PHR Newsletter, Fall 2012
PHR's online and print newsletter: Fall 2012 edition
Table of Contents:
Message from the Executive Director
New Forensic Program May Help End Impunity for Sexual Violence
Afghan Forensic Science Organization
20th Anniversary - International Campaign to Ban Landmines
One Doctor's Story: Joanne Ahola, MD
When the Arab Spring unfolded last year, it was soon clear that serious human rights violations were being committed in several countries. Knowing that PHR had important contributions to make, especially in light of what apparently were systematic attacks on doctors and their patients, we sent teams of experts to the region to investigate and document alleged abuses.
Making that region a priority has resulted in a flurry of important reports and briefing papers regarding the situation in Bahrain, Egypt, Libya, and Syria. PHR has been at the forefront of organizations protesting the militarization of hospitals, the weaponization of tear gas, and the torture and imprisonment of health professionals whose only “crime” was to care for sick and wounded people who needed their help.
Our voice carries the weight of firsthand experience when we call for reforms by regimes in the region, and our advocacy work has already helped to free several health workers who had faced lengthy prison terms.
PHR’s work in the Middle East and North Africa illustrates our ability to respond nimbly to new challenges without losing focus on our longer-term systemic programs around the world. Your support helps us continue our important work in the region while also allowing us to address new situations as they arise.
Many thanks from all of us.
Although war officially ended a decade ago in the Democratic Republic of the Congo, there has been very little peace for people in the eastern area of the country.
Numerous armed forces continue to commit mass atrocities by dislocating, raping, and killing people. Panzi Hospital in Bukavu is a rare bright spot. Under the direction of Dr. Denis Mukwege, Panzi has become the epicenter for specialized gynecological care and surgery, and the place where thousands of survivors of sexual violence have had their lives saved and their bodies reconstructed.
One of the staff physicians, Dr. Désiré Munyali Alumeti, originally trained as a pediatric surgeon. He is also one of the only practicing Congolese physicians in the country with formal training in forensic medicine. The expertise he gained at Cheikh Anta Diop University in Senegal places him at the forefront of local efforts to document and prosecute rape.
PHR considers Dr. Alumeti one of its most important partners in its Program for Sexual Violence in Conflict Zones. The program was created to help end impunity for sexual violence perpetrators by training health and legal specialists to work together to collect and document evidence of sexual violence and to increase successful prosecutions of these crimes.
A new network is forming among medical, law enforcement, and legal experts who have received training in best practices for collecting court-admissible evidence. The program focuses on five neighboring countries where mass sexual violence persists: Democratic Republic of the Congo, Kenya, South Sudan, Uganda, and the Central African Republic.
“When rape is used as a weapon of war, it is as effective as a chemical weapon,” says Dr. Alumeti. “If a village is in the way, sexual violence is used to destroy it, scattering the families. In addition to the trauma, there are many long-term health risks beyond HIV/AIDS. You might never consider malaria to result from sexual violence, but mass rape causes people to flee into the forests where malaria-infested mosquitoes spread the disease.”
Dr. Alumeti has seen the violent pain that people inflict upon one another, and has collected evidence of those crimes. When asked to tell a victim’s story, he initially says, “There are too many.” But he agrees to share two that illustrate not just the pain people suffer as rape victims, but also the extreme burden placed on entire Congolese families.
He recounts: “I think about my first sexual violence case. A pregnant 28-year-old woman, a mother of five, was working in a cornfield when a group of men suddenly appeared. They abducted and raped her. She was examined and treated at Panzi Hospital and given medicine for HIV/AIDS and other sexually transmitted diseases.
After several days, her husband came to the hospital. When he heard she was raped he flew into an explosive rage, saying that she was at fault and he never wanted to see her again. When she asked, 'What about our five children?' he said he wanted nothing to do with them either.
In that moment, her status became lower than that of a widow; she was a dishonored and abandoned woman left alone with five children.
More recently, a band of armed men came inside a home and shot the family members, except for a small 14-year-old girl. She was a virgin in a traditional culture where that is considered important. They forced the girl to lie down on her mother’s body, and this is how they raped her.
We treated the girl, and were able to repair her mother’s severe wounds. But a year later, the girl remains so traumatized that she does not want to see her own mother. The trauma has broken their family bonds, and the mother’s sorrow is so great that shes ays, 'It would be better if I had died.'"
Dr. Alumeti is adamant that this epidemic of sexual violence is a product of war and it will end when the fighting subsides. “This is not how our country was before the conflict and it cannot define us,” he says. “This is our country and every Congolese must fight for our better future.”
