Democracy Lab

Bahrain's Continuing War on Doctors

The Bahraini government needs to stop targeting medical professionals who dare to treat injured protesters. 

When the Arab Spring swept through Bahrain in 2011, citizens there -- just as in other Middle East countries -- took to the streets demanding political and economic reforms. Also just as in other Middle East countries, peaceful demonstrations were soon met with a violent crackdown by government forces.

When it began, I knew that it was my duty as a nurse to help. So I made my way to Salmaniya Medical Complex, Bahrain's only public hospital, to do what I could to aid the overwhelmed staff, even though I did not work there myself. What I witnessed was horrifying: Evidence of the use of live ammunition, bodies battered by tear gas canisters fired at close range, and protesters blinded by the use of bird shot. In the months that closely followed, nearly 50 people were killed as a direct result of the violence against protesters, a number which has risen to over 100 since 2011.

As a healthcare professional, it was my duty to aid the injured. But as a witness to the Bahraini security forces' violent response to the peaceful protests, I also felt a duty to speak out against the abuses. Many of my colleagues who felt the same way spoke on the record with the media to describe the types of injuries they had seen, shedding light on the nature of the government's brutality. After authorities barred ambulances from bringing injured protesters to Salmaniya Medical Complex, we joined in protests to demand that the wounded have access to the hospital and care.

As health care professionals, we felt a need to speak out against violations of medical neutrality. The government felt a need to silence us. And so in response to exercising our right to free speech, security forces attacked medics and brought Salmaniya hospital under military occupation. To justify their actions, the Ministry of Interior and state-controlled media falsely reported that healthcare workers were refusing to treat injured security forces. The truth is much more appalling: Security forces occupying Salmaniya hospital used their proximity to medical workers and patients to gather information about protesters. The sixth floor of the facility was used to interrogate patients, many of whom were suffering from severe injuries. As a result, patients with sometimes life-threatening injuries were afraid to seek treatment out of fear of being interrogated, or worse, by government security forces. It was these sorts of egregious actions by the government that my colleagues and I sought to expose. In turn, we soon became the targets of government brutality ourselves.

In March 2011, the Bahrain government began detaining and interrogating healthcare workers. On April 4, in response to a summons, I presented myself to the Bahrain Central Investigation Department for questioning on my role in the uprising. While in detention, I was given electric shocks to my head and face, and threatened with rape. What happened to me also happened to dozens of other medics. Since the uprising, 82 medical professionals have been arrested on a variety of politically-motivated charges meant to intimidate citizens from speaking out against the government's abuses. Their stories of receiving physical and emotional abuse were documented in a report released in May 2012 by Physicians for Human Rights.

In August 2011, 52 of those medics were sentenced by a special military court to prison terms ranging from one month to 15 years. Charges against me personally included attempting to overthrow the regime, spreading false information, and participating in an illegal public gathering. I was convicted on 12 counts and was sentenced to 15 years. These convictions were later reviewed by a civilian court, which upheld the convictions of nine medics and acquitted nine others, including myself. This past March, an additional 21 medics were acquitted, but the convictions of more then a dozen medics still stand.

Since my five-month ordeal in prison, and despite the constant threat of being imprisoned again, I have been an outspoken advocate for medical neutrality; the principle of non-interference with medical services in times of conflict. Medical neutrality requires all sides of a conflict to obey the following principles: civilians must be protected from the conflict and not targeted; medical professionals must provide care to the sick and wounded, regardless of affiliation; and medical facilities, transport, and personnel must be permitted to tend to the wounded without interference.

Denial of medical care is a breach of human rights, and its abuse in Bahrain has been well-documented. (See, for example, this latest report by the Bahrain Center for Human Rights.) The government of Bahrain did not respect the rules of medical neutrality during the uprising of 2011, and attempts to speak out against this breach of trust between the medical community and the government were swiftly punished -- a discredit to the government of Bahrain and a disgrace to our country.

I remain in Bahrain, though I am no longer allowed by the government to work as a nurse. As one of the fortunate Bahraini medics to have been freed from detention, I now feel it is my obligation to advocate on behalf of not only my colleagues in prison in Bahrain, but of other healthcare professionals around the world who have been the victims of medical neutrality violations. For most, it is unthinkable that a medic would be punished for treating injured victims and bearing witness to those crimes. Regrettably, this is a reality too many healthcare professionals face today. That is why I call upon the government of Bahrain, and governments around the world, to respect the tenants of medical neutrality and to release those medics still in prison for simply doing their job. I may no longer be in prison, but I cannot truly be free until my colleagues are as well.

