When colleagues told him the Nicaraguan government had ordered the country’s public hospitals to turn away injured protesters, Dr. Josmar Ulises Briones Montalván was shocked. “The duty of a doctor is to save lives,” he said.
Briones is a neurosurgeon who worked at his private clinic in Managua, Nicaragua’s capital, and another one in the northern city of Estelí. But after the National Police and armed pro-government groups began violently cracking down on the tens of thousands of protesters furious with Nicaragua’s government last April, Dr. Briones had to make a tough decision: violate his principles or risk prison.
During the repression of demonstrations – which began as an outcry over changes to Nicaragua’s social security but expanded to encompass widespread grievances against the government – more than 300 people were killed and over 2,000 injured. Hundreds of people were detained; many of them prosecuted without due process. Many detainees were subject to abuse that in some cases amount to torture, including electric shocks, beatings, sexual abuse, and waterboarding.
While the government denied the abuses, doctors knew officials were lying because they saw the injuries people who came to them had sustained. What Briones saw, as the injured flooded into his clinics and as he treated people on the street, changed his life.
Briones kept the doors of his clinics open and refused to turn away people in need, even though many doctors feared retaliation for doing their jobs, he told Human Rights Watch’s senior researcher Tamara Taraciuk. He also joined forces with dozens of other doctors, medical residents, and medical students. Together they created an informal network that provided medical care on the side of the road, in safe houses bordering protester barricades, and in makeshift clinics set up in classrooms at the universities near where many student-led protests took place.
Doctors knew they risked their careers. But some did so publicly, like a group of roughly 25 medical specialists working at a hospital in Estelí, who wrote a public letter saying they would care for anyone, regardless of their political affiliation. Later, Briones said that everyone who had signed that letter had been fired from their positions, including a pediatrician now living in exile who Briones said continued to provide care after she was fired. According to Nicaragua’s Medical Association, nearly 300 doctors, nurses, and other health workers have been fired for treating protesters.
Providing care against government orders was not always possible, even for determined doctors. Briones described a day when he arrived at a hospital in Estelí to care for someone with a bullet lodged in his spine, but union members and the deputy director of the hospital denied him entry, accusing him of being a “terrorist,” “coup-plotter,” and being “a doctor paid by the CIA.” The patient was not transferred to another hospital for treatment and ended up in a wheelchair.
Providing care was even more difficult amidst threats. At one hospital, at the break of dawn, a member of an armed paramilitary group rushed into the emergency room and fired a shot into the air, threatening to return and fire aimlessly if doctors continued treating protesters, a doctor who was there told Briones. Briones also said armed paramilitaries came to his clinic and threatened to kill him if he kept providing care to protesters. In a country where hundreds of critics have been unjustly imprisoned or killed, he understood the seriousness of these threats.
Briones continued providing care, despite seeing first-hand what happened when people challenged President Daniel Ortega’s authority.
Day after day, he treated protesters who told him that they had been kicked or beaten by police, even hit in the head with the butts of automatic rifles. Some had cracked ribs and head wounds. Some were beaten so badly they couldn’t open their eyes. “We routinely touched patients’ ribs to find out how many were broken,” he said.
A few protesters were brought to Briones with bullet holes in their neck and chest, around the area doctors there refer to as “the triangle of death,” in the thorax. He treated a protester whose lung was perforated by a bullet. Another had a bullet lodged in his spine.
In one case, Briones treated a patient who had been shot in the head. He transferred the protester to a hospital in Managua seeking urgent care, but the Neurosurgery Unit’s head told Briones that they would “let that dog die,” and refused to provide treatment, Briones said. The patient eventually died.
“That’s not being a doctor,” Briones said. “That’s not even being human.”
When he tended these patients, they or their friends told him their stories. Some of his patients were recently released from El Chipote, one of the main prisons holding political prisoners, after being held for a few hours or days.
They had been beaten, kicked with military boots; they had fractured ribs and bruises or scrapes everywhere, they told Briones. Some said that when they arrived there, they were first stripped naked and doused with ice water. And there was psychological torture, Briones said. Officers told the protesters “that they were going to be killed, that they were going to kill their relatives,” he said. “Women were stripped and told they would be raped.”
The two cases that horrified him the most were of two young men whose pants were soaked with blood when they arrived at the clinic. Both had anal tears. They told Briones that they had been raped by paramilitaries with the tip of an automatic rifle. The officers told them that if they continued to protest, the same would happen to their families.
But he kept treating them – until he felt he was endangering his family. In July, when Briones took his family to Estelí to visit his father, who was celebrating his birthday, an assistant at his Managua clinic called and said a group of armed civilians had visited, asking for his whereabouts. That same day, two police vehicles parked in front of his home, and a group of armed men told the woman working there that they would kill Briones. When they did not find Briones at home, he said, they poisoned his dog and left a note saying: “We have you under surveillance, dog.” Days before this incident, a neighbor had warned him that he should “stop providing care to coup-plotters” because “measures would be taken against” him, Briones said.
Briones never returned home. He and his wife picked up their children, who were at a relative’s home, and fled the country the following day. He currently lives in the United States, where he is struggling to rebuild his life. Briones says he knows more than 50 doctors who treated protesters and were forced into exile, the majority in Costa Rica or the US.
Ortega has crushed the massive protests, but the repression in Nicaragua did not stop there.
Parliament shut down nine non-governmental organizations. Journalists have been threatened; two were jailed in December 2018 and now face “incitement to terrorism” charges. One activist was stripped of her citizenship and deported; three foreign national activists were stripped of their residency. International monitors from the Inter-American Commission for Human Rights and the Office of the High Commissioner for Human Rights have been expelled from the country.
Briones shares his story to let the world know the reality of his country, with the hope that exposing these abuses will contribute to holding those responsible accountable. “I am not in favor of an amnesty, I am in favor of justice,” he said.