Targets of Retribution

Attacks against Medics, Injured Protesters, and Health Facilities

 

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.

 

Recommendations

To the Government of Bahrain

  • Immediately cease all interference by security and military forces when individuals seek medical treatment, including any transfers of patients, against medical advice or the patient’s wishes, to the Salmaniya Medical Complex (SMC), the Bahrain Defense Force Hospital, or elsewhere.
  • Immediately stop the harassment, intimidation, arbitrary arrest and detention, and torture or ill-treatment of medical staff working in the SMC or other health facilities.
  • Guarantee the neutral status of medical facilities by removing all security force personnel from the hospital facility at the SMC and other health centers and instructing armed security force personnel not to enter hospitals.
  • Release all doctors and medical staff who have been detained without charge or on the basis of non-felony charges, allow those charged with felony offenses to have access to lawyers and contact family members, and present them promptly to an independent judicial authority for an impartial ruling on their continued detention.
  • Ensure that all medical records are returned to hospitals and health facilities and carry out an investigation to determine responsibility for any tampering with medical records.
  • Allow free access to health facilities by families of patients within normal facility visiting times.
  • Ensure that all detained individuals have access to appropriate medical care (including specialized medical treatment, where necessary), and ensure the physical safety and security of these detainees.
  • Allow doctors and medical staff to treat patients without interference by security and military personnel.
  • Make public the names of all persons that were or continue to be detained at the SMC, the Bahraini Defense Force hospital, or any other hospital or medical facility, including the reason(s) for their detention and the nature of their wounds or injuries.
  • Investigate allegations of beatings and ill-treatment of patients on the sixth floor of the SMC or elsewhere and hold to account any security personnel involved in such incidents, including commanding officers who gave such orders or failed to prevent such abuse.
  • Extend an invitation to the UN Office of the High Commissioner for Human Rights (OHCHR) and relevant the UN special procedures mandate holders, including the UN Special Rapporteur on the Right to Health, and allow them to carry out a full and free investigation.

To the United Nations and the UN Human Rights Council

  • Conduct an independent investigation into alleged violations of the right of access to health care services and facilities in Bahrain by the Special Rapporteur on the Right to Health.
  • Call on the Bahraini authorities to implement the above-mentioned recommendations.
  • Request an invitation from Bahrain to the Office of the High Commissioner for Human Rights and the Working Group on Arbitrary Detention to investigate the detention of medical personnel and of patients with protest-related injuries in hospitals and health centers and report back to the UN Human Rights Council on the treatment of injured patients being held in detention facilities.

Methodology

This report primarily examines alleged government violations of human rights law in four areas: restrictions on provision of offsite medical care; siege of hospitals and medical centers; targeting of persons with protest related injuries; and the targeting and detention of doctors and other medical staff. It also delves into government allegations regarding events at the SMC, particularly violations or alleged crimes committed by protesters and medical staff members from mid-February to mid-March. The report also presents narratives that challenge those put forth by anti-government protesters but that may have been put forth by pro-government groups or independent groups.

Much of the information in this report comes from interviews and meetings conducted by Human Rights Watch researchers who were in Bahrain from February 18 until April 20. Human Rights Watch visited Salmaniya Medical Complex (SMC) more than half a dozen times in order to speak with wounded protesters and bystanders as well as doctors, other medical personnel, and hospital administrators. During this time Human Rights Watch also looked into the status of investigations announced by the government, including the Ministry of Health, regarding the adequacy of the SMC’s response to events that occurred on February 17-18.

Some of the research was conducted with the assistance of representatives from independent human rights organizations in Bahrain. During the course of investigations Human Rights Watch researchers and their local partners interviewed more than 75 people who provided information used in this report . These individuals included doctors, nurses, and other medical staff working at the SMC, as well as other hospitals and medical centers. Human Rights Watch also spoke with patients injured during the protests, family members of medical staff, and others with intimate knowledge regarding the issues discussed in this report. Human Rights Watch and its local partners conducted the interviews in English or in Arabic, sometimes with the assistance of a translator.

Human Rights Watch has also relied on official government sources such as the Bahrain News Agency, and reports by other international organizations such as Medicins Sans Frontiers (Doctors Without Borders) and Physicians for Human Rights. In addition, Human Rights Watch reviewed material provided by the Bahraini government and organizations and individuals who support the Bahraini government’s narrative regarding events that took place at the SMC and other health centers during the period in question.

Human Rights Watch researchers and consultants attempted to visit Bahrain after April 20, but the government has not allowed us to do so. Despite the government’s denial of access, Human Rights Watch researchers have gathered additional information about continuing abuses by relying on contacts that Human Rights Watch has developed in Bahrain over the past 15 years. Interviews that took place after April 20 were primarily conducted by telephone, e-mail, or online messaging services such as Google Chat and Skype.

Human Rights Watch also approached the Bahraini government, national human rights organizations, and pro-government rights bodies to express serious concerns regarding attacks on Bahrain’s medical community and restrictions on access to health services. During a March 31 meeting with members of the official National Institution of Human Rights (NIHR), for example, several members of that group told Human Rights Watch that the NIHR had launched its own investigation into the events at the SMC and would soon release a report. They indicated that their investigations had uncovered evidence confirming many of the government’s allegations. At this writing, the NIHR has not publicly released or provided to Human Rights Watch any report on this matter. Human Rights Watch is also aware that the Bahrain Medical Society, whose leadership and membership was replaced by the government following the mid-March crackdown against anti-government protests, announced in June that it is planning to release its own report regarding events that took place at the SMC and other health centers.

As an international human rights organization, however, the primary focus of Human Rights Watch’s work is to document violations of international human rights law. Because only states – and not private actors or individuals – can be parties to human rights conventions such as the International Covenant on Civil and Political Rights (which Bahrain ratified in 2006), only states (and government officials and state agents) can be held accountable for violating their provisions. In other words, if doctors or anti-government demonstrators had committed violations at the SMC or elsewhere, they would have committed a common crime – not a violation of international law – for which the government of Bahrain should hold them to account. Additionally, Human Rights Watch will challenge the persistent failure of a state to uphold its international legal obligations to investigate unlawful actions by private individuals and hold them accountable.

On April 21, Human Rights Watch wrote to the acting Minister of Health Dr. Fatima al-Balooshi, asking her office to provide information regarding official allegations against medical staff at the SMC and elsewhere. At this writing Human Rights Watch had not received a response to its requests from the ministry or any other government body.

Due to the security situation in Bahrain, and the fact that authorities are currently prosecuting some of the doctors and medical staff whom Human Rights Watch interviewed and whose testimonies were used in this and other reports prepared by Human Rights Watch, we have withheld the names of most sources and locations of interviews out of concern for their security and privacy and that of their family members.

I. Background

On February 14, 2011, thousands of demonstrators marched in Bahrain’s capital, Manama, and other towns and villages throughout the country to protest the ruling Al Khalifa family’s tight grip on power, alleged discrimination against the country’s majority Shi’a population, and the detention of political prisoners. The protesters were inspired in part by similar protests in Tunisia and Egypt which in the previous weeks had led to the ousting of those countries’ presidents. But Bahrain’s protests were also a response to the failure of the Bahraini authorities over the past decade to implement long-promised reforms, and months of escalating repression of political dissent.

Bahraini security and military forces responded to the protests with excessive force, firing teargas, birdshot pellets, rubber bullets and live ammunition at anti-government demonstrators. Between February 14 and February 18, Human Rights Watch documented scores of injuries and seven protester deaths.[1] Four were killed following a pre-dawn raid by security forces against protesters that had peacefully gathered at the Pearl Roundabout. Then, on February 19, security forces withdrew from the Pearl Roundabout in the capital and other areas that had seen large protests, and anti-government demonstrators were allowed to freely gather and initiate public protests. The government also offered limited concessions, such as the release of dozens of prisoners, a reshuffling of the cabinet, and in March, promises of political dialogue. Protesters rejected these promises as insufficient, designed more to get protesters off the streets than to address the grievances that underlay the protests.

From February 19 until March 16, the Pearl Roundabout in central Manama was the epicenter of Bahrain’s anti-government protests. Tens of thousands of protesters participated in weekly rallies there and elsewhere. The country’s main public hospital, Salmaniya Medical Complex (SMC), where many of those injured in clashes with the security forces were taken for treatment following the February clashes, became a gathering site for injured and anti-government protesters.

Demonstrations by protesters and their supporters, including doctors and other medical personnel, escalated in and around the SMC in mid-March after some demonstrators began holding protests outside the Pearl Roundabout and security forces ramped up efforts to suppress the protesters. On March 11, security forces fired teargas and rubber bullets at protesters to disperse crowds which had gathered to march toward the Royal Court in the town of Riffa, around 20 kilometers from Manama. On March 13, security forces used teargas and rubber bullets to push back to the Pearl Roundabout protesters who had shut down the streets in the Financial Harbor area and to disperse protesters at the University of Bahrain.[2]

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Thousands gathered outside Salmaniya Medical Complex on February 18 after troops open fire on peaceful protesters, killing one and wounding many more. © 2011 James Lawler Duggan

On March 15, a day after security forces from Saudi Arabia and the United Arab Emirates entered Bahrain at the request of Bahrain’s government, King Hamad bin Isa Al Khalifa declared a state of emergency, which officials referred to as a “State of National Safety.”[3] The same day Bahraini military and security forces launched a number of armed security operations against Shi’a villages, including Sitra and Ma’ameer.

Around 7:00 a.m. on March 16, military forces and riot police moved in to disperse hundreds of protesters camped at the Pearl Roundabout. Security forces initially used teargas, sound bombs, rubber bullets, and birdshot pellets to disperse crowds. Witnesses told Human Rights Watch that after security forces cleared the Pearl Roundabout, they entered several Shi’a towns near the roundabout, including Sanabis, Jidhafs, and Daih, apparently to chase down protesters and take unchallenged control over central Manama. Later that day, security and military forces surrounded and occupied the SMC. The operations on March 15-16 resulted in the deaths of at least 9 individuals, including four members of Bahrain’s security forces.[4]

With the declaration of the state of emergency, the government established by decree a special military court, the Court of National Safety, to try protesters, opposition leaders, rights activists, and persons who supported or whom authorities perceived as supporting the street protests. A military judge presides over these special military courts, along with two civilian judges, all of whom are appointed by the martial law commander, Bahraini Defense Force Commander-in-Chief Marshal Shaikh Khalifa bin Ahmed Al Khalifa. The Office of the Military Prosecutor is in charge of indictments and prosecutions before the court.

Although King Hamad declared an end to the state of emergency on June 1, and some of the more than one thousand arrested have been released, as of late June 2011 hundreds of others remain in detention, some incommunicado, and prosecutions continued before the special military court.[5] Virtually all of those detained in connection with the protests face trial before these courts, mostly on patently political charges rather than legitimate criminal offenses. The authorities have done little to address credible allegations of torture during interrogations or to pursue accountability for other abuses perpetrated by the security forces in suppressing the protest movement.

