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Published in Radical Journal of Health

Volume III, No. 3, July-September 1998, Pp. 143-156

Violence and health care profession in India:

Towards a campaign for medical neutrality

Amar Jesani

In the medical discourse in India, the concern for violence has been conspicuous by its
virtual absence. In much of the medical research, discussion, and publications, the mention
of the victims and survivors of violence, their special medical needs and rehabilitation is
rare. This is despite the fact that violence invariably inflicts physical or psychological
trauma. In any form of violence, the victims and many survivors come in contact with
health care workers. Survivors themselves approach or are taken to health care services for
the treatment of their physical injuries and psychosocial trauma suffered. After the death of
victim, the doctor conducts autopsy. In fact, the medical record of violence on the survivors
and victims constitutes one of the important evidences for police investigation and the legal
process for punishing the offenders and compensating victims and survivors. The apathy of
the medical profession could result in delayed or denied justice to many victims of violence

Violence as a public health issue

The figures quoted by the media and social science researchers from the various sources on
the incidences of all types of violence and the estimated numbers of victims are indeed
shocking. Besides, there is hardly any mention in our scientific journals and health policy
documents about the implication of such a phenomenon for the health care services. While
one does not want to sensationalise and exaggerate the phenomenon of increasing violence
in our society, one also cannot desist from saying that for the health care services it is a big
- but ignored, epidemic of the present time.

Although the intensity of this epidemic needs to be assessed, sadly, inadequate work has
been done on the subject. The data on burden of diseases presented in the World Bank
Report (1993) suggests that morbidity due to violence and accidents accounts for 8.1% of
all morbidity (DALYs lost) among women and 10.2% among men in India.

The science of medicine incorporates a sociological and epidemiological understanding.

Medicine, and for that matter, any science not geared to the real social and epidemiological
issues often loses its humanitarianism. Violence does not leave the health professionals
completely unaffected. After all, doctors also come from a social milieu, which has varied
and conflicting standpoints on violence. To what extent is the attitude of doctors to
violence shaped by their social positions and ideological orientation in our country?
Finding answer to this question is not easy. For there has been very little empirical research
conducted to find out health care providers’ attitude on the subject and the extent to which
individual biases get reflected in the medical practice.

The number of health care professionals in our country is staggering. We have 1.2 million
properly qualified doctors (1 doctor for less than 900 persons) who are legally registered
with three Medical Councils. In addition, we have about 0.3-0.5 million non-qualified and
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non-registered doctors practising in the country. We have nearly 0.6 million Nurses of
various categories and also have a large cadre of other paramedical workers. In all, we have
over two million professional and para-professional health workers who need to be
educated to take cognisance of the violence as a public health issue and undertake
advocacy to ensure that they play a positive, constructive and ethical role in caring for the
survivors of violence.

In this review, we have summarised the present situation in three parts: (1) Violence
against Women, (2) Communal and Caste Violence, (3) Violence by State Agencies. We
have reviewed selective literature to highlight lacunae in the role of health services and
profession in preventing violence and caring for survivors. Indeed, there are also many
positive features, too. However, there is very little written documentation available and is
often only considered as part of individual doctor or hospital’s philanthropic zeal. In any
case, it is still not so much a concern for the profession and the system at large. While
Indian Medical Association has begun discussing about and started some educational
campaign among its members, they leave out 60% of doctors in our country who are non-
allopathic doctors and it is restricted to torture. Besides, it hasn’t shown real commitment
to the cause by taking action or campaigning for action against those doctors who have
been named as collaborators in human rights violations.

We have also reviewed here some information on the need for education and training of
doctors in order to make them aware of the problem, take measures to prevent it and, above
all, to change their attitude towards violence and the victims. The last issue is very
important. For in all the three types of violence, there is some evidence to suggest that a
section of doctors themselves believe in the use of violence against victims/survivors in
"certain circumstances." Or that they are less than sympathetic if the victim has certain
negative attributes or when the victim is "stereotyped" by society.

