July 18, 2011

Summary

In February and March 2011 thousands of Bahrainis, most of them from the country’s Shi’a majority, took to the streets to demand political reform. The protests were in part inspired by similar protests in Egypt and Tunisia, but were also a response to unfulfilled government promises of reform and increasing repression of political dissent.

The Bahraini government reacted to the protests with a mixture of violent repression, offers of limited concessions, and, for a time, political dialogue. Since the start of the protests on February 14, more than 30 people have died in protest-related violence, mostly at the hands of the Bahraini security forces. Hundreds more have been wounded, some seriously.

In mid-March the government brought an end to the street protests with a massive security crackdown, forcibly breaking up the protesters’ camp at the Pearl Roundabout in Bahrain’s capital Manama, and imposing a state of emergency. Although the state of emergency was lifted in early June, hundreds of those arrested remain in detention and scores have been put on trial in military courts.

Since the start of the crisis in Bahrain, Human Rights Watch has documented an alarming pattern of attacks, mainly by Bahraini troops and security forces, against medical workers, medical institutions, and patients suspected of participating in protests, primarily on the basis of the injuries they had sustained. At first the attacks appeared aimed at preventing medical personnel from treating injured protesters, but once the crackdown revived in mid-March security forces increasingly targeted medical personnel and institutions themselves, accusing some doctors, nurses, and paramedics of criminal activity as well as involvement with anti-government protests.

This report documents the key elements of what appears to be a systematic campaign by the Bahraini government aimed punishing and intimidating medical professionals suspected of sympathies with protesters and hindering access to health care facilities for persons wounded by security forces.

The first element of this campaign consisted of attacks on offsite medical facilities and providers at protest sites and the denial of access to medical treatment to the injured. Beginning on February 17, three days after the start of the protests, security forces attacked paramedics, doctors, and nurses attempting to provide urgent medical care to injured protesters and bystanders at the scene of demonstrations. Security forces also attacked ambulances dispatched to treat the wounded in or around the Pearl Roundabout and volunteer medical personnel staffing a medical tent that had been set up at the roundabout. On at least one occasion in March, at the main campus of the University of Bahrain in Sakhir, uniformed security forces stood by as pro-government armed gangs attacked medical personnel and prevented them from treating individuals injured during clashes.

The second element of the government’s campaign against the medical community was the siege of several hospitals and medical centers, including the Salmaniya Medical Complex (SMC), Bahrain’s largest public hospital, where many of the most severely injured protesters were taken for treatment. On March 16, following the clearing of the protesters from the Pearl Roundabout, security and military forces surrounded and took control of the SMC and a number of other medical facilities. Forces deployed tanks and security vehicles at the entrance to the SMC and other health centers, prevented ambulances, patients, and medical staff from entering or leaving, and fired teargas, rubber bullets, and pellet guns at the entrances and windows of these medical centers.

Masked security personnel in effect turned the SMC hospital and other health facilities into detention centers where many injured and sick persons, particularly those apparently wounded by security forces, feared to seek treatment for fear of ill-treatment and arrest and where many medical staff feared to work. Security forces forcibly moved patients, sometimes against medical advice, within and between hospitals and held them incommunicado. Medical staff and families of protesters injured and killed by the security forces were unable to learn the whereabouts of detained patients. In at least four cases, officials in hospitals or police stations later called families to inform them that their relatives had died and that the families should retrieve their bodies from the hospital.

The third element of the government’s campaign has been the arrest, detention, and torture or ill-treatment of patients with protest-related injuries. Soon after military and security forces surrounded the Salmaniya Medical Complex on March 16, a doctor inside the hospital told Human Rights Watch that the Bahrain Defense Force (BDF) was now ”calling all the shots” at the SMC, and that doctors were concerned for the safety of both medical staff and patients.

The takeover of the SMC had an immediate impact on the provision of medical care at the hospital. Security forces interfered with medical decisions regarding the dispatch of ambulances, insisting on deciding where and whether ambulances would be sent and whether security officers would accompany medical staff, and on carrying out security searches of medical staff. The presence inside the SMC of security and military officers, many wearing masks and carrying arms, served to intimidate medical staff and patients alike and prevented some injured protesters from seeking necessary and timely medical attention. Security checkpoints also intimidated patients and staff and restricted entry into and exit from the SMC. Security forces also restricted the free access of medical staff to all parts of the hospital and forced staff to undergo security checks in which they searched for and examined cameras, mobile phones, and other communications devices.

Most vulnerable were the patients themselves, especially those who had apparently sustained protest-related injuries, including wounds sustained from shotgun or birdshot pellets, rubber bullets, and live ammunition. Security forces subjected these patients to arbitrary arrests and incommunicado detentions, regular beatings, torture and other forms of mistreatment. They also, in some cases, tampered with their medical records.

The fourth element of the government’s campaign against the medical community in Bahrain has been the arbitrary arrest, interrogation, mistreatment, detention, and prosecution of doctors and medical staff. The Bahraini government appears to have targeted medical professionals directly in order to punish them after they started speaking publicly about human rights violations in hospitals and providing information on injuries inflicted on protesters, indicating excessive use of force by army and security personnel. In some cases medical professionals appear to have been targeted solely for expressing their political opinions or participating in anti-government demonstrations.

Since March 17, 2011 security forces have arrested more than 70 medical professionals, including several dozen doctors. At this writing, 48 medical staff, many of whom worked at the Salmaniya Medical Complex, were being tried in a special military court on a variety of felony and misdemeanor charges. Their trial started on June 6. Most of the defendants, like hundreds of other Bahrainis detained in the crackdown, have had little or no access to lawyers and family members, and several alleged in court that security forces and interrogators insulted, harassed, abused, mistreated, or tortured them while they were in custody.

This report also considers the evidence the government and its supporters have provided to support government allegations that actions by protesters and by medical staff compelled security and military forces to take over the SMC. Anti-government protesters, including some doctors and medical staff, may have played a role in compromising the principle of medical neutrality and access to health care by turning the grounds of Salmaniya Medical Complex, the country’s largest public hospital, into a protest rally site between February 14 and March 16. However, doctors and medical staff interviewed by Human Rights Watch have denied government allegations that medical staff at the SMC withheld treatment from wounded or ill persons because they were Sunnis, or that protesters had brought weapons or other contraband into the SMC, and in the course of visits to the SMC during this period Human Rights Watch researchers observed no evidence of such activity. Human Rights Watch has so far been unable to substantiate the government’s allegations against members of the medical staff at the SMC. To date Human Rights Watch’s request to the Bahraini authorities for evidence supporting their claims has not received a response.

The Bahraini government’s violent campaign of intimidation against the medical community and its interference in the provision of vital medical assistance to injured protesters is one of the most egregious aspects of its brutal repression of the pro-democracy protest movement. In the longer term it is likely to deepen the divisions and mistrust that have been so evident during this year of political crisis. The government should end its campaign against the medical community, cease the detention and prosecution of medical professionals solely for exercising their rights to freedom of assembly and expression, allow unhindered access to medical treatment for all, investigate the violations set out in this report, and hold accountable those responsible.