Addressing War Crimes and Human Rights Violations: Susannah Sirkin of Physicians for Human Rights

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation , health policy , care delivery and the great minds
who are shaping the health care of the future. This week Mark and
Margaret speak with Susannah Sirkin , Director of Policy for Physicians
for Human Rights, an organization that uses science and medicine to
document evidence of atrocities occurring around the world in war
zones and global emergen cies. They also facilitate the documentation
of medical and psychological conditions of migrants seeking asylum to
help assess their refugee status.

Lori Robertson also checks in , the Managing Editor of FactCheck.org
look s at misstatements spoken about hea lth policy in the public
domain , separating the fake from the facts . W e end with a bright idea
that’s improving health and wellbeing in everyday lives. If you have
comments please e - mail us at [email protected] or find us on
Facebook or Twitter or wherever you listen to p odcast . Y ou can also
hear us by asking Alexa to play the program Conversations on Health Care . Now stay tuned for our interview with Susannah Sirkin , at
Physicians for Human Rights here on Conve rsations on Health Care .

Mark Masselli: We’re speaking today with Susannah Sirkin , Director of Policy at
Physicians for Human Rights a global organization working at the
intersection of medicine, science, and the law to secure justice in human rights for a ll. Ms . S i rkin oversees the international policy
engagement with the United Nations. She's launched numerous human rights investigations into genocide, war zone atrocities, the
plight of asylum seekers and the banning of landmines for which they
share the Nobel peace prize. She earned her BA in European studies
at Mount Holyoke and her MED at Boston University. Susanna h ,
welcome to conversations on health care.

Susannah Sirkin : Thank you.

Mark Masselli: You've been with P hysicians for Human Rights for over 30 years and
have dealt with some of the worst atrocities in history, the genocide in Myanmar, war crimes in Syria. By the way, I saw your full presentation to the United Nations. What a powerful presentation you made. You've also documented the mass migra tion and refugee crisis across the Mediterranean at our own Southern border. There are many NGOs in th e space, like doctors without borders. What sets
your organization apart from others? T ell us about your mission and
how you c arried out with your colleag ues?

Susannah Sirkin : Physicians for Human Rights is essentially an organization that
documents and advocates for change using science and medicine and the expertise of public health as well , and also the expertise of

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psychologists to provide often irrefut able evidence of human rights
violations. We don't provide medical care. We're really a human rights
organization that does advocacy, and uses the power and influence of
the medical and scientific professions to do this work . W e compliment
the many legal o rganizations that are also in the human rights
movement.

Margaret Flinter: Well, Susanna h , one of the things that really jumped out at us from
the report to the Security Council was this issue of the seeming
targeting of attacks on hospitals and health car e facilities by the
Syrian government against their own people . T his in spite of a UN
referendum that bans actions like this , t alk to us about what the toll
has been that the human toll and the toll just on the ability or the
capacity of the system in Syri a to res pond to the needs of its people?

Susannah Sirkin : Physicians for Human Rights has documented and reported on a tax
on health facilities and personnel all the way back to the 1980s
because this is not a new type of violation. In the war in El Salvad or,
hospitals have been bombed or attacked. Certainly in the Israeli -
Palestinian conflict that's been an issue . B ut what we've seen during
this awful eight year war in Syria is a systematic targeting of health
facilities and killing of doctors and other he alth personnel as a
strategy of war , and it's actually unlike anything else that PHR has
documented previously.

Physicians for Human Rights has now documented over 578 individual
attacks on health facilities in the last seven plus years , and the killing
of at least 890 health personnel and very likely many more . T here are
quite a lot of health professionals among others in Syria who
remained missing . This obviously has created a horrific situation for
the capacity to deliver health care in at least two thir ds of the country
of Syria. More than two thirds of the health professionals previously
in Syria, which was not a developing country , i t had a very advanced
health care system, have left the country .

M ultimillion dollar health facilities that the Syrian go vernment
established has been utterly decimated . H ealth professionals that we
know have moved from city to city to city as they've been forced into
n ow w hat is this a really terrible trap corner in Northwestern Syria.
Y ou can imagine that not only the woun ded who have been coming in
droves to these health facilities with legs blown off and terrible
shrapnel injuries and also victims of chemical weapons attacks, which
have also been used. But in addition, people with chronic health care
needs prenatal and po stnatal care, people with cancer, people who
need dialysis and the list goes on . O f course it's really incalculable t he
devastation to basic health care in a huge part of this country

Mark Masselli: You know Susanna h I was listening to your testimony and o ne of the
things that probably the lay person's not going to be familiar w ere

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that war has rules. You not only are dealing in that area and speaking
truth to power, but Physicians for Human Rights has been really
looking at the issues of l and mines. That's what led to the Nobel Peace
prize being awarded to your organization. You are very conservative
in terms of the data. T ell us how that has also influenced the work
that you've done on land mines as well as the work you do in terms of
the documentation of these abuses ?