Violence against women

Prevalence

The great surge of the women’s movement in the 1980s brought the issue of violence
against women on the political agenda of the country. Yet, a survey of violence against
women in the less developed countries has shown that it is a grossly neglected public
health issue (Heise, Raike et el, 1994). Violence against women and children is the most
common form of family violence and it has social, cultural and religious sanction. The
studies done by Flavia Agnes in the 1980s in Bombay and other studies have shown that it
cuts across the class and class barriers. These social variables only change the form of
violence, not its high prevalence. In a study of 120 families done at the NIMHANS,
Bangalore, Bhatti (undated) found that some form of violence against women was
prevalent in all families. The physical and verbal violence was the highest (88%) in the
low-income families while in the middle income (43%) and high-income (35%) families
those forms were less prevalent. However in the latter groups, there was a higher
prevalence of social and emotional violence. In a large study of 230 women from urban
middle and upper classes, Sathyanarayan Rao and his colleagues (1994) from the
department of psychiatry in the Medical College at Mysore, investigated the pattern and
causes of psychological violence against women in the family. They came to the
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conclusion that psychological and emotional torture is highly prevalent in the middle class
families. In a study by Mahajan and Madhurima (1995) of 115 women in lower caste
households in one village at the outskirts of Chandigarh in Punjab as many as 87 (75.7%)
women reported physical violence against them by their husbands. Further, of these 87
women, 58 (66.7%) said that they were beaten regularly. Similarly, dowry deaths and their
increasing number, despite changes in law, point to the pernicious prevalence of family
violence.

While the women’s movement has brought family violence out of the closet and made it a
social and political issue, the violence against children within the family and outside is still
not properly recognised, except in the campaigns against child labour and the problems
faced by street children. Studies on child abuse in India are difficult to find although our
experiences suggest that the violence against girl children, including sexual violence, is as
highly prevalent as wife beating.

Role of health care professional

The role of health care professionals is highly ambiguous in cases of family violence. In an
investigation (YUVA, MFC et al, 1990) of a gang rape in Bombay it was found that despite
the visible signs of injuries in regions, which would make any medical person suspicious of
rape, the male doctor turned away the woman after giving routine treatment of injuries.
This was done, according to the doctor, simply because the woman could not tell him that
she was raped. In this particular case, the woman had reported rape to the nurse on duty but
could not communicate the same to the male doctor. In a recent case of the rape of a
hearing impaired girl in a government run Observation Home for Juveniles in Mumbai, the
same pattern was observed in the doctor’s behaviour. An investigation team found that the
officials of the Observation Home did not report the crime for twenty days to the police.
However, they did get the victim examined by their in-house doctor, who also failed to
follow proper procedures. Indeed, the doctor also failed to do the medical examination of
and collect forensic evidence from the offender who was also present all the time in the
premises of the institution (FACSE, 1998).

Failure to collect relevant forensic evidence and counsel the survivors due to ignorance and
indifference are not the only problems the profession needs to address. There are also
instances of doctor’s direct collusion in falsification of evidence and protecting the
offenders. For instance, in a case of custodial gang rape and torture of a tribal woman by
the police in Gujarat (AI 1988), the commission of inquiry constituted by the Supreme
Court had found two doctors at the government hospital guilty of shielding the policemen.
They had also issued a false certificate.

Shally Prasad’s (1996) study in Delhi found a conspiracy of silence on the part of
physicians. The private as well as state-employed physicians seldom acknowledged the
cause and totality of woman’s injuries. They also did not make referrals to counselling
services or women’s organisations. Physicians generally avoid involvement in gender-
based abuse because of the negative social stigma. Physicians’ general attitude of denial is
manifested through delayed and often inappropriate, medical examinations, denial of the
crime and health impact on women, and limited health care assistance beyond immediate
trauma. Often physicians deliberately do not ask questions regarding the cause of injuries
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because they do not want to be involved in a legal case. Her interviews with over 30
survivors of abuse and health care providers showed that long-term care, STD screening,
counselling and preventive care were not generally included in the examination. On the
other hand, the case studies of rape survivors showed that physicians often did not conduct
thorough and time-sensitive medical examinations, which resulted in the loss of valuable
medical evidence. She recommends that associations of medical professionals should be
motivated to upgrade rape protocol, implement comprehensive treatment and long term
care for survivors, implement similar training and refresher training for medical students
and doctors etc. She also makes a plea for the establishment of a central bureau of forensic
specialists in public hospitals to co-ordinate the collection of medical evidence. It is in this
context the initiative of the CEHAT, Mumbai in developing a manual and kit for medical
and forensic examination of sexual assault victims going to be very useful (D’Souza,
1998).

