Physician Accountability for War Crimes Steven H Miles

Physician Accountability for War Crimes Steven H. Miles, MD Professor of Medicine and Bioethics University of Minnesota No Conflicts of Interest. No commercial products mentioned.

Physicians and Torture: a 10 year project. MD Codes War on Terror MDs • Book & Publications • On-line Databases • Documentary (Compilations, Variations, Harmonization, Reform) • Publications MD Accountability • Publications • On-line Database • Testimony & Collaborations (incl screening for torture) www. doctorsofthedarkside. com/ 2004 2007 2009 2012 2

Nuremburg Nazi Medicine Trial, 1946 -1947 ► 23 defendants § 7 death by hanging § 9 prison terms, 10 yrs to life, § 7 acquitted.

Convention Against Torture, Cruel, Inhuman, and Degrading Treatment United Nations UN Principles Medical Ethics 1946 1948 1956 Declaration of Geneva 1975 1980 1984 WMA Regulation in Armed Conflict Declaration of Tokyo UN Principles Protection of Persons under Detention 1988 1997 2007 Clinical Societies Policies No Licenses MDs fleeing prosecution Duty of MDs to Document and Denounce

Study Population ► Doctors punished for torture or war crimes that occurred after 1972 (date of Amnesty). ► International or national courts, medical licensing boards. ► Exclude acquittals but § Include physicians found guilty and then excused by amnesties, pardons, etc. ► Not an exhaustive list. § Some torture doctors give self-incriminating testimony in exchange for immunity or amnesty.

Torture. . . any act by which severe pain or suffering, whether physical or mental, § is intentionally inflicted on a person § by, or at the instigation, consent or acquiescence of a person acting in an official capacity. It does not include pain or suffering arising only from, inherent in, or incidental to, lawful sanctions. ► —UN Convention Against Torture (abridged)

PREVALENCE OF TORTURE SURVIVORS 500, 000 with Parkinson Disease 500, 000 Torture Survivors in US* 400, 000 persons with Multiple Sclerosis 300, 000 persons with Scleroderma in US *US Dept of Justice: Office for Victims of Crime; 2000

Prevalence of Torture in Some National or Refugee Groups 500, 000 torture survivors. Bosnia? Afghanistan Senegal Gaza Algeria S. Leone Tibet Iraq Bhutan Zaire Sudan/Somalia Ethiop/Eritrea Cambodia 75 -79 Cohort Timor Zimbabwe 80 -100 countries practice torture as policy. Amnesty International, 2008. Refugees from a given country have a higher torture prevalence than nationals. Redface: high but percents are not known. Miles SH. Compiled from multiple sources.

Torturing regimes need doctors. • Devise means to minimize scars, including psychosexual torture, (a response to human rights groups surveillance). • Keep alive those who are supposed to live. • Conceal the cause of death of those who die. Half of torture survivors report seeing a physician overseeing their torture.

Study Population ► Doctors punished for torture or war crimes that occurred after 1972 (date of Amnesty). ► International or national courts, medical licensing boards. ► Exclude acquittals but § Include physicians found guilty and then excused by amnesties, pardons, etc. ► Not an exhaustive list. § Some torture doctors give self-incriminating testimony in exchange for immunity or amnesty.

Miércoles, 21 de Febrero de 2007 | EL PAIS › LA CAUSA CONTRA BIANCO POR LA REPRESION EN CAMPO DE MAYO Dueño del destino de las embarazadas Comparta esta nota con un amigo Norberto Atilio Bianco cumplió funciones como médico en el Hospital Militar de Campo de Mayo con el grado de capitán del Ejército durante la última dictadura militar. La Justicia lo condenó en 2000 por la apropiación de dos menores de edad, pero en diciembre del año pasado las Abuelas de Plaza de Mayo sumaron a esa denuncia otra por su responsabilidad en los secuestros y desapariciones de los hijos de, por lo menos, 35 mujeres embarazadas que pasaron por Campo de Mayo. Siluetas de desaparecidos en el predio de Campo de Mayo. “Pudimos revertir el plan macabro”

Google Translator 21 Feb 2007. . . Dueño del destino de las embarazadas. [ Translate this page ] www. pagina 12. com. ar/diario/elpais/subnotas/80690 -260512007 -02 -21. html -

Wednesday, February 21, 2007 Nation> THE CAUSE AGAINST THE REPRESSION IN BIANCO CAMPO DE MAYO OWNER OF THE FATE OF PREGNANT WOMEN Original Spanish text: Owner of the fate of pregnant women La Justicia lo condenó en 2000 por la apropiación de dos menores de edad, pero en diciembre del año pasado las Abuelas de Plaza de Mayo sumaron a esa denuncia otra por su responsabilidad en los secuestros y desapariciones de los hijos de, por lo menos, 35 mujeres embarazadas que pasaron por Campo de Mayo. Norberto Atilio Bianco served as physician at the Hospital Militar de Contribute a better translation Campo de Mayo with the rank of captain in the Army during the last military dictatorship. Justice sentenced him in 2000 for the appropriation of two minors, but in December last year, the Grandmothers of Plaza de Mayo joined by another claim that its liability in the abductions and disappearances of children of at least 35 pregnant women who went to Campo de Mayo. Silhouettes of the missing at the site at Campo de Mayo. "We will reverse the macabre"

