RF_COM_H_62_SUDHA.pdf
Media
- extracted text
-
RF_COM_H_62_SUDHA
International Conference
Preventing violence, Caring for survivors
Role of health profession and services in violence
November 28-30,1998
YMCA International House
YMCA Road, Mumbai Central
Mumbai, India
CONFERENCE PAPERS - II
CEHAT
(Research Centre of Anusandhan Trust)
519 Prabhu Darshan, 31 S. Sainik Nagar, Amboli
Andhcri West, Mumbai 400 058, India
Fax: (91)(22) 620 9203, Tel: 625 0363
CONTENTS
Conference papers: 11
(Paper No. 01 to 26 and Abstracts No. 01 to 38 are in the first volume of the Conference Papers)
Title of the Paper
Author(s)
Bg.
27.
Francoise Sironi
Characteristics of violence induced by current
therapeutical systems in France: Description,
analysis and impact on ethical issues
01
28.
Hassan Shehata
Sudan: Health and aid
09
29.
Kishwar AhmedShirali
Violence to the psyche: Costs of surviving
violence
13
30.
Niraj Seth
Mental health concerns ojfamilies affected by
terrorism: A Report
16
Documents tor information
1.
About
22
1FH H RO: International Federation of Health and Human Rights
Organisations
2.
Status report
Post graduate course in human rights conducted by the department ofcivics
and politics, university ofMumbai
24
3.
About
27
Centre Georges Devereux (University Centerfor Psychological Help),
University of Paris 8, France
4.
CEHAT
List of Publications
28
"Preventing violence. Caring for survivors", November 28-30, 1998
1
Paper: 27
Characteristics of violence induced by
current therapeutical systems in France
Description, analysis and impact on ethical issues
Dr. Francoise Sironi
The Centre Georges Devereux (University Center for Psychological Help)
University of Paris 8, Saint-Denis, France
Dear Friends and dear Colleagues,
First of all let me tell you how filled with emotion and with utmost happiness I am, to be here. Amar
Jesam and Vibuthi Patel, my beloved friends, thank you for being on earth, and congratulation for all
what you are doing. Let me also congratulate the courage and the huge work (huge in quality and in
quantity) all the team of CEHAT is doing every day. 1 am very proud to be your ambassador in
France.
Who am 1 to talk to you about violence in France? 1 am a clinical psychologist and psychotherapist
who could never separate clinical practice from ethical concerns. Therefore, it was totally natural for
me to be a very active member of the Medical group of Amnesty International French Section for ten
years. 1 made my P.H.D work in clinical and pathological psychology on the treatment of torture
Victims. I described who 1 had to change my psychotherapeutic practice and what specific practice,
setting and techniques I had to find out in order to treat efficiently torture Victims and Victims of
collective violence. In my P.H.D work 1 also analysed the nature of human induced traumatism, the
methods of torture, the torture system, and the training of torturers. I strongly believe one cannot treat
a torture Victim if you don't take in account the context of torture, the methods of torture and the
intentionality of the torturer. I wrote a book on all those issues which will be available in French in
February 1999. 1 am also one of the founders of the Center Primo Levi, a treatment center for torture
Victims based in Paris, treatment center that we opened thanks to the support of Amnesty
International French Section, of Medecins du Monde (MDM) and thanks to the support of some other
NGO's in France. At present time, I no longer work in Primo Levi center anymore, because of the
responsibilities 1 have at university. 1 am actually Master of Conferences in psychology and
psychopathology at the university Paris 8 and 1 am also the director of the Center Georges Devereux,
a university treatment center located inside the university of Paris 8. This center is dedicated to
migrant populations and also to cultural, social and sexual minorities in France.
Violence must be contextualized in its cultural realities. The university of Pans 8 as well as the
Centre Georges Devereux are located in Saint-Denis, the hottest suburb of Paris in terms of
delinquency, violence, murder, poverty. How is it to work while being constantly surrounded by
violence? Although dangerousity is permanent, the doors of our University remain open all the time.
And 1 am proud to belong, as a teacher, to the only university in France who accepts students
although they failed in their secondary school examination giving university entrance qualification.
The University Paris 8 gives that way a second chance to anyone who wants to study, considering that
failing such an important examination is not a proof of lack of intelligence and interest in knowledge
but can be the consequence of social and cultural discrimination. Pans 8 university is also the most
innovative university in any fields, because it is open to various kind of experimentations, betting on
audacity of the teachers, of the students and of the type and quality of research which is made under
those conditions. Although May 68 is far behind us, the subversive spirit of the one who were
CLHA1, Mumbai. India
"Preventing violence. Caringfor survivors", November 28-30, 1998
2
teachers in our University, namely Michel Foucault, Gilles Deleuze, Helix Guattary, Noam Chomsky,
Armando Verdighone and many others, their subversive spirit is still alive, and, who knows? Possess
us for the best.
If 1 had to describe the most visible aspects of violence in France I would say that violence in France
looks like violence in any other western country: riots, unemployment, acceleration of the gap
between people who are extremely rich and people who are extremely poor, margmalization of the
excluded of the system, multiplication of neo-groups, attacks and burnings of administrative buildings
representing the power of the state. Nevertheless these last events are not related in public, those
attacks and burnings are rather hidden, in order not to frighten the population. Besides violence of the
excluded population of one of the richest country in the world, there is also an increasing state
violence in France. This kind of violence, described in the 1998 report of Amnesty International is of
the same nature as the violence reported in any other western country: policemen who murdered
persons, mainly "without having the intention of killing", (into brackets). The majority of the persons
killed that maimer, are migrants, refugees, people issued from non western countries.
Now, if 1 had to describe the less visible aspects of violence in France, but which is actually central in
the phenomenon of violence I would say the following: one of the most central yet hidden cause of
violence m France is the absolute prevalence and power of state culture. State culture is conveyed by
institutions like public schools and the legal, social and health systems.
One of the most prevalent type of violence is due to health professionals who refuse to take in
account the culture of their patients The fact of not respecting the culture of a person, of discrediting
the belongmg to a community is also a violation of human rights, a violation of the right of the
communities and a non-respect of ethical principles by health professionals. Health professionals
totally discredit and deny the idea of cultural belongings when they are confronted with migrants and
refugees coming from non-westem countries. Culture is not just like the colour of the skin, it is not
added to personality, it is part of the personality.
Let us examine the thinking or the theory that underlies the concept of human rights. It is usually
considered that they are universal, that this concept is culture-free, and that it escapes from this
complex reality constituted by the presence of various groups of belonging in one singular person.
My dear friends and colleagues, we all know (or believe) that the fish is not aware of the water. We
are not fishes....what usually separates culture from individual is mere fantasy. The individuals who
speak on behalf of human rights form actually already themselves a group : the group of the ones who
think that they belong to no group, the one who believe that they are singular individuals, free
electrons...subjects... that escape to any culture... and who refer to themselves as being universal. I
can tell you that as a health professional, as a psychotherapist bom on the french-german border from
an Italian father and an Alsacian mother, a person working and teaching in the most violent suburb of
Paris, I am not culture-free, my technique is totally underlied but cultural thinking, even if this
thinking comes from the accumulation of my singular experience. This is why 1 consider that the
group of the users of the concept of human rights are already themselves constituted in a single group
no matter the miles or kilometres that separate them. They act and behave as if they were subjects
escaping from any cultural belongings in order to refer themselves only according to the concept of
universality. Claiming the strong wish of "respect human rights" thought as being individual, smgle
rights, is actually a lure, a trap, a delusion. We act as if he is talking to a part inside us, supposed to be
universal, isolated from the rest, the "human psyche" (into brackets, comma), the "human
suffering"... but in reality we also deal with the presence of the group in the individual. That is to say
that the concept of human rights is not culture-free, because the users of this concept are themselves
constituted in a group who communicate with other groups.
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 28-30, 1998
3
Now, what analysis can we do as regards violence?
In France, as you may know, the influence, weight and presence of the state is very important. In
western countries and in France particularly, our philosophy is an individualistic one You can see it
in Laws, rights, as well as through the theories that underlie the therapeutic systems, the social,
educational and judicial (legal) systems in France. Social exclusion is getting more and more
important. The scholar difficulties of the pupils are becoming more and more disastrous, illiteracy is
growing As we all know, the school is the machinery of reproduction of the social structure. A
statement can be made: the model of integration and affiliation to a unique state culture has failed.
Neo-groups, with geographic or territorial boundaries inside some quarters of Pans or inside some
streets of the suburbs are appearing. Each group has a name, a specific culture, neo-rituals, initiatory
processes The codes are very ngids. The more you deny the existence of groups and consider only
the single individual isolated from his group, the more you will encourage the appearance of artificial
groups (like neo-religious groups, sects, neo-pohtical groups,...). We also attend to the re-appearance
of pre-existing groups (like religious ones for example) but the mles and practices of those pre
existing groups will be rigidified. We attend than to the emergence of fundamentalism
In our clinical practice at the center Georges Devereux, patients are referred by health professionals,
social workers, because they cannot go further ui treatment, because they need to understand the
problem. Usually the patients referred were treated for a long time before, without results. The
symptoms they present find no solution. They are psychological, social and educational ones. A
symptom can be the expression of hidden logic, which are not only individual and intra-psychic, but
logic that find their coherence m the historical past. Those symptoms, whatever they are, are the
testimony of the underlying existence of other ways of thinking, in an historical perspective. Those
persons with their mysterious symptoms have lost the sense of them because they are no longer
familiar with their culture of origin, they are no longer familiar with the signification and way of
treating their disorder.
What is even more interesting than looking at the causes of non-integration is looking at the function,
the role of non-integration. Non-integration is an active strategy of resistance against capture by the
various state institutions.
At that point, we can relate our analysis of violence in France to what Michel Foucault defined as the
subjected or submitted knowledge.1 He gave two definitions, the second one will be presented later.
By subjected or submitted knowledge, Foucault defines historical data and information that have been
buried, hidden in functional coherence. It is not a semiology of the life in psychiatric hospital, for
example, it is not a work of sociology of delinquency. The subjected or submitted knowledge are in
fact blocks of historical knowledge which were present hidden inside functional and systematic units.
Erudition made them reappear in a critical activity. This definition of subjected knowledge can be
related to one of the function of ethnopsychiatry: to find what is behind, what was before and what
reappears under the figure of psychopathology in our western society.
Let us consider now specifically the violence mduced by therapeutic and social systems m a western
country like France. "Although the health professionals claim that they only work in order to relieve
individual pain, we cannot ignore that the therapeutic and the social systems do actually constitute
extremely powerful social and politicalforces". 2
Illustration 1: Mrs. B.
Mrs B. is a patient that we treat in psychotherapy at the Centre Georges Devereux. She is a migrant,
coming from Algeria. About one year and a half ago, she started having.a lot of problems. Her
CEHAT, Mumbai, India
"Preventing violence. Paring for survivors". November 2H-J0. 1W8
4
husband left. Mrs B is not working. Her husband didn't leave her any money. She was alone with her
two little children. The mental health of Mrs B. declined severely. She was totally depressed and lost.
She entrusted her two children momentarily to the social services. Meanwhile she went to hospital for
treatment. But three weeks later she couldn't get her children anymore. Now, one year have passed
and she still didn't get her children back. The reason are the following :
- First, the regular psychological examination with the psychologist of the social care institution
thinks that Mrs. B. is still too fragile to be able to take care of her children. Yet this attitude induces
iatrogenic suffering. In tact Mrs. B. is sad because she cannot get her children back. The social
services also find that Ms. B. is aggressive and that she suffers from persecution. In fact they are
interpreting and pathoiogizing a behaviour totally adapted to her present condition. It shows the
angriness, sadness and powerlessness of a mother who is longing for her children.
- The second reason why she cannot get her children back is the social enquiry that has been made by
the social services. The French law stipulates that if your home is too small, i.e. if you don't have 8
square meters per child, you can't get your child back one it is entrusted to social institutions. This is
why many poor people start to hide away from any social control now. In spite of being helpful, they
are repressive.
Illustration 2: Mr J.
Mr. J. is a native of Nigeria. He is a yoruba (which is his cultural group). He married in France with a
yoruba woman. They have two children. It happened that the couple divorced. The Yorubas are
patrilinear, that means that the children belong to the paternal Imeage. The divorce took place m
France. The judgement of divorce stipulated that the children are entrusted to the mother, as it is
usually the case in France. The mother knew it, but didn't do anything, since the French law was at
her side. The father disagreed and a family council took place between the two families in Nigeria.
Finally the children were entrusted to the father. The girl was happy about this decision, knowing that
anyway she would have regular contacts with her mother. But the boy was unhappy about this
decision. His relationship to his father was not very good. He also started stealing some money in the
wallet of his father. The father was strict in education and couldn't bear that his son was stealing
money. When it happened first the lather gave him two slaps and threatened him: "If you do it again,
1 will beat you!". One day, the son had stolen again in the wallet of his father. He went to school. But
he was so scarred to go back home that he went to see the director of the school and said that his
father ill-treated him. Child ill-treatment is a magic word. Beware, I don't say that it doesn't exist, but
1 am looking of the attitude of people. How did the director react? Without checking or questioning
the child, she allowed him to stay at school for lunch. She didn't call home to advise the father and his
second wife. Both of them were anxious. They looked for the child at school. The director told them
that the child won't come home at night, he will be entrusted to an institution for children for the night
and as long as the confrontation won't take place, in order to protect the child.
Illustration 3: Cases of ill-treatment and Victims of incest that I treated in psychotherapy
As a psychotherapist, I treated some patients which have experienced ill-treatment or incest. The
problem is the following : the young girl calls an anonymous number of telephone, or she speaks at
school about the sufferance she is dealing with. The authorities arrest the father, and the child is taken
out of the family. She stays in a collective place for some time, and is afterwards placed in a family.
Almost all the time, those girls enter automatically in psychotherapy, which is also a question for me,
e. the way it is done. But most of the time, I noticed that the most important part of my job consisted
i.
m working through the guiltiness of the child of having definitively destroyed the family. Yet very
often they are ambigous because they still love their father, they don't want to see their mother crying
CEHA T, Mumbai, India
"Preventing violence. Caringfor survivors", November 28-30. 1008
5
when she spend her time between the visits she is doing to her child and sometimes in prison with the
father. Suggestion: why not suggest to call a family council ?
The therapeutical systems bring pressure upon the group of the users of those systems. The
consequence of it is the creation of associations and groups of users of different systems, and
association of persons who refuse any longer to be defined and analysed by others, health
professionals without participating to the elaboration of knowledge upon the subject. Therefore
association of patients with Aids, mucoviscidose, bulimia, mental disorders were created in France
and in many western world by the users themselves. Let us also mention the fabulous example of
homosexuality. Did you know that until 1985, homosexuality figured in the DSM (American
classification system and diagnostic of mental illnesses) were it was considered as a disorder? Thanks
to the creation of group of users who constituted powerfill groups of pressure, homosexuality is no
longer m the DSM Manual.
Dear friends and colleagues, if I gave you the impression, arriving to that point, of being pessimistic
after making such a critical presentation, I apologise It wasn't my intention at all. On the contrary. 1
would like to show you now how we can be innovative, despite of the situation. Let me describe for
you the positive clinical approach and treatment that we practice at the Center Georges Devereux with
migrants, minorities, marginalized population The way we treat our patients, whether they are
migrants, or representatives of cultural, social or sexual minorities constitutes the best prevention
against violence, both on the side of the patients we treat than on the side of the network of health
professionals we are working with
Since five years, at Pans 8 University and attached to the Department of Psychology, the center
Georges Devereux is an expenmental place of mediation between scientific thinking and thinking
brought back by the migrant populations Mediatise means first recognise and describe the
misunderstandings, oppositions and conflicts and second take up a bet that an acceptable peace is
possible, that learning the best way to live together is possible. The center has been founded by
Professor Tobie Nathan He is actually the President of the center Georges Devereux. He is also the
head of the Department of Psychology at Pans 8 University and a very popular, creative clinician and
researcher who wrote many books and articles about psychology, psychopathology and
ethnopsychiatry. If Georges Devereux (a French psychoanalyst and anthropologist who spend most of
his life in the United States) founded ethnopsychiatry as a discipline almost 30 years ago, Tobie
Nathan is the one who developed the discipline, both on the theoretical and clinical side.
Ethnopsychiatry is a discipline that brings an understanding of the suffering of the migrants and all
patients by non cutting them from their various affiliations, totally m keeping with their cultural
groups of origin. For western health professionals, mainly as regards psychology and
psychopathology, it is a permanent effort. They have the tendency to analyse cultural singularities as
being signs of psychopathology. But psychopathology is in reality a complex assembly which
associate the patient, a certain category of health professionals, and at least two theories about the
suffering, i.e. the one of the patient, of his surrounding, and of his family, and the one of the health
professional. It is this assembly that constitutes actually psychopathology. Therefore, when you do
psychotherapy, it is important to take into consideration all these elements.
Another principle of ethnopsychiatry as a discipline is the obligation which is made to the clinician
and to the researcher in human sciences to think the pre-existing categories which defined until now
the object he studies or treats. The categories can be nosographical ones for example. A patient
doesn't exists in the nature, he is build up according to categories and theories. What kind of patients
are we producing with those categories? Which items are privileged, what is left in the dark? Who has
interest of building this nosography? Chemical and pharmaceutical industries? Patients? All the
CEHAT, Mumbai, India
"Preventing violence, Caring for survivors". November 28-30. 1998
6
concepts go through this analytical process, also current concepts like ill-treatment for example:
When is the concept bom? Who has interest to rigidify the definition and use? This analysis leads to
either validate or invalidate the pre-existing categories.
Another principle which characterises ethnopsychiatry is that one of her object of study is the analysis
of all therapeutical systems, all of them without hierarchy, without excluding any, whether they are
modem, psychoanalytical, ethnical, religious, social one. The therapeutical systems are considered as
being the property of various groups (ethnical, cultural, political, religious, social,...). Studying them
is also showing their underlying theories, the hypothesis they have about a human being, their
coherence and efficiency, as well as their limits.
Another principle of the discipline is to propose to test the concepts of psychiatry, psychoanalysis and
psychology confronted with the theories of the groups whose therapeutical systems are studied by
ethnopsychiatry. This discipline doesn't take part in the quarrel opposing the defenders of universality
and the defenders of cultural relativism, since all therapeutical systems are object of study.
Ethnopsychiatry is permanently inventing methods which permit to confront theories with clinical
and cultural reality.
Another principle proposes to submit our interventions in human sciences to the expertise of
concerned persons and groups, to those we pretend to describe and treat This principle invites the
clinician and researcher in human sciences to respect a methodological constamt in order to prevent
him from produemg any statement on the persons or groups without real and contradictory
participation of the "subjects- objects of discourse or objects of thinking" to the production of the
statement or analysis.
Ethnopsychiatry is also a clinical methodology and a clinical setting which is a logic consequence of
the above mentioned principles. The ethnopsychiatnc therapeutical setting is composed by many
persons. We receive the patient in a large group composed by the following persons: the patient and
his family or friends (he come with whom he wants to come), the different persons that are part of the
network around the patient (social workers, doctors, educational workers and teachers if they are
children,...). The assembly is directed by a mam therapist. But many persons are present: co
therapists and people who come for framing (health professionals), and also students. One central
person in the therapeutical assembly is the cultural mediator. He is the one who speaks the language
of the patient, who knows very well the culture of the patients and also the therapeutical systems in
the country the patient comes from. But speakmg the language is not enough. He can go deep in the
subtleties of the meanings that are developed. Everyone in the assembly gives his thoughts and theory
to the patient, and the main therapist is organising the way the elements of understanding are restored
to the patient.
The world culture is, for Tobie Nathan, a way for legitimate the knowledge of the others. It would
permit, finally, to build an anthropology which is really symmetrical, because it would constrain the
clinicians, health professionals and researchers in human sciences to confront honestly the knowledge
issued from heterogeneous worlds. "Rehabilitate the world culture" says Tobie Nathan, "means
submitting the researchers in human sciences to the expertise of those you pretend to describe. This is
really what constitutes, according to me, a fascinating programme, on a theoretical level, a
programme that comprises new and major ethical stakes or goals".
Those are the conditions of a real ethical approach of the patients because it doesn't discredit them.
The deontological consequences of such an approach is that the patients are no longer m a position of
object. It is no longer possible to interpret their psychological functioning from any theory, unless you
clarify the theory whith which you are thinking the patient. The theory is then also becoming object
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 28-30. 1098
7
of study and not only the suffering of the patient. The patient becomes a real partner, an indispensable
alter-ego in a research that we do in common with the patient about his psychological suffering In
ethnopsychiatry, we are used to think again, with the patient, the singular suffering as well as the
theories with which it is thought and constructed. This fabrication definitely concerns him and
interests him. This way of doing is not corelated with his educational level, because any one has a'
thinking. A non-violent clinical approach obliges you definitely to consider and handle the patient as
a partner, with equal knowledge. Equal must be understood as being as equal interest as yours, it
means that his ideas and theories he is building in his head about suffering is as worthy as yours. The
patient is invited to discuss the observations of his therapists, to argue about their hypothesis, to share
the responsibility of the treatment since he has been elaborated in common. Of course the patients are
not used to it. We are training him, in a certain sense, to become what we call a "patient-expert". We
are also training the health professionals who are part of the network which surrounds a patient
(doctors, social workers, school teachers, educational workers,...).
Practiced this way, ethnopsychiatry creates through a kind of natural process, an ethical rigour,
because ethnopsychiatry doesn't subject itself to deontological principles like to an outside constraint.
What could be considered as ethical principles are in fact its theoretical positions themselves and its
usual and daily clinical practice.
At that point, what we said about our practice tn ethnopsychiatry has to be related to a second
definition Michel Foucault gave about the subjected or submitted knowledge (the fist definition has
been given before). By subjected or submitted knowledge he also considered different knowledge that
are disqualified because considered as being not enough elaborated knowledge, like what he calls
naive knowledge, or knowledge hierarchically inferior, knowledge that are considered to located
beyond the level of proper knowledge or beyond the required scientificity. Those knowledge are from
below, underneath knowledge, non-qualified knowledge, the knowledge of the delinquent, the one of
the psychiatrised patient, the knowledge of the patient, the one of the nurse, the one of the doctor, yet
parallel and marginal according to the medical knowledge. This knowledge that Foucault qualified as
being the knowledge of the people (which has nothing to do with common sense), no, on the contrary.
It is a specific knowledge for Foucault, a differential knowledge, which is unable to build unanimity
and which drags its force out of the sharpness that this knowledge opposes to all the other ones that
surround him.
Michel Foucault thinks that it is the coupling between the buried knowledge of erudition and the
knowledge disqualified par the hierarchy of knowledge and science that gives to the critique its
essential force. This is how he explained 15 years of critique that followed May 68. But this is also
how I describe the fact that ethnopsychiatry is a bomb, because it is coupling buried knowledge and
disqualified knowledge. Ethnopsychiatry is considered as being subversive. We are criticised both by
what 1 call the lifeless, flabby and weak Left, as well as by the Extreme-right. The flabby Left defend
the values of the republic, of secularism. Many health professionals are leftists, flabby socialists,
because it is culturally correct to be leftist. But they are as conservative as rightists. They don't accept
to reconsider their theories, the way they treat patients, the way they consider psychotherapy. They
are scarred to saw the foot of the chair they are sitting on. The critics of people from Extreme-right
are related to the fact that we don't discredit the theories of the migrants, that we consider their
therapeutic systems as worth to be studied and taken into consideration.
Anyway, this way of practicing is always considered as being subversive and many persons are true
interest and actively wish that we disappear. For the moment, we are still here, because on the other
side we also have a lot of support, which is growing every day in France and all over the world. This
way of practicing brings utmost freedom. It is the best way we have found to work in this violent
CblHAl, Mumbai, India
"Preventing violence, Caring for survivors", November 28-30, 1998
8
suburb of Paris, with violent patients, by totally inverting the previous logic of health care and
stopping this way to generate violence in our own practices.
Let me conclude my presentation with this African proverb :
AS LONG AS THE LIONS WON'T HAVE THEIR OWN HISTORIANS
THE HUNTING STORIES WILL CONTINUE TO GLOR1EY THE HUNTERS.
References:
1. Michel Foucault, IlJaut defendre la societe. Cours du College de Erance, 1976", Galhmard, Pans,
1997.
2. Tobie Nathan (with Alain Blanchet, Serban lonescu and Nathalie Zajde), Psychotherapies, Paris,
Odile Jacob, 1998, p. 96.
CEHA T. Mumbai, India
"Preventing violence. Caring for survivors". November 28-30, 1998
9
Paper: 28
Sudan: Health and aid
Hassan Shehata
Physicians for Human Rights, UK
London, UK
Introduction
Since the military coup in Sudan in 1989, all services have considerably deteriorated. The human
rights violations have continued despite the Sudan government This has led to serious impact on the
health services. There are several reasons that resulted in this dangerous situation. It includes the
military junta's attitude towards the war in the South, the lack of planning of central and regional
governments and the poor relationships of the ruling party with the rest of the world and in particular
the neighbouring countries Other factors include the government hindering to the NGOs and the
Western aid, the natural disasters like floods and draught and the increase influx of the number of
migrants from neighbouring countries into Sudan
It is not surprising that the Southern part of Sudan is the hardest hit due to the aforementioned reasons
in addition to the already almost absent infrastructure It is not unexpected that the Western media
focus on the troubles of the South, but there is clear evidence that other parts have reached dangerous
levels of needs.