Despite the partial success achieved by women’s groups in getting rape laws amended,
most of survivors do not come forward to report violence against them and most of those
who reported the crime, have not got justice. A lack of any system within the health care
professionals for reporting of cases of violence seen and inadequate or incorrect medical
evidence in rape cases, etc. are some of the many important reasons for such failure.
Moreover, the profession and health system do not have any mechanism to make
accountable and punish those doctors who are negligent and guilty of collusion with
offenders. In fact, medical audit and strict accountability systems are must in order to
prevent violence and help survivors get justice.

Similarly, in cases of wife beating, although such battered women do approach doctors for
treatment when severely beaten up, their medical record would invariably show the injuries
as accidental. While it is true that often women do not report the true cause of injury due to
fear, even in those cases where such reporting is done, women have found the doctors
uncooperative. Indeed, examination of medical records by us has invariably shown that in
all “medico-legal” cases the doctors are tutored not to write detailed history of assault. The
hospital managers and forensic experts have taken stand that writing history of assault is
the job of police, and not doctors. Besides, it is argued, by not writing the history of assault,
the doctor would be able to protect him/herself better in the court of law. Not only that, the
forensic experts have also taken position that in medico-legal cases doctor’s role is only to
collect forensic evidences and in such examination, no doctor patient relation is
established. Thus, according to them there is no ethical obligation on doctor to care for the
survivor. It is obvious that such a position has devastating consequences, particularly in
rape cases.

There have been some efforts to study sexism in medical textbooks and medical practice.
But there has been no efforts made to look at the violence within the families of health
professionals. In some of our work with the Auxiliary Nurse Midwives (Iyer and Jesani,
1995), we came across many instances of violence against women health professionals. In
order to sensitise health workers to problems of survivors of violence it is necessary make
them think and talk about their own lives and problems.

Communal and caste violence

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Most of the sociological studies have shown that the doctors hail from upper caste and
class strata of the society (Ommen T. K., 1978, Venkatratnam R., 1979). With the
phenomenal increase in the number of private medical colleges, the dominance of these
strata in the profession is on the increase. This social background of doctors provides a
fertile ground for the social forces using caste (castism) and religion (communalism) for
political mobilisation and capture of power. It is, therefore, not surprising that in communal
and caste mobilisations, significant support has come from the professional classes, which
include doctors. Our personal experiences with doctors at a professional level and in our
interaction with them in several health service studies in urban and rural Maharashtra, we
have found health professionals’ views highly coloured by caste and communal ideologies.
Very few studies and personal experiences of doctors are available on this subject.
However, the available material does make one concerned about their role and attitude.

Negative role: Indifference and approval

While a big section of doctors worked tirelessly in providing medical relief to victims
during communal riots in Mumbai in 1984 and in 1992-3, some doctors in personal
conversations confessed that some of them were as much involved in believing and
spreading wild rumours as the general public. During the 1984 riots, some social workers
who took survivors to the city hospitals had complained apathy and indifference,
particularly by the Class IV support staff, towards survivors from a particular community.
An eyewitness testimony by a doctor (Sharma, 1991, pg. 9) on the behaviour of doctors at
the M. G. M. Medical College and the M. Y. Hospital, Indore, during communal violence
in October 1989 (the well-known rathyatra violence) is revealing. He and his colleagues
from the Socially Active Medicos found that, the “doctors themselves harbour anti-
minority sentiments and contribute to the harassment both by spreading rumours and by
blatant discrimination in health care provision”. According to this eyewitness account, the
doctors contributed to communal tension by “increasing the death figures for the majority
caste, thus making it appear that they were the ones victimised." He also describes an
observation by his colleague on the medical care provided to minorities: “Far from
stopping at manipulation of death figures, doctors were also seen to deny proper medical
care. Dr. ..... , a member of Socially Active Medicos, while working in casualty ward
witnessed blatant discrimination of patients according to caste; at times, he even saw a
proper line of treatment suddenly changed when it became apparent that a patient was
circumcised”.