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How to Keep NATO Strong

The transatlantic alliance cannot be taken for granted.

John Kerry chose Europe as the destination for his first trip abroad as U.S. secretary of state, and he made clear that was no accident. It followed on from President Barack Obama's pledge to launch talks on a broad Transatlantic Trade and Investment agreement aiming to provide new opportunities for more than 800 million people on both sides of the Atlantic. These are timely reminders that in the 21st century, the transatlantic link remains the foundation of our freedom, our security, and our prosperity. Europe is still America's partner of choice when it comes to shaping the global agenda and setting global standards in line with the values we share.

But promoting our way of life is not enough. We also have to protect it -- and sometimes defend it. The need for a strong military alliance between Europe and North America has never been stronger. The North Atlantic Treaty Organization (NATO), a unique transatlantic military alliance bringing together 28 countries, was founded 64 years ago this month  and remains an essential source of stability in an increasingly unpredictable world. However, the transatlantic bond that unites us cannot be taken for granted -- and that means making smarter and more evenly distributed investments. Although the European Union and the United States together generate about half of global economic output, and NATO countries together account for over half of global defense spending, there are increasing concerns that the current balance of responsibilities and contributions within the alliance is neither satisfactory nor sustainable.

As we approach the end of our combat mission in Afghanistan -- NATO's biggest ever operation -- we have the opportunity to strike a new transatlantic balance, where the security burden shifts from an over-reliance on the United States to a greater sharing of responsibilities by Europe. Only by taking more responsibility for its own security -- and by making a more robust contribution to NATO's capabilities -- can Europe remain a strong global actor and sustain America's commitment to the alliance. Maintaining this link is vital for all of us, because we are all stronger when we stand together.  

Learning Lessons

Striking a new balance within NATO should help us build on what we have gained since the end of the Cold War. Over the last 20 years, NATO forces have been engaged in almost 40 missions and operations, including in Afghanistan and Kosovo, over Libya, off the coast of Somalia, and on Turkey's border with Syria, where NATO recently deployed Patriot antimissile batteries. As a result, today's NATO has the most capable, flexible, and deployable forces in history. We are better connected with partner countries and organizations around the world, and better prepared to face unpredictable threats.

At the same time, however, the threats facing NATO members are becoming more complex and interconnected -- ranging from failed states and terrorism, to the proliferation of weapons of mass destruction, to piracy and cyber attacks. In order to prepare the alliance for the future, therefore, we must learn the operational lessons of the past.

The first lesson is this: In a world where strategic surprise is the rule, NATO must be prepared for all contingencies. No two operations are alike. In Bosnia, the alliance enforced the peace and helped build stability. In Libya, it protected civilians against attacks by their own murderous regime. Off the Horn of Africa, NATO is combating piracy as part of a vast international effort to keep open vital shipping lanes. To be effective, NATO must remain capable of dealing with multiple tasks and multiple crises, ranging from conflict prevention to cyber-defense.

The second lesson is that the ability of personnel -- as well as equipment -- from different allied countries to work seamlessly together is the most powerful asset we have. It means that NATO can deliver a collective punch that few nations can deliver alone -- or only at a much greater cost. For example, combat aircraft from any NATO country are able to provide support to ground forces from any other allied country. 

The third lesson is that NATO provides flexibility, as well as political solidarity and oversight. In the Libya operation, we saw 14 allies providing naval and air forces, with eight of them conducting air strikes. But all 28 allies gave their full political support and staffed the NATO command structure, which had overall operational control. Partners as diverse as Sweden and Qatar joined in, thanks in large part to this standing multinational command structure. Tried and tested for over 60 years, it has no parallel in facilitating the rapid establishment of an international force.

Mind the gaps

Overall, NATO investment in major modern equipment has risen in recent years, but defense spending has become increasingly uneven. This has led to some growing -- and dangerous -- gaps, both within NATO and with the rest of the world.  