OLS & NGOs
Combined domestic and international pressure resulted in the launching of Operation Lifeline Sudan
(OLS) on April 1989. It is a programme for providing humanitarian relief to civilians on both sides of
the conflict. OLS was possible due to domestic political breakthrough because of the resumption of
peace talks and a simultaneous cease-fire. But as the current regime seized power in Sudan and
resumed war activities, OLS had few successes. Unfortunately OLS have become part of the war
cycle rather than being integrated into a dynamic of peace. Unknown quantities of relief are diverted
to the military on both sides, and therefore unsurprisingly war strategies revolve around relief. Aid
prevents both sides from being forced to be accountable to their constituents and relief is probably
prolonging the war and contributing to a stalemate. The relationship between relief and war has
become too close and almost certainly now too late for relief agencies to clear away themselves from
this bog.
tn significant ways, the concept of humanitarian access has become devalued as OLS has progressed,
due to the programme manipulation by the Sudan government and the SPLA. While relief has been
delivered cross-border from Kenya and Uganda, the Sudan government has hindered the ability of the
operation to deliver to some locations. Needy populations, notably the Nuba Mountains, have been
denied aid, in comparison to the government army garrisons who feed themselves courtesy of the
WFP and western taxpayers. Another aspect of OLS has been to bring NGd dperations in southern
Sudah under the discipline of rules negotiated between the UN and the Suddn government. UNICEF
is able to operate in a cotiiitry without an agteement from the govemtnent. OLS depends on
government approval and at UNICEF operates under OLS, the latter Has forfeited the element if
independence and therefore OLS has been successfill in castration of UNlCfeF's mandate. The result
is that most NGO operations Pre now subject to agreement from the Sudan government, through the
UN. More significantly, the majority of the assistance is delivered by WFP.
CEHA1. Mumbai, India
"Preventing violence. Caring for survivors". November 28-30, 1998
10
Assessments and needs
International NGOs, including CARE SCF UK, ADRA, and SCF US are undertaking joint
assessments with the UN and implementing interventions in several of the affected areas. A series of
meetings the OCHA mission held with Government authorities, the UN Disaster Management Team,
national and international NGOs and the (bKC resulted in a petition. This appeal, totalling USD
8,980,000 is sought by OCHA on behalf of the operational UN agencies to meet the following
requirements, which are seen as urgent priority needs for the most severely affected populations in the
target areas. Incorporated in the emergency response is a strategy aimed at strengthening the self
reliance of Hood victims m the coming three months, an approach which is shared by the Government
of Sudan and the major NGO's It is calculated that some 100,000 persons are in need of essential
emergency items. These include mosquito nets, blankets, and plastic sheeting and the total amount
required is USD 980,000.
Since their beginning in late August, the floods have peaked in early and mtd-September affecting 12
out of Sudan's 26 States According to official estimates, the situation in 1998 exceeds in terms of
people affected and damage to infrastructure and households, the floods of 1988, considered to have
been of unprecedented dimension. A population of over 1 million is suffering from the impact of the
floods, 500 villages have been completely destroyed and losses in the agricultural sector are still
being evaluated State authorities and communities, leaving nevertheless vast needs for international
assistance have made immediate provisions Joint UN/Govemment/NGOs teams have identified
several severely affected states over 100,000 homeless people requiring emergency interventions. As
the water levels recede, tlie serious public health situation in all affected areas, reflected m the
alarming increase in diarrhoea and malaria cases and lack of access to potable water is becoming an
overriding concern. UN agencies and other relief actors have agreed to appeal for commonly accepted
priority requirements, namely shelter materials, blankets, mosquito nets, sprayers as well as support to
community coping mechanisms and food production. The following States: Northern, River Nile,
White Nile, Gedaref and Sennar have been identified as the priority areas for UN interventions. They
have been selected on the basis of acute need and where so far aid agencies have not undertaken
major relief interventions.
The assessment of States is detailed below
North State: about 28,000 persons are homeless, requiring immediate assistance. Over 30 per cent of
the date and citrus crop and 70 per cent of the normal sorghum yield (about 90,000 metric tons per
year) have been destroyed. Irrigation systems and thousands of water pumps, vital for agricultural
production, have been damaged or destroyed. Emergency needs comprise health sector, drinking
water, sanitation and productive inputs.
River Nile State: about 35,000 are homeless, requiring immediate assistance. Some areas are still
inaccessible. A total of 400,000 feddans (2.4 Feddans = 1 hectare) of cultivated land have been
severely damaged. 12,000 feddans of the date crop and 50 per cent of the animal fodder crop are
submerged. 25 schools have been completely damaged.
White Nile State', about 10,000 persons are homeless due to flash flooding and requiring immediate
assistance. The most affected areas and Tendelti and Jazera Aba. 40 health posts, 20 schools and
nearly 1,000 sanitation installations have been damaged or destroyed. 15,500 feddans of cultivated
land has been submerged.
Kassala State: about 10,000 persons are homeless due to flooding of the Gash River. This
displaced population has lost most of its property including household items. Two schools were
destroyed m addition to other public infrastructure.
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 2H-30. 1W8
11
(Jedaref State-, about 18,000 persons are homeless due to flooding and heavy rain and m need of
immediate assistance. Roads, schools, and health clinics were all damaged in the floods in addition to
extensive destruction of cultivated land.
Sinnar State: about 1,000 persons are homeless and in need of immediate assistance and some 25
villages affected, due to Blue Nile flooding. Extensive damage has been done to cultivated land and
water facilities.
North Kordofan: flash floods in Um Ruwaba province have affected about 5,000 persons. Due to the
seventy of the flooding households lost all possession and homes.
Khartoum: Over 1,000 families have lost their homes, and about 2,000 families lost part of their
houses. Also, over 500 pit latrines have collapsed in poor displaced settlement areas. The public
health situation has already deteriorated indicated by a high incidence of malana and deaths due to
severe watery diarrhoea.
Southern Sector: the OLS assessment fieldwork has been completed in Ganyiel, however, many
locations in Upper Nile remain inaccessible due to insecurity. The number of returnees in Yambio
from the Democratic Republic of Congo to Yambio (Western Equatoria) now total to 17,000
registered, returnees arrive approximately 1,000 per day. WEE is distributing relief food to the
returnees. In Bahr el Ghazal, the airstrip in Dhiak is flooded and inaccessible, so the 24,300 targeted
beneficiaries from that area will go to Malual Bai to receive a planned distribution. In Panthou, WFP
is working closely with MSF-H on the implementation of weekly distributions to the families of
children in the feeding centre MSF-H is providing storage tents tbr tire necessary commodities.
Approximately 2,300 families are targeted. WFP will maintain a permanent presence in Panthou to
ensure the implementation of this weekly distribution In Ajiep, because of severe logistical
constraints, WFP, SRRA, and MSF-B have agreed that rations for the families of children in
supplementary feeding programmes (SFP) will be distributed bi-weekly by WFP (instead of weekly).
Approximately 2,000 families are targeted The NGOs running the feeding centres are continuing to
distribute weekly rations to the families of children in therapeutic feeding programmes (TFP).
Approximately 500 families are targeted A general food distribution is on going in Wau, 7,422
beneficiaries received relief food during the reporting period.
Current situation
The present WFP programme consists of development and emergency projects in both the northern
and southern regions of the country. In the south, civil war continues to create significant emergency
food requirements for war-affected and/or displaced populations. Up to 2.4 million people are
severely affected in the south, while in the north an additional 200,000 people displaced by drought
emergencies also require assistance.
The present Health Interventions (jointly prepared by WHO/UN1CEF) objective is to reduce the very
high nsk of outbreaks of malaria, diarrhoea including cholera and acute respiratory infections. The
joint assessment teams have reported significant increase of cases of malaria and diarrhoea from all
affected areas. The strategy in controlling outbreaks and managing existing cases relies on mobilising
staff at the local level. This will be supplemented by sensitising affected communities to low cost
methods of waste disposal and vector control measures in the
targeted States.
1. Water and Environmental Sanitation
Prime objective is the provision of clean drinking water, sprayers and insecticides, repair of pit
latrines and hand-pumps. In view of the health situation in affected communities, this component of
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors", November 28-30, J 998
12
die appeal is of critical importance. Part of the planned activity aim at enhancing community
awareness to environmental sanitation through intensive health
education.
2. Support for Community self-reliance
In order to restore communities, self-reliance in the immediate aftermath needs considerable support.
There is a need to assist m winter cultivation, particularly wheat and animal fodder crops and
vegetables. Interventions m Northern, River Nile, Sennar and White Nile States will include repair
of irrigation pumps, desiltation of irrigation canals (particularly in the noithem state where there is
no rain-fed agriculture) and provision of seeds. All items necessary for this programme can be
purchased locallv purchase. (More information can be obtained from FAO Khartoum, through
OCHA).
3. Food
Relief food assistance has not emerged as one of the priorities needs, and as such has not been
considered in this appeal. However, WFP m addition to undertaking food distribution in Kassala, is
closely monitoring food needs m other flood-affected areas and will respond if the circumstances
require.
4. Flood Preparedness measures
Since 1988, floods have occurred in one part of the country or another. The impact on people and the
material damage show a comparable pattern. Quite often simple structural measures such as drainage
and dredging with involvement of the communities concerned can have a mitigating effect. UN
agencies and NGOs agree that the disaster preparedness/prevention aspects should be looked at again
in consultation with the GOS authorities, in this connection, joint UN/GOS recommendations on
flood mitigation will be analysed again in the light of the 1998 flood emergency. The UN Disaster
Management Team (DMT) under the leadership of the Resident Co-ordinator will assume a lead role
in such an exercise.
Rural Hospitals
A system of fee for service which people cannot afford has been adopted in rural hospitals. At present
these hospitals are manned by a medical officer, a senior medical assistant and a health visitor and
vaccinator. Hospital entrance charge is Ls500, doctor consultation fee is LslOOO. Charge for seeing
medical assistant Ls500, admission fees Ls4000, minor surgery Ls7000. Major surgery fees mciude
Ls40,000 for appendectomy, Ls70,000 for caesarean section, Ls50,000 for cholesistectomy, LslO.OOO
for normal delivery. Intravenous fluid cost Ls3000, LslOOO for crystalline penicillin, Ls500 per
malaria injection. There are also extra costs incurred by patients to cover transport of medication
(about 30%), incentive to workers (about 10%), hospital support fund (10%), etc. Regarding the fees
that are collected from admissions, 60% are sent to the ministry of health and 40% for running
expenses of the hospital and of course in the end the hospital would have nothing at all.
Concluding remarks
There is no doubt that the current health situation m Sudan has reached dangerous levels in many
parts of the country and in particular the southern sector. The present Sudan government has directly
participated in the problem by continuing the war in the south and hindering relief and aid operations.
OLS, WPF and NGOs have gained wide experience in the complex issues that participate in their
programmes, which hopefully improve their position in both conflicting camps. There is a great need
for diplomatic efforts to end the several conflicts in different parts of Sudan inordrer to end the
suffering of the people whose ordeal seems to be going for too long.
CEHAT, Mumbai, India
"Preventing violence, ( anng jor survivors". November 28-3U. 1998
13
Paper: 29
Violence to the psyche: Costs of su riving violence
A report of psychotherapy and healing in Kashmir
Kishwar Ahmed-Shirali
Ayma Swasthya Kendra
Dharmashala
They say things are getting better. Feb 1998, women go about their tasks in silence. Nothing feels
good, no gatherings, no TV, no ‘Wasvan’, nothing There are worries and fears, about children’s
health, schooling, and most of all safety Mothers at sundown wait with dread in their hearts for their
sons and men to return Daughters are not allowed out at all A 14 year old son has recurrent fever,
working mother takes leave, he has tainting spells as well. A neurologist in Jammu is consulted, EEG
is normal, some pills are prescribed He tells me he has nightmares and just before fainting, he is
afraid. His house is next to the beleaguered mosque, Hazratbal The older brother cannot sleep
without the sound of rapid fire. A 14 year old girl in the OPD of the Psychiatric Diseases Hospital has
pain and burning sensations in the eyes and thighs. 1 he doctors can t find anything wrong. The father,
very strict and ‘tez’ (harsh) would not allow her out, besides going to school The mother,
accompanying her said she also had pam in her legs She drew a small girl in a frock, for The Draw a
person test, and wrote a paragraph about her, then sacartched out the face and the para.; indicating a
low, negative self image, denial and fears about being seen and seeing
Women attending the OPD of a district hospital with various psychosomatic and gynecological
complaints (N=24, ages 17-50 years) were also given the Draw a Woman test. Results showed 50%
low self esteem; 40% average; 10% good self worth; 28% lack of autonomy; 255 denial f body, but
an equal number cathected breasts, 38% decorative! narcisstic selves; 12% veiled faces, reluctance
avoidance of public (male) gaze, 62% non communicative (eyes) could be cultural or withdrawal /
anxieties / fears as in depression / mourning, and 50% had feelings of insecurity, l/3,d projected loss
of support (no legs)
Most doctors and medical/social welfare officails believed that the ’general turbulence’ since 1989
had caused a general paralysis of health services and a simultaneous increase - 60-70%, in mental,
psychosomatic problems, ‘panic abortions’ and Ceasarian births, to avoid night deliveries. Curiously,
the ‘medicate’ shops had also increased.
Psychiatric and family therapy services were well established after World War II in the valley by Dr.
Mulhk and Ms. Ema Hawk. Recently, the two wings of the Mental Hospital burnt down. Half the
premises house chronic and pyschotic patients, 84 male and 12 female patients in 3 wards.
Psychiatrists reported there was a rise in help seeking behaviour from the 6'“ day in 1990 to 59“ day
in 1994; children (0-16 years) predominantly showed epilepsy 36 13%, mental handicap 185; other,
dissociative disorders, including conversion hysteria 51%, the latter more in housewives. Suicide is a
sin m Islam, however, suicide attempts have increased alarmingly, especailly among adolescent girls
and young rural women (Marghoob et al; 1995, 1997)
A local male doctor treated a newly wed woman who was having fainting spells. Her husband and his
family were anxious about her producing a child. He advised her about the values and normality of
motherhood, and wifely duties.
CEHAT, Mumbai, India
'Preventing violence. Caring for survivors", November 28-30. 1998
14
As a member of an NGO sponsored Mental Health Needs Assessment team, which visited the Valley
in Feb- Mar 1998, 1 was critical of the absence of women mental health personnel. In May, 1 was
invited to join a private clinic tor Stress related diseases (Psychiatry, Cardiology, and Endocrinology).
I worked there for 3 months and met 319 persons (women 217, men 102) and their families, from
inner city/suburban, rural, mountain border regions. From upper./middle class, business, government
servants, doctors, teachers, scientists, politicians, orchardists, agriculturalists and the landed, the
working class, labour (daily wages, unemployed), dairy (gujjars), agriculture, fishing, craftsmen,
houseboat men They were mostly referred by the consultant psychiatrist; they had all been to general
practitioners, neurologists, psychiatrists and to their local healers ( pir babas). 1 was involved in
psychosocial and clinical assessment, case histones projective and IQ testings,
mdividual/group/tamily therapy and reiki as needed.
Stress has acqired many faces. Old, young, and even the very young have been devasted by the
ongoing climate of violence, which like AIDS engulfed all aspects of life in the valley. Nobody was
immune to it. Family dynamics , parent-child, man-woman relation, offices, services and businesses
all had been corrupted.
A six year old was silent and withdrawn, a tenyear old smashed the TV and mirrors, a sixteen year old
ran away and an eightee year old had a headaches and bodyaches, victim of interrogation, twenty one
year old was unconscious for a month, a thirty year old complained sexual dysfunction due to electric
torture to body/penis, some were sexually abused at nme-ten years old. A forty two year old busmess
man weeps, a forty seven year old was tom with guilt around incestuous feelings he was a victim of
child abuse and current violence. These were some of the male distresses.
For women the distress goes deeper, an eight year old talks, dresses and behaves like an old woman.
A ten year old is not studying, her Rorschach is full of ‘blood' but her father is butcher. A twelve year
old sees fairies calling her and fades. A thirteen year old has fainting spells and scratches her whole
dark body. A fourteen year old tears her hair, cuts her wrists, cries ‘dam dam’ (suffocation) and faints.
Another forteen year old was sexually abused by a young Pir who was called in to cure fainting
spells. A fifteen year old insisits on discoing on the streets. A seventeen year old sent for religious
studies to Ahmedabad is anorexic, hears horses neighing and cats yowling, locked in a boarding room
at night. An eighteen year old hates being a woman and wants to hang out with the guys. A twenty
year old runs away from home and wants to die. A twenty four year old lecturer has an existential
crisis. A twenty eight year old employed in a hospital, to be married abroad is terrified of roads. A
young mother has severe migraine, she feels as if the back of her head is locked and if opened she
will die. She was sexually abused by an old Pir as a teenager. Another attractive divorcee remarried a
younger man, she ahs burning sensations all over her body. She was sexually abused as a child.
Hysterical fainting is almost universal.
In older women, distresses result from family violence, second marriages, sons in lockup,
widowhood, daughters returning after marital problems, somatic problems with sexual distress,
Lability to control grown up children and husbands, loss of support, surgery ( 6 women had abdominal
surgery) from bemg over tested and over medicated. Helpless and hopeless, depressed and insecure,
combined with low self worth (projective test findings), further fragment their fragile selves.
During curfew/hartal/unemployment and long cold winter months the family dynamics, feeding on
the sounds of women wailing and grenades exploding, got more exacerbated. Violence turns on itself.
In Kashmiri families, children are over indulged and over protected, m all classes, both sons and
daughters. Perhaps, more so, now, with the general climate of fear and anxiety. Women are socialised
with a princess complex, of high expectations. With the harsh realities of violence and death they are
CEHAT, Mumbai, India
"Preventing violence. Caringfor survivors". November 28-30. 1998
15
unable to cope. Almost everyone had a close member of the family that was tortured, kidnapped or
killed. Little children were witnesses to all, leaving deep scars on their psyche.
The broadly overlapping patterns observed were tentatively recorded. The incidence percentage is
given below:
Females N = 217
Symptoms
Males N = 102
Case
s
%
Age
range
Cases
%
Age
range
Fainting
96
43.66
7-35
15
15
10-22
Depression
78
35.68
16-65
'38
38
6-50
Functional somatic
20
9
12-50
-
-
Sexual dysfunction
-
-
17
17
25-34
Acting out
-
-
3
3
10-16
Addiction
-
-
1
1
2'2
Panic
1
25
-
-
Phobia
1
28
-
-
-
Obsessive
1'
64
-
-
Paranoia
1
36
-
-
Dissociation
1
38
-
-
Incest
-
-
1
1
47
IQ testing
18
3-14
25
25
4-16
Conclusions
8.9
'
The urgent needs are psychosocial humanistic/holistic care givers to help cope with the Post
Traumatic Stress Disorders, at various age levels, to allay fears, anxieties, guilts and most of all
restore hope and faith m themselves. NGOs need to step to help revitalise the community based,
preventive health services. Peer/Mood Disorder/Womens Awareness Support Groups ; Stress
Management, sex education; coping' strategies are sorely needed. Otherwise, I am afraid
reactionary/fundamentalist and even market forces are already reaping the horrendous harvest1.
CEHA 'l , Mumbai, India
"Preventing violence. ( anng for survivors". November 28-30. 1998
16
Paper: JO
Mental health concerns of families affected by terrorism
A Report
Ms. Niraj Seth
Rajiv Gandhi Foundation
New Delhi, India
About Rajiv Gandhi foundation
Rajiv Gandhi Foundation (RGF) was set up to keep a dream alive which could not be fulfilled during
the lifetime of Shn Rajiv Gandhi due to his untimely death This was a dream to build a modem
India, strong and self reliant As a tribute to him, RGF works in areas which were of deepest concern
to him. Broadly speaking, these areas are science and technology for the service of people, literacy,
health, disabled people's welfare and welfare of deprived and underprivileged including women and
children.
Since its inception in 1991, RGF has been undertaking its activities by collaborating and networking
with other NGOs. Instead of duplicating the large scale efforts of the government programmes, RGF
identifies gaps on the basis of felt needs and then tries to fill up gaps by introducing innovative
projects. At present over 40 projects are being implemented in different parts of the country
What is INTERACT:
One of the projects being implemented by the RGF is project INTERACT. The acronym INTERACT
stands for An Initiative to Educate, Rehabilitate and Assist the Child Victims of Terrorism1 . As the
name indicates it is an effort to give a healing touch to the chidren who have lost the chance to lead a
normal family life as a result of an act of terrorism Under this programme children who have lost
either one or both parents to terrorist violence are supported till the school finishing stage. Some
meritorious children, are supported for their post school education also. The project goes beyond the
scope of simply sending them the financial assistance in the form of a cheque. It tries to assist them in
whatever way possible with the objective of seeing them settled in life, ready to make a begining
afresh. It is easier said than done. With 800 children residing in areas where normal communication
also is difficult, achieving this objective is by no means an easy task.
In the year 1993 when RGF decided to take up this project, getting the children who were affected by
terrorism was an uphill task. Places where the mere mention of the word 'terrorism' invites trouble for
those working m the area, getting the names of the genuine children whom RGF could support was
very difficult. After several attempts contacts were made at all these places. Over a period of 2-3
years we were able to identify suitable individuals/organisations which were willing to help us run the
project. These ranged from the individuals who did not want to be identified for obvious reasons, the
police department, the district administration, the DGs and also the NGOs including the State welfare
councils.
Our criteria for selecting the partners was primarily on the basis of their committment to work for
those affected by terrorism and their willingness and capacity to monitor the programme since the
children are not located at the same place. For those who are familiar with the terrains of the nprtheast will realise that with limited communication available to reach out to the difficult areas,
identification of children and then ensuring that their education is going on smoothly requires a lot of
grit and perseverence. Yet we have about 350 children from the north east. Situation in Kashmir is
even more difficult where there are no NGOs operating and people working are always
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 28-30, 1998
17
have an individual who volunteered to work for the project, on condition of anomymity, fully
realising that his services will not be compensated monetarily. Single-handedly he is monitoring
about 150 children which is commendable The police and State departments of course have the
manpower. They have been specially helpful in Andhra Pradesh, Tripura and Nagaland. No monetary ,
assistance is given to,our partners except at one place where the NGO had requested us to meet their
travel costs.
Our partners help us m the distribution of cheques ensure that they continue with their schooling
taking care of their day to day problems and bringing to our notice of some special care needs to be
undertaken of children They also identify new cases and recommend for support.
State-wise, gender-wise breakdown of children supported
State
Andhra Pradesh
Assam
I J&K
1 Manipur
1 Nagaland
Punjab
Tripura
Oilier States
Total
Total
119
42
147
157
89
158
45
63'
820
Female
47
28
73
68
17
22
343
.Male
1
-I-i
‘
72
14
|
74
|
89
I
53
106
2S
41
1
477 i
The selection of INTERACT children is done most often with the assistance of the district
Administration The procedure of selection is quite simple. The (Children are required to fill in some
basic information about themselves and their families along with the supporting documents (death
certificate certifying that the death of parent(s) has/have occurred due to terrorist attack.) These
particulars are to be verified by the District authority and sent to RGF.
The RGF team then visits the area and meets with the children to verify the details. To spread limited
funds across as many children as possible not more than 2 children per family are supported. A
financial package is then drawn up depending on the economic condition of the family. This includes
the tution fee, allowance for purchase of books and uniform and a maintenance to take care of
miscellaneous expenses. The financial package is sent into two instalments to the child - the tution fee
directly to the school and the other allowance to the guardian.
In order to ensure that the children attend schools we expect them to send their academic results at
least once a year. This is a must without which the instalments are not released. Of course we
maintain a data base - giving information about each child- to ensure a smooth running of the project.
Problems are many - results not reaching us on time, change of school without informing us,
inflexibility shown by some schools towards the pattern of receiving the tee - but we do manage.
Other inputs : Within the constraints of distance and variety of languages spoken by the children,
RGF tries to add a personal touch to the programme. It is done in whatever ways possible - by
sending them cards on their birthdays (which they value a lot), wishing them good luck before their
board exams, sending them books/gifts from time to time and most importantly bringing out a half
yearly newsletter for the children. The newsletter provides them a platform for sharing ideas with
other children facing similar problems as well as exchanging information with them. Initially the
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 2.8-30. 1998
18
articles we received were fi.111 of sadness and self pity. Gradually now more and more children are
sending us poems/stories reflecting a more positive outlook to life.
We also arrange for get togethers tor the children from time to time so that they can Interact with each,
other. Two such get-togethers have already been organised in Delhi. It was during one such get
together that we realized the need to do address their mental well being too. It was a matter of
concern for us when we saw definite psychosomatic symptoms in at least 10% children who visited
Delhi last year. After interacting with them we noticed that they were most concerned even worried
about their remaining parent Their world revolved around the surviving parent.
During their three day stay in Delhi, we had organized a workshop^ for them with-the theme ' From
Independence to Interdependence’ . This was very successfill. Various games, exercises and activities
were held emphasmg the need to help each other, be supportive and make them realise the usefulness
of collective efforts. Seeing its success, we decided to hold more intensive workshops for all the
INTERACT children in all the States.
Concerns of INTERACT children and their guardians (based on Punjab experience)
The children under this programme are all those who have lost their one or both parents and it has
been an unnatural cause for their death. There are children who have witnessed their fathers/uncles
getting killed before their eyes, they have seen the dead bodies being brought home and have
experienced the associated insecurities In most places they are still living in an environment of fear.
(In places like Manipur and Nagaland life comes to a standstill even before the sun sets). This takes a
toll on their personality development. Many children are anxious, fearfill and unsure of themselves.
They are resentful of growing up without their fathers for no fault of their own.
