch Comment on Interim Final Rule on Moral Exemptions and Accommodations Under the ACA,” December 5, 2017,

[18] Dan Diamond, “HHS Strips Lesbian, Bisexual Health Content from Women’s Health Website,” Politico, March 21, 2018, (accessed March 26, 2018).

[20] Rule at 56. For the broader definition of “person,” see 1 U.S.C. 1.

[21] Rule at 58-59.

[22] Rule at 52.

[23] Rule at 63-66.

[24] Human Rights Watch, “All We Want is Equality”: Religious Exemptions and Discrimination against LGBT People in the United States, February 19, 2018,

[25] See, for example, Title VII, which requires employers to reasonably accommodate employees’ religious beliefs – including in healthcare settings – unless the accommodation would impose an ‘undue hardship’ on the employer. The Religious Freedom Restoration Act, which prohibits the government from substantially burdening religious exercise but allows such restrictions where the burden is the least restrictive means necessary to advance a compelling governmental interest. 42 U.S.C. 2000bb et seq.

[26] The US has signed, but not ratified, the ICESCR and as such is not legally bound by its provisions. It does, however, have an obligation not to take actions that would undermine the object and purpose of the treaty. International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 49, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3, entered into force January 3, 1976, art. 12(1).

[27] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into force March 23, 1976, ratified by the United States on June 8, 1992, art. 10.

[28] Committee on Economic, Social and Cultural Rights (CESCR), “Substantive Issues Arising in the Implementation of the International Covenant on Economic, Social and Cultural Rights,” General Comment No. 14, The Right to the Highest Attainable Standard of Health, E/C.12/2000/4 (2000), (accessed March 26, 2018), para. 12.

[29] In the 1994 Cairo Programme of Action on Population and Development, delegates from governments around the world pledged to eliminate all practices that discriminate against women and to assist women to “establish and realize their rights, including those that relate to reproductive and sexual health.” In the 1995 Beijing Declaration and Platform for Action, delegates from governments around the world recognized that women’s human rights include their right to have control over and decide freely and responsibly on matters related to their sexuality free of coercion, discrimination, and violence. See United Nations, Programme of Action of the United Nations International Conference on Population and Development (New York: United Nations Publications, 1994), A/CONF.171/13, 18 October 1994, para. 4.4(c) and United Nations, Beijing Declaration and Platform for Action (New York: United Nations Publications, 1995), A/CONF.177/20, 17 October 1995, para. 223.

[30] Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted December 18, 1979, G.A. res. 34/180, 34 U.N. GAOR Supp. (No. 46) at 193, U.N. Doc. A/34/46, entered into force September 3, 1981, art. 12.

[31] CEDAW Committee, “General Recommendation 24, Women and Health (Article 12),” U.N. Doc. No. A/54/38/Rev.1 (1999), para. 14.

[32] ICCPR, art. 19(2); American Convention on Human Rights, art. 13(1). See also Inter-American Court, Claude-Reyes and others Case, Judgment of September 19, 2006 Inter-Am Ct.H.R., Series C. No. 151, para. 264.

[33] CEDAW, art. 16(e).

[34] See ICESCR, article 2(2). See also CESCR, “General Comment No. 14, The Right to the Highest Attainable Standard of Health,” U.N. Doc. E/C.12/2000/4 (2000), paras. 12(b), 18, 19.

[35] Ibid., para. 11.

[36] CEDAW Committee, “General Recommendation no. 21, on equality in marriage and family relations,” HRI/GEN/1/Rev.9 (Vol. II), para. 22.

[37] International protections for the right to non-discrimination include: ICCPR, arts. 2, 4, 26; ICESCR art.2(2); CEDAW, art. 2; International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), adopted December 21, 1965, G.A. Res. 2106 (XX), annex, 20 U.N. GAOR Supp. (No. 14) at 47, U.N. Doc. A/6014 (1966), 660 U.N.T.S. 195, entered into force January 4, 1969, ratified by the United States on October 21, 1994, art. 5; International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (Migrant Workers Convention), adopted December 18, 1990, G.A. Res. 45/158, annex, 45 U.N. GAOR Supp. (No. 49A) at 262, U.N. Doc. A/45/49 (1990), entered into force July 1, 2003., art. 1(1), art. 7.

[38] ICCPR, art. 26.

[39] CEDAW, art. 12.

[40] See Human Rights Committee, General Comment 28, "Article 3 (The Equality of Rights Between Men and Women)," March 29, 2000, UN Doc. CCPR/C/21/Rev.1/Add.10, para. 21 ("Article 18 may not be relied upon to justify discrimination against women by reference to freedom of thought, conscience, and religion."); Human Rights Committee, General Comment 22, "Article 18: Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies," 1994, UN Doc. HRI/GEN/1/Rev.1, para. 2 ("The committee therefore views with concern any tendency to discriminate against any religion or belief for any reason, including the fact that they are newly established, or represent religious minorities that may be the subject of hostility on the part of a predominant religious community."); Ibid., at 7 (noting that "no manifestation of religion or belief may amount to … advocacy of national, racial, or religious hatred that constitutes incitement to discrimination" and that "States parties are under the obligation to enact laws to prohibit such acts.").

[41] Human Rights Committee, General Comment 22, "Article 18: Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies," para. 8.

[42] Human Rights Watch, “All We Want is Equality”: Religious Exemptions and Discrimination against LGBT People in the United States, February 19, 2018, Letter from Sen. Patty Murray to Secretary Alex Azar on March 23, 2018,

Posted: January 1, 1970, 12:00 am