Dr. Alumeti believes that PHR’s sexual violence network is important, and he ha salready seen signs of progress. As one ofthe few Congolese physicians with forensic training, he once was routinely called to court simply to explain terms in a medical report — for instance, the fact that a “hymenal lesion” may be evidence of forced penetration. Now lawyers and judges are gaining a better understanding of medical terminology. He is still needed for expert testimony, but the greater degree of shared knowledge allows cases to move through the courts more efficiently.
In turn, Dr. Alumeti has a better grasp of how police conduct crime scene investigations and what evidence attorneys need to bring a case to trial. He credits the PHR training with making clear what was “known” and “unknown” among the various professionals working on sexual violence. “Many of us had never even met each other, and now we are working together to rebuild our country.” he says. “My hope is for a world without violence, where women are respected.”
PHR Trains Afghans to Unearth the Truth
There is a new urgency around preserving fragments of truth in Afghanistan. They are buried in mass graves in every province of the country.
These sites contain the remains of recent and decades-old struggles, and they hold answers to the questions, “What happened?” “How?” and “Who?”
Forensic science has been a constant focus for Physicians for Human Rights since it was founded 26 years ago. PHR decided to assist in Afghanistan because the country does not have enough expertise to conduct numerous and widespread forensic investigations. To help build local capacity and secure graves for future investigation, PHR created a paraprofessional training program in June 2010. The program, Securing Afghanistan’s Past, trained 18 participants drawn from a wide range of Afghan government offices and civil society organizations.
As a direct result of the PHR training, the paraprofessionals decided to form a new civic organization dedicated to this important work. The Afghan Forensic Science Organization (AFSO) secured a seed grant that provides startup essentials: office space, laptops, and pre-loaded forensic kits (including excavation tools, GPS devices, and cameras).
Mass Grave Registry
The first priority identified by the AFSO board is the creation of a Mass Grave Registry for Afghanistan. The goal is to map gravesites in three Afghan provinces the first year, and in four more provinces by the end of the second year.
Because many Afghans are suspicious of the motives of international organizations and sometimes bristle in the presence of foreigners, AFSO, as an Afghan-led organization, has much better access to what would be “no go” areas for foreign experts or international NGOs.
AFSO investigators are able to enter a village or city and consult directly with local leaders such as the mayor, chieftains, and village elders. They then conduct a one-day workshop in the community to underscore the need for documentation and justice. In this setting, a farmer may step forward to say, “There is a place like that in the field behind my house,” which may lead to another entry in the Mass Grave Registry.
AFSO, which has begun worki n one province and is starting in another, is discovering mass graves both in remote areas and within city limits. The pace is not fast enough for family members who believe that a loved one is buried in a mass grave. If they grow frustrated with the deliberate pace — whether because they suspect government officials are intentionally retarding exhumation, or they realize that the scale of the problem is so large — they sometimes decide to exhume the remains themselves.
But although families may think they can make an identification based on clothing or personal effects, those alone are seldom conclusive. Once a site is breached, bones may become jumbled, extraneous items can be introduced, and the excavation process can destroy evidence that might have helped to prove the cause of death.
Development is another danger for gravesites. Some mass graves are located in the path of much-needed new roadways or structures. Especially when those improvements have been promised by loca lpoliticians, there may be tremendous pressure to bulldoze a mass grave and move forward in the name of progress.
AFSO is preparing plans for “rescue exhumations” for endangered sites that might otherwise be obliterated. The procedure calls for investigators to plot and photograph a site and expediently exhume the human remains, which could then be reinterred in a safe area or stored in a secure place for further examination.
“Rescue exhumations are a form of preservation, but not the same as a full forensic investigation,” says Stefan Schmitt, director of PHR’s International Forensic Program. “The gold standard is an investigation triggered under the auspices of a formal authority. But that is not possible at every site. The stark choice may be between a stream of information that contributes to the body of knowledge, or nothing at all.”
Although it is a proudly independent body, the Afghan Forensic Science Organization needs financial support and expertise to expand its capacity to oversee a range of forensic projects. “During the last 30 years, layer upon layer of conflict was heaped upon the Afghan people,” says Schmitt, “so much so that people have a hard time determining what is the truth, or even how to go about finding it. Forensic inquiry demonstrates that you can do more than clamor for the truth — scientific evidence can prove what happened, allowing the society to accept the past and move forward.”
“In the rush for the exits in Afghanistan, it is important for the international community to remember what we have all tried to accomplish,” Schmitt adds. “AFSO has the potential to fortify civil society as it unearths the facts of Afghanistan’s past. That has all the hallmarks of a very good investment.”
In 1991, PHR and Human Rights Watch/Asia published the first comprehensive report on the deadly consequences of landmines.
Co-written by Eric Stover, PHR’s director at the time, Coward’s War: Landmines in Cambodia, documented the havoc those treacherous weapons create long after a conflict has ceased. A year later, PHR, Human Rights Watch, and four other nongovernmental organizations launched the International Campaign to Ban Landmines (ICBL).
