Physicians for Contempt for Freedom: Human Rights State Use of Tear Gas as a Weapon and Attacks on September 2013 Medical Personnel in Turkey Protesters hold up their hands as they gather in physiciansforhumanrights.org Taksim Square before clashing with Turkish riot police in Istanbul on June 22, 2013. Photo: BULENT KILIC/AFP/Getty Images About Physicians for Human Rights Physicians for Human Rights (PHR) uses medicine and science to document and call attention to mass atrocities and severe human rights violations. PHR was founded in 1986 on the idea that health professionals, with their specialized skills, ethical duties, and credible voices, are uniquely positioned to stop human rights violations. PHR’s investigations and expertise are used to advocate for persecuted health workers, to prevent torture, to document mass atrocities, and to hold those who violate human rights accountable. PHR has worked in more than 40 countries, including Afghanistan, Bahrain, Burma, the Democratic Republic of the Congo, Iran, Iraq, Kenya, Libya, Sudan, Syria, and the United States. In 1996, PHR documented the widespread and systematic use of torture in Turkey and the complicity of physicians in this practice. In 1999, PHR led the international effort to develop United Nations Guidelines on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, known as the Istanbul Protocol. physiciansforhumanrights.org Library of Congress Control Number: 2013950255 ©2013 Physicians for Human Rights. All rights reserved. ISBN 1879707756 Contents 2 Acknowledgments 3 Methods and Limitations 4 Executive Summary 6 Background on the 2013 Protests in Turkey 8 Turkish Authorities Use Unnecessary and Excessive Force 15 Introduction to Medical Neutrality 16 Violations of Medical Neutrality: Attacks on Medical Personnel and Medical Facilities A protester waves a Turkish flag during a demonstration on June 9, 2013 21 Conclusions & Policy Recommendations in Gündoğdu Square in İzmir. Photo: OZAN KOSE/AFP/Getty Images 23 Appendix: Relevant Legal Standards 26 Endnotes Physicians for Human Rights 2 Acknowledgments his report was written by This report has benefited from review PHR is deeply indebted to the Turkish Michele Heisler, MD, MPA, by PHR leadership and staff, includ- citizens and medical personnel who Physicians for Human Rights ing Donna McKay, executive director; shared their experiences with the PHR (PHR) volunteer medical Susannah Sirkin, director of internation- team, as well as the nongovernmental advisor, PHR board member, al policy and partnerships and senior organizations who care deeply for the professor of internal med- advisor; Hans Hogrefe, Washington lives and well-being of all those living in Ticine and health behavior and health director and chief policy officer; Andrea Turkey irrespective of political, religious, education at the University of Michigan Gittleman, senior legislative counsel; or ethnic identity and who made this Medical School, research scientist at and Marissa Brodney, senior program study possible. the Ann Arbor VA’s Center for Clinical associate. PHR intern Emily Nee contrib- Management Research, co-director uted background research and helped of the University of Michigan’s Robert with the implementation of the study, Wood Johnson Foundation’s Clinical and PHR interns Keith Armstrong, Scholars Program, and associate di- Jacquelyn Gitzes, and Hadley Griffin rector of the University of Michigan assisted in the editing of the report. Medical School’s Global REACH pro- gram; Vincent Iacopino, MD, PhD, This report has benefited from external PHR senior medical advisor, adjunct review by Catherine DeAngelis, MD, professor of medicine, University of MPH, PHR board member, University Minnesota Medical School, and senior Distinguished Service Professor research fellow, Human Rights Center, Emerita, professor emerita at Johns University of California, Berkeley; DeDe Hopkins University School of Medicine Dunevant, PHR director of communi- (Pediatrics) and School of Public Health cations; and Eliza B. Young, MA, PHR (Health Service Management), and publications coordinator. This report editor-in-chief emerita of the Journal is based on research conducted by of the American Medical Association Michele Heisler, Vincent Iacopino, and (JAMA); Donna Shelley, MD, MPH, PHR DeDe Dunevant during a one-week board member, associate professor of investigation to Turkey (June 25–July 2, medicine and population health and 2013). director of research development in the Department of Population Health in the New York University School of Medicine, and faculty member in the New York University Global Public Health Program; and Lois Whitman, JD, PHR board member, founder and former director (1994–2012) of the Human