Four Key Lessons from Teaching Human Rights for Health

When students go to medical school, they aspire to become doctors in order to help and heal people. The last thing they imagine is that they would become complicit in abuse.

But we know that too often doctors violate patients’ human rights—from sterilizing women living with HIV without their consent in sub-Saharan Africa, segregating Roma women in unhygienic maternity wards in Romania, to under-prescribing pain medication in Ukraine, and forcibly medicating people with mental disabilities throughout Europe.

The reasons for these violations are many, ranging from discrimination and stigma against groups of people, to misguided over-regulation of medication. But these violations also happen because doctors also often lack basic training in human rights and in working with socially excluded groups like sex workers, people who use drugs, or Roma.

That’s why over the last seven years we’ve collaborated with medical and law schools [PDF] to develop 25 courses on human rights and patient care in nine countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Russia, Serbia, and Ukraine and courses with a specific focus on human rights and access to medicines in another three countries: Kenya, South Africa, and Uganda.

In this work, we’ve learned four key lessons about teaching human rights:

  1. The “how” of teaching is as important as the “what.” Human rights cannot simply be taught through lectures or the memorization of norms. As a faculty member from Kazakhstan explained, “Lecturing gives a great opportunity to receive much knowledge, but it does not involve the class in discussion, in analyzing cases, etc. Interactive teaching makes education more alive.”

    An understanding of human rights requires going beyond abstract standards. We must apply them to messy reality, grapple with difficult issues, and confront internal biases. For instance, when confronted with a case of extremely drug resistant TB in a patient, students must balance the rights to liberty, autonomy, and freedom of movement against the danger of infection to the community. And to provide good maternal care for a woman who uses drugs students must examine and debate their own attitudes.

    Case studies can be a powerful tool. To meet faculty demand for interactive teaching materials, we partnered with Toronto University’s Health Equity and Law Clinic and the Hastings Center to develop case studies on complex health and human rights issues, such as those above.

  2. Socially excluded voices need to come into the classroom. As Enga Kameni, a faculty member from South Africa explained, students need to “feel the problems that marginalized communities face by working directly with them.” Students were outraged when a former drug user described to a classroom how he was operated upon without anesthesia and subjected to excruciating pain in punishment for his addiction.

    Students can encounter excluded voices through guest lecturers or site visits, but video is also an effective tool. Through video, students may learn the plight of a Roma family denied emergency care, a transgender man subjected to psychiatric confinement, or a homeless man attempting to access HIV care, among others.

  3. Faculty can most effectively lead change when linked to a community. While we initially planned only to develop courses, we were soon beset by faculty requests to connect with others and strengthen their teaching. Human rights in patient care is not a focus of medical or law schools, and faculty members were pioneers at their universities. They wanted a community to share ideas, materials, and experiences. To meet this need, we supported a number of workshops, as well development of a virtual Community of Practice open to the public, which includes faculty materials, articles, exercises, and a section on teaching methodology.

  4. There are important links between patient and health care provider rights. Human rights education does not pit doctors against patients; there is an innate linkage. Doctors and other providers cannot provide good care if their own rights are unmet, they face poor working conditions, or lack professional independence. It is hard to provide care to HIV patients without gloves and sterile equipment. Overworked and exhausted doctors cannot as easily respond to patient needs. And doctors face risk when prescribing pain relief in some countries—according to the International Narcotics Control Board, almost half of participating countries reported mandatory minimum sentences for unintentional mistakes in handling opioids.

With these lessons learned, a new generation of rights-respecting health and legal practitioners is emerging, ready and eager to heal instead of harm.

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Though many transitional countries have made great strides in improving legal protections covering both patients and providers, wide gaps still exist between black letter laws and how they're implemented on the ground. Legal reforms alone are usually insufficient to shift practice where there is a legacy of systematic abuse in health care settings and a weak overall rule of law. This makes provider education programs that are part of the OSF initiative especially critical. Although tremendously work- and resource-intensive, these initiatives are key to making health care around the world more ethical, evidence-based, and inclusive.

Thank you for the kind words and for the helpful contextualization.

How could it be possible to include these courses in the medical school of the University of Panama?-central America

We unfortunately do not work in Central America. However, you may wish to connect with the ASPHER (Association of Schools of Public Health in the European Region), which has partnered with us in this work and is now interested in connecting with like-minded groups internationally. Please see And, please feel free to draw on any of the materials on the Community of Practice at Thank you very much.

Absolutely correct lessons. We will not move on if we don't teach about balance between patients' rights and medical providers' rights. Students have to understand that the rights and duties exist at the both of the parties.
And, of course, lecture will be purely less productive if isn't followed by the analysis of "live" cases

Thank you for the comment and for all your great work in Kazakhstan in this area!

It is natural to be disturbed and repulse by escalating violence around the world. The lesson of the vast World War II tragedy gave birth in 1948 to the United Nations Universal Declaration of Human Rights. But about 92% of polled people had never heard of it when it was supposed to be "the world of the individual person; the neighborhood he lives in; the school or college he attends; the factory, farm or office where he works..." and this, indeed, includes the medical doctors. So, as the education plays a key role, United for Human Rights provides tools to help educate and support people in their efforts to protect human rights and to end human rights abuses:

Thank you for sharing.

