Originally published in The Washington Post, June 8, 2003.
Doctors With 'Dirty Hands'
Maryam Elahi and Adam Kushner
For most people, it's unimaginable to think of physicians assuming the role of torturers and executioners.
Yet under Saddam Hussein this is what took place. Whether the complicity was forced or voluntary,
physicians participated for years in the state's apparatus of cruelty and terror. As researchers for
Physicians for Human Rights in Iraq, we spoke to many doctors who reported on complicity in these
heinous acts. The state wanted them to have "dirty hands," said one senior surgeon, who told us that
they acted on a government mandate ordering all surgeons to participate in cutting off the ears and
branding the foreheads of army deserters. In one hospital, all surgeons -- general, orthopedic, plastic,
cardiac and neurosurgeons -- were reportedly required to perform the mutilation.
This was an extreme example of dual loyalty, whereby doctors were called on to subordinate their core
ethical responsibility to the interests of the state. According to a 1994 decree, surgeons who refused to
engage in state-sponsored torture would have their own ears cut and be branded, and if they sought
plastic surgery, the plastic surgeon would be executed. In one hospital we visited, virtually all senior
surgeons complied. We spoke to one surgeon who had hidden in a closet for an entire day to avoid the
act. He knew of many others who had been haunted by the practice and suffered greatly. Many, deeply
traumatized, quit their medical practices.
We also spoke to those who had been tortured and mutilated. One young man told us that in an
operating room, the anesthesiologist said to him, "You shouldn't have left the army. If I could let you leave
the hospital now, I would, but it is surrounded so you cannot run away. I am sorry about this." When he
came to, he was cuffed to the bed with his arms spread wide apart. Someone told him his ear was gone.
That night when he took the gauze off his head and looked in the mirror, he said, he felt "very sad, angry
and destroyed." Then he found a piece of gauze in his pocket. When he took it out and unwrapped it, he
found his ear.
Throughout Iraq, in all professional settings, there were informants. In some cases doctors reported on
medical professionals and students in their midst and accused them of disloyalty to the regime. We were
given a copy of a letter written in 1999 by a physician who reported three medical students to the
authorities. He stated that the students had notified him that they intended to kill a member of the Baath
Party. The three students were subsequently arrested and executed.
Physicians revealed to us that the Baath Party practice of creating terror and intimidation extended to
hospitals, where physicians and hospital staff suspected of "disloyalty" to the regime were publicly
executed at the workplace. Staff were then ordered not to bury the corpses for three days -- to let them
serve as a warning to others.
We are only beginning to put together pieces of a gruesome picture that may take years to fully reveal.
The stories of torture and arbitrary killings -- most recently graphically verified through the discovery of
the mass graves of thousands -- are evidence of the extent to which the state inflicted horrific injury on its
own people.
The extent to which Iraqi surgeons participated in mutilation in Iraq appears to be unprecedented, but this
is hardly the first instance of complicity, forced or voluntary, by physicians in human rights violations. In
South Africa, hearings held by the Truth and Reconciliation Commission showed how deeply the
profession's leadership was implicated in the perversion of medical values under apartheid. The response
of some institutions in South Africa, however, demonstrates one route forward -- a thorough review and
accounting of the role of members of the profession in human rights violations and a commitment to
human rights through new institutional structures and policies. Now the Iraqis must decide on an
accountability mechanism that fosters reconciliation and stability, and the United States and its allies in
Iraq should create a safe environment for this process to begin.
Maryam Elahi, a lawyer, and Adam Kushner, a physician, are research consultants for Physicians for
Human Rights.