Syrian president Bashar al-Assad is a licensed ophthalmologist, while other Syrian physicians complicit with torture would face no professional barriers to practising medicine abroad [GALLO/GETTY]
Doctors have a long history of complicity in torture, but the torture of political dissidents holds a privileged place. In Saddam Hussein's Iraq, surgeons removed the ears of men who failed to report for military service or defected from the army. In the Soviet Union, psychiatrists held political dissidents in mental hospitals with false diagnoses, in order to isolate and punish them. It is in this tradition of medical torture of dissidents that the Syrian healthcare establishment may be heading.
A July 6 report by Amnesty International documents the treatment of Wassim, a 21-year-old protester in the Syrian town of Talkalakh. After an injury from a soldier's bayonet, Wassim was taken to al-Bassel hospital, which had been occupied by Syrian security forces. As he reported: "The nurses, men and women […] swore at me and beat me hard and one female nurse punched me repeatedly with all her strength on my chest. Some were taking off their shoes and slapping me with them. I could hear many voices asking: 'You want freedom, eh?'" The report states he later had his wounds stitched without anesthesia, before being beaten on these wounds by hospital staff.
Wassim's is not an isolated incident. In May, Reuters documented the case of a protester who had lost sensation in his legs who requested to see a doctor in jail. He told the news agency: "The doctor hit my knees with his legs, and asked: 'There, is it better now?' and then he slapped me". Most pervasively, reports suggest that even when doctors have not been involved in direct abuse, they have falsified the causes of injuries and released information about patients to the Syrian regime's security forces. The result is a public distrust of hospitals, and a clear incentive for injured protestors to avoid the healthcare system.
'Some were taking off their shoes and slapping me with them. I could hear many voices asking: "You want freedom, eh?"'
Wassim, a protestor from Talkalakh
The medical torture of political dissidents holds a privileged place because it can be perversely justified. The torture of dissidents may be seen as an act of loyalty to the state. Doctors acting on behalf of the state, such as military doctors, have what is called "dual loyalty" - loyalty to both their patient and a third party.
In addressing the issue of dual loyalty, Physicians for Human Rights has proposed guidelines that physicians not be present when torture takes place, and calls on them to report all human rights violations, especially when they interfere with their loyalty to patients. Like the medical professionals from the US recently implicated in the torture and abuse of prisoners at Guantánamo Bay and Iraq, some Syrian doctors may have valued their contribution to the security of the state more than their adherence to the norms of their profession.
But, in their pursuit of perceived enemies of the state, have these physicians become enemies of the profession? Doctors involved in torture should be pursued as enemies of medicine: their crimes documented, their professional credentials revoked, and their ability to practice internationally thwarted.
Identifying and disqualifying doctors involved in torture
While it is exceedingly unlikely that Bashar al-Assad, an ophthalmologist, will go back to correcting cataracts in London - where he trained - if his regime is overthrown, other physicians culpable in his regime's torture will seek to continue clinical practice abroad.
Even with continued instability, it is likely that physicians and other elites will seek to emigrate. Could doctors involved in abuse head to Europe, North America or neighbouring Arab countries and continue to operate? How will they be identified? Critically, the majority of Syrian physicians that have not been complicit with abuses must be distinguished from those who have.
Unfortunately, the medical profession has no method for identifying or punishing doctors complicit in torture. We rely on human rights organisations to provide sporadic documentation of medical torture.
With limited access and competing priorities - such as being able to provide medical care while working in countries where torture occurs - these organisations have a narrow scope for documenting the occurrence of torture. In an excellent Lancet article, Len Rubenstein and Melanie Bittle argue that the World Health Organization is best positioned to play a leading role in documenting attacks on medical functions in conflict, and this should include those attacks committed by physicians.
Among the suggestions put forth by Rubenstein and Bittle are a UN Security Council resolution providing a mandate for the WHO to pursue investigations, and the use of mobile devices for securely and quickly transmitting information about abuse. By documenting medical complicity in torture, we give physicians under incredible pressures incentive to oppose orders from their superiors and the state.
Torture is common in Syrian prisons. Above, Syrians protest the torture of a 13-year-old boy [Al Jazeera]
The greatest challenge, however, is enforcement, and the punishment of physicians complicit in torture. No international body retains information on professional qualifications. Like most other professions, medicine has proclaimed a need to be self-regulating, yet it has no system in place to disqualify or sanction physicians on a global level (national licensing bodies exist in most countries, but there is little to no international coordination). To this day, investigations continue of Rwandan doctors now practising in Europe and Africa, accused of involvement in the 1994 genocide.
Of course, their crimes were far more widespread than those in Syria today, as doctors oversaw the killing of hundreds of patients and staff in their hospitals, but the challenge of enforcement is nearly identical. Even if medical complicity in torture does not warrant imprisonment, it ought to warrant professional disqualification - and as of yet, no institution or process is in place to disqualify a physician from practising internationally.
Honouring the heroism of Syrian doctors
Attacks on the healthcare system are common - perhaps inevitable - in modern war, but doctors don't always become complicit. In Bahrain, the Salmaniya medical centre was raided, and its doctors beaten and jailed for treating protesters. In Libya, Misurata hospital came under fire, deterring the sick from seeking care and endangering staff and patients.
Despicable as these attacks are, they have come to be expected as a feature of conflict. Attacks on the healthcare system have been documented in almost all recent conflicts including in Afghanistan, Kosovo, Nepal, Iraq, and the occupied Palestinian territories. In most cases, doctors have acted admirably, and sometimes heroically: seeing the sick in their homes, in secretive and makeshift clinics, risking their lives to provide care. Under oppressive regimes, doctors may be risking their lives just by refusing to be complicit in torture.
In Syria, a group known as the "Damascus Doctors" has been organising on Facebook to provide hidden clinics in areas of protest, as reported by CNN. These doctors are upholding a tradition of professionalism and protest that existed since at least 1980, when more than 100 healthcare professionals were arrested for striking to demand the lifting of Syria's state of emergency, in place since 1963 (as of 1990, at least 90 of them remained missing). These doctors, like many others who have opposed the regime, were subjected to gruesome physical and psychological torture.
The overwhelming majority of Syrian physicians have likely been acting heroically. It is in their honour that we should pursue aggressive international efforts to document and disqualify those physicians complicit in torture. This will require emboldened international institutions, cooperation among national licensing bodies, and the courage of doctors, journalists, activists and human rights organisations in documenting and reporting medical torture.
Rajaie Batniji MD, DPhil is a resident physician and an affiliate of the Centre on Democracy, Development and Rule of Law at Stanford University. His work examines international cooperation on health.
You can follow him on Twitter: @rBatniji
The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera's editorial policy.