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Doctors, nurses and relatives fill an emergency room March 15, 2011, at Salmaniya Hospital in Manama, Bahrain (AP).

On June 14, 2012, a court verdict was issued in the trial of Bahrain medical personnel on charges related to the February and March 2011 unrest in the kingdom.[1] In brief, nine medics were found innocent, five were released for time served and four were convicted with the right for appeal.

World reaction was varied, but for the most part it suffered from the misconception that the medical personnel were on trial for treating protesters. Opinions were furthermore influenced by reports of torture the accused were allegedly subjected to while in detention.

One interesting example was the reaction of Michael Posner, United States Assistant Secretary of State for Democracy, Human Rights and Labor. Commenting on the court’s ruling, he expressed the view that the U.S. were “deeply disappointed by the convictions” as well as by the Bahraini government’s failure “…to use alternative means to address these cases.” Posner used the report of the Bahrain Independent Commission of Inquiry (BICI) as a source of verifiable evidence to hold Bahraini authorities accountable to the injustices incurred on a segment of the population, but seems to have selectively reviewed its findings.

According to Chapter V of the BICI report, which examined the four-week protests in the Salmaniya Medical Complex (SMC), the main district general hospital in Bahrain, medical personnel effectively jeopardized medical neutrality and impartiality while allowing personal (political and religious) beliefs to infiltrate their healthcare provision (paragraphs 833, 834, 837, 847). The Commission also concluded that during this period of political and sectarian strife, patient confidentiality and consent were breached (paragraphs 836, 847) and patients’ lives endangered. The most worrying finding described the way in which expatriate patients’ non-maleficence and dignity were compromised by medical personnel (paragraph 838).

In medical ethical terms, what some of my colleagues encountered and failed to overcome was a “dual loyalties challenge.” The BICI statement that, “…these persons (some medical personnel) moved in and out of their roles as political activists and medical personnel, the latter being expected to carry out their professional, ethical and legal duties and responsibilities” (paragraph 834) succinctly simplifies for the layman how the medical obligations of some of my colleagues (at certain times during the unrest) were overshadowed by their non-medical obligations, namely their political and religious beliefs. Yet, while the BICI report is upheld by all quarters and regularly quoted, this obscured narrative dealt with in this particular chapter is not given any attention.

Even prior to the issuance of the notorious Commission report, in April 2011 “Doctors Without Borders” (Médecins Sans Frontières -MSF) described their findings on Bahrain healthcare neutrality:

…regardless of the reasons, health professionals making speeches and leading protests directly from the steps of the entrance to the hospital undermined the concept of a neutral hospital, as did the anti-government slogans painted onto the walls of the hospital.” Their report continued, “…the opposition protestors should also guarantee that the hospital will not be used as a political platform or a rallying point for protests.”

An anti-government protester throws a molotov cocktail at riot-police during clashes in Salmabad, south of Manama, the capital of Bahrain, April 2, 2012 (Reuters).

It should be noted that the globally acclaimed MSF witnessed the unrest and events in SMC during February and March. Yet their findings have been disregarded internationally, ultimately neglecting the very serious threat of repeated healthcare politicization and ethical misconduct in Bahrain. To this day, junior colleagues and medical students consider these politicized and unethical actions as the norm. For the majority of my colleagues who practiced diligently and apolitically during the unrest (without compromising medical obligations), these inclinations are dangerous for the future of a profession which cannot continue in disregard of its ethical code.

Without a doubt, these were heated times but from the findings described, medical personnel in the SMC allowed their personal beliefs to become entangled with their healthcare provision during the unrest, thereby breaching the code of medical ethical conduct. In doing so, be it inadvertent or otherwise, they illustrated that patient care, at times, was not their primary concern. Daily politicized protesting imposed the beliefs of medical personnel on their patients causing distress and alienation as a result of inappropriate and insensitive expression of religious beliefs and political views. The international consensus has remained silent on this obscured reality, this new paradigm shift in physicians being politicized – why?

To my mind, the reason is twofold. Firstly, the disproportionate response by some rogue elements in the Bahrain military apparatus to the unrest and the arrest of medical personnel has been the most important consideration. The BICI found that “… [Bahrain] security services executed unlawful arrests on SMC premises, and attacked and mistreated some individuals (although the identity of some of the attackers could not be ascertained), including medical personnel” (paragraph 842, 843, 847). This escalatory reaction sadly ended with some colleagues being subjected to prolonged incarceration, as well as alleged mistreatment and torture in detention.

This is absolutely condemnable, and these rogue elements should be held accountable. However, that does not mean that the cases of ethical misconduct should be ignored when, in fact, they can be addressed proportionately through the healthcare-governing bodies in Bahrain. These medical personnel are colleagues and friends whose actions I may disagree with, but whose plight deeply disturbs me and I can never fully appreciate their loss. Despite the ethical and professional differences, a degree of respect will always be maintained but the question which we must ask ourselves, however, as physicians, healthcare providers and patients, is if this is an acceptable end for this noble vocation.

