Mr. Binyamin Netanyahu, Prime Minister and Minister of Health
Mr. Yaakov Litzman, Deputy Minister of Health
Dr. Ronni Gamuzu, Executive Director, Ministry of Health
Mr. Aharon Franco, Commissioner, Israel Prison Service
Dr. Dini Orkin, Chief Medical Officer, Israel Prison Service
Dr. David Eligur, Intermediate Chief Medical Officer, Israel Prison Service
Dr. Benny Davidson, Director, AssafHarofehMedicalCenter
Dr. Leonid Eidelman, Chairperson, Israeli Medical Association
Re: Hunger Strikers fasting for over 40 days must be transferred from Israel Prison Service (IPS) clinics to hospitals
Physicians for Human Rights - Israel wishes to inform you that the International Committee of the Red Cross, in a press release dated May 8th, 2012, voiced support for PHR-Israel’s demand to transfer hunger strikers in advanced stages. (In their press release, the ICRC also demanded the transfer of 6 hunger strikers currently in IPS clinic to a hospital.)
PHR-Israel wishes to bring to your attention that this demand is based on the fact that IPS facilities, including the IPS clinic ("Marash"), are incapable of providing adequate medical care that will best address the needs of hunger strikers:
1.IPS doctors are employed by the IPS under the Ministry of Public Security, creating conditions of dual loyalty on the numerous occasionswhen physicians' obligations to their patient conflict with the demands and interests of their employer. PHR-Israel’s experience has demonstrated that in many cases this dual loyalty results in IPS medical professionals giving precedence to the demands of security authorities, thus shirking their obligations to the patient. Examples of alleged breaches of medical ethics during this hunger strike are cited in the medical report written by PHR-Israel volunteer physician, and in reports of lawyers who visited the detainees during this period.
a.Hassan Al Safadi: Safadi was beaten by guards upon arrival on 06/04/12 to the IPS clinic from prison. PHR-Israel suspects that IPS clinic doctors failed to report the incident, although according to Safadi, the incident was documented by IPS staff (unclear if by medical or other staff) and his lawyer observed bruises on his body.
According to Safadi’s complaint, as reported to his lawyer Mahmud Hassan (on May 6, 2012) and to PHR-Israel-affiliated physician (on May 7, 2012), on May 3, 2012, IPS physician Dr. Kluchki gave him medical treatment – an intravenous injection to his hand - by coercion, while he [Safadi] was completely lucid and objecting to the treatment both verbally and physically. He was held by guards and shackled to his bed so the treatment could be administered.
b.Bilal Diab & Thaer Halahle: In PHR-Israel volunteer physician's April 30, 2012 report after visiting Diab and Halahle, she recorded reports by the two patients that their cell was violently searched four days prior to her visit. In protest, they refused medical treatment. PHR-Israel volunteer physician was also told that two days later, after Thaer developed a high temperature that necessitated his transfer to a hospital, a doctor in the IPS clinic removed him from his wheelchair, put him on the floor, and told him he would be left there until he agreed to receive medical treatment. Only after some time was he transferred for examination in a hospital. There is suspicion that this incident, as well, went unreported.
2.PHR-Israel’s five independent medical visits to different hunger strikers in Hasharon Prison and the IPS clinic indicated that the medical follow-up currently provided to hunger strikers is inappropriate, that examinations and tests are not performed frequently enough, and that no adequate investigations of prisoners' complaints are carried out. There is thus grave concern that irreparable damage to hunger strikers' health and/or life threatening conditions are not addressed.
a.The IPS clinic's structure, operation, and lack of medical equipment render it inadequate for providing appropriate medical treatment to hunger strikers. The clinic's rooms are prison cells, and unlocking them is a time-consuming procedure, time that can be critical for certain medical treatments. Unlocking the rooms at night is even more complicated. The IPS clinic does not have the equipment to allow adequate follow-up for hunger strikers in advanced stages. There is no cardiac monitor, for example.
b.Lab tests are not performed in the IPS clinic, and it takes time for the results to reach the doctors. Doctors therefore lack timely, accurate information on patients. In advanced stages of hunger strike – when a patient's medical condition can changes abruptly – this information is critical to the patient's care.
c.The IPS clinic does not have emergency buzzers. Patients on hunger strike reported that when they are in need of medical attention they must shout for help, which is inefficient. We emphasize that these are patients who are gradually losing physical function, such as standing, sitting, and other daily functions.