Susannah Sirkin: We as P hysicians for Human Rights are relying on international
humanitarian war, which as you said, even w ars have rules . I said that
in my statement , p eople don't realize that . T hey think, oh all war is
awful. It's just a fr ee for all and people are going to kill people and
that's just the consequence. But in fact, we have the longstanding
Geneva conventions as well as other rules on weapons and so forth .
Of course, in the case of the attacks on health facilities, we have the
conventions which almost every country in the world is a party to.
Governments have obligated themselves to protect health facilities
and health personnel in war.

Similarly, governments have signed many weapons conventions
before we started the internatio nal campaign to ban l and mines,
something called the conventional weapons convention that restricts
the use of so - called conventional weapons. Prior to 1991 , the
convention on conventional weapons had restrictions on anti -
personnel l and mines. We did an in vestigation in Cambodia using
very, very precise methodology to look at land mine injuries . W e
found some really astounding data that we reported in a really a
landmark and pioneering import called the Cowards War which
detailed the not only the health con sequences and the challenges to
surgeons from the egregious injuries caused by these weapons, but
also so many of the victims were chi ldren and civilians.

The statistic that we came out with was, I believe it's one out of every
256 Cambodians was a land mi ne amputee. After that study we
discussed in our organization , should we just outright call for an
absolute ban on this weapon . As doctors we said yes, this is an
absolutely inhumane weapon and it should be banned under the laws
of war because it's inheren tly indiscrimina te just like chemical
weapons are inherently indiscriminate. You can't say who is going to
be injured by it , as we know now Afghanistan and in Somalia and in so
many countries around the world .

We called for the ban and we helped to organiz e the campaign. We're
one of the six initial founders of that incredible campaign that in five
short years created a new treaty that have affectively now pretty
much banned the use of this weapon in most parts of the world .
There are still some outstanding non signers including the United
States that has not signed or ratified this treaty. Nonetheless, because

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it's such a taboo the US has essentially abided by the terms of the
treaty without signing on the dotted line.

Margaret Flinter: Well, Susanna h , one of the issues that I think maybe we've actually
read about more with this conflict than most is the issue of sexual
violence. You've set up an infrastructure, I understand to try and
address the issue of sexual violence in conflict zones around the
world. I think that's really important to talk about the challenges of
trying to make an impact in this terrible problem that's associated
with conflict as well.

Susannah Sirkin: Sadly, this has been considered to be the so called silent crime
because it has been so incredibly difficult and stigmatizing for
survivors of sexual violence to talk about it . Physicians for Human
Rights started documenting the use of rape as a weapon of war in the
Balkans Wars where rape was indeed used as a strategy as well to
instill terror. We tried to figure out how could we document as
physicians in a safe way and a way that respected the privacy and
dignity of the survivors, the scale and scope of these crimes and how
could we also advocate with lawyers to prosecute rape as a war
c rime.

Since then P hysicians for Human Rights has been really on the
forefront of helping to figure out how you can study these crimes
without overly violating the dignity and rights of the survivors, but
also enabling them eventually to speak out. In the h orrific w ars in the
Democratic Republic of the Congo it was labeled as the rape capital of
the world because there are believed to be hundreds of thousands of
victims of rape in those w ars. We started to do a project to help local
health professionals do f orensic examinations of rape survivors. I
might add there are women and children, but there are also men and
boys who are victims and in fact that is the even more silent crime.

Finally, there has been attention to these cases and there is a
beginning of s erious prosecutions for these mass atrocities. Physicians
for Human Rights has a project working in Kenya, in the Democratic
Republic of the Congo , n ow I've been working training health
professionals as well as judges and lawyers and police in Iraq . R eally
the model that we have is meant to engage a multisectoral group of
professionals who are needed if we're going to ever achieve an end to
impunity for this crime.