In most cases the fathers were the only bread winners of the family. Their demise poses tremendous
financial constraints on the families. In Jammu most of the casei are those who have migerated from
Kashmir. Their families had successful business which came to a standstill after the sudden death of
the fathers. Not only that, they had to leave their homes and fend for themselves.
j Meena is one such child. She has five other sisters. The family migrated to Jammu after their father
| was killed in Srinagar. They had a successful carpet business with no worries for future. This
| suddenly changed after their father died. The mother had studied only till her matric which did not
| equip her to take up a job. The creditors did not return the money and the family too was
I inexperienced to handle the intricacies of business. They had some land which they sold off to give
I money to a 'trustworthy' person to buy land at a safer place, which never happened. The NSC's got
I stolen in a theft in their house Only one of the sisters was educated when the tragedy struck the
family. With great difficulty' the second daughter was sent to Bangalore to take up a professional
course and has taken up a job. RGF is supporting two younger sisters. The two sisters who are
I supporting the familiy are very reluctant to get married.
In Punjab many widows have had to face tremendous hardships on account of their relatives who
have taken advantage of the situation and grabbed their land sometimes even exploited them sexually.
Most of them were unexposed to life outside their homes, were illiterates and therefore incapable of
handling the crises.
To make things worse, society is not always kind to them. Many mothers of INTERACT children
said that life has become a long journey of mourning. They are not allowed to express happiness or
celebrate festivals which keeps reminding them of their misfortune. If they do it is invariable
followed by mourning, missing the spouse and feeling guilty subsequently. If they do buy some
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors", November 28-30, 1998
19
luxury item, say a T.V. remarks are passed that she is not affected by the death of her husband'. The
word 'widow' follows them everywhere.
Raminder and her younger brother lost their father to terrorism and were selected under the project.
Their mother, after her husband's death has some land (joint property) and her in-law's home to
herself. Her elder brother in-law exploited the widow sexually for couple of years as a precondition of
transferring the ownership in her name which he never did. The mother has lost her balance of mind
and is without a house now. Seeing the family condition, Raminder dropped out of school and
pleaded that her brother be included in the project. She was cajoled though letters requesting her to
complete her schooling Fortunately she is back in school now and her brother too has been selected
for support.
Thus the concerns of the INTERACT children and their mothers had social, emotional and economic
implications and all of these need to be addressed to if the family has to be enabled to bounce back to
normalcy. A begining was made during the workshops held in Punjab.
Objectives of the workshop: As mentioned earlier, through interactions (letters and meetings) with
the children it became evident that the scars had not healed. The surviving guardian - mostly the
mothers - were themselves going through a lot of stress and the children were not unaffected by their
mental state. Therefore, we decided to hold the workshops for both the children and their mothers
(who are the guardians in most cases).
Two day long residential programme was chalked out in consultation with Sampark' - the
counselling wing of the ’Modi Foundation Hospital ’ in Delhi. Our partners in Punjab - the Police
department, Batala and the Punjab Council for child welfare made the arrangements for the
workshop. A three member team from Sampark along with the RGF official went twice to Punjab to
conduct the workshops. A brief account of this is given as follows:
Children
To provide a platform to ventilate their feelings with others who can understand and identify with
their situation.To provide a forum where children with similar traumatic background can meet
and experience support within group.
□ To provide an opportunity to express themselves through writing and painting.
□ To build trust among others and make others trust them by becoming responsible.
□ To make them learn how to work with a group of strangers by sharing things, getting help from
others.
□ To provide them an outlet where they can enjoy, have fun and be comfortable "being
themselves".
Women
□
To provide a forum for ventilation of their feelings, the problems they are feeing at present.
To discuss alternatives or solutions to the issues relating to children's education and their
career/future.
□ To create a bonding and a support system among these women in order to make them feel
empowered and have a high self esteem m order to be able to look ahead and cope with the daily
life situation in a healthy manner.
□ To provide an opportunity for the women and children to have good/fun time, where they can be
themselves.
□
□
CEHA 'l ', Mumbai, India
"Preventing violence. Caring for survivors", November 28-30, 1998
20
Sessions
The sessions were organised separately for the mothers and the children and then together for both the
target groups. During the sessions, the mothers shared their common experiences with others who had
similar experiences. They felt that they .had sadness locked up in their hearts They said that they
often felt very depressed, exhausted to carry on themselves and wanted to escape from the situation. It
was their concern for their children which made them carry on. The workshop made the women feel
that they were being heard and they were amidst a group where they could express themselves freely.
Although many of them were meeting each other for the first time since they lived in different
villages, an instant bond was created. The facilitators too gave them lot of positive strokes for their
courage and the perseverance
1'he children shared their own experiences, some even spoke about how they had seen their fathers
getting killed. They shared their own insecurities with others. Different activities were organised for
the children to help them express themselves like writing 10 things about themselves and sharing with
others, expression through painting and also about their feelings through a few pictures which were
shown to them. Besides, there were other activities like Antakshan' and musical chairs.
After giving vent to their feelings, they were helped to see □ If the resentment is carried forward, where will it all take them
□ How do they see themselves and the children after a few decades.
□ If their resentment and anguish is dealt with here and now, would things change for them.
Most of them had initially said that they expected this tragedy to affect the next 3-5 generations. At
the end of the sessions they had a more positive outlook towards their lives.
Some of their responses were as follows:
"You have encouraged us for HJe ahead. You heard our problems. We are very happy to meet you. We
will also encourage our children like you have encouraged us." - Gurbant Kaur.
"On meeting you, 1 felt that you understood my sorrow and sadness very well. 1 really liked when you
said here you have no one to taunt you. You can dance, laugh, cry and sing as you wish" - Charanjit
Kaur.
" You have come to Punjab and encouraged us and our children to lead a normal life. You have
listened to our sorrows/woes. Please keep coming back and talking to us - we feel very encouraged." Amaijeet Kaur.
They shared their concerns about the future of their children and discussed a few options. Some local
women's organisations at Jallandhar offered a few seats for the computer course. Discussing about
these made the women feel lighter and see a ray of hope.
A few things have emerged from these interactions vis-a-vis their health concerns: (Details given in
annexure).
1. There is a very definite need to address the mental well being of the children and more so their
guardians if normal family life is to be restored and they have to be helped to have a positive
outlook towards life.
2. To achieve this objective professional help is required from those engaged m the area of mental
health.
Although the decision to organise similar workshops was taken last year, it has taken us several
months to identify suitable organisations which can conduct the workshops for us specially in the
CEHAT, Mumbai. India
"I’revcmmu violence. ( arm}’ for survivors". November 28-30. !WK
21
north-east Several constraints are there, the main one being locating a suitable organisation which is
familiar with the local language
According to the Home Ministry figures (IdQ8) for J&K alone, 18,221 people have been killed in
terrorist violence Keeping that in mind, 800 may be a drop in the ocean. But the magnitude ot the
problem must not make one overlook the other concents, specially those related to their mental health
since it affects the whole personality of die individual for life time
Annexure
Recommendations by Sninnnrk team
k
evident
the Interact child'cn
their faniilies ?.re still suffering the effect of their violent
pnst f sme hcis not hen’°d v/onnds only dulled it end buried it in everydoy of life Some of the
........... j;.—
viinuivn
vwiv tviuivoo ia> uiv viuumiji ait> onuvv
ojiii^iuino or |7VJi'ii«uiiiaiiv~au voo"uioviuvi,
PTSD is a problem recognised, researched and documented all over the world. Research shows that
25% of dtose who lost a relative to an accident or violence are diagnosed with it. They are vulnerable
not only to horrifying flashbacks, nightmares, irrational fears, sudden anger and emotional numbness
but to the less obvious anxieties, depressions, substance abuse phobias and personality disorders that
follow. Our observation of the children present in Batala and Jalandar showed the presence of PTSD
in at least 25% of the children with -milder forms existing in the others. Report from mothers
confirmed that some of the children were withdrawn in their behaviour at home and at school,
suffered from sudden anxiety attacks and recurrent nightmares and exhibited emotional
unresponsiveness.
The children who are more severely affected would need special interventions as PTSD is not
amenable to normal psychotherapeutic tools of counselling, reflexive listening or cognitive behaviour
techniques. The effectiveness ot new therapies to treat PTSD are being tested worldwide. Eye '
Movement Desentisization and Reprocessing (EMDR), developed by Francine Shapiro is the best
known, however this is currently unavailable in India
1 suggest that we should explore avenues of making new treatment especially EMDR available for
these children. Until that time, regular meetings with other children and families in a group would
keep them going by keeping their hopes alive. This is the most important intervention that we
made i .e. to keep their expectations of an improvement alive. The novelty of the new techniques and
our undivided attention to their narratives have been a factor in their improvement. As the feedback
sheet shows that they have gone back with hearts that are less sad, and tilled with hopes that they too
can be in a position to help others We would be letting the Interact children down in their
expectations of community if they could not have this experience again. After the disruption of their
lives forever, continuity itself is almost too much to hope for. 1 was personally frightened and
saddened by their beseeching in every sheet of feedback that they beg RGF to hold this camp again. It
seems that their lives have beer, so frill of losses that even the sureness something good and enjoyable
happening has been lost. This confidence we can restore by regularly meeting with them and
continuing to address collective and individual problems.
CEHA T. Mumbai. India
"Preventing violence, Caringfor survivors", November 28-30, 1998
22
About
1FHHRO
Internationa! Federation of
Z/ealth and Ffuman Aights Organisations
In 1991, four organisations - Physicians for Human Rights (PHR) (Denmark), PHR (UK), PHR
(USA) and the Johannes Wier Foundation for Health and Human Rights (the Netherlands) came
together to form a Physicians for Human Rights Network. This network was called International
Network of Health and Human Rights Organisation. In 1996, in order to increase the impact of its
work and for promoting better organisational efficiency it was converted into a federation.
1991 Mission Statement of the IFHHRO members
Sharing the objective of mobilising medical skills to protect human rights
Adhering to the principles of impartiality and objectivity
Acknowledging each other’s independence and
Desiring the fullest possible co-operation
Declares the formation of a network (federation) of their organisations and
Commit themselves specifically to.
Inform each other about intended missions and consider joint missions.
Send copies of letter writing actions to each other.
Publish short summaries of activities of the other organisations in their newsletters or other
communications.
Exchange information on each other’s skills, expertise and experience.
Provide an appropriate means of access to the network for outside organisations and output
from the network to outside organisations.
The members pledge to share views, exchange information and assist each other in such areas of
interest as:
Monitoring human rights violations in areas of conflict.
Development of health and human rights education in the health professions.
Motivation of medical associations domestically and abroad to take an active interest in
human rights.
The problem of impunity and its relation to the mental health of survivors of human rights
violations.
Protection of physicians at risk due to their human rights activities.
The dilemma that medical professionals face when their professional and legal obligations
are in conflict.
Domestic human rights issues.
The development, evaluation and follow-up of missions and other activities.
The organisation of International Conferences under the auspices of the Federation.
CEHAT, Mumbai, India
"Preventing violence, Caring for survivors", November 28-30, 1998
23
Criteria for Credentialing/Affiliation to 1FHHRO
lhat the association be independent, free standing, non-partisan, not affiliated with any party, nor
with any advocacy group. The sole exception might be affiliation with another human rights
organisation which meets'these criteria.
2. Purposes: That the association:
(a) Bring the skills and influence of the medical and other human other health professions to the
protection and promotion of human rights.
(b) Accepts the principles of the network (Mission Statement given above).
(c) Agrees that the association have among its objectives, or as its exclusive concern, the
promotion and protection of human rights.
That the association further:
3. Reflect at all times impartiality and objectivity, precision and accuracy in reporting and be non
partisan in nature.
4. Demonstrate the potential and capacity for broad appeal to fellow professionals concerned wrth
the protection of human rights.
5. Not exclude individuals from participation because of political affiliations, religious beliefs, rave,
sex, ethnic or nationality origin.
6. Maintain ten or members of the governing committee or active membership.
1.
Decision on affiliation is taken by consensus by the network representatives at their annual meeting.
Current Members:
At present there are 8 (eight) organisations affiliated to the 1FHHR0 and 4 (four) organisations have
the status of observers.
The Affiliated Organisations:
,
(l)Physicians for Human Rights (PHR), USA, (2) PHR, UK, (3) PHR, Denmark, (4) PHR, Israel, (5)
PHR, Palestine, (6) PHR, South Africa, (7) Johannes Wier foundation for Health and Human Rights,
the Netherlands, (8) CEHAT, India.
The Observer Organisations:
(1) Amnesty International, (2) British Medical Association, (3) International Committee for the Red
Cross, (4) Turkish Medical Association.
The Johannes Wier Foundation, the Netherlands, provides Secretariat of the federation.
Address:
International Federation of Health and Human Rights Organisations
C/O Johannes Wier Foundation
PO Box 1551, 3800 BN Amersfoort, The Netherlands.
Tel: 0031-33-4614812, Fax: 0031-33-4615048
Email: johannes.wier.stg@wxs.nl
CEHAT, Mumbai, India
"Preventing violence. C aring for survivors". November 2H-30. I99H
24
Status report
The post graduate course in human rights conducted by
The department of civics and politics, university of Mumbai
Department of Civics and Politics
Mumbai University, Mumbai
The Department of Civics and Politics, University of Mumbai was established in 1948 and has been
conducting postgraduate courses in Politics since then. In December 1995 when the Department
organised a seminar on human rights the then Chairman of the National Human Rights Commission
Justice Ranganath Mishra suggested that the Department should start a programme in human rights
education. This was taken up by the Board of Studies in Politics of the University of Mumbai The
Board appomted a committee consistmg of Justice S.M.Daud (Retd), Shn. Yogesh Kamdar, Dr.S.P.
Sathe, Dr. B.N. Mehrish, Professor Sudhakar Solomonraj and Ms Kalindi Muzumdar under the
convenorship of Dr. (Smt.) Nawaz B Mody to draw up the syllabus of the course. The course
designed by the committee was subsequently approved by the Academic Council of the University.
The Post-graduate diploma course in Human Rights was introduced m the University of Mumbai
during the academic year 1996-97. The course is being conducted by the Department of Civics and
Politics. The course consists of four papers namely:
Paper I
Paper 11
Paper III
Paper IV
Evolution, Philosophy and Theory of Human Rights
Human Rights in the Indian Context
Human Rights in the Global Context.
Dissertation based on field work.
While determining the resource persons for the course series of meetings were held with leaders of
non-governmental organisations, academics, lawyers, senior judges and others. Accordingly a panel
of resource persons was prepared. Initially there was an acute shortage of instruction material for the
course. In order to overcome this, linkages with British Council Library, the American Centre
Library, the Centre for Education and Documentation and a few non-governmental organisations
were developed. The University also gave special grants earmarked for this purpose. From 1997, the
University Grants Commission has also been giving us a grant for purchasing books and journals and
for extension work. A post of Reader in Human Rights has also been sanctioned and this is
recognition of the high esteem in which University Grants Commission holds the programme.
The Department enjoys the status of Department of Special Assistance from the University Grants
Commission. Recently the Department has received the extension of the DSA programme till 2003.
One of the thrust area approved under this is Human Rights.
The students of the course have a varied background, as there are participants from the armed forces,
the legal profession, engineers, teachers, activists and fresh graduates. Similarly, the faculty was also
drawn from diverse fields such as retired judges and lawyers of eminence, academicians (from
different disciplines), and activists. In order to enable professionals to enrol for this course the
lectures are scheduled only on Saturday afternoons and Sundays and are located at a central place.
Since the objectives of the course are to sensitise and create awareness among the students, a
conscious effort was made to use innovate teaching techniques, such as field trips, exhibitions, audio
CEHAT, Mumbai. India
"Preventing violence. Caring for survivors". November 28-30. 1998
25
visual method, case studies, seminars etc. I he students regularly visit the Yerawada Central Jail, Pune
and observed the conditions in the jail. Similarly on December 10, 1996, an exhibition and seminar
was organised to celebrate Human Rights Day. The Seminar was well attended by the general public.
Since the response to the exhibition was overwhelming it was kept open for three days. Similarly we
also organised a two-day workshop on “Human Rights and Medical Ethics." Over thirty doctors
attended the workshop We are planning to organise such specialised courses for professionals in
other fields such as civil servants, lawyers, police personnel and the like
Further, in order to enrich the course, we have started networking with various Non-governmental
organisations within and outside the country. We have received a favourable response from some of
the organisations such as the Amnesty International, the International Commission of Jurists and
Article XIX. We were also able to organise special lectures by experts such as Dr Cohn (a Norwegian
paediatrician) who spoke on the issue of organ transplant, as well as the rights of the child and Dr.
K.D. Irani from the City College of New York.The students are also provided with a substantial
amount of course material culled from various sources by the resource persons.
Exammations for the diploma course were held in May 1997 and May 1998 Dissertations have been
submitted on diverse areas such as human rights issues in the North-east, human rights and the armed
forces, rights of women, children and AIDS patients. Since the data in several of these dissertations
are based on the experience of the students, they provide a database and will enable the Department to
develop as a Centre for Human Rights in the future.
The evaluation by the students of the course has been heart-warming. On the basis of our experience
we have made certain changes in the syllabus. We have given more importance to the rights of the
child (and especially the problem of child labour), the rights of women, and other underprivileged
sections of society. We have also incorporated the rights to health and environment in the curriculum
in the paper on Human Rights in the Indian context. Similarly, in Paper 111 (Human rights in the
Global Order) we have incorporated the question of human rights violations during war: humanitarian
law.
The most outstanding achievement has been that the students have formed an action group to help out
NGOs and other groups to fight for their rights. Some of the students have already started working as
human rights activists. Further one of our faculty members and two of our students have attended the
specialised course for training in human rights in Strasbourg We hope to generate more course
material as we do realise that as of now there is a dearth of material in this area.
In view of this the department has published the following:
□ Said Mirza, "Some Thoughts on Human Rights Day."
□ Kannamma S.Raman, "Universality of the Human Rights Discourse - An Overview."
Similarly, we also plan to hold a Seminar on issues relating to women and children as these are the
most vulnerable section of the society and as a recent report released in the country reveals gender
equality is still to be achieved. With this in mind we are organising, on December 10 and 11, 1998, a
two-day national workshop on “The Right to Development." The four main working sessions of the
seminar are: Development and displacement; Development and Women; Development and Health
and Development and Environment.
We also hope to encourage our teachers and post-graduate students to undertake research m the area
of Human Rights. Some of the important research dissertation presented by our diploma students
are:
CEHAT, Mumbai, India
"Preventing violence. Caringfor survivors", November 28-30, 1998
□
□
□
□
□
□
□
26
Rights and the Street Child: A Study On The International and National Legislative Framework,
vis-a-vis Street Children in Mumbai,
Dalit Women and Their Rights.
Human Rights Abuses in HIV infected Patients
Police and Human Rights - Case Study of Investigation in RDX Landing
A Comparative Study of the Annual Reports of the Indian National Human Rights Commission
and The Human Rights Commission of Pakistan for the Year 1995-96.
Human Rights and the Indian Armed Forces.
Present Day Private ICU, ICCU in the City of Mumbai and The Patients Right to Health Care.
Apart from these some of our doctoral students working on human rights issues are:
□
□
Ritesh Kumar, ‘‘Crisis of Human Rights in India and the Administrative Response (With special
reference to Maharashtra),
Abhinaya Gaikwad, “ Perceiving an Unequal World: A Study of Dalit Women in Mumbai”.
Finally, the extremely favourable response for the diploma course has made us think in the direction
of a Centre for Human Rights and subsequently a post graduate degree in Human Rights.
CEHAT, Mumbai, India
"Preventing violence. Caring for survivors". November 28-30, 1998
27
About
Centre Georges Devereux
(University Center for Psychological Help)
University of Paris 8, Prance
lhe Centre Georges Devereux, university center tor psychological help, has started its activities on
January 1“, 1993. In France, this center is the first and only university unit of clinical psychological
practice, directly attached to the Department of Psychology of Pans 8 University.
200 to 300 specialised consultations in ethnopsychiatry are realised per year at the Center and more
or less 50 families are treated per year. Ten psychotherapists (who are also researchers and teacher at
the university) work in the center. They train and supervise 25 students in clinical psychology, 20
PHD students. The Center also welcomes many researchers who work temporary with us on specific
projects
The Centre Georges Devereux focuses its activities on five major directions:
1. Technical innovation in clinical psychology and psychotherapy
After having stated that the practice in clinical psychology and in psychotherapy is often no longer
adapted in dealing with the concrete and modem problems of the nowadays suffering populations, the
Center Georges Devereux offers specific treatment and follow up for migrant populations and for
cultural, social or sexual minorities.
2. Creation of a real dynamic of research in clinical psychology
Besides the therapeutic activity, the center also realises clinical researches on highly modem (i.e.
present time) problems in the field of psychology and transcultural psychopathology, called
ethnopsychiatry. Ethnopsychiatry is not only a discipline, but also an innovative methodology and an
original therapeutic setting, whose applications are various in many fields : psychopathology of
migrant populations, AIDS, cultural minorities, transsexual people and sexual minorities
3. Clinical teaching issued from our practice
The Center Georges Devereux offers to the students who are m the lasts years of their university
degree course the possibility to be trained in psychotherapy and in ethnopsychiatry.
4. Training for post-graduate health and social professionals.
Medical doctors, psychologists, nurses and social workers are also trained in our center. Those health ■
professionals are often the one who work with migrant populations, with social minorities and with
other suffering populations and who made the statement of failure in our current methods of treating
and taking in charge those populations.
5. Partnerships, on an international level, with other universities.
Due to our methodology of work based on the concept of reciprocal anthropology and psychology
many universities wanted to develop a partnership with the Center Georges Devereux. Therefore
partnerships in teaching and in research exist with many universities in the world. One of them are the
University of Rio de Janeiro in Brazil, the University of Port of Prince in Haiti, the one of Porto-Novo
in Benm, the one of Pavia in Italy.
CEHAT, Mumbai, India
"Preventing violence. Caringfor survivors", November 28-30, 1998
28
CEHATPUBLICATIONS (1991-6)
Research Centre ofAnusandhan Trust
519 Prabhu Darshan, 31 S.Sainik Nagar
Amboli, Andheri West, Mumbai 400 058, India
Fax: (91) (022) 620 9203, Tel: 625 0363,
Email: admin@cehaLilbom.emetan
(A) Health care services and financing
Studies, reports and books:
(RA.04) Patient satisfaction in the context of socio-economic background and basic
hospital facilities: A pilot study of indoor patients of the LTMG hospital, Mumbai, Iyer
Aditi, Jesani Amar, Karmarkar Santosh: Mumbai: CEHAT, October 1996, pp.56.
(RA.03)Financing of disease control programmes in India, Nandraj Sunil, Duggal Ravi:
Mumbai: CEHAT, February 1996, pp.53.
(R,A.02)The private health sector in India: Nature, trends and a critique, Duggal Ravi:
Mumbai: CEHAT, January 1996, pp.47.
(RA.01) Special statistics on health expenditure across states, Duggal Ravi, Nandraj Sunil,
Vadair Asha: Economic & Political Weekly, Vol. XXX, Part I in No. 15, April 15, 1995,
pp.834-844, and Part 11 in No. 16, April 22,1995, pp.901-908.
Papers and essays:
(PA.25) Physical standards in the private health sector, Nandraj Sunil, Duggal Ravi, in
Radical Journal ofHealth (New Series), Vol II, No. 2-3, April-September 1996, pp.141-164.
(PA.24) From philanthropy to human rights: A perspective for health activism in India,
Jesani Amar (Paper presented at the Diamond Jubilee Conference on “Social Movements”
organised by the Tata Institute of Social Sciences, Mumbai on November 3, 1996): Mumbai:
CEHAT, November 1996: pp.24.
(PA.23) National disease control programmes: Recent trends in financing, Nandraj Sunil,
Duggal Ravi: Radical Journal of Health (New Series), Vol. II, No. 1, January-March 1996,
PP(PA.22) Cost of medical care: Issues of concern in the present scenario, Nandraj Sunil
(Paper presented at the All India Peoples Science Network, Seminar on Health For All Now,
New Delhi, November 1995): Mumbai: CEHAT, November 1995, pp.13.
(PA.21) Medicos’ strike: Relevant issues, Jesani Amar: Radical Journal of Health (New
Series), Vol. 1, No. 4, October-December 1995, pp.247-50 (Editorial).
(PA.20) Market reforms in health care, Jesani Amar: Radical Journal of Health (New
Series), Vol. I, No. 3, Juiy-Scptcmber 1995, pp.171-3 (Editorial).
(PA.19) Public health budgets: Recent trends, Duggal Ravi: Radical Journal of Health
(New Series), Vol. I, No. 3, July-September 1995, pp. 177-82.
. (PA.18) Beef up the health budget, Nandraj Sunil: The Metropolis (Anniversary Special),
February 4-5, 1995, pp.l.
(PA. 17) Health expenditure patterns in selected major states, Duggal Ravi: Radical
Journal ofHealth (new series), Vol. I, No. 1, January 1995, pp.37-48.
(PA.16) The number game, Duggal Ravi: Humanscape, November 1994, pp.20-22,
(PA.15) The great divide, Duggal Ravi: Humanscape, October 1994, pp.14-15.
(PA.14) Population meet: Poor impact of NGOs, Duggal Ravi: Economic and Political
Weekly, Vol. 29. No.38, September 17, 1994, pp.2457-8.
’
CEHAT, Mumbai, India
'Preventing violence. Caringfor survivors", November 28-30, 1998
29
(PA.13) Population and family planning policy: A critique and perspective, Duggal Ravi
(Paper presented at International Conference on Population and Development, Cairo,
September 1994): Mumbai: CEHAT, August 1994, pp.6.
(PA.12) New moves: The Indian drug scene, Pilgaokar Anil: Voices, Vol.: II, No. 3, 1994,
pp.22-24.
