February 3, 2009
In News The Israel-Palestine Conflict
We need your support for a potentially influential open letter of protest regarding the inauguration last November of Dr Yoram Blachar, longstanding President of the Israeli Medical Association (IMA), as President of the World Medical Association (WMA). The WMA is the official body tasked with overseeing the ethical behaviour of doctors worldwide. For Blachar to be their President is a bit like appointing Bush’s ex-Attorney General Gonzales (“the Geneva Convention is quaint”) as head of Amnesty International. This letter, and what flows from it, should certainly play a part in the public identification of Blachar’s IMA as oblivious to ethical codes when it comes to Palestinian people.
We are focusing on torture, and Israeli doctors’ institutionalised involvement in it, in this letter- though of course the case against the IMA for refusing to act regarding violations of the Fourth Geneva Convention- the rights of a civilian population in a conflict zone- is equally damning.
Public pressure and a call for the WMA Council to fulfil their mandate to act will help to cut the ground from beneath the feet of Blachar and the IMA regarding torture, and more besides: as Hadas Ziv of Physicians for Human Rights Israel has written, if Israeli doctors were withdrawn, the everyday practice of torture in Israel could not continue as it does. We have real hopes for this initiative, which with luck and effort may also create a ripple effect well beyond matters medical.
We are seeking as many hundreds of signatures from physicians around the world as we can get for a letter- see below- that will go to the WMA Council, but at the same time will be publicised or published in an international medical journal and hopefully other media. The WMA is an organisation for physicians specifically, so this call is for physicians- though we are aware how much support for solidarity work on medical issues has come from other kinds of workers and professionals, and hope you can help recruit signatories. Regarding UK ,I would see as bedrock the 150 physicians who signed a letter of support for a boycott of IMA in the newspaper The Guardian in April 2007, but we need a body of signatories from as many countries as possible- not least from USA, Israel and Palestine.
We have not reached this point lightly. The IMA has rebuffed all appeals made to it on such issues over many years- whether from outside individuals or organisations like Amnesty, from Palestinian sources, or from reputable Israeli organisations like Physicians for Human Rights, the Public Committee Against Torture in Israel, or B’Tselem. So too, until now, the WMA, which Blachar has worked hard to neutralise. If normal channels don’t work, won’t work, we either give up and go home (which is turning away) or, honouring the gravity of principles at stake, go on to more direct challenges.
Whilst this action is of course consistent with the broader campaign for an academic boycott of Israel, what is at stake here is an issue in itself and signatories do not necessarily have to feel that they have committed themselves to a pro-boycott position in general.
We are sending out this call as widely as possible, including to Noam Chomsky, Norman Finkelstein and other prominent scholars. Please can you all consider this and use your own networks to recruit medical signatures on an urgent basis- 2 weeks, say.
Below is the letter, and below that is a background briefing paper conveying a reasonably succinct summary of the evidence upon which this call is based.
I am also attaching a facsimile of Blachar’s letter to the international medical journal The Lancet in 1997 in which (see 4th paragraph) he actually defends torture- “moderate physical pressure”- in Israel!
We are seeking the signatures of medical doctors/physicians worldwide.
We would like them simply to email me individually with name, position (if a professor, say so) or medical speciality, city or town. For those not currently in post (eg retired physicians) just tell me your speciality and home town/city.
Because my work email is sometimes affected by spam filters, can signatories please use: email@example.com.
Please act with urgency (2 weeks to collect signatories).
Do get back with any queries.
Derek Summerfield (on behalf of the UK Medical Committee for Palestine).
Dear WMA Council Chair Dr Edward Hill and the Council
We the undersigned physicians from X countries wish to publicly protest and appeal against the recent appointment of Dr Yoram Blachar, longstanding President of the Israeli Medical Association, as President of the World Medical Association. We believe that his Presidency makes a mockery of the principles on which the WMA was founded in 1947, which was as a response to egregious abuses by German and Japanese doctors in World War Two.
