October 11, 2011

David M. Keepnews, PhD, JD, RN, FAAN is an Associate Professor in the Hunter-Bellevue School of Nursing. Dr. Keepnews, an expert on health care systems and health policy, currently serves as Editor-in-Chief of Policy, Politics & Nursing Practice, a quarterly journal.

Photo Credit; MapZone.com
Photo Credit; MapZone.com

In February and March of this year, thousands of protestors gathered in the Kingdom of Bahrain, a tiny island in the Persian Gulf. Their protests followed the wave of demonstrations that had recently ended entrenched regimes in Tunisia and Egypt. The Bahraini protestors’ demands were initially more modest, calling on their government to recognize constitutional freedoms and human rights.

Their demands were answered with brutality. As the protests grew, the Bahraini government brought in troops from Saudi Arabia and the United Arab Emirates, who sought to quell the protests with tear gas, beatings and gunfire.

Salmaniya Medical Center is located near Pearl Square in Bahrain’s capital of Manama, where the Bahrain protests were centered. The hospital received large numbers of wounded. Hospital staff treated many of the protestors who arrived with shotgun wounds, head injuries and other casualties. For their efforts—for carrying out their ethical duties as health professionals by treating wounded patients—48 health care workers, including physicians and nurses, were arrested by the Bahraini regime. The regime charged that the hospital had been used as a coordination center for the protests and that the health professionals had been “abusing the hospital for political purposes.”

Some of the health care workers were arrested in the hospital; one surgeon was taken while performing surgery. Others were taken from their homes. Some reported being tortured. Rula al-Saffar, a leader of the Bahrain Nursing Society and a nursing faculty member at the College of Health Sciences, was among those arrested. Discussing her treatment in detention, she reported, “They gave me electric shocks and beat me with a cable . . . They told me they were going to rape me there and then if I did not confess.” She added, “We are completely innocent. All we did was to treat our patients.”

The Bahraini regime has made clear its intent to stamp out medical neutrality in the kingdom, whatever the source. In July, security personnel staged a violent raid on a site operated by Doctors Without Borders in Manama, confiscating medical and office equipment and supplies and arresting a Bahraini volunteer (who was subsequently released).

On September 29, the regime announced that 13 of the arrested Bahraini health professionals, including nursing leader al-Saffar, had been sentenced to 15 years in prison. Two others were given 10-year sentences and 5 received 5-year sentences. These 20 sentences were handed down by the Court of National Safety, a quasi-military court that had been created by the regime under emergency laws enacted in March.

The sentences handed down to the 20 Bahraini health professionals were met with immediate, worldwide outrage from nursing and medical organizations (including the American Nurses Association, the International Council of Nurses,the Royal College of Nurses in the United Kingdom and the World Medical Association), human rights groups (including Physicians for Human Rights and Amnesty International) and many others, including United Nations (U.N.) Secretary-General Ban-ki Moon. The U.N. statement quoted a spokesperson for the World Health Organization noting that health-care workers must be able to carry out their duty to treat injured people, regardless of their political affiliation, and even in times of conflict.

Then, on October 5, Bahrain’s attorney general, Ali Alboainain, announced in a public statement that the health professionals would be granted a new trial before Bahrain’s“highest civil court.”He declared that “By virtue of the retrials, the accused will have the benefit of full re-evaluation of evidence and full opportunity to present their defense.” He also stated that “No doctors or other medical personnel may be punished by reason of the fulfillment of their humanitarian duties or their political views.” The health professionals remain free pending the outcome of the retrials.

This announcement was greeted with relief and cautious optimism. The health professionals will not immediately face prison sentences, and the regime has promised new, civilian-court trials—but this is not, of course, a guarantee of the outcomes of those trials. Rula al-Saffar was quoted as saying, “We were hoping that all charges would be dropped because we are innocent . . . There are many unanswered questions and we don’t feel secure yet.”

International attention and outrage have helped to win a reprieve, but continued vigilance will be critical to ensuring their freedom. No health care worker should face the threat of prison for carrying out her or his ethical responsibility to provide care to those who need it.

David M. Keepnews, PhD, JD, RN, FAAN