On June 29, 2011, King Hamad bin Isa Al Khalifa announced the establishment of an independent investigative commission headed by M. Cherif Bassiouni and including four other internationally-recognized human rights experts, among them Nigel Rodley, the former UN Special Rapporteur on Torture. According to “Royal Order No. 28 of 2011,” the commission’s mandate is to investigate “the events occurring in Bahrain February/March 2011, and any consequences arising out of the aforementioned events.”[6]

 

II. Restrictions on Provision of Offsite Emergency Care

Beginning on February 17, Human Rights Watch documented attacks by security forces on paramedics, doctors, and nurses who attempted to provide urgent offsite medical care to wounded protesters and bystanders. These included attacks on ambulances dispatched to treat the wounded in or around the Pearl Roundabout and attacks on volunteer medical personnel staffing a medical tent at the roundabout on February 17. Human Rights Watch also documented the failure of uniformed security forces, for example on the afternoon of March 13 at the campus of the University of Bahrain, to protect medical staff from attacks initiated by armed plainclothes gangs.

 

Attacks at Pearl Roundabout (February 17/18)

The initial attack by security forces on the Pearl Roundabout came at around 3 a.m. on February 17. A staff nurse at the SMC was among a team of around 10 volunteers at the roundabout to provide any needed medical assistance. He told Human Rights Watch that police moved in without warning, firing teargas and rubber bullets. Despite the fact that the volunteers in the tent had identified themselves as a medical team, he said, police beat them. He told Human Rights Watch that when he managed to leave the roundabout after the attack, there were still many injured there.[7] The SMC staff who spoke with Human Rights Watch after the February 17 attack repeated the staff nurse’s allegations and said that police beat at least four paramedics who arrived at the scene to treat and pick up the wounded.[8]

Sadiq Alekry, a 44-year-old doctor from the SMC, volunteered his services at the roundabout on the evening of February 16, just prior to the attack. Alekry told Human Rights Watch that he and his staff were wearing jackets with the Red Crescent emblem on them, and carried identification cards indicating they were part of a volunteer medical team. Shortly after 3 a.m., Alekry said, he heard someone yelling that riot police were attacking the camp. He stepped out of the tent and was immediately engulfed in teargas and sounds of gunfire. Several minutes later, he said, riot police confronted him with sticks and guns. When they attempted to handcuff him, he sat on the floor, raised his hands, and told them he is a doctor. They handcuffed him from behind and several of them began punching, kicking, and beating him with sticks. They then lifted him and walked him to an unknown location. Alekry said that every 100 meters or so other riot police punched and kicked him. During one attack, someone struck him in the face with a stick, fracturing his nose.[9] As a result of the repeated beatings, Alekry also sustained damage to his left eye, which caused temporary loss of vision.

Alekry told Human Rights Watch that police then loaded him onto a dark bus parked somewhere close to the Pearl Roundabout. As he boarded the bus, one of the officers pulled down the doctor's pants, raising concern that he might face sexual assault. A police officer then pulled his pants up, walked him onto the bus, forced him into a seat with handcuffs still on, and pulled the doctor’s shirt over his head. Alekry said that before this he noticed other detainees inside the bus. Alekry said that for the next hour or so several police officers walked up and the aisle and beat the detainees repeatedly. Alekry told Human Rights Watch that one police officer said to him, “If you bleed in my chair with your dirty blood I will beat you to death!” Alekry said that police eventually allowed him and three of the other detainees to board an ambulance.[10] He was admitted to the SMC at 6 a.m. on February 17, with severe injuries to his face, back, and torso. On February 22, Alekry, still nursing a fractured nose and heavily bruised face, underwent facial surgery.

During the period from mid-February to mid-March 2011, Human Rights Watch and local partners interviewed numerous paramedics, doctors, and nurses about attacks they experienced, and investigated protester and medical staff allegations that the Ministry of Health and the SMC administration either negligently or willfully restricted access to medical services by ambulance. A member of the medical staff at the SMC told Human Rights Watch that at the time of the early morning attack on the Pearl Roundabout on February 17, staff activated the SMC’s disaster plan, which called for at least 12 ambulances to go to areas in and around the Pearl Roundabout and for another 12 ambulances to remain on standby in case backup was required. This informant said that from about 3:15 to about 6:00 a.m. ambulances arrived at the scene, picked up the injured, and transferred them to the SMC.[11]

Sometime around 6:00 a.m., the informant said, the SMC received a communication, allegedly from the Ministry of Interior, ordering all but two ambulances to return to the hospital. According to the witness, authorities may have given this order after one of the ambulances at the SMC was stolen by protesters.[12] Two paramedics told Human Rights Watch (and local partners) that they heard such an order come over the dispatch radio, but Human Rights Watch has not been able to access a recording of the communication to verify that such an order took place.[13] The informant told Human Rights Watch that hospital staff did not implement the order during the next several hours, and instead sent several ambulances to areas close to the Pearl Roundabout and instructed medics to search for wounded persons despite the withdrawal of official authorization.

According to the source, security forces attacked several ambulance drivers, in some cases with paramedics inside.[14] Several of the paramedics told Human Rights Watch and local partners that one ambulance, which the SMC staff had dispatched to the roundabout around 6:10 a.m., came under attack. The paramedics said that security forces pulled out the driver, beat him, and forced him to walk back to the SMC. Another ambulance which was dispatched around the same time also came under attack, hospital staff told Human Rights Watch.[15]

Other Bahraini medical professionals dispute this narrative. Dr. Amjad Deek Obeid, who said he has worked as an emergency room doctor at the SMC for more than 14 years, told Human Rights Watch that at 3:30 a.m. on February 17, the hospital received a “disaster page.” The dispatchers sent ambulances, but soon thereafter crowds occupied the area outside the emergency room. He said that by 6:30 a.m. the SMC medical staff became aware of problems with the dispatching of ambulances. Dr. Obeid told Human Rights Watch that some protesters entered the hospital corridors, attacked the undersecretary to the minister of health, and took over all the entrances. He said that there was some traffic in and out of the emergency room building, but that protesters stole at least one ambulance to transport protesters. Dr. Obeid told Human Rights Watch that from 6:30 a.m. to 10:00 a.m. no new patients came to the SMC, and that ambulances that had been dispatched to pick up protesters from the Pearl Roundabout returned empty by late morning, saying that there were no more injured persons to pick up.[16]

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Doctors in Salmaniya Medical Complex fight for the life of 22-year-old Ali al-Mo’men on February 17, 2011. He was pronounced dead shortly after this photo was taken. © 2011 Human Rights Watch

Human Rights Watch and local partners interviewed two paramedics who said they had picked up one injured protester, Ali Mo’men, at around 8:30 a.m. on February 17. Security forces had shot Mo’men with birdshot pellets at close range, inflicting serious injuries to his pelvic area and right thigh. He was bleeding profusely when paramedics arrived at the scene, they said. (Human Rights Watch was unable to determine whether he was shot during the initial attack or several hours later). The paramedics told Human Rights Watch that police waved them through to where Mo’men lay. When they arrived to pick him up, they said, they saw a second protester lying next to Mo’men who had sustained massive injuries to the head apparently as a result of birdshot pellets shot at close range. They said the security forces would not allow them to pick up the body of the second person, who appeared to be dead, and instructed them instead to take only Mo’men to the hospital.

As they started driving towards the SMC, the paramedics said, the ambulance came under attack by security forces who beat the ambulance driver but eventually allowed him to return to the SMC.[17] Mo’men was rushed to the emergency room at the SMC, where he underwent surgery but subsequently died due to profuse bleeding. Human Rights Watch was at the SMC when doctors declared him dead at around 9:30 pm.[18]

The SMC staff member said that the hospital sent several ambulances to the Pearl Roundabout around noon on February 17, but that it appeared all the wounded had been cleared from the area by that time.[19]

Human Rights Watch also documented attempts by Bahraini security forces to prevent injured protesters from being transferred to hospitals and medical centers on February 18. On that day, at least 10 witnesses, five of them patients, separately told Human Rights Watch that a large group of army and police, using military vehicles, attacked peaceful protesters at around 5:50 p.m. close to Pearl Roundabout, the site of earlier protests that was at this time closed off by the security forces. The victims said the scene was peaceful and that there was no warning issued before security forces opened fire using teargas, rubber bullets, and live ammunition. They said the attack did not last long because people immediately started running away.[20]

Two doctors told Human Rights Watch they had treated patients with what seemed to be injuries from live bullets rather than shotgun pellets, judging by the entry and exit holes. One had been shot in the back and another in the head.[21]

Medical staff told Human Rights Watch they had sent at least 12 ambulances to the Pearl Roundabout area, but that the security forces were blocking access to some. Two paramedics told Human Rights Watch they were stopped by police and men in civilian clothes who said they would shoot them unless they turned the ambulance around. A senior paramedic called from the scene and told the hospital not to send any more ambulances because it was too dangerous, prompting hospital staff to stop dispatching crews.[22]

In total, Human Rights Watch and local partners interviewed nine paramedics and ambulance drivers who said that security forces assaulted them on the morning of February 17. Others were threatened and prevented by security and military forces from picking up injured protesters at or near the Pearl Roundabout. Several told Human Rights Watch that they complained to the SMC administration about these attacks and contradicted government announcements that none of the medics had been attacked.[23] After a cabinet reshuffle on February 27, the newly-named minister of health, Nazar al-Baharna, announced that the ministry would investigate the handling of the events of February 17 and 18. Al-Baharna said the investigative committee would comprise several government officials as well as independent members, including representatives from the Bahrain Medical Society (BMS).[24] By the time of the March 16 attack on the Pearl Roundabout by military and security forces, the Health Ministry’s investigative committee had not yet been formed.

Human Rights Watch has been unable to determine the current status of the investigative committee announced by the minister of health. On April 3, 2011 the Ministry of Social Development temporarily suspended the BMS, and the organization was later reconstituted under new leadership.[25] Authorities also arrested and detained the head of the BMS, Dr. Ahmed Jamal, but later released him. Government authorities have since initiated legal proceedings against 48 doctors and health care professionals from the SMC and other health facilities for their involvement in alleged crimes at the SMC (see below). Some of these alleged crimes occurred between February 14 and March 16. More than 150 doctors, nurses, and medics have been suspended or dismissed from work.

Members of the official National Institution of Human Rights (NIHR) told Human Rights Watch on March 30 that the NIHR had launched its own investigations into what happened at the SMC since the beginning of protests on February 14.[26] Nazar al-Baharna resigned as minister of health on March 16. Dr. Fatima al-Balooshi, the minister of social development, took over as acting minister of health.

On April 21, 2011, Human Rights Watch wrote to Dr. al-Balooshi requesting information regarding the government’s allegations against medical staff at the SMC and elsewhere. At this writing Human Rights Watch had not yet received a response from the ministry.