On the positive side, Dr. Sharma also describes the case of Dr. Ariwala, who during those
violent days continued work at the hospital for long hours, thus leaving his house
unprotected. The rioters indeed looted his house while he was caring for survivors at the
hospital.

Caste and communal divide

While this negative role played by some doctors in events of violence must worry the
health care professionals, they should also recognise that indifference to and approval of
communalism and castism in the society could only divide them. In the worst cases, such a
division could also fuel caste and communal conflicts. For instance, in the early 1980s,
when the middle classes of our country raised the issue of abolishing reservations in higher
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education for lower castes (the Schedules Castes and Scheduled Tribes), the doctors were
very much part of the campaign. Indeed, in Gujarat in mid-1980s, the medical students
supported by doctors and organisations of their parents played a very prominent role in the
anti-reservation agitation. Medical professionals publicly castigated the reservation policy
and asserted that the ill-equipped and less-intelligent tribal doctors and those from lower
castes were primarily responsible for declining medical standards and so on. It is also
significant to note that, the anti-reservation campaign and the social atmosphere created by
such powerful forces was used, at that time, in Gujarat by vested interests to inflict
violence against lower caste individuals and groups.

Similarly, communal riots are accompanied by rumours against the minority, and such
rumours could also include vicious hate-propaganda against doctors from the minority.
This situation does not allow minority-victims to reach hospitals (because of the tense
environment outside the hospital) and also make out the majority community to be victims
in the hands of minority-doctors. Such atmosphere leads to communalisation of the
provision of immediate medical care to the survivors of violence. For instance, in mid-
December 1990, Aligarh, a town in Uttar Pradesh was rocked by communal violence. A
local Hindi daily newspaper made allegations that “patients and their relatives had been
deliberately killed on communal lines by the doctors on duty at the Jawaharlal Nehru
Medical College, Aligarh Muslim University”. Implying that the Muslim doctors at this
hospital systematically killed the Hindu patients. It was also alleged that one of the reasons
for the communal violence in Aligarh was such killing in the hospital. Indeed, these reports
alleged that the neutrality of medicine was seriously compromised in the hospital.

While there was no investigation of the allegations of violence of medical neutrality in

Lucknow hospital described above by Dr. Sharma, a medical group in New Delhi, called
Delhi Medicos’ Front sent a team of doctors to investigate the allegations in Aligarh. The
team interviewed all individuals who were supposed to be eyewitness to the massacre of
Hindu patients. Both Hindu and Muslim doctors were interviewed. The team ultimately
came to the conclusion that: (1) No incident took place between December 7-10, 1991
inside the hospital building as alleged by the Hindi newspapers of the Uttar Pradesh. (2)
There was no discrimination against patients on communal lines. (3) There were three
stabbing incidents outside the casualty on the 8th and 9th December 1991 by some masked
men. (4) Press reports in the Hindi newspapers of UP are totally false and baseless (Sofat,
Saxena, Siddiqi, 1991).

Psychosocial trauma due to communal violence

Communal violence produces serious psychosocial trauma among survivors, the victimised
community and among the witnesses. Following riots in Mumbai, there were numerous
reports in the media describing the kind of psychosocial trauma suffered by survivors.
Departments of psychiatry in various public hospitals provided information on the kind of
symptoms suffered by survivors, particularly children. (see various press reports
documented in Jesani, D’Sa, Alphonse, 1993, pgs. 74-120).