Mark Masselli: We're speaking today with Susanna h S irki n, Director of Policy at
Physicians fo r Human Rights. Susanna h , Physicians for Human Rights
also focuses in on the refugee community. Your organization does
intake interviews of people seeking asylum in various parts of the
world in places like Bangladesh where the Rohingya refugee s have
fled the genocide in Myanmar. I should note that our organization has
provided specialty access to health care providers in those refugee

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camps, but also you've focused in on the mass migration across
Europe as well as Central America . I'm wondering you could t ell us
about the work that you're doing in this area.

Susannah Sirkin: Sure. Well, first of all, thank you for the work that you're supporting.
It's extremely important. At the very beginning of any of these crisis
where large numbers of people are forced into flight where they need
to receive refugee status and care. The first thing that's needed
obviously is a basic humanitarian response. What P hysicians for
Human Rights is able to do in those same environments is doc ument
the violations that cause people to flee. The asylum work that we do
is so far largely focused on the United States where since our earliest
days back in the mid 1980s, PHR developed a network, a trained
network of health professionals who documented evidence of
persecution. Some of the impacts of the violence that people
experience in conflicts or due to domestic violence or psychological.

We need psychologists and internists who have an understanding of
the full range of physical and psychological effects to document what
has happened. In the U S we have over a thousand volunteer health
professionals who are trained to do forensic documentation of
trauma so that they can share that information with lawyers who are
representing the legitimate claims of clients who are seeking asylum.
Of c ourse, as you can imagine in the last couple of years in the United
States, the demand and need for this effort of ours has multiplied
dramatically, especially along the Mexico border, but also in so many
cities where more and more people seeking asylum ne ed that kind of
documentation.

Margaret Flinter: Well, Susannah , I wonder if I could ask you to expand upon this a little
bit because this is an issue that is so much on the minds of I think of
all of the people that we work with . T his issue of children be ing
separated from their parents , i f you want to talk about adverse
childhood events, we can't think of anything that's much higher than
being separated from your parents and not knowing when you'll see
the m again or if you will see them again or what it e ven means. How
can people follow this process or understand the work that you're
doing?

Susannah Sirkin: We have done a number of studies that compliment the incredible
and brave work that so many other medical and border organizations
and immigrant rights they're doing where we think that our medical
expertise can add to the documentation of the violations that
occurred. We've published several reports, one of them on the health
impacts of the family separation policy , and another one on the
trauma that ch ildren who have sought asylum or fled their countries
have experienced both before they left their home countries and at
the border. Both of those reports c an be found on our website at

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PHR .org .

We are actually now starting a campaign to try to support and
encourage more health facilities in the US to become what we call
sanctuary hospitals, which would have policies that prevent ICE and
CBP agents from entering the hospitals from arresting patients, from
standing in rooms where people deserve to have priva cy for
treatment. Those are the kinds of violations that we consider to be
serious human rights violations. We're doing it here in the US as well.

Mark Masselli: Susanna h , I just wonder, for our listeners who are dealing with human
rights abuses around the world, atrocities in Syria . H ow would you
describe to our listeners about what your greatest need is now and
how might they be engaged with the great work that you're doing?

Susannah Sirkin: Well, it's probably goes without saying, but we always need fund s and
we also need a stronger representation of the g lobal h ealth
c ommunity. Our vision for the next three to five years is to really
create a global network of health professional advocates for human
rights. In the last, I would say seven or eight years, we've pivoted
more to training health professionals on the front lines of many of
these crises is because more and more of the international work has
to be done locally. If you look at what's happening in Sudan right no w
where longtime dictator Omar A l Bas hir who's charged by the
international criminal court with genocid e was ousted a few months
ago, p artly because doctors started demanding human rights in
Khartoum . T hose doctors are now documenting the killings that are
happening.

This is happening in many , many countries where health professionals
are the eyes and ears where they're seeing firsthand what is
happening and they can document it medically. Maybe that's one of
many reasons that th ey are targets . W e want to defend them. We
need to understand tha t what's going on here at home in the United
States, let's say , is paralleled in so many other places. The network of
responders in this world where travel and mass communication
connects us al l instantly to what's going on, like I can look at my email
or my phone this morning and I can see a forensic report from the
Middle East and saying, please help us t his person died , c an you look
at those bu llet wounds on this photograph? We hope that more and
more will sign up and will become part of this global netw ork where
you can do advocacy from your home . Y ou can also travel to the
border and document , and maybe you can get trained to do these
asylum cases or trav el overseas to do this kind of h uman r ights
documentation.