Attacks at the University of Bahrain (March 13)

Human Rights Watch interviewed seven doctors and medical staff from the SMC who were sent to the University of Bahrain campus at Sakhir, approximately 12 miles south of Manama, on March 13 following mid-day reports of clashes involving anti-government student protesters, riot police, and armed plainclothes men.[27] One doctor told Human Rights Watch that the SMC had dispatched four or five ambulances to the university. When his ambulance arrived there, he said, he saw dozens of plainclothes men armed with sticks and knives, some wearing masks. The doctor said that he and his ambulance staff were able to escape with one of their colleagues from another ambulance who had sustained neck injuries after some armed men beat him. The doctor told Human Rights Watch that security forces present at the scene did nothing to stop the armed plainclothes men from attacking his colleague.[28]

Another doctor dispatched to the university told Human Rights Watch that when his ambulance arrived at the university he noticed dozens of armed plainclothes men, some wearing masks. He said that some of the armed men beat one of his colleagues. The doctor who spoke with Human Rights Watch said that the armed men prevented the ambulance crew from getting out to treat the wounded, questioned why they were there, and threatened them. “We told them we are here to help anyone injured,” he said. “But they said, ‘No, you only want to help the Shi’a victims!’” Several of the armed men then approached the ambulance and shattered the window with clubs and sticks on the passenger side, where the doctor was seated, leaving him with light face and neck injuries. Shortly afterward, the ambulance was allowed to leave.[29]

Several other medics who had been dispatched to the university corroborated this doctor’s testimony.

A female doctor who said she was also dispatched to the university on March 13, told Human Rights Watch that plainclothes men, some of whom were masked, threatened her and several other doctors with a knife while police on the scene did nothing. She said she saw the plainclothes men beat two staff nurses from the SMC. As the situation escalated, she said, she and other medical staff, including four doctors and five nurses, ran into a building. She said a gang of plainclothes men chased them inside, but they locked themselves in a classroom and after around 20 minutes were able to leave the area.[30]

Another doctor on the scenetold Human Rights Watch that when the ambulance she was in arrived at the university entrance, young plainclothes men carrying weapons, including sticks, knives, and swords, forced them to stop. She said that the plainclothes men were accompanied by regular police officers, not riot police, and university security. After their ambulance drove through the gate, they witnessed several plainclothes men beating someone. It was not clear who the victim was, but security forces on the scene made no attempt to stop the beating, according to the doctor. She told Human Rights Watch that she and her colleagues treated four wounded people on the scene, including one of the plainclothes men who insisted on being taken to the Bahrain Defense Force (BDF) hospital instead of the SMC. As their ambulance left, police stopped them and demanded they open the back door so they could check to see who was in it. “Once we told them we were taking the injured individual to the BDF hospital they allowed us to leave,” the doctor said.[31]

A fifth doctor who was dispatched to the University of Bahrain told Human Rights Watch that he and other doctors saw anti-government protesters beating one of the plainclothes armed men at the university. He said they were able to convince the protesters to step away, at which point they loaded the injured individual into the ambulance and took him to the SMC. Doctors at the SMC who had been dispatched to the university said that at least three alleged pro-government gang members were admitted to the SMC on March 13. Human Rights Watch attempted to interview one of these men but was told by the SMC staff taking care of him that he did not wish to be interviewed.[32]

Human Rights Watch and local partners also interviewed several paramedics who reported a pattern of attacks against ambulances dispatched to areas where clashes had occurred between anti-government and pro-government demonstrators or security forces after February 17. After the events of March 16 and the takeover of the SMC by security and military forces, Human Rights Watch staff observed that some ambulances that have been dispatched from various hospitals or health centers were accompanied by police escorts. It is not clear whether there has been a systematic policy of providing police escorts to all ambulances dispatched from the SMC or public health centers since March 16.[33]

III. Siege of Hospitals and Medical Centers

On March 15, military and security forces launched a series of offensives against Shi’a villages. During the days that followed, security and military forces targeted the country’s major public hospital, the SMC, along with numerous public health centers and some private hospitals. Security forces surrounded medical facilities, prevented ambulances, patients, and medical staff from entering or leaving, and shot teargas, rubber bullets, and pellet guns at these facilities. Human Rights Watch observed physical damage to medical facilities consistent with the use of these weapons. Soon after surrounding the SMC on March 16, security and military forces occupied the SMC and took over operations there.

Sitra Health Center (March 15)

On March 15, at around 4:45 p.m., Human Rights Watch was on the phone with a resident of Sitra, one of Bahrain’s larger Shi’a villages. This person reported that security forces had surrounded the local health center and appeared poised to enter. During the conversation, Human Rights Watch heard shots fired and the resident felt compelled to hang up and seek shelter. Later that evening the same Sitra resident told Human Rights Watch that security forces shot teargas and rubber bullets into the medical center but did not themselves enter.[34] On March 16, this resident told Human Rights Watch that security forces continued to surround the Sitra medical center and that the facility was effectively under lockdown.[35]

Two other witnesses who were in the Sitra health center on March 15 told Human Rights Watch that a little before 5:00 p.m. people started to run into the medical center because police had surrounded the facility and were shooting rubber bullets, sound bombs, and pellets at the building. They said that medical staff hid under tables as police shot at the building. After approximately ten minutes the security forces left briefly, but returned and surrounded the center again five minutes later, trapping staff and patients inside.[36] Human Rights Watch saw pellet impacts that riddled the torso and legs of one witness who said he was just outside the hospital at the time of the attack and was sheltering women as they took cover.

Salmaniya Medical Complex (March 16 and after)

Around 7:00 a.m. on March 16, military forces and riot police moved in to disperse hundreds of protesters gathered at the Pearl Roundabout, the center of anti-government demonstrations since mid-February. Security forces initially used teargas, sound bombs, rubber bullets, and birdshot pellets to disperse crowds. Witnesses told Human Rights Watch that after security forces cleared the Pearl Roundabout they entered several Shi’a towns near the roundabout, including Sanabis, Jidhafs, and Daih, apparently to chase down protesters and regain control over central Manama. Witnesses and doctors said that protesters suffered more serious injuries during this subsequent phase of the operation, which reportedly lasted several hours after the clearing of the Pearl Roundabout, and during which security forces used live ammunition.

At about 7:40 a.m. on the same day, Human Rights Watch sought to enter the SMC but observed dozens of armed riot police surrounding the main gates of the hospital. Human Rights Watch saw police diverting cars, including at least one vehicle driven by a Health Ministry staff member, away from the hospital. One doctor working in the health facility at the time later told Human Rights Watch that she heard sirens approaching the complex after security forces attacked the Pearl Roundabout, but that security forces refused to let ambulances reach the hospital.[37] Security forces at the SMC ordered some of the wounded to go to other health facilities, including government-run facilities such as the nearby Naim health center, private facilities like the Bahrain International Hospital and Ibn al-Nafis, and the Bahrain Defense Force Hospital, doctors said.[38]

Bahraini authorities have consistently denied allegations that security forces turned away injured people from the SMC or other medical facilities. They instead claimed that security and military forces had to surround and eventually take over the hospital because anti-government protesters and rioters had taken over the SMC, held hostages, prevented access to healthcare services, stored weapons at the hospital, and routinely denied medical treatment to Sunni patients.[39] On April 21, Human Rights Watch requested information from authorities that would support these allegations, but this request had received no response at this writing.

Doctors told Human Rights Watch that there was a heavy security presence both outside and inside the hospital starting March 16, and that military and security forces prevented doctors, medical staff, and ambulances from freely leaving or entering. One doctor said that on March 16 she witnessed, from the window of the ward where she was working, riot police shooting into the air as they walked through the hospital parking lot, prompting many people who had been outside the entrance and in the parking area to run inside the hospital. She said two riot police vehicles were nearby, the mobile network service stopped working, and she could see smoke rising from the direction of the Pearl Roundabout. Because of the events taking place at the Pearl Roundabout, the doctor said, she and her colleagues expected to see ambulances coming to the SMC, but no ambulances arrived for hours. The doctor said hospital staff ushered the women and children who had come into the hospital from the parking area to the second, third, and fourth floors for their protection. She said she saw men in military fatigues and carrying guns heading toward the SMC administration office.[40]

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A masked soldier and several members of the security forces guard the emergency room entrance at the Salmaniya Medical Complex.

© 2011 James Lawler Duggan

Other doctors told Human Rights Watch that the hospital was effectively in a state of lockdown from March 16 onward, and that security forces refused to provide any guarantees to medical staff who wanted to leave the SMC that they would not be assaulted or detained by the forces surrounding the hospital. “We are scared to go out,” one doctor told Human Rights Watch on March 17 by telephone. She continued:

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 Shi’as [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.[41]

Several doctors who said they witnessed events from inside the hospital during the lockdown period told Human Rights Watch that security forces shot either rubber bullets or birdshot pellets at civilians who had gathered outside the hospital’s entrance but had not managed to attain shelter in the hospital, wounding at least two people. At least one of the doctors said she had seen a wounded protester who was shot with rubber bullets just outside the hospital entrance brought in for treatment that morning. Another doctor who was at the SMC on March 16 told Human Rights Watch that she and others witnessed security forces beating two individuals, at least one of whom was an the SMC staff member, just adjacent to one of hospital parking lots – she said they saw this happening from the third or fourth story of the hospital building. She said that the security forces beat these two individuals for more than half an hour.[42] Another hospital staff member who witnessed the beating told Human Rights Watch that they called the head of emergency to send an ambulance, but they said when the ambulance arrived riot police stopped it and took away the two paramedics who had come to the scene.[43]

Human Rights Watch has not been able to confirm what happened to the individuals whom witnesses said were severely beaten in these incidents by security forces.

The siege and eventual occupation of the SMC by security and military forces also affected the level of treatment received by patients. Human Rights Watch interviewed the brother of a protester who had been seriously injured on February 18 when military and security forces fired live ammunition rounds at peaceful protesters near the Pearl Roundabout. The protester had sustained serious damage to his chest, including severe internal bleeding in the left lung. After several operations doctors were able to stabilize him but he remained in the SMC intensive care unit.

The patient’s brother told Human Rights Watch that doctors concluded that he required additional surgery and that this surgery could only be performed abroad. He said the family had been scheduled to leave the SMC in mid-March for Europe but was prevented from doing so after security and military forces occupied the hospital on March 16. Human Rights Watch does not know what happened to the patient, or whether authorities eventually allowed him to leave.[44]

Several hours after security forces surrounded the internal and external perimeters of the hospital, then-Minister of Health Nazar al-Baharna, hospital administrators, and Bahrain Defense Force officials apparently negotiated an arrangement that would allow the SMC to dispatch several ambulances to smaller area health centers to move some wounded individuals who could not reach the SMC earlier in the day because of the security cordon, sources inside the hospital told Human Rights Watch.

Two doctors, who were stuck inside the SMC on the afternoon of March 16, separately told Human Rights Watch by telephone that day that medical staff were in negotiations with security and military authorities inside the hospital in an effort to persuade security officials to allow several ambulances to leave the SMC and pick up individuals injured earlier in the day. According to these doctors, government authorities and security forces approved the arrangement only after medical staff agreed to limit the places from where they would pick up the injured.[45] Another doctor told Human Rights Watch that day that the authorities insisted that security forces should drive the ambulances and be able to search doctors and the SMC staff before they rode in the ambulances.[46]

The doctors that day told Human Rights Watch that security forces assured al-Baharna that as long as medical staff agreed to these conditions, their safety would be guaranteed.[47] Despite these assurances, however, security forces attacked one ambulance shortly after it left the SMC at about 4:00 or 5:00 p.m.[48] One doctor’s arm was fractured in this attack, and others in the ambulance were beaten and humiliated, another doctor told Human Rights Watch.[49]

Several hours after the attack on the ambulance, al-Baharna announced his resignation.

