Fighting Torture in Health Care

Health care settings should be places where human rights are realized. Yet, too often, they are places where human rights are severely abused, sometimes amounting to torture or cruel, inhuman, and degrading treatment. This abuse is especially prevalent in the care of socially marginalized groups— people living with HIV, ethnic minorities, sexual and gender minorities, people who use drugs, and people with intellectual disabilities or mental health problems—who may be deemed “deviant,” “incompetent,” and in need of evaluation or “curative” treatment through the health care system.

The legal definition of torture and ill-treatment is broad enough to encompass a range of abuses occurring in health settings. Under international law, any infliction of severe pain and suffering by a state actor or with state instigation, consent, or acquiescence can, depending on the circumstances, constitute either torture or ill-treatment.

A wide range of severe abuses in health care have been documented, for example, the denial of cheap and effective pain relief medications for patients suffering excruciating pain under the auspices of a country’s drug addiction prevention strategy, or women and girls with disabilities and/or those living with HIV being sterilized without their consent or understanding at the insistence of their caregivers or because their doctors make the executive decision that they are not fit to raise children.

It is precisely because health settings are not thought of as places of abuse that they are monitored poorly, and the violations continue. In early 2011, a coalition of organizations working to combat severe human rights violations in health-care settings launched the Campaign to Stop Torture in Health Care to increase government accountability for abuse in health settings.

The Campaign partners use legal, advocacy, and community mobilization strategies to at once increase awareness of torture in health care and to demand an end to the abuse.

While abuses in health care settings may involve a host of different rights violations, advocacy through anti-torture mechanisms provides an important tool for combating them. International law explicitly protects patients in health settings against torture and cruel, inhuman, and degrading treatment, and there are many national, regional, and international mechanisms designed to promote accountability for such abuse. Yet, these mechanisms are rarely applied to health facilities. Human rights bodies responsible for monitoring compliance with anti-torture provisions should systematically examine health settings in their reports and make actionable recommendations to governments on how to stop this abuse.

In response to this gap, the Open Society Foundations (OSF) has developed 20 Mechanisms for Addressing Torture in Health Care, a manual describing 20 anti-torture mechanisms that can be used to fight torture in health care settings. The manual covers the United Nations (UN) and the African, European, and Inter-American human rights systems. For each mechanism, it explores the mandate, procedure, possibilities for engagement, and prior work on torture in health care. The manual is circulated with this Request for Proposals.

Following the development of the manual, OSF as the coordinator of the Campaign to Stop Torture in Health Care’s Standards and Litigation Working Group, invites proposals from organizations interested in using one or more of the mechanisms described in the Manual to advance existing advocacy efforts to address torture in health care and ensure government accountability.