Physicians are known to have participated in human rights abuses in
Iraq during Saddam Hussein's Baathist regime, but the nature and extent of
that participation are not well documented.
To characterize the nature of physician participation in human rights
abuses, identify structural factors that facilitated physician participation,
and assess approaches for accountability and for prevention of future physician
participation in abuses.
Design, Setting, and Participants
A self-administered survey in June and July, 2003, of a convenience
sample of 98 physicians and semistructured interviews of hospital directors
and physicians in 3 major hospitals with general surgical units in 2 cities
in southern Iraq.
Main Outcome Measure
Respondent reports of peer and self-participation in human rights abuses
in Iraq since 1988.
The majority of participants were male (88% [86/98]) and Shi'a Muslims
(97% [95/98]). Respondents reported a mean of 6.8 years in practice. A total
of 71% of respondents (65/91) reported that torture was a problem to an extreme
extent in Iraq since 1988. The proportion of respondents indicating that,
since 1988, their physician peers as a group were extremely or quite a bit
involved in human rights abuses included 50% (42/83) for nontherapeutic amputation
of ears as a form of punishment, 49% (39/79) for falsification of medical-legal
reports of torture, and 32% (25/78) for falsification of death certificates.
Fewer numbers of respondents (range, n = 2 to 6) reported participation in
abuses themselves. More than half (52% [48/92]) indicated that physicians
did not willingly participate in these abuses; 93% (52/71) reported that the
Iraqi paramilitary force Fedayeen Saddam was responsible for initiating physician
complicity. Fear of harm to oneself or family members was a common explanation
for complicity. Respondents reported that physicians who refused to participate
in abuses faced consequences including loss of job, imprisonment, torture,
and disappearance. Respondents reported on preventive measures that should
be undertaken to prevent physician involvement in future abuses, including
increasing human rights and ethics education of physicians (99% [79/80]),
legal provisions to ensure effective monitoring (97% [73/75]), punitive sanctions
for physicians who commit abuses (96% [77/80]), and ensuring the independence
of physicians from state authorities (95% [76/80]).
Although not generalizable beyond the study participants, the findings
of this study suggest that among those surveyed, physician participation in
human rights abuses included falsification of medical-legal reports of alleged
torture, physical mutilation as a form of punishment, and falsification of
death certificates. As Iraq rebuilds, it is essential that the country address
these violations and enact measures to prevent physicians from future complicity
in human rights abuses.