Physicians Sanctioned for War Crimes / Torture 1975 -2013 Yugoslavia UK Italy Greece Pakistan Bangladesh Brazil Sri Lanka Guyana Rwanda Chile Uruguay Sanctioned Hearing Open Medical Board South Africa Argentina Domestic Court International Court Died during crim trial Combinations signify multiple events for one person 14

Court Martial (one) 1975 The First post-Nuremburg Case ► After the Greek junta fell, Dr. Dimitri Kofas, supervisor of torture: § Court martialed for dereliction of duty. § Imprisoned.

A Separate Issue: MDs who are Senior Government Officials Dr. M Stakic VP Munc Assembly Genocide Dr. B Simic War Presidency Crim ag Humanity Dr. C Bizimungu Foreign Minister Genocide These physicians acted as senior government officials, not as clinicians. There are 10 more.

Motivations Amilcar Lobo ►Careerism ►Patriotism/ Political Affiliations. ►National emergency. ► Collegiality ► Orders. ► Fear. ► Personality disorder. Brazil, Psychiatrist “man has used torture and assassination for thousands of years and permitted it as long as it is socially organized. It is but a moment from the Inquisition’s torture and murder of the Jews to the Nazi’s similar actions forty years ago. This is human nature; I am not ashamed to be part of it. ” § Lobo A. A Hora do Lobo e a Hora do Carneiro [The Hour of the Wolf and the Hour of the Sheep. ]

Governments Shelter Torture Doctors ► Amnesties/Excuse ► Require ► Block crimes committed under orders. military courts to screen cases. access to records, military testimony. ► Exempt military MDs from license punishments. ► Establish government medical associations to supersede civilian medical societies. ► Let delicensed MDs work in military hospitals.

Types of Hearings as of 2010 s Sanctioned N=57 In Progress N=18 Medical Associations Precede Court Actions (court involvement is often second action against an MD)

Courts vs. Medical License Brds ► Crimes ► Ethics Violations § Murder (incl. false death § National codes certificates) § Declaration of Tokyo § Kidnapping § Hippocratic Oath § “Torture” rarely indicted ► Sanctions because not codified. § Suspend license ► Sanctions § Revoke licenses § Imprisonment § Censure § Damages to survivors § Revoke awards. § Revoke pensions § Remove from Office. 20

Denouncing of Physicians Camilo Azar Saba Home Clinic Suspended for six months by the Medical Association for torture of prisoners at barracks of Centro Nacional de Información. Involved in case of Federico Santibanez. Address: Alto Las Condes, ubicada en Avenida Kennedy 9001, piso 7, Mall Alto Las Condes. Phone: 6366666 Web

A Schematic History of Sanctions Courts Torturing regime Obstruct complaints Amnesty, Pardons Destroy Evidence Intimidation Create new med assns Employ sanctioned MDs In gov hospitals Political affinities Med Assn Sanctions Medical Associations Med Ethics Awakening Civil society Resistance Compile evidence Build support for sanctions

MDs Sanctioned for Torture

Few allegations proceed to sanctions. Argentina 200+ Allegations Brazil 110 Allegations Chile 80 Allegations 12 Sanctions 22 Sanctions 10 Sanctions

National Stages of MD Sanctions for Torture Stage IV: Systems for sanctioning MDs for abetting torture. Argentina, Brazil, Chile, Italy, Rwanda, Uruguay. III Stage IV Stage III: Punished a symbolic MD. Greece, India, Pakistan, South Africa, Sri Lanka, UK. Stage II: Condemn complicity in principle but no punishments of MDs. Egypt, US, Philippines, Venezuela, Uzbekistan… Stage I: Suppress discussion of MD complicity with torture. China, North Korea, Syria

Doctors and Torture Doctors are essential to resistance to torture. Doctors are essential to torturing regimes. • help minimize scars, • keep alive those who are supposed to live, • conceal the cause of death of those who die. • stewards of norms Half of torture survivors report that a MD supervised the torture. against prisoner abuse (Declaration of Tokyo). • detect torture. • physicians are allied with civil dissent and testimony re torture. • Pressure other MDs to report and resist torture.

Health Professions Council of South Africa: Matter of W. J. Basson MD 28

Slides available on request Miles 001@umn. edu Miles SH, Alencar A, Crock BN. Sanctions against physicians for war crimes: A work in progress. Paper is available at IRCT. ORG.