I appreciate the insight that pedagogical styles are central to building empathy, understanding and respect for patient rights and needs among physicians. In addition, I wholeheartedly agree with the point that violations of the basic rights of providers to adequate supplies and working conditions can in turn lead to violations of patients' rights.

I see much room for work with other categories of medical professionals - such as midwives, health officers, nurses - in low-income countries. Physicians are at the top of hierarchy of medical professionals, and are influential in policymaking. However, particularly in low-income countries where there are chronic provider shortages, they are a fraction of those delivering frontline medical services to women and other clients/patients. Some of the lessons from OSI's work with physicians (role-playing and case studies) should be shared with other categories of health professionals in order to build and reinforce professional cultures and norms of respect and empathy.

Great point. Thank you for the comment.

We have the same problems in Madagascar.
I propose to create a group where we can begin by studying how to translate and disseminate this type of documents in other languages, such as french, Spanish and local language first. After we study the establishment of a community of teachers and policy makers to study the feasibility of the integration of lessons in the curriculum.

I believe this is a good approach to entrench respect for human rights of patients in future doctors. I think another approach that could help people who face and experience violation of their rights is to teach or give human rights information to patients and the community of people /patients who experience discrimination.
Sharing my experience as a person who has lived with disability for about 30years and being in development work for over 20years, I realise that the knowledge gap between what persons with disabilities need to know and what they know is very wide. So in our individual and group peer counselling sessions we also deal with rights issues and the skills to negotiate them.
I must say it is not easy even for the best of us. There were times I had to solicit for the help of doctors who know me or I have been their patient or worked with to get my point of view across on issues ranging from medication to surgery. But then I can negotiate those things because I know about myself and my disability. I also encourage others to do so.

Agreed. Providing human rights information to patients is also critical and quite complementary to engagement with health care providers. Please find some rights materials produced for patients in Eastern Europe and Central Asia at

I think is a step in a right direction as many health workers in West Africa particularly Ghana are taken things for granted.

Thanks Tamar Ezar for the work, keep it up!

Thanks for the kind words!

Dear Authors,

Thank you for your publication. As a doctor recently involved in palliative medicine, I know that the lack of care is mostly caused by the lack of training in the field .I invite your institution to sponsor studies and workshops to improve awareness and care in Africa.

Yes, this is an important need. Our International Palliative Care Initiative has supported a number of trainings for health care providers in Africa.

It will be exciting and interesting to see whether and how these courses translate into changes in attitudes and behaviors among providers. We all know they are up against a stubborn system that too often pits them against their patients. One of the most important contributions of these courses will be to test whether post-Soviet medical systems can provide a supportive environment for health providers to translate human rights knowledge into practice.

Agreed. Thank you for the comment.

A brilliant and sensitive initiative i dare say. I suggest that medical school curriculum, particularly in Africa, should be reviewed to accommodate this new idea. Africa is as much guilty as Europe when it comes to violating the rights of patients. If this is included in their courses, am convinced it will eliminate some of the medical accidents that have contributed to deforming most patients...

Thank you for the comment. There is already some work in Uganda by Makerere University's Human Rights and Peace Center (HURIPEC) in this area.

I am delighted at this innovative way of engaging with medical and law students. From my personal experience, a doctor walked out on me because he felt I was asking too many questions regarding the medical procedure he wanted to carry out on me. In some countries, doctors are next to God, and carry themselves as such, hence they are not comfortable when you are being interactive about your health. I see this attitude as a violation of my right to adequate health care services

Thank you for the comment. This is indeed the case in many places, which carry the legacy of doctors as godly and not to be questioned. However, good health care requires information and discussion and the active participation of patients.

Excellent work. So important to document and share. Thank you. I suggest it is also important to build the capacity of law students, academics and practicing lawyers to understand the health implications of their work. So that trade lawyers understand the implications of trade agreements for public health, criminal lawyers understand how criminal laws can impede or assist public health programs, etc. IDLO has supported such academic partnerships in Egypt, through Ain Shams University in Cairo. David Patterson

Thank you! Completely agree. We're starting to work with intellectual property lawyers and faculty in Eastern and Southern Africa on intersections with human rights.

Excellent initiative! Really exciting to see this work! In the hopes people would find this useful, below is a link to a health and human rights syllabi database which may be of help in this effort.

Thank you! This is indeed helpful.

This is a great initiative. In furtherance of the goal, IPPR (Uganda) has brought the first public interest litigation petition on medical brain drain. It challenges the decision by the Government to "export" or transfer public health workers to Trinidad and Tobago. The effect will be disastrous for the health system and have fatal consequences, especially for women and children. We argue that it is unconstitutional, illegal, unethical, irrational and contrary to public policy.

The precedent may advance jurisprudence on the impact of medical brain drain on the realisation of the right to health in Africa and across the developing world.

Action Group for Health Human Rights and HIV/AIDS is a product of medical students study group that used to meet weekly to caucus about health and Human rights. To date we have a medical student's chapter called students of equity in health care. As we do the advocacy they have increasingly accompanied us to very remote districts to help conduct health service delivery in health facilities in rural areas. They have also been at the fore front of advocating for their rights as health workers shifting the focus on only patients. Their working environment is as important as observing the rights of patients. Sometimes Violations of patients' rights is much caused by the inadequacies within which health workers operate.

This is an important point. Thank you for sharing.

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