The next day, March 17, a doctor who said she had been inside the SMC for several days told Human Rights Watch that security forces had allowed her and a group of other hospital staff to leave that morning. She said that the security forces lined everyone up, demanded identification, searched them, and confiscated cameras, laptops, and iPads in their possession before allowing them to leave. They were told to retrieve any personal belongings that had been confiscated at the central police station.[50]

Human Rights Watch again attempted to enter the SMC on March 19 and saw every entrance guarded by groups of masked soldiers carrying rifles and automatic weapons. At each gate of the hospital there were small tanks and armored personnel carriers. Human Rights Watch researchers saw security forces pointing guns at civilians who approached the SMC in their cars, and other security forces required passengers to leave their cars as they searched vehicles and questioned them. This happened with vehicles both entering and leaving the hospital.

On March 28 Human Rights Watch entered the SMC’s emergency room building after going through several checkpoints in an ambulance that was transferring from a private hospital to the SMC a patient who had sustained pellet-gun injuries. Once inside, Human Rights Watch noticed groups of security and military officers, many of them walking around the halls of the SMC with guns and black balaclava masks covering their faces. The several dozen security and military officers there at that time appeared to outnumber the patients then in and near the emergency building. As soon as the patient was transferred to an emergency room bed, Human Rights Watch witnessed at least five security and military personnel surround the patient and question him regarding the circumstances of his injury. Human Rights Watch has been unable to obtain information about his subsequent well-being or whereabouts.

Other Hospitals and Health Centers

On the morning of March 16, security forces also surrounded several other medical facilities, including the Naim medical center and the Bahrain International Hospital (BIH), a small privately-run hospital in Jidhafs. Security forces fired teargas, rubber bullets, and birdshot pellets at the entrance of BIH, causing some damage to the hospital. Human Rights Watch saw rubber bullet impact marks inside the waiting area as well as three medium-sized bags containing dozens of spent teargas canisters, rubber bullets, and pellet-gun cartridges that multiple witnesses said had been fired into the hospital. Human Rights Watch also saw evidence of birdshot pellet impacts at the entrance of the BIH.

Witnesses who were in the hospital on March 16 told Human Rights Watch that approximately 100 people who were wounded or suffering from teargas inhalation were in the hospital’s emergency waiting area, where staff had set up triage for incoming patients, when security forces fired teargas and pellet guns at the building. A witness who had been assisting patients as they arrived at the hospital told Human Rights Watch that moments before the hospital came under attack, patients and family members were gathered outside the main entrance of the hospital. The witness said he saw approximately 20 Ministry of Interior police vehicles lined up on the opposite side of the road at the time of the attack which lasted at least two or three minutes.[51]

In addition to these initial attacks, security forces subsequently carried out raids at several local health centers elsewhere in Bahrain in order to arrest or interrogate medical professionals working there. According to information received by Human Rights Watch, security forces raided Naim Health Center on April 10, Al-Dair Health Center on April 10, Al-Razi Health Center on April 11, NBB Arad Health Center on April 17, Ibn Sina Health Center on April 19, Shaikh Salman Health Center on April 20, Aali Health Center on April 26, Isa Town Health Center on April 26, Nuwaidrat Health Center on April 27, and Sitra Health Center on April 27. Human Rights Watch has not been able to confirm the accuracy of this information, but discussions with family members of detained medical professionals, opposition activists, and media reports published in late April suggest that security forces made more than 40 arrests of doctors, nurses, and other medical staff during the April raids.[52]

 

Makeshift Medical Clinics

One witness who was at the Pearl Roundabout on March 16 when security forces moved in on protesters told Human Rights Watch that dozens of protesters, some with serious pellet gun wounds, ended up being treated in makeshift clinics in maatams (Shi’a neighborhood religious centers) in the village of Sanabis, not far from the Pearl Roundabout. She said that local residents and protesters set up the clinics because wounded protesters could not be transferred to the SMC due to the security lockdown there.[53] In the days after March 16, Human Rights Watch received many reports of similar clinics set up by local residents in other areas because wounded protesters were afraid to visit regular medical facilities for fear of arrest and abuse.

In late March, a representative of Medicins Sans Frontieres (Doctors Without Borders) visiting Bahrain told Human Rights Watch that he was not aware of any makeshift clinics still operating, although many people with protest-related injuries still opted not to visit hospitals and medical centers for fear of being beaten and/or arrested.[54] In its public statements, MSF noted that it had treated dozens of patients who had sustained protest-related injuries inside their homes because they feared arrest, detention, or abuse if they sought treatment at hospitals or health centers.[55] It also urged the Bahraini authorities to lift the siege and occupation of the SMC and other health centers so that these patients, some of whom had serious injuries, could seek needed medical care.

Human Rights Watch received information in the weeks following March 16 confirming that some wounded persons instead sought treatment from volunteer doctors, nurses, and other medical professionals working in private homes.

 

IV. Targeting of Persons with Protest-Related Injuries

Soon after military and security forces surrounded the SMC on March 16, a doctor inside the hospital told Human Rights Watch, the BDF was “calling all the shots” at the hospital, and that doctors were concerned for the safety of both medical staff and patients.[56]

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, deciding where and whether ambulances would be sent and whether security officers would accompany medical staff, and carried out security searches of medical staff. The presence of security and military officers, many wearing masks and carrying arms, inside the SMC served to intimidate medical staff and patients alike and made some injured protesters afraid to seek necessary and timely medical attention. Security checkpoints around the hospital also intimidated staff and restricted access of medical staff to all parts of the hospital. Most vulnerable of all, however, were the patients, especially those who had apparently sustained protest-related injuries.[57] Security forces subjected these patients to arbitrary incommunicado detention, regular beatings, torture, and other forms of mistreatment. They also in some cases tampered with their medical records.

 

Identification and Segregation of Patients with Protest-Related Injuries

Two of the SMC medical staff told Human Rights Watch that they saw security forces in the hospital enter operating theaters, ask for all phones, and search communications devices belonging to medical staff, looking for videos and pictures of injured protesters, armed or masked security forces, or other images. Several staff at the SMC told Human Rights Watch that all of the injured protesters were moved to the sixth floor of the hospital, where heavily-armed military personnel guarded the doors to the wards where injured protestors were being detained, as well as main entry and exit points on the floor. According to the SMC staff, security officers limited the doctors, nurses, and other staff permitted on the sixth floor. Only pre-cleared staff were able to pass the security checkpoints to access patients in the secured wards.[58]

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A patient shot in the back with birdshot pellets by Bahrain's security forces and admitted to the emergency room at Salmaniya Medical Complex on March 15, 2011. © 2011 James Lawler Duggan

A nurse at the SMC told Human Rights Watch that she admitted 25 patients with protest-related injuries prior to the military takeover of the hospital on March 16. She said that out of the 25 cases she had admitted, more than five went missing after the security forces took over the SMC. “Patients have gone missing from the general surgery department and other areas,” she said. She explained that on one occasion, when there was a public announcement in the local press that a group of Kuwaiti doctors were coming to the SMC to provide medical assistance and equipment, security personnel moved all patients with protest-related injuries, except those in the intensive care unit, to different areas of the hospital or transferred them out. Military and security officers, who had their faces covered with black, grey, or khaki masks, moved the patients. She said that they barely spoke a word to medical staff, and each had a small handgun on his thigh and a rifle.[59]

One witness who was working in the SMC at the time told Human Rights Watch that on March 25 security forces closed Ward 62, which was filled with patients with protest-related injuries, and moved them. Human Rights Watch believes that authorities moved most of the patients to other areas within the SMC, but it is possible that some were transferred to hospitals or medical centers elsewhere. The witness, who spoke with Human Rights Watch the next day, said that one of the patients removed from Ward 62 had been scheduled for surgery but was taken to an unknown location. The witness told Human Rights Watch that security forces brought this patient back to the SMC the following week from a detention facility for the required surgery.[60] Human Rights Watch spoke to numerous health professionals who were concerned that many of the wounded protesters had been moved by security forces to detention facilities where their medical needs could not be properly met. Human Rights Watch was not able to ascertain the whereabouts of the patients who were moved on March 25.

Other witnesses told Human Rights Watch that masked security force personnel in fatigues and carrying weapons brought patients needing surgery to the preoperative area at the SMC. The security personnel then took the names of the surgeon and other doctors involved in the operation. A witness told Human Rights Watch that security forces recorded the names in a green notebook. After a surgery was completed, security personnel came to the recovery ward to take the patient back to the heavily guarded sixth floor.[61] Staff at the hospital told Human Rights Watch that on one occasion medical personnel asked security officers when a particular patient would be arriving for surgery, and the military officer replied, “He is not going to be operated on today.”[62] Other medical staff also voiced concerns about the interference by security services in the provision of healthcare to injured protesters.

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This patient was admitted to the emergency room at Salmaniya Hospital on March 15, 2011. The image in the x-ray shows dozens of metallic birdshot pellets lodged inside his body. © 2011 James Lawler Duggan

Human Rights Watch witnessed and documented one case where, on March 27, security forces forcibly removed a 22-year-old patient from a medical facility he had checked into for serious pellet-gun injuries after he was shot by security forces.[63] The patient was in great pain and doctors told Human Rights Watch he needed immediate surgery to remove more than 100 pellets that had penetrated his pelvic area and damaged his internal organs. This patient had gone to a local medical facility on March 26. He told Human Rights Watch that security forces had fired pellets at him at close range on March 25, after they entered his village in response to anti-government protests. He said he began to experience severe stomach pains and vomiting several hours later, but refused to be taken to a health facility because he feared arrest. The pain soon became unbearable, so his brothers made the difficult decision to take him to a nearby medical facility for treatment.[64]

There doctors gave him pain medication, treated some of his surface wounds, and took an x-ray of his pelvic area and buttocks. The x-ray, which Human Rights Watch reviewed, showed more than 100 pellets lodged inside the patient’s body. Doctors told him and his family that they were unable to treat him there because some of the pellets had penetrated deeply and caused internal damage that required surgery.[65]

On the morning of March 27 the patient checked into another medical facility, where doctors told him he required immediate surgery. They said they would need to request blood from the SMC.[66] They warned the patient and his family that they could not request the blood without providing his name, national identity number, and the nature of his injuries.

Approximately an hour-and-a-half later, a Human Rights Watch researcher at the scene observed about 10 security force personnel, including two plainclothes agents and at least four riot police carrying weapons, enter the medical facility. One police officer told Human Rights Watch that they were from the Isa Town police station and that they had come to take the patient. They entered his room and forced him out of bed and to his feet. They held him up and began escorting him out, but the patient was in noticeable pain and told them that he could not walk. One of the riot police sarcastically responded, “You can run away from the police but you can’t walk now?” One of the hospital staff called for a wheelchair.

Human Rights Watch asked the security agents where they were taking the patient, saying that he needed surgery and wanted to stay in the medical facility to receive care. Hospital staff communicated this same information to the security forces. One of the plainclothes agents told Human Rights Watch that they had orders to take the patient to the SMC but refused to provide more information.

They took the wounded man to the parking lot in a wheelchair and put him in an unmarked white sports utility vehicle. One plainclothes agent sat behind the wheel while the other sat with the patient in the back seat. They drove off with a four-jeep police escort. The next day Human Rights Watch learned through unofficial channels that authorities had transferred the patient to the BDF Hospital, where he had undergone surgery. Human Rights Watch has been unable to obtain information about his subsequent well-being or whereabouts.