The WMA’s own Declaration of Tokyo (1975) specifies that “physicians shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, and in all situations, including armed conflict and civil conflict”. The WMA Annual General Assembly of 2007 made it clear that inaction was not an option, stating that “this is the first time the WMA has explicitly obliged doctors to document cases of torture of which they become aware. The absence of documenting and denouncing such acts might be considered as a form of tolerance and of non-assistance to the victims”.(1) There are still more recent calls from authoritative academic sources for the international medical community to go much further in actively allying itself with efforts to suppress mistreatment of prisoners. (2)
Amnesty International concluded as long ago as 1996 that Israeli doctors working with the security services “formed part of a system in which detainees are tortured, ill treated and humiliated in ways that place prison medical practice in conflict with medical ethics”. (3) Dr Blachar, already IMA President, took no action. Amnesty’s briefing to the UN Committee against Torture in September 2008 “focuses on Amnesty International’s (continuing) concerns about Israel’s failure to implement the Convention against Torture in the Occupied Palestinian Territories and the intensification of measures amounting to cruel, inhuman and degrading treatment and punishment”.(4)
A well publicised report in 2007 by the Public Committee Against Torture in Israel (PCATI), based on the detailed testimony of 9 Palestinian men tortured between 2004 and 2006, gives a graphic demonstration of the extent to which Israeli doctors continue to form an integral and everyday part of the running of interrogation suites whose output is torture. (5) The IMA have conceded that they were aware of this report, but did nothing. More recently, at a meeting on December 10 2008 in Tel Aviv, with Dr Blachar presiding only weeks after his inauguration as WMA President, Physicians for Human Rights Israel again sought to confront the IMA about this and similar evidence in the public domain.
In its 2008 annual report to the UN Committee Against Torture, the UAT Coalition, a coalition of 14 Israeli and Palestinian human rights organisations, concluded that “since the Committee last reviewed Israel, the practice of torture and ill treatment has continued unabated. The UAT Coalition wishes to inform the Committee that in its opinion the use of torture and ill treatment by Israeli authorities against Palestinians is both widespread and systematic. The UAT Coalition has recorded evidence of acts, omissions and complicity by agents of the State at all levels….until this culture of impunity is addressed this situation is unlikely to improve”.(6)
In November 2008, PCATI filed a contempt of court motion to the High Court of Justice against the government of Israel and the General Security Service for their responsibility for a policy that grants a-priori permits to use torture in interrogations. The IMA have never challenged torture as state policy in Israel.
Dr Blachar went as far as to justify the use in Israel of “moderate physical pressure” (condemned as torture by the UN Committee Against Torture) in the fourth paragraph of a letter published in the international medical journal The Lancet in 1997 (7) This surely unprecedented action by the president of a national medical association has not been disowned, and renders him unfit for the office of WMA President. In the age of evidence-based medicine his rejection of the documentary record has been unprofessional and frequently contemptuous, as when on the British Medical Journal website he labelled as “the lies and filth he spews” and “anti-semitic” a BMJ publication which cited Amnesty, Johns Hopkins University, the International Court of Justice, a UN Rapporteur and Physicians for Human Rights Israel. (8) IMA membership of WMA appears to have been a figleaf: The IMA website pays lip service to medical ethics but Dr Blachar has overseen a studied failure to take the actions mandated by the Declaration of Tokyo.
We conclude that under Dr Blachar’s leadership the IMA made a decision on political grounds years ago to turn a blind eye to torture in Israel and the institutionalised involvement of doctors. On an issue that goes to the heart of the moral authority of the profession, Dr Blachar has offered shameful ethical leadership to doctors in Israel and worldwide.
It could scarcely be more scandalous that he now assumes the Presidency of the official international body overseeing medical ethics. This appointment will seriously damage the public reputation of the WMA and its work, and indeed risks making it a laughing stock. We call upon the WMA Council to oblige Dr Blachar to step down as a matter of priority. Since the WMA is mandated to ensure that its member associations conform to its codes, we also request an investigation into the IMA record highlighted above.
1 World Medical Association. Doctors urged to document cases of torture. Press Release 8 Oct 2007.
2 Miles S, Freedman A. Medical ethics and torture: revising the Declaration of Tokyo. Lancet 2009: 373:344-48.
3 Amnesty International. “Under constant medical supervision”, torture, ill-treatment and the health professions in Israel and the Occupied Territories. London. Amnesty International. MDE 15/37/96. 1996.
4 Amnesty International. Israel/OPT. Briefing to the Committee Against Torture. MDE 15/040/2008. 2008.
5 Public Committee Against Torture in Israel. Ticking Bombs- testimonies of torture victims in Israel. PCATI 2007.
6 Defence for Children International. Palestine Section. UAT Report: Torture and ill-treatment in Israel and the OPT. 2008.
7 Blachar Y. The truth about Israeli medical ethics. Lancet 1997;350: 1247.
8 Blachar Y. Response from the Israeli Medical Association. Rapid Responses, bmj.com, 15 December 2004
Background information for those considering adding their signature to the letter above:
1.See (attached) a facsimile of Yoram Blachar;s 1997 letter in the Lancet, justifying “moderate physical pressure” (torture). See 4th paragraph.
