Health care for torture victims DARWIN MENDIOLA Advocacy Officer Medical Action Group, Inc.
Medical action group, inc. • The Medical Action Group (MAG) is a health and human rights non-governmental organization (NGO) of health professionals, students and other allied health workers. • It recognizes and promotes human rights and the right to health of the Filipinos. • Since its inception in 1982, it has rendered a total health services to the most vulnerable sectors like women and children, and victims of human right violations particularly torture.
Health and human rights • The human right to health means everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services and the guarantee to enjoy all social determinants of health. • The human right to health care means that health care services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where and when needed.
Right to Health care of victims of Human rights violations • The right to health care is more essential to those whose rights have been violated. • The right to health care is part of the right of victims to remedy and reparation.
Torture and other cruel, inhuman and degrading treatment and punishment • Torture is one of the most serious human rights violations. It inflicts not only physical but also psychological harms to victims. • Although international human rights law prohibits torture everywhere, at all times, and that there are no exceptional circumstances whatsoever and for any purpose it can be justified, the practice of torture continues unabated throughout the world including the Philippines.
Mag’s work for torture prevention • MAG is involved in the torture prevention campaign. • MAG pioneers the work on medical documentation by providing necessary health and medical services to torture victims.
Mag’s work for torture prevention • MAG introduced the use of “the Istanbul Protocol” or the UN Manual on the Effective Investigation and Documentation of Torture and other Cruel, Inhuman and Degrading Treatment and Punishment and has trained a number of medical doctors and health professionals particularly the members of the Association of Municipal Health Officers of the Philippines (AMHOP). • MAG has also established partnership with the Department of Justice for the capacity building of the justice sector to have legal appreciation on evidence based gathering using the medical documentation.
r.a. 9745 or the anti-torture law • The Republic Act No. 9745 or An Act Penalizing Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment and Prescribing Penalties was signed into law November 10, 2009 and its Implementing Rules and Regulations (IRR), was adopted on December 10, 2010. • The Anti-Torture Act does not only provide criminal sanctions but also imposes obligations to the states and guarantee the rights of victims to remedy and reparations.
Torture defined • "Torture" refers to an act by which severe pain or suffering, whether physical or mental,is intentionally inflicted on a person for such purposes as obtaining from him/her or a third person information or a confession; punishing him/her for an act he/she or a third person has committed or is suspected of having committed; or intimidating or coercing him/her or a third person; or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a person in authority or agent of a person in authority. It does not include pain arising only from, inherent in or incidental to lawful sanctions.
Essential Elements: #1Act: Intentional infliction of severe physical or mental or psychological pain or suffering
Essential Elements: #2Perpetrator: Person in authority or agent of a person in authority: - direct infliction - instigation - consented/acquiesced
“Person in authority” - any person directly vested with jurisdiction… “Agent of a person in authority” - charged with maintenance of public order & protection and security of life and property - a person who comes to the aid of a person in authority
#3Purpose: (a) To obtain information or confession* (b) To punish* (c) To intimidate or coerce* (d) To discriminate *the person or a third person
Medical and Health Aspect of the state Obligationsunder r.a. 9745 and its irr Section 12. Right to' Physical, Medical and Psychological Examination. • the right to be informed of his/her right to demand physical examination; • by an independent and competent doctor of his/her own choice; • If cannot afford the services of his/her own doctor, he/she shall be provided by the State;
Medical and Health Aspects of the state Obligationsunder r.a. 9745 and its irr Section 12. Right to' Physical, Medical and Psychological Examination. • provide the victim with psychological evaluation; • Any person arrested, detained or under custodial investigation, including his/her immediate family, shall have the right to immediate access to proper and adequate medical treatment. • The physical examination and/or psychological evaluation of the victim shall be contained in a medical report, duly signed by the attending physician, which shall include in detail his/her medical history and findings, and which shall be attached to the custodial investigation report. Such report shall be considered a public document.
Medical and Health Aspects of the state Obligationsunder r.a. 9745 and its irr The Implementing Rules and Regulations Sec. 19 – Free Medical and Health Care Services DoH should refer victims to appropriate health facilities Cost of health and medical services should be funded by PAGCOR and PCSO Sec. 20 – Access to Medical and Health Care Services is executory right and not dependent on any court order or legal proceedings.
