Source:MEDSCAPE

By Karla Gale

Mar 23

In a second report by members of the Boston-based organization, nearly half of households surveyed in southern Iraq report at least one incident of extreme abuse during the same period. Both articles are published in the Journal of the American Medical Association for March 24/31.

The physician surveys were self-administered and conducted anonymously in July 2003 at three hospitals in An Najaf and Nasyriyah, two cities in southern Iraq. Surveys from 98 physicians were completed.

Torture was "a problem to an extreme extent in Iraq since 1988," 71% of respondents disclosed. Physicians had been involved in nontherapeutic ear amputations and torture, falsification of death certificates and medical records, and "mercy" killing.

"Physicians were absolutely helpless in [avoiding commission of] these types of atrocities because they were threatened," Dr. Lynn L. Amowitz told Reuters Health. Dr. Amowitz, based at Harvard Medical School, is co-author of both studies.

"Almost all reported that the Fedayeen Saddam and other members of the armed regime came and said, 'You will do this or we will kill you or we will kill your family,'" she added. Many physicians said that their colleagues had been shot, hanged, or "disappeared."

The Physicians for Human Rights team also interviewed members of nearly 2000 households in An Najaf, Al Amarah and An Nasyriyah, representing more than 16,000 household members.

Torture, killing and other abuses of household members were reported by 47% of respondents. More than half the incidents occurred between 1991 and 1993, during the Shi-a uprising, and nearly a third since 2000.

Other members of the household witnessed the majority of incidents, Dr. Amowitz noted, which had a severe effect on the mental health of all involved. As a result, rates of attempted suicide ranged between 5% and 7% in the last year, while suicidal ideation was reported by 27%. "That is extraordinarily high, and will overwhelm the medical system that currently exists in Iraq," she said.

"Losing medical neutrality is a problem, both for physicians and for the population they are trying to serve. In any type of totalitarian regime, physicians are co-opted into these types of abuses, and we should be aware of this from the beginning, not 15 or 20 years into it," Dr. Amowitz continued, adding that Physicians for Human Rights had advocated for interventions in Iraq to prevent genocide in 1988 and 1991.

Even though the United Nations' Universal Declaration of Human Rights is now 50 years old, "it risks becoming little more than a pious and self-righteous travesty if an orderly yet firm international means for enforcement is not found," Dr. Edmund D. Pellegrino, a bioethicist at Georgetown University in Washington, DC writes in an accompanying editorial.

JAMA 2004;291:1471-1486,1505-1506.

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