(PA.11) Health finance of the Brihan-Mumbai Municipal Corporation, Duggal Ravi,
Nandraj Sunil (Background paper for Medico Friend Circle, Mumbai Group’s Workshop on
Improving Public Hospitals in Mumbai, June 1994): Mumbai: MFC - Background papers,
May 1994, pp.37-44.
(PA.10) Peoples economy: context and issues from India, Duggal Ravi (Paper presented at
Seminar on “Market Economy Also for the Poor”, Berne, Switzerland, May 1994), Mumbai:
CEHAT, May 1994, pp.14.
(PA.09) For a new health policy: A discussion paper, Duggal Ravi (Paper presented at the
study circle organised by the MFC/FMES/ACAS1I, Mumbai, on August 21, 1994): Mumbai:
CEHAT, August 1994, pp.13.
(PA.08) Health manpower in India, Duggal Ravi (Paper prepared as National Consultant on
WHO project, for the Ministry of Health, New Delhi): Mumbai: CEHAT, August 1993,
pp.20.
(PA.07) Health care utilisation in India, Duggal Ravi: Health for the Millions, Vol., No. ,
pp.10-12.
(PA.06) Resurrecting Bhore: Re-emphasising a universal health care system, Duggal
Ravi: MFC Bulletin, No. 188-9, November-December 1992, pp.1-6.
(PA.05) Trends in FP policy and programmes, Duggal Ravi (paper presented at seminar on
“Trends and perspectives for FP in the Nineties”, Mumbai Union of Journalists, August
1992): Mumbai: CEHAT, August 1992, pp.15.
(PA.04) Cost and concern in primary health care, Duggal Ravi: Health Action, Vol 5, No.
8, August 1992, pp.
(PA.03) Regional disparities in health care development: A comparative analysis of
Maharashtra and other states, Duggal Ravi (paper presented at the national workshop on
health and development in India, NCAERZHarvard University, Delhi, January 1992),
Mumbai: CEHAT, 1991, pp.20.
(PA.02) Ending the underfinancing of primary health care, Duggal Ravi, MFC Bulletin
No. 177-178, November-December 1991, pp.7-9.
(PA.01) Private health expenditure, Duggal Ravi, MFC Bulletin, No. 173-174, July-August
1991,ppl4-6.
(B) Health legislations, ethics and patients’ rights
Studies, reports and books:
(RB.03) Medical ethics: For self-regulation of medical profession and practice, Iyer
Aditi, Jcsani Amar: Mumbai: CEHAT, January 1996, pp.39.
(RB.02) Laws and health care providers, Jesani Amar, Mumbai: CEHAT, January 1996,
, pp.135.
(RB.01) Physical standards in the private health sector: A case study of rural
Maharashtra, Nandraj Sunil, Duggal Ravi: Mumbai: CEHAT, November 1995. pp. 133.
Papers and essays:
(PB.24) Cross practice at the cross-roads, Jesani Aman Issues in Medical Ethics, Vol. 4,
No. 4, October-December 1996, pp.103 (Editorial)
CEHAT, Mumbai, India
'Preventing violence. Caringfor survivors". November 28-30, 1998
30
(PB.23) Medical ethics and professional self-regulation: Some recommendations, Jesani
Amar: Health for the Millions, Vol. 22 No. 4, July-August 1996, pp. 24-9.
(PB.22) Crisis of credibility: The talc of Medical Councils, Iyer Aditi: Health for the
Millions, Vol. 22 No. 4. July-August 1996. pp. 17-20.
(PB.21) Editorial, Jesani Amar (As guest editor): Health for the Millions, Vol. 22 No. 4,
July-August 1996. pp. 2.
(PB.20) Physical standards in the private sector: A case study of rural Maharashtra,
Nandraj Sunil, Duggal Ravi: (Accepted for publication in Radical Journal of Health, New
Series). 1996.
(PB.19) Law, ethics and medical councils: Evolution of their relationships Jesani Amar,
Medical Ethics, Vol. 3, No. 3, July-September 1995, pp.C-IX-XII.
(PB.18) Medical ethics: General principles, Pilgaokar Anil: Medical Ethics, Vol.: 3, No: 2,
April-June 1995, pp.C-V to C-V1II.
(PB.17) Self-regulation or external control?, Jesani Amar: Medical Ethics, Vol.: 3, No.: 2,
April-June 1995, pp.18. (Editorial).
(PB.16) In the pink: Need for asserting patients’ rights, Jesani Amar, Pilgaokar Anil:
Keemat, Vol.: 24, No: 3, March 1995, pp.12-4.
(PB.15) Ethics of professional bodies, Pilgaokar Anil: Medical Ethics, Vol.: 3, No: 1, JanuaryMarch 1995, pp.2 (Editorial).
(PB.14) Assessing the need for and designing an accreditation system: Situation in
India, Nandraj Sunil (Paper prepared as consultancy for Institute of Health Systems,
Hyderabad, July 1994): Mumbai: CEHAT, August 1994. pp.10.
(PB.13) Beyond the law and the Lord: Quality' of private health care, Nandraj Sunil:
Economic and Political Weekly, Vol.: XXIX, No: 27, July 2, 1994, pp. 1680-5.
(PB.12) Medical ethics, Jesani Amar: Medical Ethics, Vol. 1, No: 3, May-July 1994, pp.8.
(Book Review).
(PB.ll) The unregulated private health sector, Jesani Amar, Nandraj Sunil: Health for
Million, Vol. 2, No. 1, February 1994, pp.25-28.
(PB.10) Patient’s autonomy: Throwing it to the winds?” Jesani Amar, Pilgaokar Anil:
Medical Ethics, Vol. 1 No. 1, August-October, 1993, pp.6-7.
(PB.09) Patients’ rights: A perspective, Jesani Amar, Nadkami Vimla: The Indian Journal
of Social Work. Focus Issue: Patients’ Rights, Vol.: LIV, No: 2, April 1993, pp.167-71.
(Guest editorial)
(PB.08) User charges and patients' rights, Duggal Ravi: The Indian Journal of Social
Work, Focus Issue: Patients’ Rights, Vol.: LIV, No: 2, April 1993, pp.193-97.
(PB.07) Medical ethics and patients’ rights, Jesani Amar: The Indian Journal of Social
Work, Focus Issue: Patients’ Rights,- Vol.: LIV,No: 2, April 1993, pp.173-187.
(PB.06) Consumers and the medical community, Jesani Amar: Christian Medical Journal
ofIndia, 1992, pp.5-7.
(PB.05) Medical ethics: Awaiting a patients’ movement, Jesani Amar, Duggal Ravi:
VHAI, State of India’s Health (Book): New Delhi: 1992, pp.365-77.
(PB.04) Private nursing homes: A social audit, Nandraj Sunil (report submitted to the
committee appointed by the Mumbai High Court to regulate nursing homes/hospitals in
Mumbai City, July, 1992), Mumbai: CEHAT.
(PB.03) Regulating the private health sector, Duggal Ravi, Nandraj Sunil: MFC Bulletin,
No. 173-4, July-August 1991, pp.5-7.
(PB.02) Educational intervention in medical malpractice, Jesani Amar: FRCH Newsletter,
Vol. V, No. 4, July-August 1991, pp.4-5 (and 8).
(PB.01) Medical malpractice: What it is and how to fight it (Report of a workshop, MFC
Mumbai Group): Jesani Amar, MFC Bulletin, No. 171-2, May-June 1991, pp.1-3.
CEHAT, Mumbai, India
"Preventing violence. Caringfor survivors", November 28-30, 1998
31
(C) Women’s health
Studies, reports and books:
(RC.01) Garbhapat: Samaj ani Adhikar, Gupte Manisha, Bandewar Sunita, Pisal Hema,
(Slide Show, in Marathi), Mumbai: CEHAT.
Papers and essays:
(PC.14) Abortion needs of women : A case study of rural Maharashtra, Gupte Manisha,
Bandewar Sunita, Pisal Hemlata (Paper presented at the conference organised by Stimezo, a
Dutch Foundation of Abortion Clinics in the Netherlands in March 1996): Mumbai: CEHAT,
December 1995, pp.16.
(PC.13) Women’s perspectives on the quality of health care and reproductive health
care: Evidence from rural Maharashtra, Gupte Manisha, Bandewar Sunita, Pisal Hemlata
(Scheduled for publication in a book to be brought out by the Ford Foundation): Mumbai:
CEHAT, December 1995, pp.28.
(PC.12) Umaltya kalayanche prashna, Gupte Manisha, Pisal Hemlata (article for AFARM):
Mumbai: CEHAT, December 1995, pp.4. (Tn Marathi)
(PC.ll) Jant: Prasar ani laxane, Pisal Hemlata: Mumbai: CEHAT, September 95, pp.8. (In
Marathi)
(PC.10) Saad sharirachi, Gupte Manisha: Palakneeti, Vol. 65, Diwali 1995. (In Marathi)
(PC.09) Our health costs little, Duggal Ravi: in Karkal Malini (Ed.) Our lives, our health,
(Book) New Delhi: Coordination Unit, World Conference on Women, Beijing, 1995, August
1995, pp.54-59.
(PC.08) Abortion: Who is responsible fbr our rights, Jesani Amar, Iyer Aditi: in Karkal
Malini (Ed.) Our lives, our health, (Book) New Delhi: Coordination Unit, World Conference
on Women, Beijing, 1995, August 1995, pp.l 14-130.
(PC.07) Women, health and development, Gupte Manisha, Karkal Malini, Sadgopal Mira:
Radical Journal ofHealth (new series), Vol.: 1, No: 1, January-March, 1995, pp. 7-8.
(PC.06) Violence against women and children: The role of media and health care
professionals, Jesani Amar (Paper presented at Xavier’s Institute of Communication’s
seminar on Health Communication held in Mumbai on November 17, 1994): Mumbai:
CEHAT, November 1994, pp.3
(PC.05) New approaches to women’s health: Means to an end?, Prakash Padma:
Economic and Political Weekly, December 18, 1993, pp.2783-6. (A background paper fbr the
MFC meet on “Social construction of reproduction” at Wardha, January 13-15,1995).
(PC.04) Women and abortion, Jesani Amar, Iyer Aditi: Economic and Political Weekly,
November 27, 1993, pp.2591-94 (A background paper for the MFC meet on “'Social
construction of reproduction” at Wardha, January 13-15, 1995).
(PC.03) On being normal (whatever that is), Gupte Manisha: MFC -Bulletin, No. 197-201,
August 1993, pp.4-6. (A background paper for the MFC meet on "Social construction of
reproduction”, at Wardha, January 13-15, 1994).
(PC.02) Sexism in medicine and women’s rights, Prakash Padma, George Annie, Panalal
Rupande: The Indian Journal ofSocial Work, Focus Issue: Patients’ rights, Vol.: LIV, No: 2,
April 1993 pp.l99-204.
(PC.01) Nurses as women, Jesani Amar: Economic and Political Weekly, March 2-9, 1991,
pp.493. (Book Review)
CEHAT, Mumbai, India
"Preventing violence, Caringfor survivors", November 28-30, 1998
32
(D) Investigation and treatment of psycho-social trauma
Studies, reports and books:
(RD.04) Mumbai riots: January 1993: A selected documentation from a section of the
print media, Jesani Amar, Alphonse Mary, D’Sa Aloysius: Solidarity for Justice, Mumbai
March. 1993, pp.180.
(RD.03) An enquiry by the fact finding team into the police firing that led to the killing
of a tribal and caused injury to others in Dahanu Taluka, Thane District, Maharashtra,
Oza Bhushan, Jesani Amar and others, Mumbai: Fact Finding Team, July 1992, pp.17.
(RD.02) Human rights issues from investigation into the murder of Sr. Sylvia and Sr.
Priya, Jesani Amar, Mumbai: Solidarity for Justice, November 1991, pp.27.
(RD.01) Will truth prevail? A report of the investigation team on the murder of Sr.
Sylvia and Sr. Priya at Snehasadan, Jogeshwari,, Jesani Amar and others, Mumbai:
Solidarity' for Justice, April 12, 1991, pp.31.
Papers and essays:
(PD.15) Violation of medical neutrality in India, Jesani Amar (Paper presented at the
international Congress on “Violation of medical neutrality” organised by Johannes Wier
Foundation at Utrecht, the Netherlands, on November 8, 1996): Mumbai: CEHAT, November
1996, pp.5.
(PD.14) Report from India: Post-graduate diploma course on human rights, Jesani
Amar: PST Quarterly (The Philippines), Vol. 1, No. 2, July-September 1996, pp.30-1.
(PD.13) Directory of persecuted scientists, engineers and health professionals, Jesani
Amar: Issues in Medical Ethics, Vol. 4, No. 4, October-December 1996, pp. 135 (Book
Review)
(PD.12) PST Quarterly inaugural issue, Jesani Amar: Issues in Medical Ethics, Vol. 4, No.
4, October-December 1996, pp.135 (Review of Journal)
(PD.ll) ENHHRO conference of health, human rights, ethics, Jesani Amar: Issues m
Medical Ethics, Vol. 4, No. 1, January-March 1996, pp. 27.
(PD.10) Health of child labourers in India, Sinha Roopashri: Mumbai: CEHAT, December
1995, pp.6.
(PD.09) Police, prison and physician, Jesani Amar: Medical Ethics, Vol. 3, No. 4, OctoberDecember 1995, pp.58 (Editorial).
(PD.08) Supreme court judgement violates medical ethics, Jesani Amar: Medical Ethics,
Vol. 3, No. 3, July-September 1995, pp.38 (Editorial).
(PD.07) The doctor’s dilemma: A supreme court judgement on death by hanging
violates medical ethics, Jesani Amar, Vadair Asha: Humanscape, March 1995, pp.12-3
(PD.06) Violence and the ethical responsibility of the medical profession, Jesani Amar:
Medical Ethics, Vol.: 3 No: 1, January-March 1995, pp.3-5.
(PD.05) Medical Ethics: In the context of increasing violence, Jesani Amar (Presented at
the Indian Medical Association workshop on “Medical Ethics and Ethos in Cases of Torture,
at New Delhi from November 25 to 27, 1994): pp.7. (Published in the Workshop Report, New
Delhi: IMA, pp.52-56).
(PD.04) Slippery slopes of Nazi medicine, Jesani Amar: Economic and Political Weekly,
Vol. XXIX, No. 43, October 22, 1994, pp.2805-2807. (Review Article).
(PD.03) When medicine went mad: Bioethics and the Holocaust, Jesani Amar: Medical
Ethics, Vol. 2, No. 1, August-October 1994, pp.10-11. (Book Review).
(PD.02) Doctors and hunger strikers, Jesani Amar: Humanscape, June 1994, pp.7-9 & 29).
(PD.01) Repression of health professionals, Jesani Amar: Economic and Political Weekly,
October 5, 1991, pp.2291-2.
CEHAT, Mumbai, India
INTERNATIONAL CONFERENCE
ON
PREVENTING VIOLENCE, CARING FOR
SURVIVORS:
Role of Health Profession and Service in Violence
November 28 to 30, 1998
MODEL AUTOPSY PROTOCOL
Organised by:
CEHAT
Research Centre of Anusandhan Trust
Mumbai - 400 058
Presented by
HENRI TIPHAGNE,
Director, People’s Watch - Tamil Nadu
Madurai 625 002, INDIA
MODEL AUTOPSY PROTOCOL
A. Introduction
Difficult or sensitive cases should ideally be the responsibility of an objective,
experienced, well-equipped and well-trained prosector (the person performing the autopsy
and preparing the written report) who is separate from any potentially involved political
organization or entity. Unfortunately, this ideal is often unattainable, this proposed model
autopsy protocol includes a comprehensive checklist of the steps in a basic forensic post
mortem examination that should be followed to the extent possible given the resources
available. Use of this autopsy protocol will permit early and final resolution of potentially
controversial cases and will thwart the speculation and innuendo that are fueled by
unanswered, partially answered or poorly answered questions in the investigation of an
apparently suspicious death.
This model autopsy protocol is intended to have several applications and may be of
value to the following categories of individuals:
(a)
Experienced forensic pathologists may follow this model autopsy protocol to
ensure a systematic examination and to facilitate meaningful positive or negative
criticism by later observers. While trained pathologists may justifiably abridge
certain aspects of the postmortem examination or written descriptions of their
findings in routine cases, abridged examinations or reports are never appropriate
inpotentially controversial cases. Rather, a systematic and comprehensive
examination and report are required to prevent the omission, or loss of important
details;
(b)
General pathologists or other physicians who have not been trained in forensic
pathology but are familiar with basic post-mortem examination techniques may
supplement their customary autopsy procedures with this model autopsy protocol.
It may also alert them to situations in which they should seek consultation, as
written material cannot replace the knowledge gained through experience;
(c)
Independent consultants whose expertise has been requested in observing,
performing or reviewing an autopsy may cite this model autopsy protocol and its
proposed minimum criteria as a basis for their actions or opinions;
(d)
Governmental authorities, international, political organizations, law enforcement
agencies, families or friends of decedents, or representatives of potential
defendants charged with responsibility for a death may use this model autopsy
protocol to establish appropriate procedures for the post-mortem examination prior
' to its performance;
(e)
Historians, journalists, attorneys, judges, other physicians and representatives of
the public may also use this model autopsy protocol as a benchmark for
evaluating an autopsy and its findings;
(f)
Governments or individuals who are attempting either to establish or upgrade their
medico-legal system for investigating deaths may use this model autopsy protocol
as a guideline, representing the procedures and goals to be incorporated into an
ideal medico-legal system.
While performing any medicolegal death investigation, the prosector should collect
information that will establish the identify of the deceased, the time and place of death, the
cause of death, and the manner or mode of death (homicide, suicide, accident or natural).
It is of the utmost importance that an autopsy performed following a controversial
death be thorough in scope. The documentation and recording of the autopsy findings
should be equally thorough so as to permit meaningful use of the autopsy results (see annex
II, below). It is important to have as few omissions or discrepancies as possible, as
proponents of different interpretations of a case may take advantage of any perceived
shortcomings in the investigation. An autopsy performed in a controversial death should
meet certain minimum criteria if the autopsy report is to be proffered as meaningful or
conclusive by the prosector, the autopsy's sponsoring agency or governmental unit, or
anyone else attempting to make use of such an autopsy’s findings or conclusions.
This model autopsy protocol is designed to be used in diverse situations. Resources
such as autopsy rooms. Xray equipment or adequately trained personnel are not available
everywhere. Forensic pathologists must operate under widely divergent political systems. In
addition, social and religious customs vary widely throughout the world; an autopsy is an
expected and routine procedure in some areas, while it is abhorred in others. A prosector,
therefore, may not always be able to follow all of the steps in this protocol when performing
autopsies. Variation from this protocol may be inevitable or even preferable in some cases. It
is suggested, however, that any major deviations, with the supporting reasons, should be
noted.
It is important that the body should be made available to the prosector for a minimum
of 12 hours in order to assure an adequate and unhurried examination. Unrealistic limits or
conditions are occasionally placed upon the prosector with respect to the length of time
permitted for the examination or the circumstances under which an examination is allowed.
When conditions are imposed, the prosector should be able to refuse to perform a
compromised examination and should prepare a report explaining this position. Such a
refusal should not be interpreted as indicating that an examination was unnecessary or
inappropriate. If the prosecutor decides to proceed with the examination notwithstanding
difficult conditions or circumstances, he or she should include in the autopsy report an
explanation of the limitations or impediments.
People's Watch - Tamilnadu
2
Certain steps in this model autopsy protocol have been emphasized by the use of
boldface type. These represent the most essential elements of the protocol.
B. Proposed model autopsy protocol
I.Scene Investigation
The prosector(s) and medical investigators should have the right of access to the
scene where the body is found. The medical personnel should be notified immediately to
assure that no alteration of the body has occurred. If access to the scene was denied, if the
body was altered or if information was withheld, this should be stated in the prosector's
report.
A system for co-ordination between the medical and non-medical investigators (e.g.
law enforcement agencies) should be established. This should address such issues as how
the prosector will be notified and who will be in charge of the scene. Obtaining certain types
of evidence is often the role of the non-medical investigators, but the medical investigators
who have access to the body at the scene of death should perform the following steps:
(a)
Photograph the body as it is found and after it has been moved;
(b)
Record the body position and condition, including body warmth or coolness,
lividity and rigidity;
(c)
Protect the deceased’s hands, e.g. with paper bags;
(d)
Note the ambient temperature. In cases where the time of death is an issue,
rectal temperature should be recorded and any insects present should be
collected for forensic entomological study. Which procedure is applicable will
depend on the length of the apparent post-mortem interval;
(e)
Examine the scene for blood, as this may be useful in identifying suspects;
(f)
Record the identities of all persons at the scene;
(g)
Obtain information from scene witnesses, including those who last saw the
decedent alive, and when, where and under what circumstances. Interview any
emergency medical personnel who may have had contact with the body;
(h) Obtain identification of the body and other pertinent information from friends or
relatives. Obtain the deceased's medical history from his or her physician(s) and
hospital charts, including any previous surgery, alcohol or drug use, suicide
attempts and habits;
(i)
Place the body in a body pouch or its equivalent. Save this pouch after the
body has been removed from it;
(j)
Store the body in a secure refrigerated location so that tampering with the body
and its evidence cannot occur;
(k)
Make sure that projectiles, guns, knives and other weapons are available for
examination by the responsible medical personnel;
People's Watch - Tamilnadu
3
If the decedent was hospitalized prior to death, obtain admission or blood
(I)
specimens and any X-rays, and review and summarize hospital records;
(m)
Before beginning the autopsy, become familiar with the types of torture or
violence that are prevalent in that country or local (see annex III).
2. Autopsy
The following Protocol should be followed during the autopsy;
(a) Record the date, starting and finishing times, and place of the autopsy ( a
complex autopsy may take as long as an entire working day);
(b) Record the name (s) of the prosector(s), the participating assistant(s), and
all other persons present during the autopsy, including the medical and/or
scientific degrees and professional, political or administrative affiliations (s) of
each. Each person's role in the autopsy should be indicated, and one person
should be designated as the principal prosector who will have the authority to
direct the performance of the autopsy. Observers and other team members are
subject to direction by, and should not interfere with, the principal prosector. The
time (s) during the autopsy when each person is present should be included. The
use of a “sign-n" sheet is recommended;
(c) Adequate Photographs are crucial for thorough documentation of autopsy
findings;
(i) Photographs should be in colour (transparency or negative/print), in focus,
adequately illuminated, and taken by a professional or good quality camera.
Each photograph should contain a ruled reference scale, an identifying case
name or number, and a sample of standard grey. A description of the camera
(including the lens “f-number” and focal length), film and the lighting system must
be included in the autopsy report. If more than one camera is utilized, the
identifying information should be recorded for each. Photographs should also
include information indicating which camera took each picture, if more than one
camera is used. The identify of the person taking the photographs should be
recorded.
Serial photographs reflecting the course of the external examination must
(ii)
be included. Photograph the body prior to and following undressing,
washing or cleaning and shaving;
Supplement close-up photographs with distant and/or immediate range
(iii)
photographs to permit orientation and identification of the close-up
photographs;
(iv)
Photographs should be comprehensive in scope and must confirm the
presence of all demonstrable signs of injury or disease commented upon in
the autopsy report;
People's Watch - Tamilnadu
4
(v)
identifying facial features should be portrayed (after washing or cleaning
the body), with photographs of a full frontal aspect of the face, and right and
left profiles of the face with hair in normal position and with hair retracted, if
necessary, to reveal the ears;
(d)
Radiograph the body before it is removed from its pouch or wrappings. X-rays
should be repeated both before and after undressing the body. Fluoroscopy may
also be performed. Photograph all X-ray films;
(i)
Obtain dental X-rays, even if identification has been established in other ways;
(ii) Document any skeletal system injury by X-ray. Skeletal X-rays may also
record anatomic defects or surgical procedures. Check especially for fractures of
the fingers, toes and other bones in the hands and feet. Skeletal X-rays may also
aid in the identification of the deceased, by detecting identifying characteristics,
estimating age and height, and determining sex and race. Frontal sinus films
should also be taken, as these can be particularly useful for identification
purposes;
(iii) Take X-rays in gunshot cases to aid in locating the projectile (s). Recover,
photograph and save any projectile or major projectile fragment that is seen on an
X-ray. Other radio-opaque objects (pacemakers, artificial joints or valves, knife
fragments etc.) documented with X-rays should also be removed, photographed
and saved;
(iv) Skeletal X-rays are essential in children to assist in determining age and
developmental status;
(e)
Before the clothing is removed, examine the body and the clothing,
Photograph the clothed body. Record any jewelry present;
(f)
The clothing should be carefully removed over a clean sheet or body pouch. Let
the clothing dry if it is bloody or wet. Describe the clothing that is removed and
label it in a permanent fashion. Either place the clothes in the custody of a
responsible persons or keep them, as they may be useful as evidence or for
identification.
(g)
The external examination, focusing on a search for external evidence of injury is,
in most cases, the most important portion of the autopsy;
(i)
Photograph all surfaces- 100 percent of the body area. Take good quality,
well-focused, colour photographs with adequate illumination;
(ii)
Describe and document the means used to make the identification. Examine the
body and record the deceased's apparent age, length, weight, sex, head, hair
style and length, nutritional status, muscular development and colour of skin, eyes
and hair (head, facial and body);
People's Watch - Tamilnadu
5
In children, measure also the head circumference, crown-rump length and crown
(iii)
heel length;
(iv)
Record the degree, location and fixation of rigor and livor mortis;
(v)
Note
body
warmth
or
coolness
and
state
of preservation;
note
any
decomposition changes, such as skin slippage. Evaluate the general
condition of the body and note adipocere formation, maggots, eggs or
anything else that suggests the time or place of death;
(vi)
With all injuries, record the size, shape, pattern, location, (related to obvious
anatomic landmarks), colour, course, direction, depth and structure involved.