Human Rights Watch witnessed a similar incident on March 28, when security forces ordered doctors at another medical facility to transfer a wounded 19-year-old to the SMC because he was in need of critical care.[67] This patient had also been shot with a pellet gun at close range on March 25. More than 100 pellets had entered the right side of his body and damaged his right kidney, colon, and right lung, causing several lacerations and ruptures, according to an attending doctor.

Doctors at the local medical facility told him and his family that he needed urgent care, possibly surgery, and that he would need to be transferred either to the SMC or the BDF Hospital. Security authorities eventually allowed him to be transferred to the SMC in an ambulance without a police escort and said that he would receive proper treatment. The family remained very worried about his condition, and feared that authorities had transferred him to the sixth floor of the SMC where many other patients with protest-related injuries were being held. Human Rights Watch has been unable to obtain information about his subsequent well-being or whereabouts.

Human Rights Watch also documented the case of 32-year-old Hani Abd al-Aziz Jumah, whom security forces shot with one or more pellet guns at close range on March 19 in the village of Khamis. Having shot him, the security forces apparently had left him gravely wounded and bleeding profusely in the empty room of a building under construction for more than an hour before neighbors found him and took him to a local medical facility. There doctors struggled for nearly two hours to stabilize him after massive blood loss. Jumah’s father, Abd al-Aziz Abdullah Jumah, told Human Rights Watch that after his son was brought to the medical facility, an ambulance arrived accompanied by two masked security officers who announced they were transferring Jumah to the BDF Hospital. That was the last time Jumah’s family saw him alive. They had no subsequent contact with him and when they contacted the BDF Hospital on March 20 and 21, officers told them he was not there and gave them no further information about him. The next news the family heard about Jumah was on March 24 when BDF Hospital officials contacted them to inform them that they should collect his body from the SMC the following day.[68]

On March 29, the Interior Ministry’s undersecretary for legal affairs announced that one patient had died and another was in critical condition because their families, fearing they would be detained and mistreated, delayed admitting them to hospitals, which “resulted in the deterioration in the condition of [one of the protesters] and the death of the other.”[69] Human Rights Watch has confirmed that the death the ministry was referring to was Jumah’s, although his death does not appear to be attributable to any dereliction of responsibility on the part of his family. So far as Human Rights Watch is aware, authorities sent no official communication to the families of the two wounded patients who were taken to the SMC and the BDF Hospital on March 27 and 28.

Detention, Harassment, and Beatings of Injured Patients

Human Rights Watch documented several cases in which patients with protest-related injuries were transferred to or sought treatment at the SMC and were then severely harassed and in some cases beaten. Numerous witnesses told Human Rights Watch that military authorities at the SMC systematically segregated people with protest-related injuries from the other patients and moved most of those with pellet-gun or live ammunition wounds to wards on the sixth floor. The sixth floor was inaccessible to all but a handful of the SMC staff and security personnel, these witnesses said.

One former patient described a six-day ordeal at the SMC where he had gone for treatment of pellet-gun wounds to his face, eye, and thumb after security forces attacked protesters at the Pearl Roundabout on March 16. He told Human Rights Watch that at around 8:30 p.m. on March 17, he and four hospital roommates in Ward 23 heard men shouting and slamming doors. A group of armed and masked men, some in civilian clothes and the others in police uniforms, entered his room and demanded that he and his roommates identify themselves, give their addresses, and describe their injuries.[70]

The armed men forced him and his roommates out of their beds, pushed them to the ground, tied their hands behind their backs, beat them, and dragged them out of the room, this person said. The men took them to the hospital’s reception area, where they forced them to lie face down on the ground with their hands tied for four hours, along with dozens of other patients. The witness said the security men kicked and swore at the patients while reviewing their medical records.

The witness said that the next day, at around 4:00 or 5:00 p.m., hospital authorities transferred him and many of the others who had protest-related injuries to Ward 62 on the sixth floor. He said that from that evening until early the next morning several groups of men, some in uniforms and others in civilian clothes, most of them masked, entered their room and repeatedly interrogated them on videotape, demanding to know about their alleged relationships with opposition figures, Iran, and the Lebanese political party Hezbollah. The men used anti-Shi’a slurs against the patients. He said one of the men told the others to beat them with their shoes because they were unclean, at which point the men beat the patients on their heads, hands, and necks.

Over the next two days, the witness said, the patients held under guard on the sixth floor ward were subjected to repeated beatings and interrogations. The witness told Human Rights Watch that starting on March 19, authorities directed doctors to assess some of the patients who had less serious injuries and ordered the hospital to discharge them. On March 21 he and several others were discharged.[71]

Human Rights Watch interviewed at least two other witnesses who recounted similar stories of beatings of patients at the SMC by masked security forces. One of them, an SMC staff member, described how a patient who had recently undergone surgery had pleaded with medical staff to transfer him from the sixth floor of the hospital after he suffered regular beatings by security personnel. The patient told medical staff that masked security force personnel entered his ward on the sixth floor and beat patients at around 8:00 p.m., 10:00 p.m., and 1:00 a.m. every night. Although he was recovering from serious surgery, he was beaten severely on the hands, one part of his body that remained accessible. The witness described the patient’s hands as being purple from the beatings.[72]

Other international organizations, such as MSF and Physicians for Human Rights, also documented abuse and torture perpetrated by security forces against injured protesters. Jonathan Whittall, MSF’s head of mission in Bahrain, recently told The Independent that “the security forces basically took control of the hospital on 17 March when tanks moved outside and set up checkpoints for anyone entering or leaving. Inside, many of the wounded with injuries that could have been sustained during the protests were taken to the sixth floor, where they were beaten three times a day.” “The hospital became a place to be feared,” Whittall continued. “One patient was caught trying to leave and he was beaten both at Salmaniya and then later in jail – there was no evidence that he was a ringleader. The situation was so bad some people didn’t dare come to the hospital – in some cases, people had no access to healthcare and that is still the situation today.”[73]

Whitthall said MSF also documented cases where authorities removed injured protesters from hospitals and those patients later resurfaced with more serious injuries. “One guy was brought into the hospital with a saw injury to the head, but he was removed by government forces and disappeared for weeks. His family had no idea what had happened to him until he reappeared with severe brain damage. There were no medical reports or any indication of what had happened to him during his detention.”[74]

In April 2011, Physicians for Human Rights reported that security forces tortured patients on the sixth floor of the SMC in order to extract confessions. In their report Physicians for Human Rights described severe beating suffered by an injured protester:

On his second day in the hospital, three armed security forces in black combat gear entered ward 23 on the second floor, where he was being held. One leveled his assault rifle at Ali’s head and threatened, “Are you proud to have been at Pearl Square? Do you want to become a martyr?” They then handcuffed Ali and the dozen other wounded young men in his ward behind their backs with black plastic wrist ties and began to beat them. Then the security forces threw Ali and the other patients face first into the floor and dragged them out into the hallway, leaving trails of blood on the hallway floor.
An Indian nurse told the armed men, “Don’t hurt them. They are our patients.” One of the Bahraini security forces yelled back, “They are not your patients – they are criminals!” One of the armed men with a Saudi accent hurled insults at the bloodied patients on the floor and cursed, “Grave worshippers! Sons of whores! Sons of Mut’a!” (derogatory references to Shi’a Muslims). Another armed man in black shouted, “We’re going to hang you. We’re going to kill you!” Ali and the other patients lay on the floor for four hours until they were transferred to ward 62 on the sixth floor.
Later that night, police in blue uniforms and men in civilian dress wearing black masks stormed the ward and beat Ali and the other patients with the butts of their rifles and kicks to the groin, stomach, and flanks. One policeman … threatened to rape Ali. Small groups of these armed men took turns beating each patient in the ward hurling insults and curses at them. The patients in ward 62 were subjected to sleep deprivation by constant beating and striking. Then began the interrogation. Ali reported to Physicians for Human Rights that the armed men took the patients’ finger prints and tried to extract confessions from the patients while being filmed on video: “Tell us that you were at the Pearl Roundabout with guns and swords. Tell us that Hassan Mushaima gave you guns and swords and that he told you to attack the police. Tell us that Hassan Mushaima told you that he will take you to Iran for military training.”[75]

Physicians for Human Rights also documented the case of 17-year-old Sadiq, who was taken by ambulance to the SMC after sustaining serious birdshot pellet wounds. Sadiq was blinded in his right eye as a result of the shooting.

On his second day there, the BDF took over security and administration of the entire hospital. After physicians treated Sadiq in the emergency department, he was transferred to ward 64 on the sixth floor. That night armed security forces in blue uniforms came into his room. They humiliated him by stripping off his clothes and taking photographs. They then pummeled him with their batons and fists. One of the Bahraini police forced his baton into Sadiq’s mouth while he lay in bed.[76]

Sadiq told Physicians for Human Rights that “different groups of five to seven security forces entered his room, which he shared with three other male patients in their 20’s who were wounded during protests, twice each night at around 10:00 p.m. and 3:00 a.m.”[77]

V. Targeting and Detentions of Doctors and Other MedicalStaff

 

Since March 17, 2011 security forces have arrested more than 70 medical professionals, including several dozen doctors, and suspended or terminated more than 150 from their jobs. The arrests appear to be part of a systematic campaign by authorities to punish medical and paramedical professionals who spoke out about alleged human rights violations, participated in anti-government protests, or expressed support for such protests.[78] On May 3, 2011 the government announced that at least 47 medical professionals, including more than two dozen doctors, would be tried in a special military court for various crimes. On June 6, a military judge convened the first court session against 48 medics. Most of the medical professionals currently on trial have had limited access to lawyers and family members, and several reportedly alleged in court that security forces and interrogators insulted, harassed, abused, and mistreated them while they were in custody, and in some cases tortured them.[79]

After security forces first attacked protesters on February 17 and 18, 2011, doctors and medical professionals from the SMC and other health facilities spoke openly and critically with journalists as well as to Human Rights Watch about the use of live fire by security forces and the resulting deaths and injuries among protesters. They also criticized the SMC administration, Ministry of Health officials, and other government authorities for what they believed was an inadequate response to the attacks. Some participated in anti-government protests.

On March 17, two days after authorities announced a “state of national safety,” security forces arrested Dr. Ali Alekry at the SMC. Dr. Alekry, a consultant and orthopedic surgeon at the SMC, had been an outspoken critic of the government’s actions, especially following the attack on protesters at the Pearl Roundabout during the early morning hours of February 17. That security operation led to the deaths of four protesters. Alekry had also provided volunteer medical services to protesters at the Pearl Roundabout.

Alekry’s arrest came at the start of a wave of arrests and interrogations of medical professionals. Most were arrested during nighttime raids on their homes by security forces, some of whom were masked, or while they were at work in hospitals or healthcare facilities. On March 15, Dr. Mahmoud Asghar, a pediatric surgeon, left home to go to his post at the SMC. He stayed there for three days, and at 2:00 p.m. on March 18 he called his wife to say he was on his way home. He never arrived home. When his wife called the SMC, staff there said that when he left the hospital, security forces took him into a tent set up in the parking lot. Two army officers followed him inside.[80] Immediately after Asghar’s arrest his wife made formal enquiries at four police stations and was told there was no record of her husband in detention. Authorities have since acknowledged that Asghar is in custody. Asghar is one of the 48 medics currently on trial, and one of 20 charged with committing felony crimes.