2. Brief summary of the case: Torture and the Israeli Medical Association.
Torture in Israel has a long history and there is a mountain of documentation in the public realm attesting to it- from both international and regional (Israeli and Palestinian) human rights organisations .
In 1993 the existence of a “fitness for interrogation” form came to light, to be signed by a doctor. Since interrogation customarily meant torture, the doctors signing these forms were giving the green light to the interrogators and their methods and were thus part of the process themselves.
Amnesty International concluded in 1996 that Israeli doctors working with the security services “formed part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics”.Amnesty, and others, who approached the Israeli Medical association (IMA) to urge them to take a stand were consistently rebuffed. This too has been my experience when I published articles in mainstream medical journals- notable the British Medical Journal and the Lancet. In response to one of these, published in the Lancet in 1997, the longstanding president of the IMA Dr Y Blachar actually justified the use of “moderate physical pressure”, the euphemism in Israel for torture, and declared as such by the UN Committee Against Torture! I’m attaching a pdf of this letter.
The moral position and strategic line taken over many years by the IMA was well captured by a remark made by Professor Eran Dolev, than IMA Head of Ethics (yes, Ethics!) in an interview in 1999 with a visiting delegation from the Medical Foundation for the Care of Victims of Torture, London (for whom I was principal psychiatrist for 9 years). Prof Dolev stated that that “a couple of broken fingers” during the interrogation of Palestinians was worthwhile for the information it might garner. When I published this in the Journal of the Royal Society of Medicine, verified by those present at the interview, Dr Blachar defended Prof Dolev.
Indeed 2 years earlier, after a human rights conference in Gaza in 1997, I had written to Dolev in his capacity as Head of Ethics. An Israeli physician had told me that a medical colleague had confessed to her that he had removed the intravenous drip from the arm of a seriously ill Palestinian prisoner, and told the man that if he wanted to live, he should co-operate with his interrogators. I asked Dolev to investigate but he never replied, even after reminders.
When an Israeli psychiatrist Dr Ruchama Marton, a psychiatrist, publicised the unethical role that fellow Israeli doctors were playing in detention centres by labelling seriously mentally ill Palestinian detainees as “malingerers”, and denying them treatment, the IMA charged her with slander rather than investigating the allegations.(2)
The titles of 11 Amnesty reports on Israel/OPT between 2002-7 contained the word “torture”.
Torture continues to be state policy in Israel. The Israeli human rights documentation centre B’Tselem recently confirmed (April 2007) that almost all Palestinian detainees suffer physical and mental abuse amounting to torture, citing the testimonies of 73 men gathered between July 2005 and January 2006. The IMA maintains a studied silence.
No recent firsthand evidence is more telling than that compiled by the Israeli organization Public Committee Against Torture (PCATI), entitled ‘“Ticking Bombs”. Testimonies of Torture Victims in Israel’. Published in May 2007, their report records the detailed testimony of 9 Palestinian men tortured by Israeli security services between 2004 and 2006. Here is graphic demonstration of the conclusions published by Amnesty International in 1996, and over and over again by other organisations,, that Israeli doctors form an integral and everyday part of the running of the interrogation suites whose output is torture. Doctors, several of whom are actually named, saw the prisoners at various points between episodes of torture (which in one case led to spinal cord damage), did not take a proper history, did not protest on these men’s behalf, and typically prescribed simple analgesia before returning them to their interrogators. They did not need to ask the prisoners what had happened to them because they knew perfectly well. It is also remarkable that doctors in position of authority were directly involved in several of these cases, and are also named: the Chief Medical Officer of the Israeli Prison Service, Dr Alex Adler; the Chief Medical Officer of Israeli Police Dr.Tzvi Lankovski; and- most telling of all- no less than the Chairman of the Ethics board of the Israeli Medical Association, Professor Avinoam Reches. These accounts carry the imprimateur of a human rights organization of many years standing and high reputation. The named doctors have not demanded a retraction or sued the report’s authors in order to clear their names. When 7 of us published a short account in the Lancet, the IMA wrote to us to threaten to sue, though in the same email they conceded that Professor Reches had been sent a copy at the time. Thus the IMA condemned itself out of its own mouth, since inaction in the face of reputable evidence of torture, and of doctor’s involvement, violates the WMA codes- in particular the anti-torture Declaration of Tokyo- to which the IMA is signed up as a member. As the Executive Director of Physicians for Human Rights-Israel put it in the Lancet in 2003, the IMA’s collusion with torture is part of “its long tradition of siding with ‘national Israeli considerations’ rather than with universal medical ethics”.