That campaign brought together hundreds, and eventually thousands, of individuals, organizations, and governments to press for a halt to the use, trade, production, and stockpiling of antipersonnel mines. The grassroots coalition achieved exhilarating success; after five years, most of the world's nations agreed to sign the Mine Ban Treaty. For their leadership, PHR and 10 other groups forming the ICBL Steering Committee shared the 1997 Nobel Peace Prize.
Landmines, which can remain lethal for decades, remain a humanitarian crisis. According to the ICBL, the devices maim or kill every year about 5,000 people, 70% of whom are civilians. In 2000, PHR published guidelines for groups conducting epidemiological surveys that quantify the public health consequences of landmines. And although more than 160 countries have now signed on to the treaty, new mines continue to be laid: Just last year, PHR called for Syria to halt the use of landmines along the Lebanese border.
Of the 34 nations that still have not signed the Mine Ban Treaty, only two are in the Western Hemisphere: Cuba and the United States. We need to lower that figure. Please join with PHR in this 20th anniversary year in pressing for universal commitment to the Mine Ban Treaty, greater support for mine clearance programs, and greater access to medical care for mine victims.
Dr. Ahola, a psychiatrist in private practice in New York, joined the Network because “It seemed the perfect way to use and deepen my clinical skills to help people who have suffered persecution attain safety — the first step of healing.” Now, more than a dozen years later, having successfully gained asylum for more than 60 people, she describes this as “the most compelling and rewarding work I have ever done.”
Through the PHR Asylum Network, hundreds of health professionals like Dr. Ahola volunteer to help people who have fled torture, sexual violence, assaults, and threats based on their race, nationality, religion, political opinion, or social affiliations.
For those seeking a safe haven in the US, the physical or psychological evaluation conducted by a health professional is often the only piece of evidence submitted in court. That critical examination record, submitted as a legal affidavit, has the power to save the life of a person who has endured abuse or has a well-founded fear of future persecution.
Dr. Ahola remembers the first applicant she accompanied to court. James (name changed for privacy) was terrorized in Jamaica because he was gay. When he was a young man, his mother scalded his hands to curb his effeminate gestures. His family was so deeply ashamed of him that when they emigrated from Jamaica to start a new life in Canada, they left him behind in the care of an elderly relative. He faced continual abuse in the community, and when his co-workers physically attacked him, James fled to the US.
Dr. Ahola brought James to a lesbian/gay/bisexual/transgender asylum workshop at Brown University, where she was speaking as part of PHR’s national conference for students in the health professions. The prospect of telling his story made him quake, but he and Dr. Ahola pooled their courage. There were several workshops that day, so they were not sure if medical students would attend the session. Students not only came, but after filling every chair, they sat on the floor and on the windowsills. They listened with rapt attention, and stood in line afterwards to speak with James and shake his hand.
Only after the workshop session did James admit that this was the first time he had ever said out loud that he was gay — a declaration that could have incited his murder in Jamaica. His courage inspired Dr. Ahola. She continues to prepare medical-legal affidavits for asylum seekers, and has pledged to present in-person testimony in every case she accepts.
After many psychological evaluations of asylum seekers, Dr. Ahola experienced what she calls a “thunderbolt moment”: she knew she needed to tackle the issue of asylum on a larger scale. She is now the medical director of the Weill Cornell Center for Human Rights, which trains medical students to perform asylum evaluations. Through PHR, Dr. Ahola is also a mentor and senior trainer for other health professionals in the Asylum Network.
Dr. Ahola has teamed up with Dr. Coleen Kivlahan, another deeply committed Network volunteer, to train health professionals in documenting trauma in asylum seekers. While Dr. Kivlahan focuses on physical exams, Dr. Ahola specializes in the “invisible scars” of torture, abuse, and persecution. Together they have recently led training sessions in Boston, Houston, Los Angeles, Miami, New York, and Washington, DC.
“Dr. Ahola brings three superb contributions to the PHR Asylum Network: her willingness to undertake so many critical case evaluations; her remarkable record in securing asylum for those she has helped; and her ability, through training, to transmit that dedication and knowledge to other health professionals,” says Christy Fujio, Asylum Program Director. “She is a remarkable example of what one person can achieve.”
■ Joanne Ahola, MD, PC: Adjunct Assistant Clinical Professor of Psychiatry, Weill Cornell Medical College; Medical Director, Weill Cornell Center for Human Rights; Assistant Clinical Professor of Psychiatry, Columbia University College of Physicians and Surgeons
PHR's Asylum Program will train health professionals in both basic and advanced sessions in 2013. Please email asylum [at] phrusa [dot] org to request notification of upcoming locations and dates.