Attempt to distinguish injuries resulting from therapeutic measures from
those unrelated to medical treatment. In the description of projectile wounds,
note the presence or absence of soot, gunpowder, or singeing. If gunshot residue
is present, document it photographically and save it for analysis. Attempt to
determine whether the gunshot wound is an entry or exit wound. If an entry
wound is present and no exit wound is seen, the projectile must be found
and saved or accounted for. Excise wound tract tissue samples for
microscopic examination. Tape together the edges of knife wounds to
assess the blade size and characteristics;
(vii)
Photograph all injuries, taking two colour pictures of each, labeled with the
autopsy identification number on a scale that is oriented parallel or perpendicular
to the injury. Shave hair where necessary to clarify an injury, and take
photographs before and after shaving. Save all hair removed from the site of the
injury. Take photographs before and after washing the site of any injury. Wash the
body only after any blood or material that may have come from an assailant has
been collected and saved;
(viii)
Examine the skin. Note and photograph any scars, areas of keloid
formation, tattoos, prominent moles, areas of increased or decreased
pigmentation, and anything distinctive or unique such as birthmarks. Note
any bruises and incise them for delineation
of their extent. Excise them for
microscopic examination. The head and genital area should be checked with
special care. Note any injection sites or puncture wounds and excise them to
Note any abrasions and
use for toxicological evaluation.
excise them;
microscopic sections may be useful for attempting to date the time of injury. Note
any bite marks; these should be photographed to record the dental pattern,
swabbed for saliva testing (before the body is washed) and excised for
microscopic examination. Bite marks should also be analyzed by a forensic
odontologist, if possible. Note any burn marks and attempt to determine the
cause (burning rubber, a cigarette, electricity, a blowtorch, acid, hot oil etc). Excise
People's Watch - Tamilnadu
6
any suspicious areas, for microscopic examination, as it may be possible to
distinguish microscopically between burns caused by electricity and those caused
by heat;
(ix) Identify and label any foreign object that is recovered, including its relation to
specific injuries. Do not scratch the sides or tip of any projectiles. Photograph
each projectile and large projectile fragment with on identifying label, and
then place each in a sealed, padded and labelled container in order to
maintain the chain in custody.
(x) Collect a blood specimen of atleast 50cc from a subclavian or femoral vessel;
(xi) Examine the head and external scalp, bearing in mind that injuries may be
hidden by the hair. Shave hair where necessary. Check for fleas and lice, as
these may indicate unsanitary conditions prior to death. Note any aiopecia
as this may be caused by malnutrition, heavy metals (e.g. thallium), drugs or
traction. Pull, do not cut, 20 representative head hairs and save them, as
hair may also be useful for detecting some drugs and poisons,
(xii) Examine the teeth and note their condition. Record any
that are absent,
loose or damaged, and record all dental work ( restorations, fillings etc.,), using a
dental identification system to identify each tooth. Check the gums for periodontal
disease. Photograph dentures, if any, and save them if the decedent’s identity is
unknown. Remove the mandible and maxilla. If necessary for identification. Check
the inside of the mouth and note any evidence of trauma, injection sites,
needle marks or biting of the lips, cheeks or tongue. Note any articles or
substances in the mouth. In cases of suspected sexual assault, save oral fluid or
get a swab for spermatozoa and acid phosphatase evaluation. (Swabs taken at
the tooth-gum junction and samples from between the teeth provide the best
specimens for identifying spermatozoa). Also take swabs from the oral cavity for
seminal fluid typing. Dry the swabs quickly with cool, blown air if possible, and
preserve them in clean plain paper envelopes. If rigor mortis prevents an
adequate examination, the masseter muscles may be cut to permit better
exposure;
(xiii)
a.
Examine the face and note if it is cyanotic or if petechiae are present;
Examine the eyes and view the conjunctiva of both the globes and the eyelids.
Note any petechiae in the upper or lower eyelids. Note any scleral icterus. Save
contact lenses, if any are present. Collect at least 1 ml of vitreous humor
from each eye;
People's Watch - Tamilnadu
7
(h)
The internal examination for internal evidence of injury should clarify and augment
the external examination;
(i) Be systematic in the internal examination. Perform the examination either by
body regions or by systems, including the cardiovascular, respiratory,
biliary,
gastrointestinal,
reticuloendothelial,
genitourinary,
endocrine,
musculoskeletal, and central nervous systems. Record the weight, size,
shape, colour and consistency of each organ, and note any neoplasia,
inflammation, anamolies, hemorrhage, ischemia, infarcts, surgical procedures or
injuries. Take sections of normal and any abnormal areas of each organ for
microscopic examination. Take samples of any fractured bones of the age of
the fracture;
Examine the chest. Note any abnormalities of the breasts. Record any rib
(ii)
fractures, noting whether cardiopulmonary resuscitation was attempted.
Before opening, check for pneumothoraces. Record the thickness of
subcutaneous fat. Immediately after opening the chest, evaluate the pleural
cavities and the pericardial sac for the presence of blood or other fluid, and
describe and quantity any fluid present. Save any fluid present until foreign
objects are accounted for. Note the presence of air embolism, characterized
by frothy blood within the right atrium and right ventricle. Trace any injuries
before removing the organs. If blood is not available at other sites, collect a
sample directly from the heart. Examine the heart, noting degree and
location of coronary artery disease or other abnormalities. Examine the
lungs, noting any abnormalities;
(iii)
Examine the abdomen and record the amount of subcutaneous fat. Retain 50
grams of adipose tissue for toxicological evaluation. Note the inter relationships of
the organs. Trace any injuries before removing the organs. Note any fluid or
blood present in the peritoneal cavity, and save it until foreign objects are
accounted for. Save all urine and bile for toxicologic examination;
(iv) Remove, examine and record the quantitative information on the liver, spleen,
pancreas, kidneys and adrenal glands. Save atleast 150 grams each of kidney
and liver for toxicological evaluation. Remove the gastrointestinal tract and
examine the contents. Note any food present and its degree of digestion. Save
the contents of the stomach. If a more detailed toxicological evaluation is
desired, the contents of other regions of the gastrointestinal tract may be saved.
Examine the rectum and anus for burns, lacerations or other injuries. Locate and
retain any foreign bodies present. Examine the aorta, inferior vena cava and
iliac vessels;
People's Watch - Tamilnadu
9
b. Examine the nose and ears and note any evidence of trauma, hemorrhage or
other abnormalities. Examine the tympanic membranes;
(xiv)
Examine the neck externally on all aspects and note any contusions, abrasions
or petechiae. Describe and document injury patterns to differentiate manual,
ligature and hanging strangulation. Examine the neck at the conclusion of the
autopsy, when the blood has drained out of the area and the tissues are dry;
(xv)
Examine all surfaces of the extremities: arms, forearms, wrists, hands, legs
and feet, and note any "defence" wounds. Dissect and describe any injuries.
Note any bruises about the wrists or ankles that may suggest restraints such as
handcuffs or suspension. Examine the medial and lateral surfaces of the fingers,
the anterior forearms and the backs of the knees for bruises;
(xvi)
Note any broken or missing fingernails. Note any gun powder residue on the
hands, document photographically and save it for analysis. Take fingerprints in
all cases. If the decedent’s identify is unknown and fingerprints cannot be
obtained, remove the “glove” of the skin, if present. Save the fingers no other
means of obtaining fingerprints is possible. Save fingernail clippings and any
under-nail tissue (nail scrapings). Examine the fingernail and toenail beds for
evidence of objects having been pushed beneath the nails. Nails can be removed
by dissecting the lateral margins and proximal base, and then the under surface of
the nails can be inspected. If this is done,
the hands must be photographed
before and after the nails are removed. Carefully examine the soles of the feet,
noting any evidence of beating. Incise the soles to delineate the extent of any
injuries. Examine the palms and knees, looking especially for glass shards or
lacerations;
(xvii) Examine the external genitalia and note the presence of any foreign material
or semen. Note the size, location and number of any abrasions or contusions.
Note any injury to the inner thighs or peri-anal area. Look for peri-anal burns;
(xviii) In cases of suspected sexual assault, examine all potentially involved orifices.
A speculum should be used to examine the vaginal walls. Collect foreign hair by
combing the pubic hair. Pull and save al least 20 of the deceased's own pubic
hairs, including roots. Aspirate fluid from the vagina and/or rectum for acid
phosphatase, blood group and spermatozoa evaluation. Take swabs from the
same areas for seminal fluid typing. Dry the swabs quickly with cool, blown air if
possible, and preserve them in clean plain paper envelopes;
(xix) The length of the back, the buttocks and extremities including wrists and ankles
must be systematically incised to look for deep injuries. The shoulders, elbows,
hips and knee joints must also be incised to look for ligamentous injury;
People's Watch - Tamilnadu
8
(v) Examine the organs in the pelvis, including ovaries, fallopian tubes, uterus,
vagina testes, prostate gland, seminal vesicles, urethra and urinary bladder. Trace
any injuries before removing the organs. Remove these organs carefully so as
not to injure them artifactually.
Note any evidence of previous or current
pregnancy, miscarriage or delivery. Save any foreign objects within the cervix,
uterus, vagina, urethra or rectum;
(vi)
Palpate the head and examine the external and internal surfaces of the scalp,
noting any trauma or hemorrhage. Note any skull fractures. Remove the
calvarium carefully and note epidural and subdural haematomas. Quantify, date
and save any haematomas that are present. Remove the dura to examine the
internal surface of the skull for fractures. Remove the brain and note any
abnormalities. Dissect and describe any injuries. Cerebral cortical atrophy,
whether focal or generalized, should be specifically commented upon;
(vii)
Evaluate the cerebral vessels. Save at least 150 grams of cerebral tissue for
toxicological evaluation. Submerge the brain in fixative prior to examination, if this
is indicated;
(viii)
Examine the neck after the heart and brain have been removed and the
neck vessels have been drained. Remove the neck organs, taking care not
to fracture the hyoid bone. Dissect and describe any injuries. Check the
mucosa of the larynx, pyriform sinuses and esophagus, and note anyh petechiae,
edema or burns caused by corrosive substances. Note any articles or substances
within the lumina of these structures. Examine the thyroid gland. Separate and
examine the parathyroid glands, if they are readily identifiable;
(ix)
Dissect the neck muscles, noting any haemorrhage. Remove all organs, including
the tongue. Dissect the muscles from the bones and note any fractures of the
hyoid bone or thyroid or cricoid cartilages;
(x) Examine the cervical, thoracic and lumbar spine. Examine the vertebrae from
their anterior aspects and note any fractures, dislocations, compressions or
haemorrhages. Examine the vertebral bodies. Cerebrospinal fluid may be
obtained if additional toxicological evaluation is indicated;
(xi) In cases in which spinal injury is suspected, dissect and describe the
spinal cord. Examine the cervical spine anteriorly and note any haemorrhage in
the paravertebral muscles. The posterior approach is best for evaluating high
cervical injuries. Open the spinal canal and remove the spinal cord. Make
transverse sections every 0.5 cm and note any abnormalities;
(xii) After the autopsy has been completed, record which specimens have been
saved. Label all specimens with the name of the deceased, the autopsy
identification number, the date and time of collection, the name of the prosector
People's Watch - Tamilnadu
10
and the contents. Carefully preserve ail evidence and record the chain of
custody with appropriate release forms;
(I) Perform appropriate toxicologic tests and retain portions of the tested
samples to permit retesting;
a. Tissues: 150 grams of liver and kidney should be saved routinely. Brain, hair
and adipose tissue may be saved for additional studies in cases where drugs,
poisons or other toxic substances are suspected;
b.
Fluids: 50 cc (if possible) of blood (spin and save serum in all or some of the
tubes), all available urine, vitreous humor and stomach contents should be
saved routinely. Bile, regional gastrointestinal tract contents and cerebrospinal
fluid should be saved in cases where drugs, poisons or toxic substances are
suspected. Oral, vaginal and rectal fluid should be saved in cases of suspected
sexual assault;
(ii) Representative samples of all major organs, including areas of normal and
any abnormal tissue, should be processed histologically and stained with
hematoxylin and eosin (and other stains as indicated). The slides, wet tissue
and paraffin blocks should be kept indefinitely;
(iii) Evidence that must be saved includes;
a. all foreign objects, including projectiles, projectile fragments, pellets, knives and
fibres. Projectiles must be subjected to ballistic analysis;
b. All clothes and personal effects of the deceased, worn by or in the possession
of the deceased at the time of death;
c.
Fingernails and under nail scraphings;
d.
Hair, foreign and pubic, in cases of suspected sexual assault;
e.
Head hair, in cases where the place of death or location of the body prior to its
discovery may be an issue;
G) After the autopsy, all unretained organs should be replaced in the body, and
the body should be well embalmed to facilitate a second autopsy in case one is
desired at some future point;
(k) The written autopsy report should address those items that are emphasized in
boldface type in the protocol. At the end of the autopsy report should be a
summary of the findings and the cause of death. This should include the
prosector's comments attributing any injuries to external trauma, therapeutic
efforts, post-mortem change, or other causes. A full report should be given to
the appropriate authorities and to the deceased’s family.
Evolved in a Workshop on drawing up the Model Autopsy Protocol jointly organised by People's
Watch - Tamil Nadu and Indian Institute of Medicine.
People's Watch - Tamilnadu
11
Crisis in Bhutan
Introd action:
Location: Perched in the Himalayas with India to the east, west and south and Tibet the Autonomous
Region of China in the north.
Area: 46.500 sq. km.
Population Three major ethnic groups namely
a)
Ngalongs, who are of Tibeto-Mongoloid origin and established themselves in Bhutan around lo"1
century They comprise around 16% of the country's total population and are predominant in the
fertile valleys of Ha. Paro, Thimphu. YVangdiphodrang. Punakha in the north-western part of the
country The ruling elite belong to this group
b)
Sarchops are of Indo-Burmese and Mongoloid origin and are believed to have settled m Bhutan in
7" century and are considered to be the original inhabitants of Bhutan. They comprise about 33%
of the country's total population and are found in the districts of Shemgang. Tongsa. Bumthang.
Lhuntsi, Mongar, Tashiyangtse, Tashigang. Pemagatsel. northern pan of Samdrupjongkhar, in the
eastern and central Bhutan.
c)
Lhotsampas are Nepali speaking people and the first batch is believed to have migrated in
1624.AD but their migration continued al different periods of time on Bhutan s initiation fhis
group comprise about 45% of the country's total population. They are settled in the districts of
Samchi. Chhukha. Sarbhang. Chirang. Dagana and Samdrupjongkhar in southern Bhutan
There are other minor ethnic groups such as Doyas. Brokpas. Totas. Santhals. Adivasis etc who
comprise about 1% of the country's total population and are
country.
scattered in different parts ol the
Languages: Dzongkha. literally the language of the fort i e . the rulers, is lhe language spoken by the
Ngalongs and is the National language of Bhutan. Tsangla. the language spoken by lhe Sarchops
covers several dialects in different areas. It does not have any script of ils own. Nepali, the language
spoken by the people in the south, which once was accorded official recognition and taught in school.
is now abolished
Religion: Buddhism is the stale religion of Bhutan but there are other religions practised by different
communities. The Ngalongs are the followers of Drukpa Kargyupa sect of Buddhism while Sarchops
follow Nyingmapa sect
People in the south are mostly Hindus though there are quite a good number
of Buddhists amongst them. Recently Christianity has made in roads in Bhutan though there is
restriction in practising it openly.
System of Government:
Monarchy: Bhutan is under absolute monarchy system since sir Ugyen Wangchuk was crowned as
the first king of Bhutan in 1907 Bhutan has no written constitution or a bill of rights The words of
the king becomes law. Ring is the head of the stale and the government. He is the highest court of
appeal and commander-in-chief of lhe country's armed forces The third king Jigme Dorji Wangchuk
introduced some constitutional reforms and during the 30the session of lhe National Assembly in
1969 introduced the system of seeking the vote of confidence in the National assembly by the ruler
once in three years. Soon after his passing away and a year after the present king's accession to the
1
throne the 39dl session of the national assembly in 1973 annulled the resolution of the 30dl national
assembly.
The king is vested with unlimited powers. He and his coterie wield absolute power in all matters of
the country There is no freedom of expression -and assembly Opposition to the government and its
policies is not tolerated and is considered an act of treachery and liable for capital punishment.
Formation of union or organisation is not permitted
Legislative Body: Tshogdu or the National Assembly of Bhutan was established in 1953 It
comprises of 151 members, of them 105 are elected’ for a period of three years. 33 are nominated by
the king and 13 by monk body Representation is grossly unfair and not proportionate to the
country's ethnic composition and geographical distribution of population For instance there are only
14 members to represent 45% Lholsampas (Southern Bhutanese) from five districts, where as there
are 34 members representing the Ngalong community who are around 16% of the country’s total
population.
The members are not elected through ballots but are nominated or hand picked by the government
authorities. The members are not free to raise issues concerning the people So a member holds the
office as the peoples’ representative so long he enjoys the confidence of the government In 1988
when the member of the Royal Advisory' Council Mr Tek Nath Rizal petitioned the king to apprise
him about the high-handed approach of the census officials and sought his intervention. Mr. Rizal not
only lost his job as a peoples' representative but was also arrested, tortured for four days and declared
his move, a treachery' and anti-national When in 1988 he fled to Nepal and started his campaign
against the injustice meted out to the Bhutanese people, he was abducted, taken to Bhutan and put in
He is still languishing in prison tn Bhutan despite Amnesty International and other
prison
international communities repeated appeal to release him. Therefore, it can be said that the National
Assembly' of Bhutan is merely an institution used to give legitimacy to the government’s claim that
Bhutan has a constitutional monarchy.
Royal Advisory Council: In 1963 Lodoe Tshogdu or the Royal Advisory' Council was established
supposedly to advise the king and the ministers on the day to day affairs of the country. It consists of
ten members who are also the members of the National Assembly by virtue of being counsellors.
Council of Ministers: King directly appoints the ministers who font! his council of ministers. Their
job is to help the king in the day' to day affairs of the country'. Usually' the ministers hold office so
long they enjoy the confidence of the king, it can be even for life if he manages to satisfy the king.
Recently’ the king fired six of his ministers and appointed new ones who were earlier serving as
deputy ministers in their respective ministries
Dzongdhags: They are the district administrators appointed by the government. They are first class
officers addressed to as dashos or nobility. They exercise full executive and legislative powers and
very often than not the powers arc misused to suppress the people and please the higher authorities.
■Judiciary: Bhutan has laws promulgated by Sabdrung Ngawang Namgyal in the 16dl century' Though
most of the laws have become obsolete and are not in conformity of the international laws they are
still enforced. The country’s judiciary too is not free from interference of the government Courts
merely function as institutions to further the interests of the rulers. It is not a norm to try' political and
Human rights activist in the court but occasionally shame trials are arranged in order to legitimise
detention of political and human right activists.
Contrary to all international norms, in Bhutan a person is held guilty unless proved otherwise. There
are no qualified or professional lawyers and one need not necessarily be a graduate in law or versed
in county's law to become a judge There is no system where by a defendant can lake the help of a
defence counsel. The Jambis who are supposed to do this job too are not qualified to carry out their
jobs. The name Thrim Khang literally means the house of punishment, the Bhutanese court are used
to punish the people and settle scores rather than a house for imparling justice.
the country has only one radio station. Bhutan Broadcasting Service, BBS and only one weekly news
bulletin Kuensel Both are owned by the stale and are mouth piece of the government often used as
machinery for government propaganda. No private owned news papers or any publications are
allowed Watching television is banned and offenders are liable for fine or imprisonment or both
Only selected or censored news papers and magazines from outside are allowed to be sold in the
country
Genesis of the Current Problem:
The crux of the current problem is due to the inherent weakness in the institution and its attempt to
protect and perpetuate the interest of a few ruling elite through enactment of series of discriminatory
laws.
Citizenship Act: When the government had hardly completed issuing the Citizenship Identity Cards
after the nation wide census of 1982 fresh census exercise was initiated in 1988 targeting only one
community on the basis of newly enacted citizenship Act of 1985 Government adopted high handed
and unreasonable measures to determine the nationality of a person People were asked to produce
thirty years old land lax receipt in order to prove their domicile in the country. Those who failed to
produce these documents had their citizenship revoked and declared non-nationals People were
divided into seven categories viz.. Fl, F2. F3. F4. F5. F6,
F7 and people who were living in
Bhutan for generations as bona fide citizens of the country faced the possibility of immediate
expulsion
It was obvious that the government intended to reduce the population of the one particular
community, as the census team relused to accept the land tax receipt even prior to that of 1958 The
manner in which the census team conducted the census exercise created terror and apprehension
among the ordinary village populace and intellectuals as well People requested the then peoples'
representative from the south and member of the Royal Advisory Council Mr. Tek Nath Rjzal to
apprise the king on the matter. On April 9. 1988 Mr. Rizal petitioned the king seeking his immediate
intervention. However, the Government regarded this as an act of treason and Nir. Rizal was stripped
of hrs position as a counsellor and member of the legislative Assembly. He was arrested and after four
days of torture and interrogation he was forced to make an undertaking stipulating that he would not
meet more than three persons at a time and would remain confined to his home town. The humiliation
meted out to their representative sent shock waves through out the country and ended hopes of the
people to gel justice by such means
Green Belt Policy: The government's motif to depopulate the southern Bhutan became known when
it forwarded its plan to create one kilometre wide forest corridor along the southern border with India.
The plan would have covered most of the Bhutan's cultivable land and would have displaced 20-30
percent of local population from their ancestral land However, it was abandoned when the donors
refused to fund the project seeing the elaborate plan of displacing a sizeable population and
destroying prime agricultural land.
3
Driglam N’aniza: Under the slogan of "One Nation One People", Driglam Narnza (code of etiquette)
was introduced. The law requires all the Bhutanese regardless of their ethnic and religious -
traditional background, to speak one prescribed language, don prescribed dress and follow prescribed
customs and traditions The rule demands strict adherence by all and any one found to be violating the
rule as liable for fine or imprisonment or both Following the introduction of ‘One Nation One
people' policy the lingua franca mother tongue of the people in southern Bhutan has been dropped
from the school curriculum since 1989 The textbooks were burnt in the open school grounds and in
some instances their traditional dress burnt or tom Restriction has been imposed on free practices of
culture and religion.
Forced Labour and Conscription: People are asked to provide free labour to the government.
sometimes even to the private estates owned by the nobility and the royal family. Through the system
of various forms of voluntary labour like. Goongdawoola. Seplolemi, Chunidum etc. people are
required to work with out any wage or allowance. Failure to do so invite punitive measure People are
also forced to sign contracts and work on low wages m the construction sites in the remote areas.
Such imposition naturally brought resentment among other ethnic groups who are following their own
distinct culture and customs and traditions as this would mean forgoing their own customs and
traditions they value so much This added more frustration created due to census exercises. The
dissension culminated into first ever peaceful rallies tn all the five districts of southern Bhutan during
September - October 1990. The government called out the army from their barracks and let loose on
the demonstrators. The aftermath was rape, mass torture, killing, arrest and imprisonment of hundreds
of people. Schools were closed down and turned into army barracks and prisons.
The demonstration was labelled as ’armed rebellion' by the Government and all those who took part
in the peaceful demonstration were branded as 'Ngolops' or anti-national. RGOB
deployed the
military in the six districts of southern Bhutan leading to mass arrests, arbitrary detention, looting.
plunder, rape, torture and hunting down of the pro-democracy and Human rights activists even outside
the country with the help of antisocial elements or unlawful means All basic social facilities were
abruptly ceased with schools being turned into army barracks are detention centres, hospitals and
infirmaries being closed to the public, and the movement of essential commodities like common salt
and kerosene was banned. This resulted in. the people becoming apprehensive of the state sponsored
terrorism and systematic deprivation of the individual and family security, as a result of which they
had to flee the country' to save their life.
Encouraged by the exodus of the people, prominent citizens and the family members of these who
fled were targeted and harassed. Despite the atrocities, those who stayed back were ‘forced’ at gun
point to sign “Voluntary Migration Forms” stating that they decided to emigrate of their own free
will. They were paid nominal compensation and immediately expelled from the country. Over 100.000
people have been systematically evicted mostly between 1990 - 1993 They are now sheltered in seven
UNHCR administered refugee camps in Nepal Another 25000 Bhutanese people are scattered in the
North- eastern Slates of India.
Nepal Bhutan Talk: For the last five years Bhutan and Nepal are engaged in bilateral talks to find
out the solution to this refugee crisis Even eight rounds of ministerial level meeting between the two
countries has failed to achieve anything It has become evident that Bhutan is not keen to take back its
people and its engagement in the talk is a tactic to procrastinate the problem and prevent Nepal from
taking the refugee issue to the International Forum, India, which besides being Bhutan’s closest
neighbour and having tremendous influence over Bhutan's polity' and economy can play a crucial role
in finding a solution to problem. But it has been avoiding to get involved in the issue and is
overlooking the grave Human Rights violation taking place m the next door.
