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(Manama) - Bahraini authorities refused to let injured people reach the country's largest public health facility on March 16, 2011, and interfered with medical services at other facilities as well, Human Rights Watch said today. Security forces prevented ambulances transporting injured people from reaching the hospitals.

The security forces prevented access to medical care after they used teargas, rubber bullets, gunshot pellets, and live ammunition rounds to disperse protesters at the Pearl Roundabout in Manama early in the morning and established control over surrounding Shia areas. The security operation on March 16 and operations in several other Shia villages on March 15 resulted in the deaths of at least six civilians and three members of Bahrain's security forces, and hundreds of injuries, according to media reports.

"There can be no justification for denying critical medical care," said Joe Stork, deputy Middle East director at Human Rights Watch. "King Hamad, as the commander of Bahrain's army, bears responsibility for this flagrant violation of the right to health and potentially the right to life."

Around 7 a.m. on March 16, security forces moved in on hundreds of protesters gathered at the Pearl Roundabout, the center of anti-government demonstrations for more than three weeks. Security forces initially used teargas, sound bombs, rubber bullets, and shotgun pellets to disperse crowds. Witnesses told Human Rights Watch that security forces also entered several Shia towns near the roundabout, apparently in an effort to chase down protesters and regain control over central Manama. The witnesses and doctors said that many of the more serious injuries to protesters occurred during this subsequent phase of the police operation, and that live ammunition was also used.

At about 7:40 a.m. Human Rights Watch tried to enter the Salmaniya Medical Complex, the country's largest public health facility, but was not allowed to pass dozens of riot police surrounding the main gates. Human Rights Watch observed police diverting cars, including at least one Health Ministry vehicle, away from the hospital. One doctor working in the health facility told Human Rights Watch that she heard sirens approaching the complex after security forces moved in on the Pearl Roundabout, but that security forces refused to let ambulances reach the hospital.

The government denied allegations that security forces turned away ambulances or cars carrying injured people to the health facility, claiming that security forces intervened at the hospital because anti-government forces were holding hostages at the hospital. They did not provide more concrete details.

Some of the injured were directed by security forces at the Salmaniya complex to other health facilities, including government-run facilities in nearby Naim and Ibn-al Nafis, private facilities like the Bahrain International Hospital, and the Bahraini Defense Force hospital, Salmaniya doctors said.

But sources told Human Rights Watch that security forces surrounded all three of these medical centers and fired teargas at Bahrain International, causing some damage to the facility. One witness who was at the Pearl Roundabout when security forces moved in on protesters told Human Rights Watch that dozens of protesters, some with serious gunshot pellet wounds, ended up being treated in a makeshift clinic in a mosque in the village of Sanabis, not far from the Pearl Roundabout.

Human Rights Watch is concerned that some of the injured were unable to reach any medical facility adequately prepared to provide the needed care.

Several doctors told Human Rights Watch that in the early afternoon the health minister, Nizar al-Baharna, hospital administrators, and Bahraini Defense Force officials negotiated an arrangement that would allow Salmaniya to dispatch several ambulances to small area health centers that had taken in some injured people who couldn't reach Salmaniya because of the security cordon but that did not have adequate facilities to care for them.

Security forces agreed to the arrangement only after medical staff agreed to limit the areas where they would pick up the injured, one doctor said. Another doctor said that security forces assured al-Baharna that as long as medical staff agreed to these conditions, their safety would be guaranteed. Despite the promises, security forces attacked one of the ambulances soon after it left Salmaniya. One doctor's arm was fractured, and others in the ambulance were beaten and humiliated, another doctor told Human Rights Watch.

Several hours after the attack on the ambulance, al-Baharna announced his resignation. Salmaniya doctors told Human Rights Watch that the Bahraini Defense Force is now "calling all the shots" at Salmaniya and that the doctors are concerned for the safety of both doctors and patients. Their concerns were not unfounded; Human Rights Watch has received confirmation from two separate sources inside Salmaniya that security forces arrested Dr. Ali Alekry on or around March 17. Dr. Alekry has been an outspoken critic of the government's actions, especially following the attack on protesters gathered at the Pearl Roundabout during the early morning hours of February 17. That security operation led to the deaths of four Bahrainis.

Several doctors told Human Rights Watch that the hospital has effectively been in a state of lockdown since security forces surrounded it early on March 16. Security forces have provided no guarantees that those who want to leave the complex won't be assaulted by the forces surrounding the hospital, one doctor said.

"We are scared to go out," the doctor said. "Some [medical staff] have been here for two to three days straight. We can't perform our duties under these conditions. The government is accusing us of discriminating between Sunnis and Shias [patients]. I am a Sunni. We just don't have this issue here. We have been doing our jobs under severe conditions and we don't deserve this."

A doctor who had been inside for several days told Human Rights Watch on the morning of March 17 that security forces had allowed her and a group of other hospital staff to leave. She said that forces lined everyone up, demanded identification, searched them, and confiscated any cameras, laptops, and ipads they were carrying before allowing them to leave. They were told to retrieve any personal belongings that had been confiscated at the central police station.

Even before March 16 Human Rights Watch had documented a troubling pattern of security forces preventing medical staff from providing urgent care to wounded protesters and assaulting doctors and paramedics dispatched to provide treatment to the injured.

On March 15 residents described similar actions. At around 4:45 p.m. Human Rights Watch was on the phone with a resident of Sitra, one of the Shia villages where security operations took place, who reported that security forces had surrounded the local medical center and were poised to enter. During the conversation, shots were heard in the background and the resident was forced to hang up to seek shelter.

The Sitra resident later told Human Rights Watch that security forces shot teargas and rubber bullets into the medical center but did not go in. On March 16 the resident told Human Rights Watch that security forces continued to surround the Sitra medical center and that the facility was effectively under lockdown. Doctors interviewed by Human Rights Watch said that security forces had "hijacked" several ambulances dispatched from Salmaniya to Sitra and other villages on March 15. At least three people were killed and hundreds injured as a result of the March 15 operations.

Human Rights Watch also interviewed seven doctors and medical staff at Salmaniya about events at the University of Bahrain on March 13. Doctors and medical staff who had been dispatched there said that armed vigilantes threatened or attacked them when they reached the university campus, where demonstrations were taking place, and that security forces did nothing to stop them. One of the doctors told Human Rights Watch that four or five ambulances had been dispatched to the university. When his ambulance arrived there, he saw dozens of armed men, some wearing masks. The doctor said that his ambulance staff were able to leave with one of their colleagues, who had neck injuries as a result of a beating by the armed men.

The doctor told Human Rights Watch that the armed men prevented the ambulance crew from getting out of the ambulance to treat the wounded, questioned why they were there, and threatened them. "We told them we are here to help anyone injured," the doctor said. "But they said ‘No, you only want to help the Shia victims!'" Several of the armed men then approached the ambulance and shattered the window on the passenger-side, where the doctor was seated. The glass caused light face and neck injuries. Shortly afterward, the ambulance was allowed to leave.

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