Medical and Health Aspects of the state Obligationsunder r.a. 9745 and its irr The Implementing Rules and Regulations Sec. 22 – Obligation of Medical Examiner • Under legal and ethical obligation to conduct diligent and complete medical examination. • Any violation by conduct or omission shall be referred to relevant authorities and medical associations for further investigation.
Medical and Health Aspects of the state Obligationsunder r.a. 9745 and its irr Section 19 provides for the formulation of a comprehensive rehabilitation program for the victims of torture and their families. The Department of Social Welfare and Development (DSWD), Department of Justice (DOJ), Department of Health (DOH) and other concerned government agencies are mandated to formulate comprehensive rehabilitation program in consultation with human rights nongovernment organizations.
Comprehensive Rehabilitation Program for Torture Victims: Philippine Contribution • Section 19 of the Anti-Torture Act mandates the formulation of a rehabilitation programme within one year of the law taking effect. • The Comprehensive Rehabilitation Program which was promulgated in March 2014 provides framework for rehabilitation including objectives, terms of reference of government agencies involved, and flowchart of its proposed operationalization.
Medical and Health Aspects of the state Obligationsunder r.a. 9745 and its irr Section 39 of IRR provides for components of comprehensive rehabilitation program for the victims of torture and their families which include physical, mental, social and psychological healing and development of victims and their families. Sec. 40 of IRR states that agencies mandated to provide rehabilitation services shall provide necessary budget for its implementation.
Linking rehabilitation to the prevention of torture • Therefore, rehabilitation should make a significant contribution to the pursuit of justice and the development of preventive measures. • The victim’s perspective on psychosocial support and other rehabilitation services.
Institutional Responsibilities Department of Health a. Provide technical assistance to LGUs and NGOs in the implementation of the rehabilitation program specifically in the provision of medical intervention to the victims of torture and their families and the perpetrators with due consultation from trainers who have both theoretical and experiential knowledge on the subject. b. Allocate budget for the implementation of the various components of the rehabilitation program. c. Ensure that the DOH retained hospitals shall readily accommodate all referrals for medical treatment. d. Conduct medical documentation training for City health officers (CHO), municipal health officers (MHO), Doctor’s to the Barrios (DTTB), Provincial health officers (PHO).
Institutional Responsibilities Department of Health e. Coordinate with mental health service providers (psychiatrists or psychologists) with due training in handling torture cases to provide a comprehensive psychological assessment f. Train health officers on documentation and reporting of torture. g. Issue a memorandum mandating medical officers on the mandatory reporting of tortured cases.
NGO Initial Observations • There is no specific lead agency in its implementation and there is no detailed step by step plan and concrete commitments from the relevant government agencies on how it will be put to effect. • There are no clear provisions for separate allocation of funding for the rehabilitation program. This open the door for government agencies considering torture rehabilitation activities as one of the many service components that they are already doing without establishing the necessary expertise and capacity.
NGO Initial Observations c) There are existing efforts (particularly DoH) to integrate its existing programs and services and operationalize in its system the implementation comprehensive rehabilitation program. d) The hindering factor in the implementation is the devolution system in government in which the role of national agencies is limited to technical assistance and policy formulation.
General Conclusions • Right to rehabilitation for victims of torture and ill-treatment is an obligation and it is thus the primary responsibility of States to make this a reality in their jurisdiction. • This implies ensuring that domestic law provides for rehabilitation as one element of reparation and developing appropriate services that are available and promptly accessible to all victims of torture and ill-treatment within their jurisdiction. • Not only is the State the primary duty bearer but since most components of rehabilitation services are part of basic State functions such as health, social and legal services, the State is also centrally placed to ensure its delivery.
General Conclusions • The rehabilitation is an important link in the treatment of torture survivor towards restoration of his/her dignity. • The purpose of rehabilitation is to empower the torture victim, families and communities to resume a full life as possible. • Therefore, treatment for torture survivors requires a holistic and multi-disciplinary response, which embraces clinical, social, psychological and legal understanding of care.
General Conclusions • The medical and health sector plays an important role in providing health care for torture victims.