On March 19, security forces arrested four other doctors who had been publicly critical of the government. Security forces stopped Dr. Ghassan Dhaif and his wife, Dr. Zahra al-Sammak, at Bahrain International Airport as they attempted to leave the country. Dr. al-Sammak was released shortly afterwards. On March 19 security forces also arrested Dr. Ghassan's brother, Dr. Bassim Dhaif, who also worked at the SMC. On April 11, authorities rearrested Dr. al-Sammak but released her on May 4.[81]

At around 2:45 a.m. the same day, March 19, security forces raided the home of Dr. Nada Dhaif, who had appeared on an Al Jazeera broadcast speaking about events in Bahrain, and arrested her. Authorities have since released Nada Dhaif, though at this writing she and 20 others faced trial on felony charges, including possession of unlicensed weapons and ammunition, inciting others to overthrow the regime, and destroying medical equipment.[82]

Abd al-Nabi Alekry, the head of the Bahrain chapter of Transparency International, told Human Rights Watch that on March 25 that his cousin, Dr. Radhi Alekry, a 53-year-old physician, was stopped at a checkpoint close to the Hamad Town roundabout. A security officer asked for his identification and then asked him if he was related to Dr. Ali Alekry, who had been detained earlier. After Radhi Alekry said that Ali Alekry was his cousin, the officer ordered Dr. Radhi to get out of the car, insulted him, and took him into custody. Authorities released Radhi Alekry on March 27. According to a family member, Dr. Alekry had been subjected to beatings and other ill-treatment in custody.[83]

Authorities continued their systematic targeting of medical professionals, particularly at the SMC, in April and May 2011. Some were interrogated or detained after being called in for questioning, while others were arrested in their homes or while they were at work. Interior Ministry officials summoned Dr. Sadiq Abdulla, a vascular surgeon at the SMC, to ministry headquarters in Manama at around 11:00 p.m. on April 14, according to a source close to his family. His wife and his father-in-law accompanied him to the ministry. They waited outside for several hours but Dr. Abdulla never emerged. The source told Human Rights Watch that the family contacted an officer at the Interior Ministry on April 15 to inquire about Dr. Abdulla and was told that he would be in custody for “a few more days.” Later, on April 15, Dr. Abdulla called his wife and told her that “he was fine.”[84] The authorities allowed Dr. Abdulla’s family to drop off his medications at the Criminal Investigations Directorate in Adliya, but did not allow his family or his lawyer to visit him.[85] Dr. Abdulla was released on June 28 and at this writing was still facing trial on misdemeanor charges.

Beginning on April 10, security forces launched a series of raids on local health centers throughout Bahrain, which resulted in the arrests of approximately 40 medical professionals. Most were later released, but several alleged that they were physically or psychologically abused while in police custody. According to information received by Human Rights Watch from detained doctors and their family members, the ill-treatment and torture included blindfolding, solitary confinement, standing for long periods of time, beatings, insults, and sexual harassment and threats. Interrogators forced some of the individuals arrested during these raids to sign confessions or blank documents, sometimes while they were blindfolded.

Security forces also targeted individuals assisting medics during this period of time. On May 6, they arrested Saeed Mahdi, an employee of MSF who was engaged in humanitarian assistance and helped the organization with its local operations. The arrest took place two days after security forces raided Mahdi’s home and burned it down. After more than a month of incommunicado detention, authorities released Mahdi on June 11 uncharged.[86]

Relatives of some of the 48 medical professionals who are currently on trial have also alleged that the security forces had abused or tortured some of the detainees. One family member who met with her detained relative for several minutes after his June 6 trial session told Human Rights Watch that he complained of abuse and torture while at the Criminal Investigation Directorate detention facility in Adliya. The abuse included blindfolding for long periods of time, forced standing for long periods of time (which resulted in swelling of the feet), and beatings.[87] The relative of another detainee told Human Rights Watch that he was subjected to insults and slaps during interrogation. She also said that he was forced to sign a confession paper while blindfolded.[88]

Another doctor who is currently on trial told Human Rights Watch that after his arrest security forces and interrogators subjected him to repeated harassment, intimidation, and physical and psychological abuse in order to secure his forced confession. He said that after his arrest authorities transferred him to the Ministry of Interior building in central Manama called al-Qal’a (the Fort):

On arrival to the Criminal Investigation Directorate in Adliya they handcuffed, [finger]printed, and blindfolded me. They took us from Adliya to Qala. [At Qal’a] they checked our blood pressure, and that’s when the physical abuse began. They removed my blindfold and put a bandage around my eyes and ears. Then several people started beating me, right there in the middle of the [detention center] clinic. One of them said, “Don’t use a clean needle – use the other dirty one. These guys are like dogs. They are criminals. They don’t deserve a sterile needle.”

The doctor told Human Rights Watch that his blood pressure and heart rate shot up as a result of the beatings and the authorities transferred him to another location, where they gave him an IV drip before transferring him back to the Adliya police headquarters. On Saturday, April 16, he said the interrogations began. He was blindfolded and handcuffed.

They shouted and screamed horrible insults at me about my mother, sisters and wife. They started beating me before they even asked questions. They hit me with a big rubber cable – all over my back, buttocks, and thigh. I told them that I was ready to sign anything they wanted me to confess to. But they said, “You have to confess. We don’t want lies.”

The doctor said that the interrogation session lasted approximately 3 hours, and that it primarily focused on the medical procedures he performed back in February 2011. He told Human Rights Watch that his interrogator accused him of increasing the size of wounds sustained by protesters following the pre-dawn raid on the Pearl Roundabout by security forces on February 17.

The next day the doctor said that his captors took him to a different location. He was not sure where it was.

When I got there I was surprised to hear the voices of several doctors whom I recognized. The guard told me that that I was there so they could take my confession on camera. I could hear the voices of [several of the doctors] giving their statements, but the interrogators kept telling them what to say and what not to say. Sometimes they would dictate complete sentences to the detainees.

The doctor told Human Rights Watch that he eventually confessed to having increased the size of wounds sustained by one patient, and his jailors then videotaped his confession in front of Bahrain TV cameras. He told Human Rights Watch that the rehearsed taping session took approximately an hour, during which he read the statement his captors had essentially prepared for him.

After giving his statement, he was taken to another room where a military interrogator and his assistant questioned him further. The session lasted approximately six hours and he could hear the assistant typing while he gave his answers. The doctor said he was blindfolded the entire time except when the interrogator directed him to sign his confession papers. He told Human Rights Watch that he provided his signature on ten different documents but that he was not allowed to read them. He was then blindfolded and driven to another detention facility 20 minutes away.

Despite the nature of the interrogation sessions, the authorities did not charge the doctor with any crimes related to the treatment of patients at the SMC or elsewhere. .[89]

VI. Government Allegations Regarding Events at the Salmaniya Medical Complex

From February 18 until March 16, Human Rights Watch conducted several visits to the SMC in order to speak with wounded patients, doctors and other medical personnel, and hospital administrators. Human Rights Watch also tried to learn the status of an investigation that the Ministry of Health said it was launching into the adequacy of the SMC’s response to the events of February 17 and 18.

During these weeks Human Rights Watch had regular and relatively unrestricted access to the SMC, and observed several tents that had been set up in the parking lot in front of the emergency building entrance. These tents, which were often staffed by volunteers, some of whom were medical personnel, provided information to visitors, including journalists, regarding clashes between protesters and security forces. The tents also included a collection of riot control equipment used by security forces, including teargas canisters and rubber bullets. The parking lot in front of the emergency building and the outside walls of the emergency building were covered with pictures of some of the seven protesters who had been killed by security forces between February 14 and 18, and anti-government slogans in the form of posters and placards could be seen in the same area.

The politicized and sometimes chaotic atmosphere in and around the SMC was particularly notable after clashes between security forces and protesters on February 17/18, March 11 and March 13 (see above). Human Rights Watch visited the SMC on March 11, after security forces fired teargas and rubber bullets at protesters who attempted to march to the Royal Court in Rifaa. Human Rights Watch again visited the SMC on March 13 after clashes broke out between security forces, armed gangs, and protesters at the University of Bahrain (see above), the Financial Harbor, and the Pearl Roundabout. During this three-day period the parking lot outside the emergency building at the SMC was often full of protesters and injured patients, some of whom camped out in the parking lot. On the evening of March 11 Human Rights Watch observed an opposition leader addressing a crowd of supporters.

On March 31 several members of Bahrain’s official National Institution of Human Rights (NIHR) told Human Rights Watch that the NIHR had launched investigations into the events at the SMC and would soon release a report. They indicated that their investigations had uncovered evidence confirming many of the government’s allegations.[90] At this writing, Human Rights Watch has seen no report from the NIHR. Human Rights Watch has, however, reviewed material provided by the Bahraini government and organizations and individuals who support the government’s narrative regarding events that took place at the SMC and other health centers.[91]

On April 11, Fatima al-Balooshi, the minister of social development and acting minister of health, said that a government investigation found that the SMC staff at all levels had been involved in a “conspiracy” against the government and against “national interests.” She claimed that authorities had found a variety of weapons, including sharp metal objects and firearms, inside the SMC and that the hospital served as a command and control center for anti-government demonstrators, including medical staff.[92]

On May 3, 2011, authorities announced that the military prosecutor, Col. Rashed al-Faleyfel, was questioning 48 medical and paramedical employees about their alleged involvement in “recent deplorable unrest which gripped the Kingdom of Bahrain.”[93] At a news conference Justice Minister Shaikh Khalid bin Ali Al Khalifa, along with al-Balooshi, said that the group included 23 doctors and 24 other medical professionals. They accused the medical and paramedical staff at the SMC of taking “full control of the premises, including facilities, equipment and human resources.”[94]

According to the official Bahrain News Agency, the military public prosecutor charged the 48 defendants with “refusal to extend assistance to a person in need, embezzlement of public funds, assault that resulted in death, unauthorized possession of weapons and ammunition, refusal to perform duties and putting people's lives and health at risk, illegal detention, abuse of authority to suspend and stall laws and regulations, attempt to occupy buildings by force, incitement to the forceful overthrow of a political regime, incitement to the hatred of a regime, incitement to the hatred of a segment of society, dissemination of false news and malicious rumors that could harm public interest and participation in unauthorized rallies and meetings.”[95] On May 12 the military prosecutor announced the temporary release from detention of 24 of the SMC doctors and nurses pending trial.[96]

An observer at the June 6 session of the trial of the 48 medical professionals said they were divided into two groups – those charged with misdemeanors such as inciting hatred of regime, inciting the forceful overthrow of regime, and participating in unauthorized rallies, and those charged with felonies such as assault and kidnapping. The observer said that during the session the defendants’ lawyers complained that they had previously requested to meet with their clients and attend the interrogations, but that these requests were ignored. In response, the presiding military judge said that the lawyers would be able to meet with their clients after the session for a brief period of time. The observer also told Human Rights Watch that the lawyers had not received the case files of their clients prior to the June 6 session.

