Secret aid worker: what should doctors do when we witness human rights abuses?

2019-08-29 01:21:17


After finishing my medical training as a doctor, I was excited to start working for a healthcare NGO in an African country that was making a lot of progress, despite only recently coming out of a civil war. However, while I was proud of the healthcare advancements during my stay, I came to struggle with the government’s egregious human rights abuses, and the sense that in some ways by simply being there I was complicit.

The government in my host country has received a lot of international support, partially because of its success in the healthcare arena. Yet, I personally witnessed several instances of manipulating health statistics, from maternal and infant deaths going unreported in my own hospital (so as not to hurt the country’s mortality rates data) right up to the health ministry bragging to international papers that their new national health insurance scheme covered almost twice as many people as it actually did. Looking back, I wondered what my obligation was to report the falsified data I came across. By not reporting each incident was I protecting the current government? But at the same time, when I invited policymakers to investigate the apparent discrepancies when they visited our hospital, they weren’t interested.

As a doctor, I also struggled with the notion that the international community sat on their hands while the government in my host country supported paramilitary groups in a neighbouring country, who had already been linked to crimes against humanity. The government was given a pass, in part at least, because of the drastic improvements in healthcare since the end of the civil war. I lay awake each night, contemplating if we saved a few dozen lives through an innovative new programme but the militias killed a few thousand, was it a net loss or net gain for me to work here?

My host country is certainly not unique in attracting expatriate doctors while committing human rights violations. It’s not uncommon for medical NGOs to deal with corrupt and authoritarian regimes the world over, working in the countries but rarely partnering with those governments. However, the mantra of global health for the last 20 years has been to work with national governments to support their initiatives and build the local infrastructure to enhance sustainability – even if that means working with partners we disagree with politically on important issues, or worse, governments that violate human rights.

Doctors in global health must therefore walk the tightrope of bearing witness to human rights abuses to advocate for our patients, but must also not be so outspoken that the relationship with their host government sours, possibly preventing them from providing care for the most vulnerable. Doctors without Borders, for example, has previously been both criticised for not doing enough to stop the genocides in and but then later for speaking out too strongly against government-sponsored violence. Yet colleagues with whom I discussed my dilemma frequently said “Don’t let perfect be the enemy of good”.

However, as doctors or humanitarians, if we do not utilise the pulpit given to us by society, we could be judged by history as collaborators, complicit in the crimes committed by an authoritarian regime.

The discussion of the physician’s role in politics is nothing new, and if we follow Dr Rudolf Virchow, the father of social medicine, who suggested politics is a larger form of social medicine, then physicians have the responsibility to work towards good governance and a duty to publicly bear witness to governments gone awry.

The true cynic might argue that some authoritarian regimes use the political cover provided by humanitarians to maintain favoured status in the halls of power. Even worse would be the suggestion that NGOs allow themselves to be used as tools of propaganda in order to maintain favoured status in that country.

Interestingly, when the UN condemned my host country’s most recent humanitarian abuses, the US government didn’t follow suit for another nine months, suggesting the large presence of American NGOs, including those connected to a former US president, staved off the public criticism.

At the end of the day, I couldn’t justify working with a government that wilfully flaunted human rights without feeling like an accomplice. I was fed up of the government trying to discredit me when I did raise uncomfortable questions. I packed my bags and moved to a country with serially-weak and allegedly corrupt governments, presenting a new set of challenges. Although I don’t agree with all the politics, I’m content to work with the country’s current government towards an improved public health system. I also recognise that when their next election comes, I may have to start over with the next administration, but that is the price that you pay for working in a democracy.

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