Health and Human Rights at Global Health Day

From political battles in the United States to conflict zones in the Middle East, the notion that health care is a human right is under attack, according to speakers at Global Health Day in May. Since 2008, according to one speaker, it has become more dangerous to be a health care provider in a conflict zone than a peacekeeper. Denying health care has become a weapon of war, said Hani Mowafi, M.D., and health workers also may be targeted as witnesses to human rights violations. And, in the United States, said another speaker, the right to health care has become a political and partisan battleground as opponents of the Affordable Care Act try to undo the health care legislation. Health and human rights was the theme of this year’s Global Health Day, sponsored by the Office of Global Health and the Department of Internal Medicine on May 8.

“The relationship between health and human rights is a relatively new area of academic inquiry,” said Asghar Rastegar, M.D., director of the Office of Global Health and professor of medicine. Historical precedents linking the two, he said, include the Nuremberg trials after World War II and the Universal Declaration of Human Rights in 1948. Under the universal declaration, everyone has a right to a standard of living adequate for health, including access to food, clothing, housing, medical care, and social services. “Several of our speakers today have been in the forefront of the struggle to protect equal rights among the most marginalized human populations,” Rastegar said.

The day began with the Department of Medicine’s grand rounds, as two physician brothers from the Kermanshah, a city in western Iran, described their efforts in the late 1990s to offer treatment programs to people living with HIV/AIDS. They soon adopted a “triangular” approach, caring also for injecting drug users and people with sexually transmitted infections.

They proceeded without government support. The Islamic government’s attitude, recalled Arash Alaei, M.D., went something like this: “This is a Western disease. We don’t have this disease because we are a Muslim country. Nobody has HIV/AIDS in this country.”

Over the next few years Alaei and his brother, Kamiar Alaei, M.D., opened treatment centers in Iran, exported their model to neighboring countries in the Middle East, and established links with universities and institutions in the United States, including Yale’s School of Public Health. In 2008, however, a few years after a conservative regime took power in Iran and the brothers landed in an Iranian prison, accused of collaborating with the enemy.

In their talk at grand rounds, the Alaei brothers recounted the months they spent in solitary confinement, in tiny cells, with lights on 24 hours a day, not allowed to talk even to themselves. Once released into the general population, they began organizing activities for other inmates—exercise regimens, a smoking cessation program, English classes, and a sports league to overcome barriers between the wealthier and poorer inmates.

Prison officials got wind of what the brothers were doing, banned their activities, and banished them to the prison bakery. There, they improved the facilities and started baking better bread. Prison officials moved the brothers to a prison in the Iranian desert.

Physicians for Human Rights, The American Association for the Advancement of Science, Human Rights Watch, and the International AIDS Society had by then taken up the brothers’ cause. Kamiar was released in 2010, after two and a half years in prison, and Arash, in 2011, after three years. They came to the United States and founded the Global Institute for Health and Human Rights, based at the University at Albany, State University of New York. The institute studies the intersection between health and human rights.

The discussion continued that afternoon in Hope 110 with speakers including Mowafi, of the Department of Emergency Medicine; Gregg Gonsalves from Yale Law School’s Global Health Justice Partnership; and Monzer Yazji, M.D., of the Union of Syrian Medical Relief Organizations.

Gonsalves, an HIV/AIDS activist and doctoral candidate at the School of Public Health, traced the history of efforts to enshrine health as a basic human right. “The right to health has been embedded in politics and how we conceive of ourselves as a civilized nation,” Gonsalves said. “What is civilized has shifted over time and over place. We live in a country where the right to health is as contentious as they come. … All one has to do is look at the fight over providing medical care to all Americans to see that this struggle is an ongoing one.”

Mowafi, assistant professor of emergency medicine and chief of the Section of Global Health & International Emergency Medicine, spoke of his experiences in North Africa and the Middle East, home to a quarter of all current armed conflicts. And the environment has become increasingly dangerous for aid workers. Health care workers are no longer seen as neutral or non-aligned, and with camera phones so ubiquitous, medical workers may pose a threat to combatants who see them as potential witnesses to human rights abuses. “The people who are there, armed, whose job it is to maintain the peace, are suffering fewer casualties than the people who are there in white coats and stethoscopes, whose job it is to bandage the wounded,” Mowafi said.

Yazji, an internist and critical care physician now in private practice in Texas, has organized medical relief efforts inside his native Syria. In that country’s civil war the targeting of health care workers and facilities has been described as a deliberate weapon of war, Mowafi said as he introduced Yazji. “Intimidation of health care workers suspected of treating protesters was the norm,” Mowafi said.

That has led to underground health care networks that provide medical care. Yazji is a founding member of the Union of Syrian Medical Relief Organizations, which serves as an umbrella group for 14 smaller networks. From Texas, Yazji began to organize doctors to provide medical care inside Syria. With a chat room on Skype as his main organizing tool, Yazji has traveled secretly to Syria to provide care.

Promoting and protecting health, Rastegar said, depends on the promotion and protection of human rights and dignity. He quoted the late Jonathan Mann, M.D., M.P.H., a pioneer in advocating the linkage between health and human rights. That linkage, Rastegar said, proposes that modern human rights provides “a better guide for identifying, analyzing, and responding directly to critical societal conditions than any framework inherited from the biomedical or recent public health tradition.”