Dr. Harish Shetty and Dr. Anjali Chhabria (1997) have documented psychosocial problems
suffered by people due to riots. Some of the findings of various studies documented by
them are as follows:
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“A study conducted by the Dept. of Psychological medicine at the R. N Cooper Hospital,

Mumbai, among 400 survivors between Jan-April, 1993, showed that: (1) Survivors
refused to visit the hospital to talk to the staff, but they willingly waited near their homes
for the team to arrive, (2) intrusive thoughts, flashbacks, avoidance behaviour, numbness of
emotions, hyperarousal, 'existential dilemma' and ghetto mentality were evident in some
areas, (3) Avoidance behaviour is more common among the middle aged and middle and
upper middle class socio-economic groups, (4) Somatic symptoms are noticed in adults, (5)
Hyperarousal, intrusive thinking and hostility increased after a month of the event and
decreased with passage of time, (6) Depression increased with the passage of time, (7) A
persistent feeling of uncertainty was the commonest negative emotion.

“A study conducted by the Dept. of Psychiatry, B. Y. L. Nair Hospital, of 192 hospitalised

patients revealed that: (1) 33% expressed anger and were in a state of shock, fear and
helplessness, (2) 2% of them had attempted suicide - all females who had seen the mangled
bodies of their husbands, (3) 36% had suicidal thoughts, (4) 21% suffered from severe
anxiety, (5) 41% had paranoid thinking and obsessional symptoms, (6) 100% had loss of
libido, (7) PTSD feature scored very high and a few were emotionally anaesthetised.

“Another study conducted by the Dept. of Psychiatry, B. Y. L. Nair Hospital, among 500
children from two Municipal Schools revealed that: (1) psychiatric morbidity was very
high, (2) victims were affected more than non-victims, (3) children staying in hutment were
affected more than those staying in chawls. (4) A follow up study after six months revealed
that 11% of the children were suffering from distress.

“According to the educational department of the Municipal Corporation, 30,000 children

dropped out of the schools after the riots.”

While day-to-day discrimination against women and the lower castes in the provision of
health care is prevalent and unethical, the role of health professionals during the large-scale
caste and communal violence has remained unexplored. During the communal violence in
Bombay in 1992-3 we came across some doctors in public and private hospitals who
justified the violence against minorities. At the same time, we also came across many
doctors who were opposed to communal violence and showed their commitment by taking
care of survivors at great personal risk. To what extent the caste and communal biases
amongst doctors get manifested into overt discrimination in the treatment? This subject
needs more exploration and research.

Violence by state agencies

Autopsy

The abysmal condition autopsy rooms across the country, conduct of autopsies, quality of
their reports and access to these reports etc. have been a matter of concern for long. There
have been reports in the press about the pressure exerted by the police on doctors to give
favourable findings. The famous case of police custody death of Dayal Singh made the
Resident Doctors’ Association of the AIIMS (New Delhi) protest against such pressure is
mentioned in the Amnesty International (AI, 1992) report titled “Torture, Rape and Deaths
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in Police Custody”. Similarly, the autopsy reports of two nuns murdered in a Bombay
suburb and the doctors’ role in unscientific interpretation of its findings created a great
furore (Solidarity for Justice, 1991). In addition to the autopsy reports of these nuns, we
also had an opportunity to go through a sizeable number of autopsy reports of custody
deaths and so called ‘encounter deaths’ in the last few years. In general we found that they
usually have incomplete and often unscientific documentation. It is significant to note that
the Supreme Court had to pass an order in 1989 that all post-mortem examinations held at
the AIIMS be standardised.

