Bahrain's medics politicised by crisis
A group of Bahraini health workers have found themselves on the frontlines of a battle over medical neutrality as the aftershocks of the Arab Spring continue to rumble through the Gulf island kingdom.
In theory, medical neutrality is a simple concept: physicians must be allowed to care for the sick and wounded; soldiers must receive care regardless of their political affiliations; and all parties must refrain from attacking and misusing medical facilities, transport, and personnel.
Violations constitute a crime under the Geneva Conventions.
But for the medics who have been caught up in the unrest that swept Bahrain since February 2011, what is a simple principle has become a far more complex and sometimes terrifying dilemma.
The kingdom's main public hospital is Salmaniya Medical Complex (SMC). It was considered the jewel in the crown of Bahrain's public healthcare system.
Bahrain is a country unlike any other in the Gulf. It has a Shia Muslim majority ruled by a Sunni Muslim royal family. Shia have long complained of discrimination, poor housing and high youth unemployment in a country that has grown rich on oil resources first discovered in 1931.
But one discipline where Shia had faced little discrimination until two years ago was medicine, and many of the SMC's leading consultants were Shia Bahrainis.
The hospital is close to what was an iconic landmark in the capital, Manama - Pearl Roundabout - which was peacefully occupied by pro-democracy activists on 14 February 2011. Although there were some Sunni protesters, the vast majority were Shia.
When security forces first stormed the roundabout in the early hours of 17 February 2011, doctors, nurses and paramedics went to the aid of people who had been shot, beaten and tear-gassed.
They staged a protest after word spread that security forces were preventing the wounded from being brought to the hospital.
For the next few weeks, the government allowed the protesters to re-occupy the roundabout. Doctors from SMC set up a medical tent to provide care for the thousands who camped out there to press their demands.
Some of the medics appeared on international news outlets criticising the government and the security forces. Others chose to stay quiet and tend to the protesters' medical needs.
Regardless of whether they spoke out or not, the medics found they had crossed a line and entered an increasingly angry and intense political debate.
And then, on 14 March 2011, Saudi Arabia led a Gulf Co-operation Council (GCC) force down the King Fahd Causeway, which links Bahrain to the Arabian Peninsula.
Martial law was declared and Saudi troops took up positions at key installations, while Bahraini police and soldiers cleared Pearl Roundabout by force.
Two days later the authorities sent the army, known as the Bahrain Defence Force (BDF), into the Salmaniya Medical Complex. At the time, the government said it had been forced to take the step because armed protesters were threatening staff and patients.
Then, Shia doctors and nurses began to be arrested in a series of night-time raids. Many were allegedly tortured into giving false confessions before being convicted by a military tribunal and sentenced to lengthy terms in jail.
The treatment of the doctors provoked an international outcry. It alerted the world to the ongoing human rights abuses in the kingdom.
"That was the red line for me. It got me off my chair," US Congressman Jim McDermott told the BBC last week.
In response to the situation in Bahrain he introduced a bill in the summer of 2011, the Medical Neutrality Protection Act, but it died on the floor of the House of Representatives.
Had it passed, it would have required the US secretary of state to maintain a list of countries which violated medical neutrality rights, suspended select military assistance, and imposed visa bans on officials.
"Medical neutrality is a worldwide issue that we are dealing with, but most people, including politicians don't know what it is. It is hard to get people to take it seriously", Mr McDermott told the BBC.
Pressure for reform
But international pressure, sparked largely by what had happened to the medical personnel, did force the Bahraini government's hand.
In June 2011, Sheikh Hamad bin Isa Al Khalifa asked an independent panel of international human rights experts to investigate alleged abuses.
The Bahrain Independent Commission of Inquiry (BICI), chaired by the Egyptian lawyer Cherif Bassiouni, submitted a damning indictment five months later.
The report documented numerous abuses, including the systematic torture of detainees by security forces, and confirmed that medics had been mistreated in detention and forced to sign confessions under duress.
King Hamad accepted the report in full and promised reforms.
The BICI report noted that some of the doctors at the Salmaniya Medical Complex had engaged in political activities in and around the hospital that were "difficult to reconcile with the full exercise of their medical responsibilities".
However, the commission found no evidence to substantiate the most serious charge that they had stored weapons in the hospital as part of a plot to overthrow the government.
The report found that the security services had carried out unlawful arrests in the hospital, attacked medical personnel and that on 16 March 2011 the BDF had taken "control of the entire complex and placed some injured persons, whom it sought to keep under its control, on the sixth floor of SMC".
Although the BICI did not address the issue directly, it was clear from the evidence that medical neutrality had been violated - in some instances by the doctors themselves - but most profoundly by the government and the security forces.
Thirty-one of the 48 Salmaniya medical workers who were convicted before the military tribunal were subsequently acquitted by a civilian court.
'Society is very sick'
One of those acquitted was Rula al-Saffar, a professor of nursing and the president of the Bahraini Nursing Society. She went to help the wounded at Pearl Roundabout and spoke out against the BDF's seizure of the hospital.
Ms Saffar did not work at the SMC, but she was arrested on 4 April 2011, and spent five months in detention, during which she says she was tortured and threatened with rape. She was tried by a military court and sentenced to 15 years in jail.
She was subsequently released and finally acquitted of all charges last year.
"Three doctors remain in jail, but another six who served their terms are unable to work," she told the BBC.
Ms Saffar herself has not been allowed back to her teaching job, despite her acquittal.
"I call upon the government of Bahrain, and governments around the world, to respect the tenets of medical neutrality and to release those medics still in prison for simply doing their job," she added.
Ms Saffar was recently in Washington, where she called for 16 March - the day the BDF seized control of Salmaniya - to be declared global Medical Neutrality Day.
One of the politicians Ms Saffar met was Congressman McDermott. In October 2012, he was the lead author of a letter to King Hamad signed by 24 Republicans and Democrats.
The letter called on Bahrain's ruler to pardon eight doctors convicted of weapons possession, incitement and taking part in illegal demonstrations.
"Based on conversations with the medics themselves as well as independent investigators, we believe they were targeted not because of criminal activity, but because they were first-hand witnesses to the injuries caused by the Bahraini security forces' excessive use of force," it said.
Mr McDermott, who is a former US military psychiatrist, told the BBC: "I am a doctor myself, trained to care for patients. You don't ask about somebody's political beliefs or what side they are on. You treat the patient. That's what these medics did."
He condemned the Bahraini government's treatment of the doctors and noted: "When you lose medical neutrality, as Bahrain has done, the civility of society is lost. It is a sign that a society is very sick."
No-one from Salmaniya Medical Complex or Bahrain's department of health was available for comment.