During visits to the SMC between February 17 and March 16, Human Rights Watch saw no evidence of weapons of any sort in the hospital prior to the military takeover, after which security forces routinely carried weapons in and outside the hospital. Human Rights Watch researchers also spoke with non-medical staff who were volunteering at the hospital in order to direct traffic and assist arrivals in the emergency department. Human Rights Watch found no evidence or indication that medical staff or these volunteers were involved in hoarding weapons or discriminating against patients based on sectarian affiliation. Human Rights Watch also spoke to a government official familiar with what happened at the SMC during the period in question who flatly rejected the government’s allegations.[97]

Human Rights Watch also documented three incidents where security forces entered hospitals other than the SMC with weapons. Human Rights Watch interviewed the neighbor of a detained doctor in March 2010, who said that, during the night-time raid on the doctor’s house, security forces searched for allegedly stolen medical supplies. Family members of the doctor confirmed that security forces found no stolen medical supplies in the doctor’s house, but that they nevertheless took the doctor into custody. The doctor remained in detention at this writing.

On April 21, Human Rights Watch sent a letter to Acting Minister of Health al-Balooshi requesting information regarding these allegations against medical staff at the SMC and elsewhere. At this writing, Human Rights Watch has not received a response from the ministry or other officials.

 

Acknowledgements

Faraz Sanei, researcher with Human Rights Watch’s Middle East and North Africa Division, researched and wrote this report, with assistance from Tirana Hasan, a researcher in Human Rights Watch’s Emergencies Division. Dan Williams, also with Human Rights Watch’s Emergencies Division, contributed additional research. Human Rights Watch extends special thanks to independent local human rights organizations in Bahrain for their invaluable assistance during the research and preparation phases of this report. Joe Stork, deputy director of Human Rights Watch’s Middle East and North Africa division, Tom Porteous, deputy director in the Program Office of Human Rights Watch, and Rebecca Schleifer, advocacy director for the Health and Human Rights division at Human Rights Watch, edited the report. Clive Baldwin, senior legal advisor at Human Rights Watch, provided legal review. Amr Khairy, Arabic translation and website coordinator with the Middle East and North Africa Division of Human Rights Watch, arranged the translation of Arabic documents into English and supervised translation of this report into Arabic. Adam Coogle and David Segall, associates with the Middle East and North Africa Division, provided research and production assistance. Grace Choi, Publications Director,Kathy Mills, Publications Coordinator and Fitzroy Hepkins, Administrative Manager, prepared the report for publication.

Last but not least, Human Rights Watch would like to thank members of Bahrain’s medical community – doctors, nurses, paramedics and other health professionals – who agreed to share their stories with us, and patients and family members of those affected by recent events in Bahrain. This report would not have been possible without their efforts and assistance.

Appendix: Letter from Human Rights Watch to the Government of Bahrain

April 21, 2011

Her Excellency Dr. Fatima al-Belushi

Minister of Health

Kingdom of Bahrain

Via Fax: +973-17-811-130

Your Excellency:

The purpose of this letter is to request information from the Government of Bahrain about recent developments that appear to have compromised the neutrality of medical professionals and impeded access to medical care. Human Rights Watch is preparing a report addressing these issues and we would very much like to reflect the views of Bahraini authorities.

Human Rights Watch has been on the ground monitoring the human rights situation in Bahrain since February 17, 2011. We appreciate having had the opportunity to look into allegations that protesters and the government have violated the principle of medical neutrality.

These violations include, on the side of protesters, using the grounds of Salmaniya Medical Complex (SMC) to hold what were in effect political rallies. On the side of the authorities, these violations include restrictions on the provision of offsite emergency care (including alleged attacks on ambulance staff and doctors dispatched to help injured protesters), the siege and takeover of hospitals and medical health facilities by members of the military and security forces, targeting of persons with protest-related injuries, and targeting and detentions of doctors and other health care professionals. We would welcome the views of your government regarding these allegations.

More specifically, Human Rights Watch would like answers to the following questions:

1)      Has the Government of Bahrain launched independent investigations into the Ministry of Health and Salmaniya Medical Complex administration’s handling of care provided to patients injured as a result of clashes between protesters and security or military forces during the period between February 14 and February 18, as per the investigative committee that was supposed to form after the previous Minister of Health, Nazar al-Bahrana, called for investigations in late February. If so, what were the results of these investigations?

2)      Has the government conducted investigations into any allegations regarding violations of medical neutrality covering events since February 18? If so, could you share with us the results of those investigations?

3)      Has the Government of Bahrain looked into allegations that during the period between February 14 and April 21, 2011 (and especially on February 17/18, March 13, and March 15/16), security or military forces prevented or otherwise restricted ambulances dispatched from Salmaniya Medical Complex or other medical health facilities from providing urgent care to wounded protesters or others? If so, what were the results of these investigations?

4)      Has the Government of Bahrain looked into allegations that during the period between February 14 and March 16 (and especially on February 17/18, March13, and March 15/16) security or military forces used excessive force (including the use of tear gas, rubber bullets and other crowd control equipment) and/or assaulted against, doctors, medical staff, and medical volunteers gathered at the Pearl Roundabout? If so, what were the results of these investigations?

5)      Has the Government of Bahrain looked into allegations that beginning on March 15, and especially on March 16, security or military forces surrounded Salmaniya Medical Complex and other health centers, restricted access to these facilities, or shot at the premises using tear gas, rubber bullets or other riot control equipment? If so, what were the results of these investigations?

6)     Has the Government of Bahrain implemented any rules, regulations or procedures since March 15 requiring all hospitals and medical health facilities to identify or report individuals who may have sustained injuries (i.e. injuries caused by tear gas, rubber bullets, birdshot pellets, other riot control equipment, or live ammunition) as a result of clashes with security or military forces to the authorities? We would appreciate it if you could provide us with the text(s) of any such rules, regulations or procedures.

7)      Has the Government of Bahrain looked into allegations that security or military forces have prevented, restricted, or delayed the provision of medical care to individuals who sought treatment in hospitals or health facilities and who may have sustained injuries (i.e. injuries caused by tear gas, rubber bullets, birdshot pellets, other riot control equipment, or live ammunition) as a result of clashes with security or military forces? If so, what were the results of these investigations?

8)     Has the Government of Bahrain looked into allegations that security or military forces have targeted, segregated, detained, harassed, tortured or otherwise abused patients in hospitals or health care facilities on grounds that they had sustained injuries (i.e., caused by tear gas, rubber bullets, birdshot pellets, or live ammunition) as a result of operations by security or military forces? If so, what were the results of these investigations?

9)     According to information we have received, authorities have arrested at least 35 doctors, nurses, medical students and other medical professionals since March 15, 2011. It is our understanding that some of these persons have been released. We would appreciate any information you can provide concerning the reasons the authorities have detained these persons, including criminal or other charges that have been lodged against them, and whether they have had access to legal counsel and family.

10)  Has the Government looked into allegations that doctors, nurses, medical students, other health care professionals, or protesters at Salmaniya Medical Complex or other health care facilities prevented, restricted, or delayed the provision of medical care to individuals who sought treatment in hospitals or health facilities? If so, what were the results of these investigations?

11)   Has the Government looked into allegations that doctors, nurses, medical students, other health care professionals, or protesters at Salmaniya Medical Complex or other health care facilities prevented, targeted, detained, harassed, or otherwise abused patients in hospitals or health care facilities? We would appreciate it if you could share with us any evidence that supports these allegations.

12)  Has the Government looked into allegations that doctors, nurses, medical students, other health care professionals, or protesters at Salmaniya Medical Complex or other health care facilities stockpiled weapons of any sort inside hospitals or health care facilities? We would appreciate it if you could share with us any evidence that supports these allegations.

We would be happy to receive any information regarding the above-mentioned issues, and to meet with you or other relevant officials to discuss our findings, recommendations, and methodology. We would appreciate it if we could have your response no later than May 5 in order that we can reflect the Government’s views in our report.

We hope that you will allow us this opportunity, and look forward to your response.

Sincerely,

Sarah Leah Whitson

Executive Director

Middle East & North Africa Division

cc:

His Excellency Sheikh Khalid bin Ahmed Al Khalifah

Minister of Foreign Affairs

Kingdom of Bahrain

His Excellency Sayed Mohamed al-Fayhani

Special Advisor

Ministry of Foreign Affairs

Kingdom of Bahrain

Her Excellency Houda Ezra Ebrahim Nonoo

Ambassador, Embassy of the Kingdom of Bahrain

3502 International Drive NW

Washington, DC 20008

[1]See, e.g., “Bahrain: Allow Medical Care, Investigate Attacks on Medics,” Human Rights Watch news release, February 18, 2011, http://www.hrw.org/en/news/2011/02/18/bahrain-allow-medical-care-investigate-attacks-medics; “Bahrain: Army, Police Fire on Protesters,” Human Rights Watch news release, February 18, 2011, http://www.hrw.org/en/news/2011/02/18/bahrain-army-police-fire-protesters; “Bahrain: End Deadly Attacks on Peaceful Protesters,” Human Rights Watch news release, February 17, 2011, http://www.hrw.org/en/news/2011/02/17/bahrain-end-deadly-attacks-peaceful-protesters; “Bahrain: Stop Attacks on Peaceful Protesters,” Human Rights Watch news release, February 15, 2011, http://www.hrw.org/en/news/2011/02/15/bahrain-stop-attacks-peaceful-protesters. The seventh protester, Abdal-Redha Buhamid, died on February 21 after sustaining serious injuries caused by live ammunition fired by military and security forces during a peaceful protest on February 18.

[2] “Special Report: In Bahrain, a symbol at the heart of revolt,” Reuters, June 17, 2011, http://old.news.yahoo.com/s/nm/20110617/wl_nm/us_bahrain_gfh_2 (accessed July 1, 2011).

[3] “HM King Hamad Declares State of National Safety,” Bahrain News Agency, March 15, 2011, http://www.bna.bh/portal/en/news/449960?date=2011-04-15 (accessed July 1, 2011).

[4]“Bahrain: Investigate Deaths Linked to Crackdown,” Human Rights Watch news release, March 29, 2011, http://www.hrw.org/en/news/2011/03/29/bahrain-investigate-deaths-linked-crackdown.

[5] At this writing, there were reports that the government had ordered the transfer of cases from the special military court to ordinary criminal courts, but no ordinary court hearings in these cases had taken place to Human Rights Watch’s knowledge.

[6]“HM King Hamad Sets Up Royal Independent Investigation commission Made of Worldly Reputed Personalities,” Bahrain News Agency, June 29, 2011, http://www.bna.bh/portal/en/news/462967 (accessed July 1, 2011).

[7] Human Rights Watch interview, Manama, March 2, 2011.

[8] These interviews were conducted in Manama over the course of two weeks in late February and early March.

[9] Human Rights Watch interview with Sadiq Alekry, Manama, February 26, 2011. See also “Bahrain: Hold Perpetrators of Crackdown Accountable,” Human Rights Watch news release, February 28, 2011, http://www.hrw.org/en/news/2011/02/28/bahrain-hold-perpetrators-crackdown-accountable.

[10] Human Rights Watch interview with Sadiq Alekry, Manama, February 26, 2011.

[11] Human Rights Watch interview, Manama, March 3, 2011.

[12]The ambulance was found and later returned to the SMC.