Torture

Some of the retired and senior police officers, “reared in the old school of correct
policing”, have publicly criticised the “new methods of policing." These new methods are
“supposed to be firm, unorthodox, effective and harsh, and they condone the use of torture,
illegal detention and tempering with records, and in worst cases even condone execution by
police officers of hard core criminals” (Rustamji, 1992). The 1992 report of the Amnesty
International cites 13 cases of custody death due to torture in the period 1985-89 in
Maharashtra. However, a Bombay newspaper The Independent, (Anonymous, 1991)
reported a study by the prestigious Karve Institute of Social Work, Pune giving the toll of
custody deaths in Maharashtra as 155 in 1980-89 period. It was found that of these 155
deaths, 102 (20.4 per annum) had taken place in the five year period of 1985-89 for which
the AI had reported only 13. On analysing the causes of the 155 custody deaths, it was
found that only 9.7% were admitted as due to police action. However, of them, 44.5% were
attributed to suicide or acts of the accused, 7% to acts of the public, 22.6% to disease and
illness, 13.6% were termed natural deaths and in 2.6% the cause was not known or record
not available (Jesani, 1995). Indeed, this record reflects more poorly on the indifferent and
incompetent way autopsies have been conducted than on the actual causes of deaths.

In one of the investigations (CPDR, 1990) of a police custody death in Bombay it was
found that the young victim was brought to a public hospital in a serious health condition.
The doctor took case history and gave routine medical care in the presence of a police
officer that had accompanied the victim. As a consequence, the victim did not inform
doctor about the torture. He was taken back to the custody where he was tortured more. He
eventually died.

These examples only represent the tip of the iceberg. It is not that the doctors who often
come into contact with the survivors and victims are always conscious accomplices in
covering up cases. A section of doctors involved are plainly ignorant about this aspect
of medical work. Another section is indifferent to the plight of sufferer due to their own
social biases against survivors and victims. Such indifference is also produced by social
pressure to conform to the dominant belief. Besides, the psychosocial trauma inflicted by
torture is completely ignored, often because there is no training imparted to them for
managing such trauma and also due to the low economic value of such medical work. A
third section simply believes that being in the employment of the government, the police
department or the prison, they are bound by the orders of their superiors and the code of
their service does not allow them to “blow the whistle”. Another reason for doctors’ apathy
to these issues is that they consider themselves as mere technicians. Some doctors have
often remarked, “we are doctors, we treat illness, we are not interested in torture or rape."
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They, therefore, do not make the necessary efforts to explore the causes and history. This is
both inadequate science as well as inadequate understanding of medical ethics.

Doctor’s knowledge and attitude

Recently, in a survey done amongst its members (743 doctors, 61.5% of them General
Practitioners, and 17.2% of them in Govt. Service), the Indian Medical Association (1995)
found that 71.1% (or 533 out of 743) of doctors in India have come across a case of torture
in their medical practice. Interestingly, of those who have seen a case of torture, only
23.8% said that such case was brought to them by the police, thus indicating that the
survivors of torture do directly approach the medical professionals. Further, 15.7% of
them said that they were witness to the infliction of torture, 18.2% said that there are
doctors in India who have knowingly participated in torture, but only 18.2% knew where to
report suspected cases of torture.

The most disturbing finding of this study is that 57.5% believed that coercive techniques
might be justified to elicit information from uncooperative suspects. 58.3% thought that
manhandling during interrogation was unavoidable. 36.7% said that solitary confinement
was not torture. 49.3% justified forcible feeding of hunger strikers. And 49.7% found
nothing wrong or unethical in doctors remaining present during the process of execution by
hanging.

The data of the IMA survey generally confirm what we have said earlier. They also
emphasise that there is a great need to educate doctors in India to change their attitude in
cases of human rights violation.

What needs to be done?

Treatment and Rehabilitation of Survivors

All types of violence produce a traumatic effect on survivors. The trauma could be on the
body or on the mind. In a famous case of mass torture of villagers by the security forces in
Manipur, although there were official denials, a team of doctors which also included
psychiatrists visited and examined 104 survivors in that area after 22 months of the
incident. They found that a very high number of them were suffering from the post-torture
traumatic stress. They found that 36.6% were suffering from recurrent dreams of torture,
66.3% of disturbed sleep, 54.4% were not able to enjoy village festivals, food, sex and even
friendship, 37.6% showed loss of self confidence, developed a sense of foreshortened
future, etc. (Biswas, Das et al, 1990).