The biggest gap is between the United States and the other allies. Today, the United States represents 72 percent of total NATO defense spending, up from 63 percent in 2001.The fact that the U.S. defense budget has more than doubled since 2001 provides only a partial explanation for this shift. Over the same period, European defense budgets have either stagnated or decreased. This has serious operational, as well as political, consequences. Once again, the Libya operation is a case in point. The United States was the only country able to provide critical capabilities -- such as air-to-air refuelling and intelligence, surveillance, and reconnaissance -- at sufficient levels. This imbalance has rightly prompted a new generation of American politicians and voters to wonder why they should continue to "subsidize" Europe's security if Europeans themselves appear unwilling to make the necessary investment.

A second gap can be observed within Europe itself. European allies account for 68 percent of NATO's common funding, covering collective requirements such as command and communication arrangements, which are not the responsibility of any single member. However, nearly 50 percent is provided by just four of them -- the United States, Britain, France, and Germany -- and only a few allies still have the full spectrum of capabilities. On the plus side, Europeans have markedly improved their capacity to deploy more quickly and over a longer period of time. For instance, those NATO allies that were unable to conduct night air raids during the Kosovo campaign in 1999 could do so during the Libya operation, which meant that the vast majority of strike sorties over Libya were conducted by non-U.S. aircraft. If the capability gap between European allies continues to grow, however, fewer of them will be able to deal effectively with crises on their doorsteps.

The final gap is between NATO and the rest of the world. While total defense spending by NATO allies is going down, total defense spending by new and emerging powers has been going up -- particularly in Russia, Brazil, the wider Middle East, and the Asia-Pacific region. In 2012, for the first time ever, Asian defense spending exceeded that of Europe in nominal terms. Ultimately, this will create a strategic gap between the capacity and the will of those nations to exert influence in the world, and NATO's ability to do so. 

Striking a new balance

While none of these gaps is new, the economic crisis has made them deeper and America's growing -- and justified -- focus on the Asia-Pacific region has made them more evident. If we are to sustain a strong Europe and a strong American commitment to Europe at the same time, we need to redress the balance and better share the transatlantic security burden.

The first step is to hold the line on defense investment. There is a lower limit of how little we can spend on defense, while still being able to meet our responsibilities. In Europe, we have reached that limit. As soon as our economies start to recover, we must start investing more in defense. 

This is not just about money, but also about capabilities. Within NATO, I would like to see a new political commitment that no single ally needs to provide more than 50 percent of certain critical capabilities. And I welcome steps that non-U.S. allies are already making to develop capabilities in areas such as strategic airlift, and intelligence, surveillance, and reconnaissance.  This will allow for more balanced and sustainable burden sharing between the two sides of the Atlantic as well as within Europe.

Simply put, Europeans must do more, and must do better. This is an opportunity for all allies to work more closely together, and for European allies to take the lead in developing some of the key capabilities that will be needed in the future.

At last year's NATO summit in Chicago, NATO welcomed the initiative by European allies on air-to-air refuelling. This is an excellent example of a possible division of labor in capability development, and should provide a much-needed operational enabler to both the European Union and NATO. In December, the European Union will hold a summit dedicated to security and defense that could help lay the groundwork for the two organizations to consult, coordinate, and cooperate more effectively. This is the time to give all of our tax-payers value for their money, because our countries have only one set of armed forces, and one budget, and they need to make the best of what they have, rather than waste resources through duplication.

Finally, as our operational tempo is forecast to decrease, we need to increase our training and exercises. In 2015, NATO will hold its first major live exercises in nearly a decade. This will keep fresh the lessons learned in operations, and make best use of the forces that the United States has pledged to rotate through Europe to train with the NATO Response Force, the alliance's rapid reaction formation. In the coming years, we could also envisage European forces crossing the Atlantic to exercise on North American soil under the NATO flag, to maintain an expeditionary mindset and to demonstrate Europe's readiness to share responsibilities.

Europe's choice

Like any relationship, the transatlantic bond needs continued investment: economic, military, and political. Europe and North America must talk more regularly, more openly and more strategically. We must overcome the perception that NATO can only discuss emerging crises where we plan to become involved and take action. The Alliance must live up to its role as the political forum for transatlantic consultations on common security concerns, including on those that lie beyond the Euro-Atlantic area. Above all, Europe must look outwards, not inwards, to develop a truly global perspective on security.

In a world where we are all interconnected, we must recognize that the transatlantic relationship remains the most important relationship we have. It is not only vital for the freedom, security, and prosperity of Europe and North America, but it also provides the bedrock of the rules-based global order. To remain America's partner of choice, Europe must choose to become the strong partner that America needs.

Photo courtesy of NATO