4
Present Crisis in the East: Ln the early nineties Bhutan government targeted every people in the
south and treated the whole community as terrorists or anti national It went around organising mass
meetings and fanning communal passions and instilling haired against the people in the south
Initially it seemed to he carried away and government succeeded in crushing the legitimate voice of
the people with iron hand. Gradually people came to know about the government’s real motif behind
the move The disenchantment among the Sarchop community which had been suppressed for years
began to surface and now it has developed into open dissension against the government Thus the
ploy of the government to give the movement of the people a communal colour failed The same army
which was used to crush the voice of the people in the south are now deployed in the east. The
government has been adopting the same methods of repression as it did in the south
In the recent past one monk was shot dead by a district administrator for taking part in the peaceful
demonstration More than 150 people have arrested for their involvement in the anti government
activities in peaceful manners. Thirteen Nyimapa
Shedras (religious Buddhist schools) have been
forced to close down. Recently fourteen Buddhist monks have been arrested. Even primary school
children have been arrested for their participation in the demonstration (it is important to know that
Sarchops-people m the east follow Nyimapa sect of Buddhism which is not tolerated by the ruling
elite belonging to Drukpa Kagyupa sect.! Amnesty International Report - Jan 1998)
Resettlement Program: Ln an effort to placate the people from the Sarchop and Ngalong community
government has initiated an ambitious plan to resettle them on the land belonging to the refugees and
other Lhotsampa community There are instances of people being forced to settle in the south by the
government Though the resettlement program was initiated in 1992 itself with the settlement of 58
families in Bhangtar it was only the 75dl session of the National Assembly of Bhutan that endorsed
the resettlement program. Following this, the work is going on in full swing. Already 436 houses in
Gaylegphug, 319
in Chirang have been resettled and similar work is going on in the districts of
Dagana. Samchi and Chhuka. This is bound to make the process of the refugee repatriation more
complex and difficult This might create tension between those who are resettled by the government
and the rightful owners of the land and plunge Bhutan further into era of clashes.
Expulsion of Civil Servants: Pursuing further its grand design of depopulation and disowning its
own people tn exile, the government has expelled 219 civil servants in various department from their
jobs in the first phase They all happen to be the relatives of those who are living in exile as refugees
and those who were involved in opposing the policies in 1990 and the government has declared that n
W'ould expel everyone with such record This would mean further eviction of people from Bhutan in
the days to come in a phased manner.
Change in the Ministry: Just a few days before the commencement of the 76th Session of the
National Assembly of Bhutan (NAB), His Majesty the king in a surprise move sacked six ministers
and nominated six bureaucrats to be “elected “ by the NAB. .Among those who were sacked are Home
Minister Dago Tshering. the chief architect of the refugee crisis (presently the Bhutanese Ambassador
to India), Dawa Tshering. the most astute and longest serving foreign minister and Om Pradhan. the
sole person from the Lhotsampa community
The king’s reform initiative have raise more eyebrows. Though it is claimed that henceforth the
ministers w'ould be elected by the NAB. we must know how free is the NA from government
influence, we must look into the composition of member and the manners in w'hich these members
find their way into the NAB. The house is filled with king's nominees and government appointees,
king alone has the power to nominate 33 members, while clergy can nominate 13, in addition there is
reservation for the business community. They are selected and nominated by the government. How can
these members be expected to go against the -wishes of His Majesty or the government. The king has
5
retained power to award portfolios to the 'elected' ministers which give him enough room for
manipulation
The task of selecting the new ministers and awarding them the portfolios has been done very
carefully Two bureaucrats from Sarchop community have been appointed considering the
deteriorating situation in the east and rising popularity of Druk National Congress, the party which
has been launching a crusade for democracy, people close to the palace have also found berths in the
ministry The present cabinet members though educated have been the staunch supporters of the
government and were working as deputy ministers and had been instrumental in implementing the
government's infamous policies. These ministers are expected to work more zealously in the interest
of the government rather than the people
Conclusion: Bhutanese people both inside and out side are passing the most difficult lime of their
lives due to the harsh policies of the government. Over 1 <«).(.».)() Bhutanese refugees who are living in
Nepal and tn different parts of India are desperate to go back But this can be possible only when
Royal Government of Bhutan slops its hostile policies and work with the people towards finding a
durable solution to the country's long standing problem Governments of different countries and other
International bodies should persuade Bhutan to positive steps that would lead to the peaceful
settlement of the problem and to the satisfaction of all the Bhutanese rather than the rulers only. India
, the largest democracy and the closest ally of Bhutan and bearing the major chunk of the financial aid
to Bhutan for its development and defence is seen and expected by all peace loving people to play an
active role in diffusing this refugee crisis at the earliest before it gets out of control
We the
Bhutanese people inside and outside the country sincerely believe that our closest neighbour will and
can help the Bhutanese people to live in peace and hannony once again in the long term interest of
both INDIA and Bhutan
Paper presented in die "International Conference on Preventing Violence. Caring for Survivors: Role of Health
Profession and Sendees in Violence". November 2S - 30 199S. Mumbai India
6
Note : TSA WA means main elements i e. King, country
and People Sum means three in Dzongkha, national
language of Bhutan. The National Assembly of Bhutan
confirmed and approved death punishment for offenses
against TSA WA SUM during its 69th session held be
tween March 19-26, 1990.
The Treaty of Sinchula, 1865
Article 1 : There shall henceforth be perpetual peace
and friendship between the British Government and the
Government of Bhutan.
Article 2 : Whereas in consequences of repeated ag
gressions of the Bhutan Government and of the refusal
of that Government to afford satisfaction for those ag
gression and of their insulting treatment of the officers
sent by His Excellency the Governor-General-in-Council for the purpose of procuring an amicable adjustment
of differences existing between the two States, the Brit
ish Government has been compelled to seize by an
armed force the whole of the Doars, bordering on the
District of Rungpoor, Cooch Behar and Assam, together
with the Talook of such point as may be laid down by the
British Commissioner appointed for the purpose is ceded
by the Bhutan Government to the British Government
for ever.
Article 3 : The Bhutan Government hereby agree to sur
render all British subjects as well as subjects of the Chiefs
of Sikkim and Cooch Behar who are now detained in
Bhutan against their will, and to place no impediment in
the way of the return of all or any or such persons into
British territory
30
Article 4 : In consideration of the cession by the Bhutan
Government of the Territories specified in Article 2 of
this Treaty and of the said Government having expressed
its regret for past misconduct, and having hereby en
gaged for the future to restrain all evil-disposed persons
from committing crimes within British territory or the ter
ritories of the Rajahs of Sikkim and Cooch Behar and to
give prompt and full redress for all such crimes which
may be committed in defiance of their commands, the
British Government agree to make an annual allowance
to the Government of Bhutan of a sum not exceeding
fifty thousand rupees (Rs. 50.000) to be paid to officers
not below the ranks of Jungpen, who shall be hereby
agreed that the payments shall be made as specified
below
On the fulfillment by the Bhutan Government of the con
ditions of this Treaty twenty-five thousand rupees (Rs
25,000).
On the 10tr' January following the 1s' payment, thirty-five
thousand rupees (Rs. 35.000).
On the 10" January following forty-five thousand rupees
(Rs 45,000).
On every succeeding 10tn January fifty thousand rupees
(Rs. 50,000).
Article 5 : The British Government will hold itself at lib
erty at any time to suspend the payment of this compen
sation money either in whole or in part in the event of
misconduct on the part of tne Bhutan Government or its
failure to check the aggression of its subjects or to com
ply with the provisions of this Treaty.
Article 6
: The British Government hereby agree, on de
31
mand being duly made in writing by the Bhutan Govern
ment, to surrender, under the provisions of Act VI of 1854,
of which a copy shall be furnished to the Bhutan Gov
ernment. all Bhutanese subjects accused of any of the
following crimes who may take refuge in British domin
ions. The crimes are murder, attempt to muroer, rape,
kidnapping, great personal violence, maiming, dacoity,
thugee, robbery, burglary, knowingly receiving property
obtained by dacoity, robbery or burglary, cattle stealing,
breaking and entering a dwelling house and stealing
therein, arson, setting fire to village, house, or town, forg
ery or uttering forged documents, counterfeiting current
coin, knowingly uttering base or counterfeit coin, per
jury, subordination of perjury, embezzlement by public
officers or other persons, and being an accessory to any
of the above offences.
Article 7 : The Bhutan Government hereby agree, on
requisition being duly made by or by the authority of the
Lieutenant Governor of Bengal, to surrender any British
subjects accused of any of the crimes specified in the
above Article who may take refuge in the territory under
the jurisdiction of the Bhutan Government, and also any
Bhutanese subjects who, after committing any of the
above crimes in British Territory, shall flee into Bhutan,
on such evidence of their guilt being produced as shall
satisfy the Local Court of the district in which the of
fence may have been committed
Article 8 : The Bhutan Government hereby agree to re
fer to the arbitration of the British Government in all dis
putes with, or causes of complaint against, tne Rajahs
of Sikkim and Cooch Behar, and to abide by the deci
sion of the British Government: and the British Govern
ment hereby engage to enquire into and settle all such
32
disputes and complaints in such manner as justice may
require, and to insist on the observance of the decision
by the Rajahs of Sikkim and Cooch Behar.
Article 9 There snail be free trade and commerce be
tween the two governments. No duties shall be levied
on Bhutanese goods imported into Bntish territories nor
shall the Bhutan Government levy any duties on British
goods imported into, or transported through, the Bhutan
territories. Bhutanese subjects residing in British terri
tories shall have equal justice with British subjects and
British subjects residing in Bhutan snail have equal jus
tice with the subjects of the Bhutan Government.
Article 10 . The present Treaty of Ten Articles having
been concluded at Smchula on the 11r day of Novem
ber 1865. corresponding with the Bhootea year Shim
Lung 24 day of the 91’ month, and signed and sealed by
Lieutenant-Colonel Herbert Bruce C.B.. and Samdojey
Deb Jimpey and Tnemseyrensey Donai. the ratifications
of the same by His Excellency the Viceroy and Gover
nor General or His Excellency the Viceroy and Governor
General-m-Council and by Their Highness the Dhurm
and Deb Rajahs snail be mutually oeiivered within thirty
days from this date.
H. Bruce, Lieut, Col.
Chief Civil and Political Officer in Dabe Nagri
In Bhootea language
This treaty was ratified on the 29th November 1865 in
Calcutta by me
John Lawrence Governor General
Treaty Between India and Bhutan,
1949
The Government of India on the one part, and His High
ness the Druk Gyalpo’s Government on the other part
equally animated by the desire to regulate in a friendly
manner and upon a solid and durable basis the state of
affair caused by the termination of the British
Government's authority in India and to promote and fos
ter the relations of friendship and neighborliness so nec
essary for the well-being of their peoples, have resolved
to conclude the following Treaty, and have for this pur
pose named their representatives, that is to say Sri
Harishwar Dayal representing the Government of India,
who has full powers to agree to the said Treaty on be
half of the Government of India and Deb Zimpon Sonam
Tobgye Dorji, Yang-Lop Sonam, Chho Zim Thondup, RmZim Tandin and Ha Drung Jigmie Palden Dorji, repre
senting the government of His Highness the Druk
Gyalpo, Maharaja of Bhutan, who have full powers to
agree to the same on benalf of the Government of
Bhutan.
Article 1 : There shall be perpetual peace and friendship
between the Government of India and the Government
of Bhutan.
Article 2 : The Government of India undertakes to exer
cise no interference in the internal administration of
Bhutan On its part the Government of Bhutan agrees to
be guided by the advice of the Government of India in
regard to its external relations.
Article 3 In place of the compensation granted to. the
Government of Bhutan under Article 4 of the Treaty of
25th January 1866
33
34
"Preventing violence, Caring for survivors". November 28-30, 1998
82
Paper: )
Torture scenario in Bhutan
Khem Kumar Adhikari
Bhutan Health Association
C/o, Jhapa, Nepal
e/o - Sc/2 Q U cjj
Bhutan does not have a written constitution or bill of rights. The institution of absolute
monarchy with inherent feudal characteristics has ruled the country since 1907. The ruling elite
constitutes a very small proportion of the country’s population. The judiciary is not independent
and there is no lawyer with a law degree in the country. There is no system of defence counsel.
There is no freedom of speech, expression. Any one speaking for the general public and in the
interest of the country, which may not suit the ruling elite, is labelled as anti-national, and may
face a death sentence.
The Huriian Rights Movement of 1952 lead to the packing off of Mr.Mahasur Chhetri of
Chirang district in a sack and was thrown alive in Sankosh river. Similarly, Mr.Gaija Man
Gurung of Samchi district disappeared inside a Dzong (fort) in Paro where he had gone to
submit the land taxes of the district. The spiritual head of the Druka Kargyupa sect of
Buddhism, the Shandrung Rinpoche, the present incarnation lives in exile in Manali in India
after the previous two incarnations were brutally murdered by the Govt, of Bhutan for the sake
of the power. Hundreds of people from eastern Bhutan are taking asylum in Arunachal Pradesh
in India since 1962. Hundreds have disappeared for no fault of their own.
Arbitrary arrest, detention, torture, beating and flogging, starvation, overcrowding, no toilet and
bathing facilities, inadequate food unfit for human consumption served once a day,
incommunicado confinement for long time, no communication with the outside world, relatives
not allowed to see even once, detention without charge or trial, are very much prevalent even
today in Bhutan. Handcuffs or iron rods made into chains are put on the legs and hands
continuously and made to work heavy manual works. Medical facilities are not made available
until the prisoner reaches last staged when he is released on the verges of death so that Govt.
cannot be blamed for his death in custody.
Every aspect of the life, social, political, economic and religious is totally controlled by the
Govt. No social groups or NGOs exists in Bhutan to help and counsel these torture victims, as
they are totally banned. The only option left is to live as such or die or flee the country. In 1990
when the Southern Bhutanlprotested peacefully and petitioned the king for their basic rights as
Rights to Nationality and citizenship and other fundamental human rights, they had to face
some consequences and ultimately flee the country to lead refugee life for the past seven years.
At present over a hundred thousand Bhutanese refugees are staying in seven camps, monitored
by UNHCR and Govt of Nepal in eastern part of Nepal Since 1997 the Eastern Bhutanese are
being tortured in the same way for their peaceful protest and hundreds of them had to flee the
country to nearby north east India and Nepal The Bhutanese people are living in a state of
terror since 1990 with no certainty and security of their life.
Since 1992 upon pressure from the International community and Amnesty International, the
Govt, of Bhutan has allowed the International Committee of the Red Cross Society (ICRC) to
visit the country but they have given access to only one prison located in the capital, Thimphu.
CEHAT. Mumbai. India
"Preventing violence. Caring for survivors". November 28-30. 1998
83
not
They a re'a I lowed to visit the southern and eastern part of the country Same is the case with the
Amnesty International. Consequently hundreds of Bhutanese people are still languishing in the
prison under inhuman conditions with no access to the outside world and without charge and
trial Therefore it is only the International Community, NGOs and the donor countries to
Bhutan that can bring considerable pressure on die Govt, of Bhutan to allow them to visit the
country to monitor the situation and ask the Govt, to drastically improve the Human Rights
conditions in Bhutan. Bhutan, being one of die least developed countries in the world, heavily
depends on the donor countries for her economy. India is die major donor and the closest ally of
Bhutan with considerable influence upon the geo-political aspect, economy, social and cultural
life of the Bhutanese people. Therefore, India has die major responsibility of solving the present
refugee crisis in Bhutan. India is supposed to look and guide die foreign and defence policy of
Bhutan as per the Indo-Bhutan treaty of 1949. Co-ordinated effort of NCOs, INGOs and the
International community can certainly bring about an improvement in the human rights
situation in Bhutan. Finally, I on behalf of the suppressed Bhutanese people both inside and
outside the county would like to request the participants of this International conference, to
kindly have deliberation about the situation in Bhutan and come out with a concrete proposal.
about the situation in Bhutan.
Torture methods prevalent in Bhutan
Bhutan does not have written constitution/bill of rights, The Judiciary is not independent and
there is no lawyer with a Law degree in the country. There is no system of defence counsel.
There is no freedom of speech, expression, assembly, etc. Political parties and Human Rights
groups are banned. Study of Law and Political sciences is not allowed. People are exploited for
the interest of the ruling elite since time immemorial.
Arbitrary arrest, detention, torture before and after arrest, beating and flogging, starvation,
overcrowding, no toilet and bathing facilities, isolated confinement for long time, no
communication with the outside world, not allowed to see relatives even once, detention
without charge and trial, made to eat food cooked with sand, glass pieces, nails etc. are very
prevalent even today in Bhutan. Handcuffs or iron rods made into chains are put on the legs and
hands continuously. Medical facilities are not made available until the prisoner reaches the last
stages of illness. The prisoner is released on the verge of death so the Govt, cannot be blamed
for his death in custody. When national activities were planned to overthrow the government, it
deployed heavy military and para-military forces in each five districts, leading to mass
indiscriminate arrest of innocent villages, clergymen, arbitrary detention, looting, plunder, rape
in broad daylight, torture and hunting down of Human Rights Activists even outside the
country with the help of social element or unlawful means. All basic social facilities were
abruptly ceased, schools turned into detention centres and army barracks, hospitals and
infirmaries closed to the public. No warrants were issued for arrest. Army arrested whoever
they saw and found, tortured and kept in detention without trial. Many of our friends in prison
died due to inhuman treatment and torture.
Torture methods in use by the government of Bhutan
1. The most common forms of torture are severely beating and kicking. Severe beating
inflicted at the time of arrest, and or in order to extract information or force the signing of a
confession. Daily beating by prison guards and being forced to beat each other. Beatings were
frequently done with bamboo canes or wooden sticks, rods, electric wire, belt, whips, rifle
butts, bayonets, roots of trees, and thorn branches.
CEHAT, Mumbai. India
"Preventing violence. Caring for survivors". November 28-30. 1998
84
2. Other forms of torture:
□
□
□
□
□
□
□
□
□
□
□
□
Insufficient and contaminated food - mixed with small glass pieces, sand, nails etc. and not
cooked properly and use of dirty water.
Insufficient access to toilet and washing facilities - Must go to toilet at a fixed time once or
twice a day and if you want at other times you are supposed to urinate / defecate in a small
tins provided and kept near you to be thrown the next day.
Starvation methods- not giving anything to eat for 3 to 10 days.
Force statements - beating to extract the truth and to avoid this intense torture one must say
whatever the Govt, wants.
No water to drink and if we ask sometimes we are made to drink the urine or salted water,
which we must drink.
Whoever begs for water during beating and interrogation, salt poured in their mouth.
Guards urinate on their faces
Often crowded - As many as 20 people are kept in a small room that is normally fit for five
people, so there is no question of sleeping but must sit down the whole night.
Defecate in their clothes or in front of others in the room.
Washing facilities are denied completely.
Due to living in filthy condition lice are common.
-r
Beating, hunger, being kept in filthy condition and no communication outside world.
Methods of torture
a.
b.
c.
Severe beating and kicking
Being kept in handcuffs or hands tied
Being kept >n leg shackles
d.
e.
Detention in isolation cells
No light-being kept in dark with windows
and doors closed
Exposure to extremes of cold
f.
Leg shackles are worn continuously and they are
forced to do hard labour.
For years in some cases
Forced to dip in river with the temp, of below 5
degrees for hours in the name of bathing.
h.
Cramped confinement (unable to lie flat to
sleep)
Leg cramps
I.
Made to behave as animals
,)•
k.
1.
m.
Sexual abuse
Suspended by hands
Paraded naked in front of other prisoners
Made to stand upside down on hands for long period
Blindfold
Cut or slashed
Strangulation
Clean toilets with hands
Needle/pin under the fingernails
Submersion in water
g-
n.
0.
pqr.
s.
CEHAT, Mumbai, India
Thick plank or wood are placed above and below
thighs, tightened with rope, the guards stand on the
planks to increase die pressure.
Walking on all 4 limbs and made to climb on each
other’s backs and bull-fight
Forced to perform oral and anal sex.
Handcuffed and hung from hook
"Preventing violence. C.anngfor survivors", November 28-30, 1998
y-
Beaten on genital
Forced to eat beef
‘Tuppi’ pulled out by roots
Put in pit
Taking of blood
Forced labour
z.
Forced signing of confession
t.
u.
V.
XV.
X.
85
Hindus do not take beef.
Prisoners are made to work from 8.00am to 4.00
p.m. frequently in freezing weather with leg
shackles, they are beaten if they are slow
After interrogation and torture, most prisoners are
forced to sign statements
Bhutanese victimdf torture-case history
Background: Bom in 1938, son of a farmer, grew up in the village like many other Bhutanese
and attended local school upto 3rd class and could net continue beyond. Since the age of 22
years Mr.X took up business as his profession and continues, the export of oranges, cardamom,
apple, and potatoes and strengthens his socio-economic status in the village. He became a well
to do middle class businessman in the district. Father of 5 children all of whom are school
going Mr.X was absolutely all right with no major illness or any chronic disease. The family
was happy about the situation till one fine day, when the Royal Bhutan police raided his place
to arrest him. The bad days started for him, his family and all the southern Bhutanese.
It all started in Sept-Oct.’90 when the southern Bhutanese came out openly on the street
peacefully to denounce the Human Rights violation and discriminatory policies of the Royal
Govt, of Bhutan demanding some changes in the governance system and demanded respect for
basic human rights as freedom of press, expression, assembly, right to nationality etc. (see other
documents). The govt, reacted swiftly and imposed military rule in southern Bhutan converting
school into army barracks and prison, closing all essential facilities and mass arrest of southern
Bhutanese. Mr. X had participated in the peaceful rally. This is his mistake; he became a
wanted man for the govt, and an anti-national.
Feb '91 Mr. X was busy in his business of collecting oranges and cardamom. He used to stay in
a make shift camp. At night around 5 policeman raided the camp but could not find him as he
was out to a nearby town. They left after inquiring from other people about his whereabouts.
Next day at about 10.00 a.m., the police came and asked him to see the Dasho (district
authority) and took him along with them to a nearby hotel and there was Dasho waiting for him.
Dasho asked him to accompany him and took him to a junior high school that had been turned
into army barrack and jail. Then they put him in a room, which was dark and splashed with
blood and locked him up after tying both hands tightly with a rope. He was kept there the whole
day without food and toilet. He was not beaten that day.
Next day at 9.00 a.m. He was given food in the room; it was not fit for human consumption
mixed with small pieces of glass, sand and nail pieces etc. But “I was so hungry that I could
have eaten vomits even if given to keep myself alive”, I ate the food.
Two days later the district superintendent of police came and questioned him on why he had
come here? Did I make any bomb? He also asked him to show the place where bomb had been
made and to name other people who are involved, and help the Govt, to arrest etc. He replied
that he was not aware of any such thing about the rally and others. Then the DSP blasted him
saying that he was anti govt, and not in favour of the govt, and levelled him as an anti national.
He took his statement and left.
CEHAT, Mumbai, India
"Preventing violence. Caringfor survivors", November 28-30, 1998
86
Next day the head of RBA stationed at Damphu (district HQ) Mr.Cimmi Doiji came with the
statement and read it. He called one of his friends also arrested for same reason, untied the rope
on his hands, asked him to bend down and asked his friend to beat heavily on his back with big
cane After few canes X could not bear it and passed urine in pant and defecated too After this
he was asked to tell the truth. Out of beating that X got for the first time in life, X got furious
and with the tied hands tore off his shirt and asked him to shoot and kill. He replied that he can
kill him and many others at least 15-20, and the govt, will do nothing but promote him to higher
rank then X- repeated his version again. He locked him up and went back. For the next 4 days
X was not touched.
Mass arrest was going on in the village, so every day hundreds of villagers were brought and
tortured, and the reign of terror dominated the day and night. They would bring somebody
unknown to him and ask why he was brought here. When X used to reply that he doesn’t know
then they used to beat with rifle butts, sticks, wires, etc. regularly.
After 2 days one high-ranking officer from Thimphu came and asked what X has done and
started beating with canes on his head. X bled and fainted. Then he hit on his knees. After that
it became a routine once in 4 days.
X was allowed to go to toilet with guard and tied hands once in the morning and once in the
evening. In between if needed a small tin was provided to pass urine and kept near to be thrown
next day. Fourteen of them were kept in a small room normally fit for three people only. They
had to sleep on the cemented floor without any clothes, rather sit the whole night dosing off as
the room was too small for all of them to sleep.
Food as described earlier (once or twice depending on their mood), starvation, beating, no
bathing or shaving, hands tightly tied together, no medicine, no news of what is happening
outside, whether family members are dead or alive and continues addition of innocent villagers
went on for 6 months. No friends, well wisher, journalist, or family members were allowed to
visit/ see us.
They were regularly asked to hit each other, fight-cook fight and bull fight, made to stand on
one leg for hours, perform different sexual acts on each other, forced to drink urine if asked for
water, eat like animals and iron. X was like others beaten on the sole, ear, and genital area.
Regular pin pricks under the nails; hanging upside down etc. had become the routine activities
of his life. By now X has become immune to these tortures and his body had become pain
insensitive.
After six months of intensive torture, the police shaved off the hair and beard and the next day
loaded them in army trucks and were taken to Chemgang central prison near Thimphu where
the normal temperature remains below -0 degree Celsius.
“Before we entered the central jail at Chemgang Thimphu our handcuffs were removed and
iron rods of 2-3kgs. moulded into chins were fixed permanently on the legs about 5 inches
apart”.
The life in Chemgang became relatively easy as it was more of manual and mental tension
rather than harsh beating though beating was regular if they could not work as per their
direction. Daily routine included, Jogging bare foot in the morning with chains intact and on the
snow, heavy manual work from 7 a.m. to 5 p.m. that included breaking big rocks with small
CEHAT, Mumbai, India
'Preventing violence. Caringfor survivors", November 28-30, 1998
87
hammer, uproot trees with spade, carry big logs and stones, dig vast area of barren land. Food
used to be given on the will of the authorities and if they are not able to do the work then they
used to be starved.