There is extensive work done by doctors on the treatment and rehabilitation of survivors of
violence in many countries, but in India the health professionals have not done much
organised work. The survivors of violence are special types of patients, and they would be
missed, and continue to suffer if not treated. While there is no doubt about their individual
sufferings, they also add into the socio-political problem. The medical documentation and
record generated in the process of treatment could be formidable evidence to get justice for
them. Thus, an independent, conscious and trained health professional while treating cases
of violence can also become a deterrent and a means prevention of violence.
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For prevention of violence and rehabilitation of survivors, doctors need to work with other
professionals, activists and officials. While doctors in India have gradually become used to
working with hospital social workers (particularly in big hospitals), they still have not
learnt to network with human rights lawyers, human rights organisations, anti-communal
groups, women’s organisations etc. to assist survivors in getting justice and for their
rehabilitation. Rehabilitation of survivors of violence in our own society has many socio-
political, cultural and economic dimensions. Often survivors need shelter homes, jobs and
other support to start a new life or protection from offenders to go back to their homes in
the locality where the violence had occurred. While doctors themselves are not in a
position to undertake such social responsibilities, the success of treatment and
rehabilitation normally depends upon getting such support for survivors. Such a medical
goal can be achieved only in collaboration with other professionals and activists. Besides,
despite democratic spaces available in our country, it is not uncommon for doctors actively
trying to help victims to have to face threats and violence themselves, thus needing
protection. This could be achieved only by having the support of strong and active
professional organisations, as well as by having the support of human rights lawyers and
activists.

Education and training of doctors

The educational and training intervention among health professionals (doctors, nurses and
other paramedical) is at present a pressing need in India. Such an intervention must have
three components:

(a) Effecting attitudinal changes and promoting professional ethics, (b) Education and
training for providing ethical and rational treatment to survivors and for developing skills
in investigation of human rights violation, and (c) Creating an environment and building an
institutional support system for health professionals, including legal protection, to make it
possible for them to play a positive and constructive role in both caring for survivors and
preventing violence.

It must also be kept in mind that doctors and other health professionals are ultimately a part
of society, and the code of ethics cannot completely insulate them from the societal
influences in their ideology and practice. When a society condones violence against certain
groups of people and when a section of it tends to participate in inflicting such violence
from time to time, it cannot provide a correct and conducive environment for health
professionals to be ethical in the event of violence. Thus, it is equally, if not more,
important to back up such intervention among health professionals with strong public
advocacy and education on the subject.

Campaigns for medical neutrality

The long-term goal of all health activists is to make doctors real social reformers. They
have often used the term social doctor to contrast the technician doctor. In the situation of
violence, the first step for making the doctor socially oriented is to make him or her respect
medical neutrality. The medical neutrality emphasises that in the situation of violence
doctor’s ethical obligation is to care for survivors and victims, never to side with offender
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and aid the pursuit of justice. At societal level the medical neutrality emphasises protection
for doctors to discharge their ethical duties, protection for doctors who are “whistle
blowers” (who make known the violation of human rights and unethical medical actions).
To build such a campaign is the responsibility of health profession as well as the society at
large.

Will health profession in India be able to ever build such a campaign? Given the rising
curve of violence in India, the health profession is going to come under the greater medical,
social and international scrutiny for its role in coming time. There is a need to make such a
beginning. However, given the history and numerous reports of doctors’ collusion in
human rights violence in India, at the beginning of such campaign the professional
associations and their councils will have to first take firm stand against medical collusion.
They will have to make those who are guilty accountable and weed them out from their
ranks. A casual admission that there are few black sheep within the profession would not
have much credibility. It needs to be backed by concrete decisive actions. Such actions
would greatly aid in building genuine campaign for medical neutrality in India.

References and Notes

Agnes Flavia, “Journey to Justice: Procedures to be followed in a rape case” Bombay:

Majlis, 1990, pp. 68.

Agnes Flavia, “Give us this day Our daily bread: Procedures and case laws on
maintenance”, Bombay: Majlis, 1992, pp. 170.

Amnesty International (AI), “Torture, Rape and Deaths in Police Custody," London: AI,
1992, pg. 73.

Amnesty International, “India: Allegations of rape by police: The case of a tribal woman
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