The above description illustrates that hunger strikers in IPS custody are exposed to physical assaults by guards and doctors alike. PHR-Israel is concerned that IPS doctors fail to report abuses of hunger strikers; that IPS doctors violate medical ethics, and that the health and lives of hunger striker are unnecessarily jeopardized when they are kept in a place that claims it can answer their medical needs, but in practice cannot and does not.
Given all of the above evidence, attention should be paid to the fact that IPS objects to independent doctors’ visits to hunger strikers, and does everything within its power to prevent such visits. When such visits are allowed, they are performed in the presence of medical or non-medical IPS staff thus violating patients' confidentiality and right to privacy and weakening the patient-doctor relationship and violating standards of medical ethics and recommendations for the treatment of hunger strikers. Lawyers' visits, too, are severely restricted and delayed.
In addition, IPS Chief Medical Officer, Dr. Dini Orkin, announced on May 4, 2012 that she will be on leave between May 5th and May 27th. Replacing her is Dr. David Eligur, against whom a prisoner previously submitted a court appeal, accusing him of issuing threats after the prisoner submitting a complaint on inadequate medical care. According to the prisoner, Dr. Eligur told him that if he did not withdraw the complaint, Dr. Eligur would send him to a regular prison where he would not get the treatment he needs.
PHR-Israel is deeply concerned that the IPS uses its medical system to exert pressure on hunger strikers, violating medical ethics, and endangering their health and lives. We are concerned that efforts to prevent visits by independent doctors and lawyers are aimed at isolating hunger strikers and avoiding transparency in prison conditions.
Bilal Diab was returned from Assaf HaRofeh hospital to the IPS clinic (on May 8, 2012) while on day 71 of his hunger strike. The IPS clinic holds a number of hunger strikers, some in advanced stages and some with prior medical problems that put them at risk. As long as these individuals are in the custody of the IPS, the IPS is fully responsible for their health and lives.
The IPS's close cooperation with Assaf HaRofeh, as well as the fact that the director of the department where hunger strikers are hospitalized (Prof. Ahuva Gulik) also provides oversight within the IPS clinic, makes Diab's discharge from the hospital even stranger, as both Assaf HaRofeh staff in general and Prof. Gulik in particular are well aware of the conditions within the IPS clinic. Diab's treatment calls into question the ability of Assaf Harofeh to provide appropriate medical treatment for future hunger strikers who may be referred there.
PHR-Israel demands that, due to the concerns raised in this letter, the Ministry of Health and the Israeli Medical Association act immediately to transfer hunger strikers currently held in the IPS clinic to hospitals. In addition, we demand an immediate investigation of these complaints.
We wish to emphasize that the transfer of hunger strikers to hospitals should not be delayed until your investigation or queries are answered, but must be done immediately. PHR-Israel strongly believes that as public authorities responsible for health and as bodies in possession of the above information, the MoH and the IMA have equal responsibility to that of the IPS for the lives and health of hunger strikers.
We view the submission of this document, as a submission to all bodies, levels and officials in the MoH, IPS, AssafHarofehMedicalCenter, and the IMA, including the Public Comptroller, the committee tasked with on receiving medical professionals’ reports on abuse of inmates, the IMA Ethics Committee, and the MoH Ethics Committee.
We request your immediate response before we turn to legal measures.
Director, Prisoners and Detainees Department
Physicians for Human Rights-Israel
CC: http://www.haaretz.co.il/misc/1.133651409/05/12 Hunger Strikers fasting for over 40 days must be transferred from Israel Prison Service (IPS) clin...