Apart from this, they had to entertain the guards by singing, dancing, and fighting performing
different acts that are not done normally or are impossible to perform Sexual acts as sodomy
was a regular feature and had to be performed in front of all. If they deny these then the guards
would hit with whatever is available and hang upside down. Once while X was eating the
contaminated food the guard hit with boots on his face saying that this was the beer and fried
chicken that X used to eat on business trips. “Profuse bleeding from nose with no water to drink
and the pain was one of my worst experiences in the custody”.
They had to go to river once in fifteen days to take bath. The temperature would be below -0
degree Celsius and the water frozen. They were supposed to dip in the water. One of the prison
inmates died in the custody due to the torture meted to him in front of X. Medical facilities are
not given even if you are dying. No communication with outside world-newspaper, radio,
visitors and relatives were allowed at all.
After six months in the central prison, 313 of them were released on condition that they leave
the country after signing the necessary Govt, documents. X had never thought that he would
come back alive from the prison to meet and see his family and friends. But then he realised
that it is not easy for human beings to die and God helps for the truth. X came back with all
torture, and by now X was not able to walk straight, sit straight, talk normally, suffers loss of
memory, hypertension, frozen body in the morning, burning feet and hands and physical
deformity around the hip joint.
Back home the local authorities began to haunt him asking him to sell his orchard and land to
them at a normal price and if not face the consequence of re-arrest and torture. At first X denied
flatly but then the pressure increased from all the comers. Ultimately to save his life and his
family X was left with no alternative but to flee the country.
At present X is dwelling in the refugee camp along with his family where he is getting the
treatment for Hypertension, frozen body and other symptoms. Despite the treatment given to
him by CVICT (KTM) in the initial years and now by the SCF (UK), there is no sign of
improvement and relief for him. It looks that X is crippled for the rest of his life and will di#
from this suffering. He can’t wake up in the morning and can do no productive work. Burning
pain in the sole and hands remains day and night.
CEHA T, Mumbai, India
So stem the pressure from the dissidents and the inter
national community, the king of Bhutan effected some
cosmetic changes recently. This is being viewed as a
step towards democracy by some Bhutan-watches but
the truth is that the move lacks sincerity The ministers
who were sacked so unceremoniously have now been
appointed to ambassadorial posts in Delhi, and the UN
The dissidents fear that there could be some conspira
torial understandings and agreements among the king
and his ministers (those sacked as well as those in of
fice). They want the king to declare democracy, repatri
ate the refugees, conduct elections and hand over power
to the people. India has a big role to play in the advent of
democracy in Bhutan as a guide in its foreign policy mat
ters and as its defender
In this context the govt, of India maintained that the refu
gee crisis is a bilateral matter between Bhutan and Nepal
and that the democratic movement is an internal affair
of Bhutan. A few MPs and some conscientious people
based in Delhi have been advocating the cause of the
refugees and the democratic forces This group should
be followed by other democracy-lovers in India The
people of India can lobby their representative in the union
parliament to raise the Bhutanese issue. The solution to
this problem could lead to lessening of tension, suffer
ing and trauma in the region
Citizenship Law of 1958
The National Law of Bhutan
Having found necessary to amend the law relating to the
acquisition and deprivation of Citizenship which has been
m force till date His Majesty the Druk Gyalpo, in accor
dance with the suggestions put up by the Royal Advisor.
15
people and the monastic body, is pleased to incorporate
the following change
1
This law may be called the national law of Bhutan
1958 and shall be effective throughout the King
dom of Bhutan
2.
This law shall be in force throughout the Kingdom
of Bhutan from the day of its enactment
3.
Any person can become a Bhutanese National
a
If his/her father is a Bhutanese National and is
a resident of the Kingdom of Bhutan; or
b. If any person is born within or outside Bhutan
after the commencement of this law provided
the previous father is a Bhutanese National at
the time of his/her birth.
4.
a. If any foreigner who has reached the age of
majority and is otherwise eligible, presents a
petition to an official appointed by His Majesty
and taken an oath of loyalty according to the
rules laid down by the Government to the satis
faction of the concerned official, he may be re
enrolled as a Bhutanese National provided that
i.
the person is a resident of the Kingdom of
Bhutan for more than ten years; and
owns
ii.
agricultural land within the Kingdom
b. If a woman, married to a Bhutanese National
submits petition and takes the oath of loyalty as
stated above to the satisfaction of the concerned
official and that she has reached the age of
majority and is otherwise eligible, her name may
be enrolled as a Bhutanese National
16
iv registered as a Bhutanese national but has left
his agricultural land or has stopped residing in
the Kingdom; or
c If any person has been deprived of his Bhutanese
Nationality or has renounced his Bhutanese
Nationality or forfeited his Bhutanese national
ity the person cannot become a Bhutanese na
tional again unless His Majesty grants approval
to do so
5
a. If any foreigner submits petition to His Majesty
according to rules described in the above sec
tions and provided the person has reached the
age of majority and is otherwise eligible and has
served satisfactorily in Government service for
at least five years and has been residing in the
Kingdom of Bhutan for at least 10 years, he may
receive a Bhutanese Nationality Certificate.
.
Onge the certificate is received, such a person
has to take the oath of loyalty according to the
rules laid down by the Government and from
that day onwards he will be enrolled as a
Bhutanese National.
v.
7.
ii. When Bhutan and India are engaged in a war
with some other country if any citizen or na
tional of Bhutan is found indulging in business
correspondence or helping the enemies; or
iii. If any person, within the period of five years
from the day when he was enlisted as a
Bhutanese National, if imprisoned in any coun
try for more than one year, the person is liable
to be deprived of his nationality without prior
notice.
Any person who .
i
becomes a national of a foreign country and
resides in that country; or
ii
has renounced Bhutanese nationality and
settled in a foreign country; or
iii.
claims to be citizen of a foreign country if pledges
oath of loyalty to that country; or
17
a If a Nationality certificate has been obtained on
presentation of false information or wrong facts
omission of facts, the government may order
the certificate to be cancelled.
b. i. If any citizen or national engages in activities
against His Majesty or any national of Bhutan;
or
b Any foreigner who has reached the age of ma
jority and is other wise eligible, can receive a
Nationality Certificate provided that, in the opin
ion of His Majesty, his conduct and his service
as a Government servant is satisfactory.
6.
being a bona-fide national has stopped resid
ing in the country or fails to observe the laws of
the Kingdom as per his National Certificate, shall
forfeit his nationality.
8.
To implement this law, if necessary, His Majesty
may incorporate any additional rules.
9.
This law supersedes all laws, rules and regulations,
ordinances relating to the acquisition and forfeiture
of nationality from the day of its commencement.
18
Citizenship Act — *1958
3.
A person granted citizenship by Royal Government
is required to register his/her name in the record of
the Royal Government from the date of the grant
of Citizenship
4
All those granted citizenship are required to pledge
(ascribe) to the following oath to be administered
by the Home Minister
a Henceforth. I owe allegiance only to His Maj
esty the King of Bhutan.
(As revised by the Lhengyel Shungshog in its 8lh
session held on March 22, 1977)
Conditions required for the grant of Citizenship
1
2
3
In the case of government servants an applicant
should have completed 15 years of service without
any adverse record.
In the case of those not employed in the Royal Gov
ernment an applicant should have resided in Bhutan
for a minimum period of 20 years
b. I shall abide by and observe the rules and
regulations of the Royal Government with
unswerving reverence.
In addition, an applicant should have some knowl
edge of the Bhutanese language both spoken and
written and the history. Only those applicants who
fulfill the above requirements may apply for grant
of Citizenship to the Ministry of Home Affairs which
will ascertain the relevant facts and submit the
application to the Royal Government for further
action
c. I shall observe all the customs and traditions of
the people of Bhutan
d
e. As a citizen of Bhutan, I hereby take this oath in
the name of Yeshey Geompo and undertake to
serve the country to the best my abilities
Eligibility and Power
1
2
The power to grant or reject an application for
Citizenship rests solely with the Royal Government.
Hence, all applicants who fulfill the above
conditions are not necessarily eligible for grant of
citizenship
Any applicant hold the citizenship of another coun
try or with criminal records in other countries or
those who are related to any person involved in
activities against the people, the country and the
King should not be granted Citizenship even if all
the other conditions are fulfilled
19
I shall not commit act against theTSA-WA-SUM
: the king, country and people
Special Grant of Citizenship
1
A foreigner in possession of special or extraordi
nary qualifications will be granted citizenship with
out consideration of the required conditions except
for the administration of the oath of allegiance
Renouncement and Re-application for
Citizenship
1.
In case a Bhutanese citizen, who having left the
country returns and applies for citizenship, the Royal
Government shall keep the applicant in probation
20
for a period of at least two years. On successful
completion of the probation period, the applicant
will be granted citizenship provided the person in
question is not responsible for any activities against
the Royal Government.
2
3.
2
3.
A foreigner who has been granted Bhutanese Citi
zenship may apply to the Royal Government for
permission to immigrate with his/her family. Per
mission will be granted after an investigation of the
circumstances relating to such a request. After grant
of permission to immigrate, the same person may
not re-apply for Bhutanese citizenship. In the event
of an adult family member of any person permitted
to leave the country, does not wish to leave and
makes an application to that effect, the Home Min
ister will investigate the matter and will permit such
persons to remain in the country after ascertaining
that the country's interest is not harmed.
Reproduction of Thrimshung KA 12-2
1
If anyone, whether a real Bhutanese or a foreigner
granted citizenship, applies for permission during
times of crisis such as war, the application shall be
kept pending until normalcy returns.
CHA
1.
All children born of a father who is a Bhutanese
citizen should be registered in the official record
one year of their birth whether the children are born
inside or outside the country.
2
All children born within the country are required to
be listed with the Dzongkhag or the Dhungkhag of
their birth. Children of Bhutanese parents born in
other countries should be recorded with the Royal
Bhutanese Embassies. Where there are no em
bassies nearby the information should be conveyed
CHA
When a Bhutanese woman is married to foreigner.
only she is a citizen, her husband and children will
not be considered a Bhutanese citizen. If they desire
Bhutanese citizenship, such cases will be considered
in conformity to the procedure laid down in this Act
applicable to foreigners applying for citizenship
21
With the exception of a genuine Bhutanese whose
family domiciled in Bhutan but he himself has to
stay away in other country in connection with works
of the Royal Government, private business or reli
gious practices but other who live in foreign coun
tries, serve the government and people of such
countries or have settled in a foreign country or
holding official post of a foreign government are
considered non-nationals
Registration Procedure
Procedure for Acquisition of
Citizenship
1.
When a Bhutanese man is married to a foreign
woman the children will be considered Bhutanese
The wife will have to fulfill the requirements of this
Citizenship Act as applicable to foreigners apply
ing for citizenship
In the case of Bhutanese citizens residing in other
countries, the citizenship law subhead KA-12 No
2 which is reproduced below, shall be applicable.
J
22
to the Home Ministry through correspondence.
3
4
If a child is more than one year and not registered
within that period, registration is not permitted but
may apply for registration to the Home Ministry by
the concerned local authority. The Home Ministry
will then investigate the matter before granting per
mission for the registration.
Validity of Census Record
THA : Status of the Provision
1.
all census reports must bear the Seal of the Royal
Government and the signature of an officer not
lower in rank than a Dzongdag. Other records will
not be acceptable.
NYA
All Kashogs with the people which were not granted
by His Majesty will be investigated into by the Home
Minister and reported to the Royal Government.
Penalty for Violation of Rules
2.
2
Anyone having acquired Bhutanese citizenship in
volved in act against the King or speaking against
the Royal Government or being in association with
people involved in activities against the Royal Gov
ernment shall be deprived of their Bhutanese Citi
zenship
In the case of any person knowingly presenting false
information at the time of applying for citizenship,
23
CITIZENSHIP BY BIRTH
A person whose parents are both citizens of Bhutan
shall be deemed to be a citizen of Bhutan by birth.
3.
TA
1
THIS ACT MAY BE CALLED THE BHUTAN
CITIZENSHIP ACT, 1985
It shall come into force from Twenty-third day. 401
month of wood bull year of the Bhutanese calendar
corresponding to June 10,1985. In case of conflict
between the provisions of this Act and the provi
sions of any previous laws, rules and regulations
relating to citizenship, the provisions of this Act shall
prevail.
Enquiry of Kashog
1.
In case of conflict between the provisions of this Act
and the provisions of any previous laws, rules and
regulations, provisions of this Act shall prevail.
THE BHUTAN CITIZENSHIP Act 1985
1.
JA
1
the Kashog granting him/her citizenship will be with
drawn after due verification of the false informa
tion presented.
CITIZENSHIP BY REGISTRATION
A person permanently domiciled in Bhutan on or
before December 31,1958 and whose name is reg
istered in the census register maintained by the
Ministry of Home Affairs shall be deemed to be a
citizen of Bhutan by registration.
4.
CITIZENSHIP BY NATURALIZATION
A person shall be deemed to apply for Bhutanese
citizenship to the Ministry of Home Affairs in Forms
24
i
KA-1 and KA-2 must fulfil all the following condi
tions to be eligible for naturalization
i
The person must have attained the age of 1
years and 15 year in the case of a person ei
ther of whose parents is citizen of Bhutan
li.
The person must be mentally sound,
iii.
The person must have resided in Bhutan for
15 years in the case of Government employ
ees and also in the case of applicants, either
of whose parents is a citizen of Bhutan and 20
years in all other cases and this period of resi
dence must be registered in the records of the
Department of Registration;
iv.
The person must be able to speak, read and
write Dzongkha proficiently;
v
The person must have good knowledge of the
culture, customs, traditions and history of
Bhutan;
vi.
The person must have good moral character
and should not have any record of imprison
ment for criminal offenses in Bhutan or else
where;
vii.
The person must have no record of having spo
ken or acted against the King, country and
people of Bhutan in any manner whatsoever;
and
viii The person must be prepared to take a sol
emn Oath of Allegiance to the King. Country
and people of Bhutan according to the pre
scribed form KrlA On receipt of the applica-
tion Form KA-1 and KA-2 for naturalization, the
Ministry of Home Affairs will take necessary
steps to check all the particulars contained in
the application The Ministry of Home Affair will
also conduct written and oral tests to assess
proficiency in Dzongkha and knowledge of the
culture, customs, traditions and history of
Bhutan. The decision of the Ministry of Home
Affairs on the question of eligibility for natural
ization shall be final and binding. The Royal
Government of Bhutan also reserves the right
to reject any application for naturalization with
out assigning any reason
■i -
GRANT OF CITIZENSHIP
a. A person whose application for naturalization
ahs been favourably considered by the Ministry
of Home Affairs shall take the Oath of allegiance
according to the Form KHA of this Act.
b. A person shall then be deemed to be a citizen
of Bhutan upon receiving a Kashog from His
Majesty the King of Bhutan in accordance to
Form GA of this Act.
6.
TERMINATION OF CITIZENSHIP
a
Any citizen of Bhutan who acquires the citizen
ship of another country shall cease to be a citi
zen of Bhutan The wife/husband and children
of that person if they are Bhutanese citizens shall
have the right to remain as citizens of Bhutan
provided they are permanently domiciled in
Bhutan and are registered annually in the Citi
zenship Register maintained by the Ministry of
26
Home Affairs
b
Any citizen of Bhutan who has acquired citizen
ship by naturalization may be deprived of citi
zenship at any time if it is found that naturaliza
tion has been obtained by means of fraud, false
representation or the concealment of any ma
terial fact
c
Any citizen of Bhutan who has acquired citizen
ship at any time if that person has shown by act
or speech to be disloyal in any manner whatso
ever to the Kin, Country and People of Bhutan
d
If both the parents are Bhutanese and in case
the children leaving the country of their own
accord, with the knowledge of the Royal Gov
ernment of Bhutan and their names are also
not recorded in the Citizenship register main
tained in the Ministry of Home Affairs, then they
will not be considered as citizens of Bhutan,
(Resolution No. 16(2) adopted by the National
Assembly of Bhutan in the 62nd Session.)
e
Any citizen of Bhutan who has been deprived
of Bhutanese citizenship must dispose off all
immovable property in Bhutan within one year,
failing which, the immovable property shall be
confiscated by the Ministry of Home Affairs on
payment on payment of fir and reasonable com
pensation.
THRINISHUNG CHHENPO TSA-WA-SUM
CHAPTER SEVENTEEN-LAW OF BHUTAN
(ENGLISH TRANSLATION)
Articles
TSA 1
Matters regarding anti-nationals - those averse
to the development of the Kingdom and those
who assist the enemies
TSA 1-1 The King of Bhutan, the Kingdom of Bhutan
and the Government of Bhutan are the three
main elements of Bhutan
TSA 1 -2 Whether beneficial or harmful to one, whether
big or small matters, whether high or low as
mentioned at (O), person any who with the in
tention to cause harm to the three main ele
ments or any of them as mentioned under the
above clause TSA 1 -1, if commits offenses or
does not commit or attempts to commit of
fenses falling under the clause TSA 1 -3 to TSA
1-10 shall be treated as a traitor and shall be
liable to the punishment of treason as written
under the clause TSA 1-11.
/
TSA 1-3 If death is caused to the three main elements
of Bhutan or any one of them or if an attempt
is made, if harm is caused to the body of the
five organs or if such attemptsis made
TSA 1 -4 If the three main elements or any one of them
is challenged with weapons or without weap
ons.
TSA 1-5 If defamation is caused to the three main ele
ments or any of them within Bhutan or outside
o if such an attempt is made.
27
28
TSA 1-6 If attempt is made to create differences be
tween Bhutan and a foreign country
TSA 1-7 If with the intention to cause harm to the three
main elements or any one of them, the people
within Bhutan or people of a foreign country
are instigated or such an attempt is made.
TSA 1-8 If with the intention to cause serious harm to
the three main elements or any one of them,
correspondence is made or conversation is
held (whatever the topic may be) with person
within Bhutan or with foreign nationals or if
correspondence ,s made or conversation is
held with persons in Bhutan and foreign na
tionals (who are not supposed to be conversed
with).
TSA 1-9 If any conspiracy is heard or seen with
intentions to cause harm to the three main
elements or any one of them, if someone
known to be anti-national, if such matter is
concealed and not reported immediately to the
Government.
TSA1-10 If know to be rebels or enemies against the
three main elements or any one of them (if
known or recognised to be a rebel or an en
emy), if arms are sold to them or given freely
or given for use, if guided, if secrets are dis
closed, if food-water is provided or if any help
is given to increase the rebel manpower or
earnings.
TSA 1-11 All those who commit offenses or do not com
mit or attempt to commit them as described
under the above clause TSA 1-3 to TSA 1-10
shall be treated as anti-national and shall be
liable to treason to punishment for treason
Note TSA WA means mam elements i e King, country
and People Sum means three in Dzongkha, national
language of Bhutan The National Assembly of Bhutan
confirmed and approved death punishment for offenses
against TSA WA SUM during its 69"' session held be
tween March 19-26, 1990
The Treaty of Sinchula, 1865
Article 1 : There shall henceforth be perpetual peace
and friendship between the British Government and the
Government of Bhutan.
Article 2 Whereas in consequences of repeated ag
gressions of the Bhutan Government and of the refusal
of that Government to afford satisfaction for those ag
gression and of their insulting treatment of the officers
sent by His Excellency the Governor-General-in-Council for the purpose of procuring an amicable adjustment
of differences existing between the two States, the Brit
ish Government has been compelled to seize by an
armed force the whole of the Doars, bordering on the
District of Rungpoor, Cooch Behar and Assam, together
with the Talook of such point as may be laid down by the
British Commissioner appointed for the purpose is ceded
by the Bhutan Government to the British Government
for ever.
Article 3 : The Bhutan Government hereby agree to sur
render all British subjects as well as subjects of the Chiefs
of Sikkim and Cooch Behar who are now detained in
Bhutan against their will, and to place no impediment in
the way of the return of all or any or such persons into
British territory
30
CONFRONTING STATE VIOLENCE
BY TAJINDER SINGH AHUJA
PRESIDENT,
HUMAN RIGHTS TRUST
645, Parmanand Colony West,’
Delhi-110009, Ph: 7437632
BACKGROUND
The situation in Punjab had been a cause for concern for the civil Liberties
activist^ especially since 1982. The massive violation of human rights in Punjab had been
the subject of discussion and documentation by both the National as well as International
Civil Liberties Organizations. The situation also led to the rise of a number of Civil
Liberties groups within Punjab which were involved with confronting the state violence
as well as documenting the instances of disappearances, extrajudicial killings, torture and
illegal detention.
In January 1995 a petition was filed in the Punjab and Haryana High Court by the
Human Rights Wing of Akali Dal a political party that more than eight hundred bodies
had been cremated by the Punjab police in two cremation grounds of Amritsar City alone
by showing them as unidentified during the years 1992 to 1994. The said petition was
dismissed by the High Court of Punjab and Haryana. Thereafter a petition was filed in the
Supreme Court stating therein that the number of bodies cremated by the police as
unidentified was more than 3000 and the police knew about the names and addresses of a
large number of persons who had been cremated as unidentified. The copies of the
register of the cremation grounds were made as an annexure to the petition. An inquiry by
the Central Bureau of Investigation on the directions of the Supreme Court revealed that
more than 850 persons who had been cremated, were persons who could have been extra
judicially executed and their bodies cremated by the police in order to destroy evidence.
It was also revealed that a number of these people had earlier been picked up by the
Punjab Police. The matter has been referred to the National Human Rights Commission
and the final outcome is pending but the thing which is most relevant for the purpose of
this paper is that inspite of regular visits and investigations, publication of reports and
press statements of various International, National and State Civil Liberties and Human
Rights Organizations the information received by various civil liberties and human rights
organization the number of disappearances reported to these organizations was not more
than 150 for the entire State of Punjab. The number of those reported disappeared from
the Districts of Amritsar and Gurdaspur to these civil liberties organizations was not
mpre than 50. Even though it goes to the credit of the National, State and Local level
humgn rights activists and organizations that they kept the banner of civil liberties flying
in’the most difficult of and trying circumstances but it also points out to a dismal situation
that more than 800 families did not report to any of the civil liberties groups and nor did
it ohtrie to the knowledge of any of the civil liberties groups about the disappearance of
these persons.
During the course of investigations into violation of Human Rights I came across
a person who stated that he had been illegally detained in a police station for several days
2
as the police wanted information regarding his son and held him as a hostage for the
production of his son. This old man stated that nothing had been done to him by the
police authorities. This itself was surprising as on seeing the general situation it could be
presumed that there would have been some torture, indignities and humiliation inflicted.
On further questioning it was revealed that even though the person had been slapped,
abused, kicked and made to stand for long hours with his hands above his head he did not
consider the same to be torture, cruel or inhuman treatment. It was further revealed that
during the course of further investigations that there were several people in that village
who had been similarly treated but were not coming forward to report as they did not
consider it fit to report as they considered the infliction of these ‘minor’ indignities as a
norpiM part of police duties. Most of them considered as torture only if severe injuries
had been inflicted and slapping, kicking and abusing was considered a normal part of a
police officers duties.
The Times of India in a news story published on February 7, 1995 in their Delhi
edition reported that the Delhi Police were routinely torturing people detained at the anti
kidnapping cell at R.K.Puram, New Delhi and that the residents of the area were mute
witnesses to the police showering batons, boots and the choicest of abuse. What was most
distressing was that the residents were not opposed to torture but wanted the police to
torture only after closing the windows, or not to torture when they were eating their grub
as they found the shrieks to be very disturbing. During the course of a lecture session to
senior police officials, I was informed by a senior police official that they were frequently
approached by a father who wanted his delinquent son to be given a drubbing or a wife
who wanted her errant husband to be taught a lesson. Examples where influential persons
have used their influence in getting their scores settled with the intervention of the police
are not few. It is considered usual to get ‘delinquent’ workers, domestic servants or
inconvenient neighbors taught a lesson with the intervention of police officials who may
be willing to oblige. It was best summed up in what one person told the correspondent of
Times of India “ Chor ko marenge nahin to kaya pyar karenge” ( They will obviously
beat up the culprit and not be affectionate to him)
HYPOCRACY OF THE STATE:
In 1977 the Indian Government co-sponsored United Nations General Assembly
Resolution 32/62 which requested the drafting of a convention against Torture and other
forms of ill treatment. In 1977 it was also the chief sponsor of resolution 32/64 which
called on member states to reinforce their support for the declaration against torture and
ill treatment. In 1979 India made such a unilateral declaration.
Every year hundreds of deaths are reported to take place in custody. Wide spread
practice of torture and terror has become an ingrained way of law enforcement in the
Country. Every citizen knows from his own experience that the police are a law unto
themselves. The attitude of the government, the politicians and the senior level police
officials at the senior level is to either dismiss as outright that torture and ill treatment
takes place in police custody or to dismiss it outright as an aberration on the part of some
lower level police official and to not to show it as part of state policy. Thus in 1988 when
J
the Late Prime Minister Shri Rajiv Gandhi was questioned on the British Television
programme ‘Panorama’ about India’s Human Rights record he said “ We don’t torture
anybody. I can be categorical about that. Wherever we have had complaints of torture, we
have had it checked and we have not found it to be true.” It is difficult to imagine that
bodies of over 800 victims of extra judicial execution can be cremated without it being a
part of the state policy and that too only in one district. In fact the scale of massacre itself
is sufficient to put dictators like Pinochet to shame, but some how the largest democracy
of the world has escaped attention on this score. The views expressed by Shri Rajiv
Gandhi were in sharp contrast to the views of his mother Late Prime Minister Smt Indira
Gandhi in 1980 when she remarked that there must be “basic faults in police training to
mak,e‘them so inhuman” and calling for changes in police manual. The recent statements
of Mg^arashtra Chief Minister Shri Manohar Joshi as well as that of Shiv Sena supremo
Bal Thackeray on the indictment of Mumbai police by the Sessions Judge Mumbai on
the killing of two persons in two separate incidents of alleged “Encounter” and the
manner in which support was intended to be provided to the guilty police officials clearly
points out to the fact that fake encounters, extra judicial executions, torture, custodial
deaths and ill-treatment and illegal detentions have not only had the tacit support of the
ruling parties but has also been an integral part of State policy. The hue and cry raised by
the Punjab Government, the various political parties and the police officials on the setting
up of a people's commission in Punjab also glaringly points out to the fact that the extra
judicial executions, disappearances and torture were being carried out as an integral part
of State policy and not as an aberration. The manner in which two unarmed innocent
business men in the heart of Delhi Connaught Circus can be shot dead and similarly an
unarmed businessman can be shot dead by the police officials on Delhi Meerutt highway
a few kilometers away from Delhi points to a disturbing trend and is a clear indication
that in an atmosphere of apathy and under those regimes who rule by fear no one is safe.