[13] Human Rights Watch interview, Manama, March 5, 2011.

[14] Human Rights Watch interview, Manama, March 3, 2011.

[15] Human Rights Watch interviews, Manama, March 2-3, 2011.

[16] Human Rights Watch interview with Dr. Amjad Deek Obeid, Washington, DC, May 10, 2011.

[17] Human Rights Watch interview, Manama, March 2-3, 2011.

[18]“Bahrain: Allow Medical Care, Investigate Attacks on Medics,” Human Rights Watch news release, February 18, 2011, http://www.hrw.org/en/news/2011/02/18/bahrain-allow-medical-care-investigate-attacks-medics. One medic informed Human Rights Watch that the second protester who lay next to Mo’men and had suffered severe head injuries was Isa Abd al-Hussein. Another witness later told Human Rights Watch that around 7:40 a.m. on February 17 she saw a security officer point a pellet gun at Isa’s head and shoot him from less than a meter away. The witness said she saw Abd al-Hussein’s head blown apart as a result of the shooting. Human Rights Watch interview, Manama, March 7, 2011. He was pronounced dead upon arrival at the SMC on February 17.

[19] Human Rights Watch interview, Manama, March 3, 2011.

[20] “Bahrain: Bahrain Army, Police Fire on Protesters,” Human Rights Watch news release, February 18, 2011, http://www.hrw.org/en/news/2011/02/18/bahrain-army-police-fire-protesters.

[21]Ibid.

[22]Ibid.

[23] Human Rights Watch interviews, Manama, March 2-3, 2011.

[24] “Independent Probe Vowed,” Gulf Daily News, March 2, 2011, http://www.gulf-daily-news.com/NewsDetails.aspx?storyid=300885 (accessed July 1, 2011).

[25]“BTS Dissolved and BMS Suspended,” Bahrain News Agency, April 6, 2011, http://www.bna.bh/portal/en/news/451954 (accessed July 1, 2011). The minister of social development, Fatima al-Balooshi, was named acting minister of health on March 24. On May 23 , 2011, the newly-installed and government-friendly Bahrain Medical Society sent a letter to Human Rights Watch in which the organization accused some Bahraini doctors of committing crimes and violating medical neutrality during the protest period, adding that the society supported the government’s prosecution and suspension of these doctors. BMS announced in June that it is planning to release its own report regarding events that took place at the SMC and other health centers.

[26] Human Rights Watch meeting with NIHR (Maryam al-Jalahma, who is also the assistant undersecretary for primary healthcare and public health, Abdulla al-Dosary, and Ali al-Aradi), Manama, March 3, 2011.

[27]Medical staff and injured patients at Salmaniya hospital with whom Human Rights Watch spoke on March 13 said young plainclothes men, some of whom were masked, attacked students involved in anti-government demonstrations on campus with sticks and knives. The government alleges that it was the anti-government demonstrators who attacked students at the University of Bahrain and destroyed school property on that day.

[28] Human Rights Watch interview, Manama, March 13, 2011.

[29] Human Rights Watch interview, Manama, March 13, 2011.

[30] Human Rights Watch interview, Manama, March 13, 2011.

[31] Human Rights Watch interview, Manama, March 13, 2011.

[32] Human Rights Watch interview, Manama, March 13, 2011.

[33]A witness who spoke to Human Rights Watch on June 30 said that police escorts of ambulances dispatched from the SMC and other hospitals has largely ended.

[34] Human Rights Watch telephone interview, March 15, 2011.

[35] Human Rights Watch telephone interview, March 16, 2011.

[36] Human Rights Watch telephone interview, March 15/17, 2011.

[37] Human Rights Watch interview, Manama, March 30, 2011.

[38]“Bahrain: Injured People Denied Medical Care,” Human Rights Watch news release, March 17, 2011, http://www.hrw.org/en/news/2011/03/17/bahrain-injured-people-denied-medical-care.

[39]See section VI of this report.

[40] Human Rights Watch interview, Manama, March 29, 2011.

[41] Human Rights Watch telephone interview, March17, 2011.

[42] Human Rights Watch interview, Manama, March 30, 2011.

[43] Human Rights Watch interview, Manama, March 30, 2011.

[44]Human Rights Watch interview, Manama, March 29, 2011.

[45] Human Rights Watch telephone interview, March 16, 2011.

[46] Human Rights Watch telephone interview, March 16, 2011.

[47] Human Rights Watch telephone interview, March 16, 2011.

[48] Human Rights Watch telephone interview, March 16, 2011.

[49] Human Rights Watch interview, Manama, March 30, 2011.

[50] Human Rights Watch telephone interview, March 17, 2011.

[51] Human Rights Watch interview, Manama, March 21 2011.

[52]See, e.g., “Bahraini medical centres and schools ‘raided,’” Al Jazeera English, April 26, 2011, http://english.aljazeera.net/news/middleeast/2011/04/2011426205632924276.html (accessed July 1, 2011). Matar Ibrahim Matar, a former parliamentarian who was interviewed by Al Jazeera English and confirmed attacks on at least two health centers on April 26, was arrested by security forces less than a week later on May 2.

[53] Human Rights Watch interview, Manama, March 16, 2011.

[54]Human Rights Watch interview with representative of MSF, Manama, March 27, 2011.

[55]See, e.g., “From hospital to prison – medical aid in Bahrain,” MSF press release, May 13, 2011, http://www.msf.org/msf/articles/2011/05/from-hospital-to-prison.cfm (accessed July 1, 2011).

[56] Human Rights Watch interview, Manama, March 30, 2011.

[57]Protest-related injuries include wounds sustained as a result of live ammunition, rubber bullets, sound bombs, gunshot pellets (sometimes referred to as birdshot), or other anti-riot control equipment used by military or security forces. A substantial number of injuries, some of them fatal, were caused by pellet guns shot at close range. Protest-related injuries also included teargas inhalation or wounds sustained, often to the head, as a result of beatings by security forces.

[58]Human Rights Watch interviews, Manama, March 30. Human Rights Watch interviewed several medics, including doctors, who confirmed that the sixth floor, and Ward 62 in particular, was used to detain injured protesters for a while after security and military forces took over the SMC.

[59] Human Rights Watch interview, Manama, March 26, 2011.

[60] Human Rights Watch interview, Manama, March 26, 2011.

[61] Ibid.

[62] Human Rights Watch interview, Manama, March 27, 2011.

[63]“Bahrain: Protesters Beaten, Detained,” Human Rights Watch news release, March 30, 2011, http://www.hrw.org/en/news/2011/03/30/bahrain-wounded-protesters-beaten-detained.

[64] Human Rights Watch interview, Manama, March 27, 2011.

[65] Human Rights Watch interview, Manama, March 27, 2011.

[66]The SMC has Bahrain’s only blood bank (other than the BDF Hospital).

[67]“Bahrain: Wounded Protesters Beaten, Detained,” Human Rights Watch news release, March 30, 2011, http://www.hrw.org/en/news/2011/03/30/bahrain-wounded-protesters-beaten-detained.

[68]“Bahrain: Investigate Shooting, Arrest of Man Caught in Police Sweep,” Human Rights Watch news release, March 23, 2011, http://www.hrw.org/en/news/2011/03/23/bahrain-investigate-shooting-arrest-man-caught-police-sweep.

[69]Ibid.

[70]Human Rights Watch interview, Manama, March 29, 2011.

[71]Ibid.

[72] Human Rights Watch interview, Manama, March 29, 2011.

[73]Alistair Dawber, “Bahraini Leadership Faces New Claims that Torture Took Place in Hospital,” The Independent, June 20, 2011, http://www.independent.co.uk/news/world/middle-east/bahraini-leadership-faces-new-claims-that-torture-took-place-in-hospital-2299944.html (accessed July 1, 2011). See also Christopher Stokes, “Bahrain: From Hospital to Prison,” Al Jazeera English, May 12, 2011, http://english.aljazeera.net/indepth/opinion/2011/05/201151285040679763.html (accessed July 1, 2011).

[74] Ibid.

[75]Physicians for Human Rights, “Do No Harm: A Call for Bahrain to End Systemic Attacks on Doctors and Patients,” April 2011, https://s3.amazonaws.com/PHR_Reports/bahrain-do-no-harm-2011.pdf (accessed, July 1, 2011). Hasan Mushaima is an opposition leader and the head of the Haq Movement. Security forces arrested him on March 17, 2011, and authorities charged him and 20 other co-defendants with various national security and terrorism crimes. A special military court sentenced him and several others to life imprisonment on June 22, 2011.

[76] Ibid.

[77] Ibid.

[78]See, e.g., Joe Stork, “Bahrain’s Medics are the Targets of Retribution,” The Guardian, May 5, 2011, http://www.guardian.co.uk/commentisfree/2011/may/05/bahrain-medics-arrest-retribution (accessed July 1, 2011).

[79]Human Rights Watch telephone interview, May 16, 2011.

[80]“Bahrain: New Arrests Target Doctors, Rights Activists,” Human Rights Watch news release, March 20, 2011, http://www.hrw.org/en/news/2011/03/20/bahrain-new-arrests-target-doctors-rights-activists.

[81]Ibid.

[82]Ibid.

[83] Human Rights Watch interview, Manama, March 28, 2011.

[84] Human Rights Watch interview via email, April 16, 2011.

[85] Human Rights Watch interview via email, April 16, 2011.

[86]“Updated: MSF staff member in Bahrain remains detained,” MSF press release, May 31, 2011, http://www.msf.org/msf/articles/2011/05/msf-staff-member-in-bahrain-remains-detained.cfm (accessed July 1, 2011).

[87] Human Rights Watch telephone interview, June 9, 2011.

[88] Human Rights Watch telephone interview, June 9, 2011.

[89]Human Rights Watch telephone interview, July 5, 2011.

[90] Human Rights Watch meeting with members of the NIHR, Manama, March 31, 2011.

[91] This information includes CDs with pictures that purport to show anti-government demonstrators, some of whom include medical staff members, in and around the SMC.

[92]Nalia Barakat, “SMC’s 180 staff faces investigation; 30 doctors, paramedics suspended: Minister Al Balushi,”24X7 News, April 12, 2011, http://twentyfoursevennews.com/gcc/headline/smcs-180-staff-faces-investigation-30-doctors-paramedics-suspended-minister-al-balushi/ (accessed July 1, 2011). See also Clifford Krauss, “Hospital is Drawn into Bahrain Strife,” New York Times, April 12, 2011, http://www.nytimes.com/2011/04/13/world/middleeast/13bahrain.html?pagewanted=1&_r=1 (accessed July 1, 2011).

[93] “Justice and Health Ministers Reveal Doctors’ Crimes During Recent Unrest,” Bahrain News Agency, May 3, 2011, http://www.bna.bh/portal/en/news/455193 (accessed July 1, 2011).

[94] Ibid. Authorities initially announced charges against 47 medics but later they added an additional one to the list of defendants being charged.

[95] Ibid.

[96]Habib Toumi, “Bahrain released 24 detained doctors and nurses,” Gulfnews.com, May 12, 2011, http://gulfnews.com/news/gulf/bahrain/bahrain-releases-24-detained-doctors-and-nurses-1.806947 (accessed July 1, 2011).

[97] Human Rights Watch interview, May 13, 2011.

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