Doctors Without Refuge

By Leonard S. Rubenstein
Monday, March 5, 2007

In war, health workers are often heroes and often victims. Though the Geneva Conventions are supposed to protect them as they fulfill their ethical duty to provide care to wounded combatants without regard to affiliation -- what is known as medical neutrality -- they frequently become targets by attending to the enemies of one side or another.

The United States has always stood up for the protection of health workers in war, condemning violations of medical neutrality. And until now, it has offered asylum to doctors, nurses and other health workers forced to flee their home countries after they complied with their obligations to treat any and all wounded. But in another instance of the corrosion of human rights that has been the hallmark of this administration since Sept. 11, 2001 -- including torture, secret detention and denial of due process -- the Department of Homeland Security is contesting asylum requests by health workers whose lives are at risk for having provided assistance to wounded members of rebel groups.

The government claims that providing such medical care amounts to prohibited "material support" to terrorists and thus is a basis for denying asylum. Its position is as radical a departure from past practice -- where it protested interference with a physician's duty to treat without political distinction -- as it is chilling. For example, the State Department's human rights report for 1999 condemned the Serbian government of Slobodan Milosevic for having "threatened and intimidated doctors working in the province to prevent them from treating [Kosovo Liberation Army] members."

The reversal is even more dramatically illustrated by the position the U.S. government took regarding a physician caught up in the brutal war in Chechnya. Performing surgery in late 1999 and early 2000 under conditions resembling those of the American Civil War, this doctor adhered to the highest traditions of medicine and medical ethics and saved the lives of civilians, Russian soldiers and Chechen rebels. Because he treated fighters from both sides, though, the physician became a target of Russian forces as well as the rebel groups. The rebels distrusted and threatened him while Russian forces labeled him the "bandit doctor." He was detained overnight and later warned by both Russian and Chechen fighters that he could be arrested and executed.

The doctor escaped and, with the help of the U.S. Embassy, made his way to the United States. When he applied for asylum, his request, as someone persecuted for upholding medical ethics in wartime, was granted in a mere two weeks.

But now the U.S. government is appealing an immigration judge's decision granting asylum to a Nepalese health worker who was twice kidnapped by a Maoist group that wanted him to attend to a wounded rebel. It rejected the asylum claim of a Colombian nurse who was kidnapped by the Revolutionary Armed Forces of Colombia, assaulted and forced at gunpoint to provide medical care to its members.

These actions are part of a larger and disturbing pattern of denying asylum even for victims of the most horrific human rights violations. A report by Human Rights First last year showed how the Department of Homeland Security's interpretation of the ban on providing "material support" to terrorists has extended to victims of abuse, such as a journalist who gave money to a rebel group after being beaten and a fisherman who was abducted and forced to pay ransom for his release.

The administration's interpretation goes far beyond what the law requires. Indeed, medical care is not even included among the practices Congress listed as amounting to "material support." In response to an outcry about its policy, the administration said it would offer selected waivers from the "material support" exclusion. While providing justice for some, that stance doesn't begin to restore the commitment to refugee protection that has been central to our values and our policies.

Congress must revise the law to protect medical ethics and restore America's commitment to being a place of refuge for those fleeing persecution. This step is also essential to revive principles of medical neutrality. Just as the government diminished itself and U.S. standing by adopting perverse interpretations of law and medical ethics to justify torture and to enlist doctors' help in breaking down detainees, it is undermining America's long and critical support for medical services for the wounded in war.

The writer is executive director of Physicians for Human Rights.

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