Amnesty International’s briefing to the UN Committee Against Torture of 30 Sept 2008 concludes as before: “This briefing focuses on Amnesty International’s concerns about Israel’s failure to implement the Convention against Torture in the Occupied Palestinian territories (OPT) and the intensification of measures amounting to cruel, inhuman and degrading treatment and punishment…….”
On 2 Nov 2008, the Public Committee Against Torture in Israel, in conjunction with the Association for Civil Rights in Israel, and HaMoked, the Centre for the Defence of the Individual, PCATI “filed a contempt of court motion to the High Court of Justice against the government of Israel and its head, Prime Minster, Ehud Olmert, and against the General Security Service (GSS) and its head Yuval Diskin, for their responsibility for a policy that grants a-priori permits to use torture in interrogations that fundamentally violate the High Court of Justice decision of September 1999.”
In its 25 Nov 2008 Annual Report, the United Against Torture Coalition (UAT), a coalition of 14 Palestinian and Israeli human rights organisations, has undertaken an in-depth and critical analysis of Israel’s compliance with the Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. The report examines the continued and systematic use of torture by the State of Israel in both Israel and in the Occupied Palestinian Territories (OPT). The Report includes more than 80 pages of affidavit material, forming the basis of their submission to the UN Committee Against Torture in September 2008, pending the Committee’s next review of Israel’s compliance with CAT due in May 2009. The UAT Coalition examined the use of torture and ill-treatment by the Israeli authorities against Palestinians from the point of arrest, through interrogation and detention as well as the use of coerced confessions in the military courts. Their Report also considers:
– The use of torture and ill-treatment in non-conventional circumstances, including house demolitions, the Gaza siege and the coercion by Israeli Security Agency (ISA) of medical patients attempting to exit Gaza in order to access necessary medical treatment.
– The continued use of incommunicado detention and lack of prompt access to lawyers for Palestinian detainees.
– The discriminatory nature by which laws and practices are applied to Palestinian detainees compared to Israeli citizens.
– The impunity with which ISA interrogators, police officers and members of the Israeli army torture and abuse Palestinian detainees, including children as young as 12.
– A legislative exemption that allows the ISA (Security Services) to interrogate Palestinian detainees without audio visual recordings as is required in other investigations.
– The failure of the State of Israel to clearly prohibit the use of torture and ill-treatment in its domestic legislation as recommended by the UN Committee.
The UAT Coalition concludes that the use of torture and ill-treatment by Israeli authorities against Palestinians is both widespread and systematic. The State is either unwilling or unable to fulfill its treaty obligations under CAT. The UAT Coalition has recorded evidence of acts, omissions and complicity by agents of the State at all levels, including the army, intelligence service, the police, the judiciary and other branches of government. The Coalition is of the view that until this culture of impunity is addressed the situation is unlikely to improve.
This, then, is a brief account of torture as state policy in Israel, and of the shameful and unethical role played over many years by the IMA and its longstanding President Dr Yoram Blachar. He was Chair of Council of the World Medical Association (the official international watchdog on medical ethics) from 2003-7- an appointment I sought to highlight and contest in the BMJ in 2003. And now the Presidency itself! Next thing we’ll have Donald Rumsfeld or ex-Attorney Gen Gonzales (“the Geneva Convention is quaint”) as head of Amnesty International…!!
We are challenging Blachar’s appointment on the torture issue specifically, though the other arm of our case against him and the IMA would be their refusal to hold the Israeli Government and Defence Force to account for their systematic violations of the 4th Geneva Convention – specifically those clauses which guarantee the right of a civilian population in a conflict zone to unimpeded access to services vital to life: food, water, health care etc, and which guarantee health workers, clinics, ambulances etc immunity from military action. The last few weeks in Gaza have amply and terribly borne out what Physicians for Human Rights Israel (for whom I have the greatest respect) wrote at the time of the 2002 invasion of the West Bank. “We believed that the IMA might be able to curb the appalling deterioration in the attitude of Israeli military forces towards Palestinian health and rescue services. Yet despite severe injury to medical personnel and to the ability of physicians to act in safety to advance their patients’ interests; despite Israeli shells that have fallen on Palestinian hospitals; despite the killing of medical personnel on duty- IMA has chosen to remain silent.”