The second reason is that rarely in history have medical personnel politicized their profession in this fashion. It remains an outlandish and profound concept to most that healthcare workers would compromise their medical obligations in such a manner. Being the only active maxillofacial surgeon on the island during the last 15 months, I have exclusively treated head and neck injuries resulting from clashes between law enforcement officers and rioters as well as protesters and bystanders. My experiences have been presented in international maxillofacial conferences from Tunisia to more recently, the United Kingdom. From an anecdotal perspective, in my lecturing tours I have noticed a worrying trend amongst healthcare personnel in the countries of the so-called “Arab Spring” wherein medical personnel are becoming increasingly politicized, and to some extent militant. If this trend is allowed to develop unaddressed, the concept of “healthcare neutrality,” as we know it, may be changed drastically with potentially dangerous social reverberations.

It is my opinion that politically motivated non-medical obligations are patently irrelevant to medical decision making, but unfortunately during the unrest, medical decision making in SMC was too often blurred by political motivation and ambition…. The role of Bahrain’s medical personnel is still very much a part of the political unrest, having played a crucial role in the February and March escalation as well as in the continuing political instability and dialogue. It has polarized both the larger Bahrain community, as well as the local medical community, to what now seems an irreparable divide, which is deeply worrying for the future of healthcare in Bahrain and the torn social fabric internationally decried by the likes of Posner and a wide range of other officials and observers.

A comprehensive review of the Bahrain unrest and its many errors should acknowledge this very serious medical ethical breach and seek to address it so that the country may proceed on the path of reform and reconciliation, necessary for the future of Bahrain and, indeed, the region.


[1] The last year, 2011, has been a turbulent one for the Kingdom of Bahrain since the beginning of the February 2011 protest. What has most caught the world’s attention was the arrest of a number of Bahraini healthcare workers, their subsequent detention, trials and allegations of mistreatment. Recently the court cases have neared a resolution following verdicts issued by the civilian High Criminal Court of Appeal in Manama. Being a physician myself I will not comment on the legal process, which has gained much attention due to the serious errors which have occurred, but I will raise concerns relating to healthcare and the obscured reality, which people shy from highlighting.


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Dr. Mohammed A. Al-Muharraqi

Dr. Mohammed A. Al-Muharraqi is a UK-trained Bahraini consultant Maxillo-Facial Surgeon and a Senior Lecturer in Anatomy as well as the head of the Bahrain Dental licensing body. He has had numerous publications on head & neck surgery in peer reviewed journals and takes a keen interest in medical ethics, sociology and evidence-based healthcare.

8 Comments

  1. Chaingang_9933

    July 13, 2012

    @MohdMuharraqi: who broke the code of ethics?
    Al- Muharraqi mentioned that his surgical team has been involved in the treatment of almost all jaw’s injuries to Bahraini protesters and detainees like Mr. Abdulhadi Al-Khawaja, who was tortured and underwent an operation in BDF as reported in BICI in the case number 8 of the Victims of Torture, which was examined by forensic experts in 3rd August 2011 ((… and immediately after the arrest, he received a hard blow to the side of the face ,which broke his jaw and kocked him to ground. He was taken to the Ministry of Interior clinic and then to the BDF hospital, where he had major jaw surgery for four broken bones in his face. He spent approximately 7 days in BDF hospital where he was blindfolded whole time and handcuffed to the bed using tight cuffs. And when he asked the hospital staff to loosen the cuffs, they refused and the security personnel threatened him with sexual abuse and execution)) .Were not all these practices far from medical ethics and humanity which were under your sight and your team’s care? Was not that contradicting the ethics of the profession??
    Dr Muharraqi who broke the code of ethics? The doctors who protested because ambulances were prevented from fetching the injured during the attack on the roundabout, and because medical staff were attacked while doing their job , or the doctors like yourself who kept quiet on these atrocities , worked on defaming his colleagues & witnessed against them!!!

    Reply
  2. Osama Alaradi

    July 11, 2012

    To the writer I tell you are wasting your time and efforts trying to mask the truth and brighten the ugly shameful image that Government of Bahrain and Alkhalifa created for themeselves humiliating and torturing senior consultants who served the ministry of health more than 25 years before you graduate from medical school! Come on! You want to teach them ethics? Where were you when the massive casualties inflicted by the criminals against Bahraini civilians rushed to the hospital and these sincere physcians and surgeons were working day and night to treat them?. If you are trying to brighten the image of Bahrain government unfortunately it is too late! Even the paid PR firms in the USA receiving thousands of dollars monthly could not do it bec it is too ugly to be brightened. If any one has any doubts about those docs call them to see what they were subjected to and why they were jailed!

    Osama Alaradi,MD
    USA Michigan

    Reply
    • fred willie

      July 11, 2012

       https://www.youtube.com/watch?v=hZSPaRCnCuc&feature=player_embedded – where and when did Ekri and his people train in the gutter or Ireland in

      Reply

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