The manner in which Jaswant Singh Khalra the person who filed the case regarding the
cremation of bodies in Punjab just disappeared after having been picked by the police and
the increasing attacks on human rights activists especially in the North East and Andhra
Pradesh with no or negligible action against guilty officials have put several question
marks on the efficacy of both domestic and international human rights groups. It is time
when Human Rights activists should ask themselves some uncomfortable questions and
then prepare a strategy for the future.
SOME SUGGESTIONS
The human rights circles in India have been of the considered opinion for a long
time that the Indian Government (irrespective of which party has been in power) has been
a repressive government. The government has attempted to rule by fear especially in
those areas which have witnessed a serious challenge of state authority. It has been using
torture, cruel and inhuman treatment as one of the forms of repression in conjunction
with extra judicial executions, death squads, disappearances and custodial death. Even
though people from all walks of life, men women and children are targets but the worst
sufferers are the poor, downtrodden and the under privileged. Most of those killed in
custody belong to the weaker sections of society. It is always attempted to put the blame
on the lower level police officials who are often projected to be monsters in uniform and
4
a number of state agencies are involved in this cover up either in the name of security of
state or saving the country from threats of secession or protecting the society from
criminal elements and providing the people with safety and security The self justification
of torture or extrajudicial executions or disappearances may come from a distorted vision
of nationalist feeling or as a good object of protecting the society from evil or from
getting quick results. There is need to understand how certain people can inflict physical
and mental pain on others. To dismiss them as animals or unnatural means that the forces
in society which shape and influence human behaviour are also being dismissed. In order
to fight against state violence especially torture, cruel and inhuman treatment it is also
necessary to understand what brings people to a point where they can become part of this
practice. The logic which is given by the police officials as a part of self justification
need to be countered.
An excuse usually given by the law enforcement officials and accepted by the
public is that if they will not torture how are they expected to investigate a case and what
is wrong in punishing the guilty and are we not helping the criminals by saying that they
should not be beaten and are the police expected to treat them to a cup of tea when they
are caught and made to stay in a hotel. A common statement also given is that if these
rights are implemented the criminals will have a field day and it will contribute to the
spread of crime. Police officials are also usually heard to say that there is pressure from
the higher officials to show results and it is quicker method of producing results.
Human Rights Trust is not opposed to criminals being brought to book for the
crimes that they have committed. Human Rights Trust believes that the criminal justice
system should be revamped and made more efficient and honest, so that criminals do not
escape punishment. But the work of the police is to investigate and not to punish. There
should be a system of checks and balances. Once the police is given the power to punish
there is no check. How is it to be ensured that the person who is being tortured is guilty
or not? Is it not unjustified that to locate one criminal tens of persons should be tortured?
Excessive power to the police is bound to cause excesses in a civil society. The police
need to be trained in modem scientific investigative methods so that they can build up a
fool proof case and not a case built upon torture which they are unable to prove in a court
of law. People need to be aware that the penal justice system provides for punishment for
different types of offences and our own constitution says that only punishment according
to law will be given and no more. The work of awarding punishment to the guilty is that
of the judiciary and not of the police.
Some Human Rights organizations are of the opinion that there should be more
laws to punish the guilty police officials and the burden of proving their innocence should
be shifted on the accused police officials. We do not agree with the said contention and
consider that simply having more laws or declarations that torture, cruel or inhuman
treatment is bad and the violators will be strictly punished but the fault lies in the
implementation part of it. The local police man who mishebaves, hurls abuses or just
beats up a rickshaw puller may be doing it with a clear conscience that he is helping the
society move in an orderly manner and it is necessary for the implementation of the rule
of law and knowing fully well that no harm would come to him. Moreover officials
torturing so called secessionists and terrorists may consider themselves satisfied that they
5
are doing it for the cause of their nation and the general public out of a sense of
nationalism may consider persons who get results by torture and other inhuman means to
be tb^e symbols of national pride and give them a high place in society thereby
unwittingly endorsing their illegal and inhuman acts. Moreover if we demand that the
burden of proof be shifted on the accused police officials why should the same logic not
apply in the case of alleged terrorists. The state only takes this as an excuse to grab more
an<j more power. Presumption of innocence till proved guilty is an important concept of
modern jurisprudence and needs to be protected if the trial is to be independent and not a
hoa\and the accused should have the full right to defend himself.
It is necessary that the public be made aware about the ill effects of torture, cruel
and inhuman treatment as well as extra judicial executions, disappearances and custodial
deaths'on the society as well as on the victim and his family members alongwith the
lovyfer level police officials in order to enable them to refuse any illegal orders that they
may receive from the senior police officials. It is not enough to criticize the police but
we should consider the police officials are also a part of the big human family who will
be subject to reason and logic and we can make them understand that not only ill treating
people of torturing or giving them cruel treatment is morally wrong and illegal but also
has adverse affect on the person and family of those who torture or indulge in extra
judicial killings or disappearances. The people will also have to be made aware that
torture, cruel and inhuman treatment is a form of intimidation and punishment
governments use to perpetuate their own rule and police training is also geared towards
that. Once we are able to raise public opinion it will help in better monitoring of
violations of human rights and we will also not be looked upon as adversaries of police,
bureaucracy and judiciary who will be more willing to listen.
It is not meant to be stated that only public awareness should be done but it should
definitely form part of any strategy of all human rights organizations and should be used
in addition to the modes already being adopted only then is it likely to have a long term
impact and usher in a better society.
(L.O nq H " 6
GUIDELINES FOR HEALTH CARE PROFESSIONALS:
RESPONDING TO WOMEN FACING VIOLENCE
every day and 19 dowry deaths occurred on a daily
basis. In 1999 in Mumbai alone, over one thousand
cases of sexual crimes were reported—including
rape, molestation, sexual harassment, immoral
traffic, and indecent representation of women
(NCRB, 1999).
Domestic violence—also called "intimate partner
abuse," "battering," or "wife-beating"—refers
specifically to gender-based violence that occurs
within the context of an intimate relationship,
including marriage. Domestic violence can be
physical, psychological, financial, or sexual in
nature and is one of the most common forms of
gender-based violence. It is also characterized by
long-term patterns of abusive behaviour and control
(Human Rights Watch, 2003). Because the home
is considered a safe and private space, violence
within the home is often not discussed. In our
society, it is often not questioned when a husband,
I.
Introduction
father, brother, and/or son inflicts violence upon
women in the family. Rather, such behaviour is
Violence against women is a global phenomenon.
viewed as a man's prerogative and women are left
It cuts across all boundaries of class, caste, religion,
with no choice but to endure the resulting pain
/ace, and education. A report recently released by
silently.
the United Nations Development Fund for Women
(UNIFEM) reveals a startling statistic—one in three
Such violence negatively impacts the health of
women around the world will be raped, coerced
victims
into unwanted sexual relations, or abused in another
psychologically, and socially. For the treatment of
form during her lifetime (UNIFEM, 2003). These
these violence-related injuries and health
figures are not drastically disparate from those
complaints, women approach the health care
and
their
families—physically,
specific to India and the City of Mumbai. According
system. However, this is generally only after the
to the National Crime Records Bureau (NCRB), in
violence has escalated to a severe and dangerous
2000 an average of 480 cases of crimes against
level. When these women do come in contact with
women were reported every day. It was also
providers, only the current and obvious health
determined that in this year, 45 women were raped
complaints are investigated and there is usually no
evidence or documentation of earlier episodes and
□ What we know about domestic violence in
India: Summary of research studies
injuries. Documentation of violence by the health
system is crucial in building a woman's case, as it
□ Why health providers should care about
serves as Medicolegal proof within the criminal
domestic violence: The International Scenario
justice system. It is crucial that this documentation
not only describe physical injuries but also other
□
health consequences not immediately apparent,
details of the current violent episode (location of
incident, relationship to abuser) and the history of
violence (severity and frequency of earlier episodes
of violence).
Health outcomes and consequences of violence
against women
□
How can we identify victims? Overview of signs
and symptoms of domestic violence
□ What can nurses do?
□ What can community health volunteers do?
The definition of health is "a state of complete
physical, mental, and social well-being and not
II. What We Know About Domestic
merely the absence of disease" (Alma Ata
Violence in India: Summary of research
Declaration, 1978). This definition implies that
studies
health care providers must not only restrict their
practices to treatment, but must incorporate both
prevention and treatment strategies. Health care
providers need to be aware about the social
environment the patient is living in to prevent
further damage and may be death. There is an
urgent need to re-evaluate the role of the health
care system in responding to victims and survivors
of domestic violence. It is imperative that the agenda
of domestic violence as a health issue be owned at
various levels within the system. At each level,
health care providers have roles to play in
£
Domestic violence needs to be looked at as a public
health issue and not just as a social issue, as it has
reached epidemic proportions and creates a large
burden of illness and injury. The Maharashtra Vital
Statistics Hand Book (1996) indicates that the single
largest cause of death among women in the state is
burns, drowning and/or suicide (26.3%). Such
violence extends to unborn girl children as well.
The sex ratio for Maharashtra has dropped from
934 girls per thousand in 1991 to 922 girls per
thousand in the year 2001, below the national
average of 934. Of 8,000 foetuses aborted at a
combating this problem and mitigating its harmful
Mumbai clinic in 2002, 7,999 were female^
effects. In order for providers to assume these roles,
(UNICEF, Reference Kit on Violence Against
it is necessary to sensitise them towards the issue
Women and Girls in South Asia').
of domestic violence and provide them with the
information and tools necessary to effectively
Studies conducted in health care settings indicate
screen, identify, and respond to victims of domestic
that women are approaching hospitals for treatment
violence. These guidelines were written with the
of health complaints and injuries caused by
goal of contributing to this educational process and
domestic violence. A 1996 Mumbai-based study
contain the following information:
examined cases of women recorded in the
Emergency Police Register of the Casualty
violence, including refugees. India is a signatory
Department in J. J. Hospital, a public hospital
to the CEDAW.
managed by the State Government (Daga et. al.,
1998).
Of the 833 women whose records were
The issue of violence against women has recently
available, only those above 15 years of age (N = 745)
gained explicit attention in many international
were studied. The researchers found that 22.4% of
meetings. The International Conference on
cases were definitely due to domestic violence (the
Population and Development, held in Cairo in
survivors themselves reported violence carried out
1994, adopted a programme of action emphasizing
by family members) and another 44.3% were
the advancement of gender equality, the
possible cases of domestic violence (it was
empowerment of women, and the elimination of
suspected that women suffered from domestic
all forms of violence against women, and
violence, but were unable to report the incident/s).
incorporating them as the corner stones of
Overall, two-thirds of the women above 15 years
population and development programmes.
of age (66.7% or 497/745) were definitely or
Governments were called upon to take full
possibly victims of domestic violence. Considering
measures to eliminate all forms of violence against
i^the Casualty is generally confronted with the most
women, adolescents, and children—including
serious injuries, the MLC register only touches the
preventive action and the rehabilitation of victims.
tip of the iceberg of the actual prevalence of injuries
The activities of the World Health Organization
due to interpersonal violence. Furthermore, while
(WHO) in the area of violence against women were
all cases of reported assaults, poisoning, burns,
initiated by the Women's Health and Development
patients brought by police and accident cases are
Program (WHDP) in 1995. This work focuses on
recorded in the Casualty Police Register, violence
the role of the health care system in preventing
faced by patients coming to the OPD for care go
violence against women and responding to its
unreported unless the patient insists on making a
detrimental consequences. The long-term aim of
Medicolegal case. Therefore, we should consider
these activities is to identify effective strategies
these data findings—as alarming as they are—as
within the public health framework to prevent
under-calculations of the actual prevalence and
violence and decrease morbidity and mortality
severity of violence against women accessing the
among victims and survivors of gender-based
violence. One of the outcomes of this critical work
^facility.
is the development of guidelines for health care
III. Why Health Providers Should Care
providers which help them to identify and respond
The
appropriately to women and girls who have been
international Standards and mandates
abused. The WHO issued a set of guidelines
About
Domestic
Violence:
outlining the ethical responsibilities of doctors and
The Convention on the Elimination of ail forms of
Discrimination Against Women (CEDAW, 1979) is
the most extensive instrument addressing the rights
of women. In 1992, CEDAW formally included
gender-based violence in their charter. The new
charter recommends that the state should provide
support services to victims of gender-based
other health care providers in responding to victims
and survivors of violence. These guidelines detail
the role these providers can play in screening,
identifying, and assisting their patients facing
violence.
GENDER-BASED VIOLENCE THROUGHOUT THE LIFE CYCLE
LIFE PHASE
TYPES OF VIOLENCE
PRE-BIRTH
❖ Sex selective abortion
❖ Abuse of women during pregnancy (emotional & physical impact on woman;
impact on birth outcome)
❖ Unequal access to food and health care
INFANCY
❖ Female infanticide
❖ Unequal access to food & health care
❖ Physical, sexual, & psychological abuse
CHILDHOOD
❖ Forced child marriage
❖ Incest
❖ Female genital mutilation
❖ Child prostitution
❖ Physical, sexual, & psychological abuse
❖ Unequal access to food, health care,
|
& education
ADOLESCENCE
❖ Dating and courtship violence
❖ Sexual assault and rape
❖ Sexual coercion
❖ Forced prostitution
❖ Unequal access to food, health care,
❖ Trafficking
& education
❖ Psychological, physical, sexual abuse by
family members
❖ Incest
❖ Sexual violence in the workplace
❖ Partner homicide
CHILD-BEARING ❖ Domestic violence (social isolation;
❖ Forced abortions / forced pregnancies
YEARS
physical, psychological, sexual, &
❖ Sexual violence in the workplace
economic abuse by family member/s)
❖ Unequal access to food and health care
Rape (including marital rape)
❖ Forced prostitution and pornography
❖ Dowry demands; Dowry-related homicide
(sexual exploitation)
❖ Partner homicide
OLD AGE
❖ Physical, sexual, and psychological abuse by family members and/or other caretakers
**’ Neglect and maltreatment by family members and/or other caretakers
*♦* Forced suicide or homicide of widows
❖ Unequal access to food and health care
SOURCE: Heise etal, 1994
I
Health Outcomes of Violence Against Women
Non-fatal Outcomes
Fatal Outcomes
• Homicide
v
• Suicide
• Maternal mortality
• AIDS-related
Physical Health
Chronic Conditions
Mental Health
© Injury
• Chronic pain syndromes
® Post-traumatic stress
• Functional impairment
• Irritable bowel syndrome
disorder (PTSD)
• Physical symptoms
• Gastrointestinal disorders
• Depression
• Poor subjective health
• Somatic complaints
e Anxiety
• Permanent disability
• Fibromyalgia
Negative Health Behaviours
• Smoking
• Alcohol and drug abuse
• Sexual risk-taking
• Physical inactivity
Reproductive Health
® Unwanted pregnancy
0 STDs/HIV
• Gynaecological disorders
• Unsafe abortion
• Pregnancy complications
• Miscarriage/low birth weight
• Pelvic inflammatory disease
• Vaginitis
• Colpitis
SOURCE: Center for Health & Gender Equity (CHANGE). Population Reports (Dec, 1999) Vol. XXVII.
• Phobias / panic disorder
• Eating disorders
• Sexual dysfunction
• Low self-esteem
• Substance abuse
• Nightmares
• Affective numbing
• Autonomic arousal
• Difficulty concentrating
• Hyper vigilance
• Heightened startle
• Memory loss
IV. What are some of the signs and symptoms that can help you in identifying
women facing domestic violence?
Department
Gynaecology /
Obstetrics
Essential Signs
Vital Signs
□ History of assault
□ Chronic Leukoria
□ Infertility
□ MTP cases
□ Post-partum psychosis
□ Multiparty
□ Spontaneous abortions
□ Injury marks on labia, breast, and/
□ Women repeatedly giving
birth to girl child
Surgery
Medicine
Pediatric
or other sexual organs
□ All ANC/ cases
□ History of fall during pregnancy
□ Abruption of placenta
□ Pelvic Inflammatory Disease
□ Unwed mothers/Pregnant widows
□ History of assault
□
□ Abdominal trauma
□ Reporting Falls
Burns
□ All women with CLW, IW, Contusion, lacerations, and/ or bruises
□ History of consumption of poison.
□ Chronic Anaemia
□ Pyrexia of unknown origin
□ Breathlessness
□ Tuberculosis (T.B.)
□ Constant bodyache, headache,
□ Fainting spells
□ Chronic patch of T.B.
□ Swellings/tenderness
□ Irritable Bowel Syndrome
and/or backache
□ Sudden weight loss
□ Repeated health complaints despite normal reports
□ Convulsions
□ Child abuse (all cases)
□ Chronic abdominal pain
□ Mothers not breast feeding the child
□ Sexual abuse
□ Repealed headaches
□ Bedwetting
□ Lack of concentration
□ CLW, IW, contusion,
□ Anemia
lacerations, bruises
Orthopaedic
Skin
□ All fractures
□ Minor sprains
□ All falls / assaults at home
□
□ STIs
□
□ RTI
□ Repeated allergies
HIV+ and AIDS patients
Ligament injury
□ Eczema
□ Eczematous change
□ Contusions
□ Chronic ache in back, shoulder, neck
□ Allergic rashes around the neck,
thighs, waist, and/or forehead
□ Fungal infection
Casualty
□ All cases
□ Pregnancy with history- of fall/assault
□ Poisoning
□ Women with unexplained bruises,
□ Burns
□ Fractures
□ All remaining patients
CLW, lacerations, and/ or abrasions
□ Repeated health complains
□ Falls
despite normal reports
□ Assault
Psychiatry
Dentistry
ENT
' Opthalmology
| VCTC
□ Depression
□ Anxiety / tension
□ Obsessive compulsive disorder
□ Substance abuse
□ Insomnia
□ Self harm
□ Eating disorders
□ Repeated health complaints
□ Jaw fracture
□ Broken teeth
□ All remaining patients
□ Perforated eardrum
□
□ All injuries and fractures
□ H/o
□ Eye injury
□ All HIV+ cases
□ Bruised eye
Locked jaw
hearing capacity-
□ Chronic discharge from ears
□ Sudden loss of voice
□ All remaining patients
□ All remaining patients
□ Difficulty in swallowing
V. What Can You, As A Doctor, Do?
As doctors, you are perceived as non-threatening
and the patient has immense faith in you. Women
are, therefore, likely to share their history of
violence during medical visits. You should provide
to all women you see materials relating to domestic
violence, such as the brochures and pamphlets
published by Dilaasa describing what constitutes
domestic violence and what services are available
to victims and survivors. In addition to distributing
such materials to a// women, you can also follow
the set of guidelines presented below if you suspect
the woman is facing violence.
> Start by sharing with the woman that, in your
experience as a doctor, you have come across
many women reporting domestic violence. You
should assure her that whatever she shares with
you will be kept confidential.
> You must understand that in case of domestic
* violence, women find it difficult to speak out as
the abuse is by a family member. You therefore
need to talk to her alone.
> For those doctors working in the Casualty
Department, screening for cases of violence is
particularly critical as all suspected cases of
violence are reported at Casualty. In cases of
violence reported by women, it is mandatory
for you to record in the MLC Register details of
the resulting injury/injuries and of the violent
episode (such as location of incident,
relationship to abuser, severity and frequency
of earlier episodes of violence, and other health
consequences not apparent at the time of the
medical visit). The Medicolegal Complaint
(MLC) is the only record that a woman can use
.
as evidence of the violence she has faced. The
‘
importance of keeping an MLC as
documentation should also be explained by you
to women. In case of a woman who comes at
night and you suspect any threat to her life, you
can admit her in the hospital and refer her to
the social worker or Dilaasa.
> While working in an OPD, you should refer
women reporting a violent episode to the
Casualty to file an MLC and also refer her to the
Dilaasa Crisis Centre (Department No. 101) or
to a social worker who can provide emotional
and psychological support, assist in filing a
formal police complaint against the abuser,
provide referrals to other needed services (such
as legal help, shelter, job training, and other
women's groups), facilitate joint meetings with
the abuser(s), and provide general social
support.
> While treating patients admitted in the wards,
you should document any history of violence
that the woman may share with you in the
indoor papers. In case you suspect violence and
you are unable to speak to the woman please
ask the social worker to talk to her.
> While treating patients for any illness, it is your
duty to not only prescribe treatment but also to
speak of prevention. For example, when a
patient reports loose motions, patients are asked
to undergo a stool examination. Based on the
results of this examination, further treatment is
prescribed and simultaneously there is a
discussion about preventing further infection—
you may instruct the patient to drink boiled
water and/or avoid oily food. This mode of
practice also extends to women reporting
domestic violence. In addition to treatment, you
must also provide additional information about
the availability of other services—counselling,
shelter, and legal assistance—that can help
reduce the severity of violence and/or protect
women from further episodes of violence that
may otherwise prove to be fatal.
> Please remember that failure on your part in
identifying and documenting cases of domestic
violence can be viewed seriously by the court
of law.
VI. What Can You, As A Nurse, Do?
As a nurse, you spend maximum time in direct
contact with the patients—whether assisting a doctor
at an OPD or Casualty or in the inpatient
department. Hence you are able to see the relatives
of the patient and also observe her interactions with
them.
Given your unique position, you are able to...
>
Distribute informational pamphlets and
brochures on domestic violence and available
services to each patient admitted in the ward
> Attempt to talk to all women, especially those
who may have consumed poison, reported falls
or pelvic bleeding, come for an abortion, or had
a still birth. You have the authority to ask the
relatives to leave the bedside. This is the time
you can ask the woman questions in a sensitive
manner and private space.
> Assure her of confidentiality. Otherwise, the
woman may not be able to reveal her
experiences of violence.
> Start the conversation by saying that, in your
experience of talking with women, some do
report domestic violence but some hesitate to
talk about it. Ask her, "Have you ever faced
any such incident?" Or, you can share your
observations, such as "You seem tense
whenever your family members visit...would
you like to share something that is bothering
you?"
> Convey the importance of a formal police
statement and assure her that doing this ensures
her safety and also serves as evidence of the
violent episode. If she has given the doctor a
different history of the source of her sustained
injuries, notify the doctor immediately to
document her desire to change her statement.
> Refer her to the Dilaasa Crisis Centre,
Department No. 101 or to the social worker.
VII. What Can You, As A Community
Health Volunteer (CHV), do?
Remember that you are an important link between
the hospital and the community. You are also
viewed as non-threatening in the community
because you handle issues related to immunization
of children, family planning, and reproductive
health. Your work provides an important entry point
into women's lives, as it puts you in direct and
personal contact with the women. You are in a
unique position to ask women whether they face
violence at home in any form.
> In order to ease the process of asking about
violence, you can share with women that you
come across many other women who talk about
violence at home. Let them know that there is
help available if they are willing to share the
history of violence, tell them about the Dilaasa
Crisis Centre for Women, and give them the
necessary informational brochures and
pamphlets containing contact information of
service organizations that can help them.
> Provide her emotional support by sharing that
she is not alone. Impart information on filing a
police complaint as well as seeking medical help
whenever she faces violence. Give her
information about the social work department
in the hospital as well as the community centers
and counseling centres that may be addressing
the issue of violence.
> While doing this, it is important to assure her of
confidentiality.
> You need to assess women's safety. In case there
is a threat to their safety, you need to provide
them with information on emergency shelters
and encourage them to use them
> You must reach out to all the women whorr|
you meet.
References:
Daga et. al., 1998.
Human Rights Watch (2003).
Maharashtra Vital Statistics Hand Book (1996)
National Crime Records Bureau (NCRB), 1999.
The United Nations Children's Fund (UNICEF) , Reference
Kit on Violence Against Women and Cirls in South Asia
United Nations Development Fund for Women (UNIFEM).
2003. Not A Minute More: EndingViolence Against Women.
Accessible via the Worldwide Web at: wwwjiiiifem.org
Acknowledgment:
This document has been prepared by the Dilaasa teanj|
(Dr Seema Malik, Ms Purnima Manghnani, Ms Sangeeta
Rege, Ms Padma Deosthali, Ms Lorraine Coelho). We are
grateful to Ms Aruna Burte, Dr Kamaxi Bhate, Dr Nandkishore
Sawant, Dr Sanjay Nagral, Dr Usha Shelar, for reviewing
the document and giving valuable feedback.
Dilaasa - Crisis Centre for Women
A joint initiative of the Public Health Department - K.B. Bhabha Hospital, Bandra (W) and
Centre for enquiry into health and allied themes (CEHAT),
research centre of Anusandhan Trust
K.B. Bhabha Hospital, Dept. No. 101, R.K. Patkar Marg, Bandra (W), Mumbai - 400 050.
Tel.: 26400229 (Direct), 26422775, 26422541 Extn. 4376
Position: 1764 (3 views)