Rights Watch Children’s Rights Division. Contempt for Freedom: State Use of Tear Gas as a Weapon and Attacks on Medical Personnel in Turkey Methods and Limitations 3 indings contained in this re- PHR’s Ethical Review Board (ERB) ap- Given that this was an emergency field port are based on a one-week proved this research. PHR has had an investigation conducted over a short investigation conducted in ERB since 1996 to ensure protection time frame of seven days, it is subject Istanbul and Ankara, Turkey of human subjects in its research and to limitations in duration, scope, and from June 25 to July 2, 2013. investigations. PHR’s ERB regulations access. The scope of the current inves- The Physicians for Human are based on Title 45 CRF Part 46 provi- tigation did not permit a full analysis of FRights (PHR) team gathered indepen- sions (see: http://ohsr.od.nih.gov/guide- all written and video documentation dent evidence of excessive use of force lines/45cfr46.html), which are used by of events. The following PHR investi- and violations of medical neutrality. In academic Institutional Review Boards gative study should be considered as order to assess the nature and extent (IRBs). All of PHR’s research and investi- a snapshot in time, with partial rather of these abuses, PHR conducted 53 in- gations involving human subjects must than complete accounts or prevalence terviews with medical and non-medical be approved by the ERB and conducted reports of human rights violations. victims and witnesses of police violence in accordance with the Declaration of Notwithstanding these limitations, the and violations of medical neutrality. The Helsinki as revised in 2000. study produced sufficient firm data to team also interviewed representatives make informed recommendations. of organizations who are in the pro- For all interviews, the PHR team ob- cess of documenting abuses. The team tained informed oral consent from each examined secondary information from interview subject following a detailed other sources, including the Turkish explanation of PHR, the purpose of the Medical Association (TMA), the Human investigation, and the potential benefits Rights Foundation of Turkey (HRFT), the and risks of participation. Before each Human Rights Association (HRA), the interview, PHR staff ascertained wheth- Contemporary Lawyers Association, er the interviewee wished to remain the Turkish Bar Association, and other anonymous. For those who requested nongovernmental organizations. PHR anonymity, PHR investigators made requested interviews with Turkey’s min- every effort to protect their identities. ister of health on multiple occasions, PHR researchers did not record their but the interview was not granted. For names, nor did they make audio or vid- the qualitative domains of semi-struc- eo recordings of these interviews. They tured interview instruments, the team conducted interviews with interpreters adapted health and rights instruments in private offices. Participants could used by PHR in similar settings in which stop the interview at any time or refuse excessive force and violations of med- to answer any questions. Since the ical neutrality had occurred. The PHR identities of many victims of violence team sought to triangulate eyewitness during the demonstrations had already accounts with reports from other wit- been made public, most of the inter- nesses, news reports and video foot- viewees granted permission for their age, legal records, medical documenta- names to be included. All medical and tion, and other sources. legal personnel interviewed authorized the use of their names in this report. Physicians for Human Rights 4 Executive Summary n response to peaceful protests that against protesters, attacks on medical • Police and other law enforcement began in May 2013, the Turkish personnel, and other violations of med- officials attacked clearly identifiable, government used unnecessary and ical neutrality.2 The findings of the PHR independent medical personnel and excessive force and attacked inde- investigation corroborate the reports medical facilities with tear gas, water pendent medical personnel who of human rights violations document- cannons, and rubber bullets. Police courageously provided care to the ed by the Turkish Medical Association beat and detained dozens of physi- Iinjured in accordance with international (TMA), the Human Rights Foundation cians and other medical personnel medical ethical standards and Turkish of Turkey (HRFT), the Human Rights for providing emergency medical law. Association, the Istanbul Progressive care to those injured during the Lawyers Association, the Contemporary demonstrations. Demonstrators initially assembled to Lawyers Association, and the Turkish