Margaret Flinter: We've been speaking tod ay with Susannah Sirkin, Director of Policy at
Physicians for Human Rights . Y ou can learn more about their
important work by going to PHR. or g or follow them on Twitter

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@P4HR or @ Susannah Sirkin . Susannah , thank you so much for your
commitment to human righ ts and for sharing your message with us
today on Conversations on Health Care .

Susannah Sirkin: Thank you.

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Mark Masselli: A t Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare refor m and
policy. Lori Robertson is an award - winning journalist and Managing
Editor of FactCheck.org , a n onpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US p olitics. Lori,
what have you got for us this week ?

Lori Robertson: Deadly mass shootings in El Paso, Texas and Dayton, Ohio have again
prompted debate on the public health issue of gun control. One piece
of legislation readers have asked us about in the past is a law signed
by President Donald Trump that elimi nated a social security
administration reporting requirement for gun background checks
regarding beneficiaries deemed to have a mental impairment. The
reporting requirement applied to disability applicants unable to
manage their finances due to a mental he alth condition. Under the
federal background check system, which was launched in November
1998 individuals, “c ommitted ” to any mental institution , o r
“ adjudicated ” as a mental defective by a court board commission or
other lawful authority are prohibited f rom purchasing or possessing a
gun.

States can report those individuals to the national database used by
federally licensed firearm dealers to screen for prohibited gun buyers.
The Social Security Administration final rule issued in December 2016
one month before Trump took office was meant to comply with
requirements in a 2007 act calling on federal agencies to report
individuals prohibited from acquiring guns to the national instant
criminal background check system. As of December 2015 , more than
3.5 mill ion people were receiving benefits because of a mental
disorder. The Obama Administration estimated that the reporting
requirement would cover about 75,000 people each year. Those who
had a severe mental health issue received disability benefits and were
u nable to manage those benefits.

Trump opposed the rule the White House said , because it , “ could
endanger the second amendment rights of law abiding citizens. ”
Other critics of the rule included the National Rifle Association and
the American Civil Libertie s Union, two groups that are usually on
opposite sides of gun - related issues. The rule included a way for
individuals to petition for the ability to obtain a gun. Trump repealed
the rule months before the Social Security Administration actually had

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to comp ly with its requirements . T hat's my fact check for this week.
I'm Lori Robertson, Managing Editor of F act C heck.org .

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on Conve rsations on Health Care.

[Music]

Margaret Flinter: Each week Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. Here's a
question for you. What is the last sound that you would want to hear when you die? Would it be this [ beep ] or this [ Orchestra ]? That’s the
question the ambient musician and composer Yoko Sen asked after an
illness led to an extended hospital stay. During that time, Sen was
hooked up to multiple machines that made a cacophony of discordant
and disturbing sounds.

Yoko Sen: I was terrified by the sound of alarms i n such dissonance . L ying on a
hospital bed, I wondered why does it have this way , c ould it be
better?

Margaret Flinter: She thought these sounds are not only jarring for pa tients who have
no way to escape the con stant din, but she also surmise they are l ikely
pretty stressful for hospital clinicians and staff as well . Sh e set out to
compose hospital machines sounds that would create a more soothing and harmonious oral enviro nment.

Yoko Sen: What if I tuned some of these into [Music] to make it too F major to
sam e sound, just different tuning. Already, this is better.

Margaret Flinter: She found Sen Sound, a social enterprise that's aimed at reducing
noise pollution in hospita l settings and creating what she's calling the
future of hospital sound. Sen Sound is collaborating with hospitals to
reduce overall noise by interviewing patients and staff about what noises most disruptive and unsettling , and then creating solutions to
a ddress these concerns. As an artist in residence at the Johns Hopkins
Sibley Innovation Hub , Sen has design ed a multimedia tranquility
room to relax with soothing music , moving projections, aromatherapy
NT .

Yoko Sen: Staff members don’t really have a place they can go to relax when
there are stressful moments . As a patient, I believe that the heart of
patient experience is really the compassionate interaction with staff members, especially nurses. If we could help take care of them who

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take care of patients , ultimately I think we are making everybody's
experience better .
Margaret Flinter: Since hearing is often the last sense to leave before someone passes
away, Yoko Sen is driven to provide a better answer to this question.
Yoko Sen: What is the last sound you wish t o hear at the end of your life?
Margaret Flinter: Sen Sound . Now that's a bright idea.
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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Pea ce and health.
Female : Conversations on Health Care is recorded at WESU at Wesleyan University,
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podcasts. If you have comments, please email us a t [email protected]
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brought to you by the Community Health Center.
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