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 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 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 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

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 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 8^th and 9^th 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:

“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 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." 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.

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 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 in Gujarat, Guntaben”, London: AI, March 1988 (AI Index: ASA 20/04/88).

Anonymous (staff reporter), “State has one lockup death every month” in The Independent, Mumbai, December 16, 1991.

Bhatti Ranbir Singh, “Sociocultural dynamics of family violence," Bangalore: NIMHANS, (Mimeo, undated and unpublished)

Biswas Bipasa, Das Sujit Kumar et el., “Post torture state of Mental Health: Report of a medical study on the delayed effects of torture on Nagas in Manipur”, Calcutta: Drug Action Forum, West Bengal, July 1990.

CPDR (Committee for the Protection of Democratic Rights), “Another Lock up Death : An Investigation”, Bombay: July 1990.

D’Souza Lalita, “Manual and kit for collection of medical and forensic evidence in cases of sexual assault on women," Mumbai: CEHAT, 1998.

FACSE, “Investigation Report: Sexual assault of a deaf mute juvenile in Observation Home, Umerkhadi, on September 21, 1997” Mumbai: Forum Against Child Sexual Exploitation (FACSE), February 1998, pp 11.

Heise Lori L., Raike Alanagh, Watts Charlotte H., Zwi Anthony B., “Violence against women: A neglected public health issue in less developed countries”, in Social Science Medicine, Vol. 39, No. 9, pp. 1165-1179.

Indian Medical Association (IMA), “Report on Knowledge, Attitude and Practice of Physicians in India Concerning Medical Aspects on Torture”, New Delhi: IMA, 1995, Pgs.24.

Iyer Aditi, Jesani Amar, “Women in Health Care: Auxiliary Nurse Midwives”, Mumbai: Foundation for Research in Community Health, 1995, pp. 159.

Jesani Amar, “Violence and ethical responsibility of the medical profession," in Medical Ethics, Vol. 3, No. 1, January-March, 1995, pp. 3-5.

Jesani Amar, Alyosius D’Sa, Alphonse Mary, “Bombay Riots: January 1993”, Mumbai: solidarity for Justice, 1993, Pgs. 180.

Mahajan A, Madhurima, “Family violence and abuse in India," New Delhi: Deep and Deep Publication, 1995, pp. 178.

Ommen T. K., “Doctors and Nurse: A study in occupational role structures”, Bombay: MacMillan, 1978.

Prasad Shally (1996), “The medico-legal response to violence against women in India: Implications for women’s citizenship”, Paper presented at the International Conference on Violence, Abuse and Women’s Citizenship, Brighton, UK.

Rao Sathyanarayana, Rao Vasumathy et al., “A Study of Domestic Violence in urban middle class families”, Mysore: Department of Psychiatry, J. S. S. Medical College and Hospital, 1994, (mimeo, unpublished)

Rustamji K. F, “Passion of the fanatic: The government’s response has been a confused one” in The Afternoon Dispatch and Courier, Bombay, February 18, 1992.

Sharma Rajeev Lochan, “The Communal Virus Among Doctors”, in Health for the Millions, June 1991, pgs. 9-11.

Shetty Harish, Chhabria Anjali, “Bombay Riots: A case study with an emphasis on psychosocial consequences” (Rough Draft), Presented at the National Workshop on “Psycho-social consequences of disaster,” December 4-6, 1997, NIMHANS, Bangalore (Organised jointly by NIMHANS, NCDM, SUPPORT and OXFAM).

Sofat Rajesh, Saxena D. K., Siddiqui Md. Najeeb, “When falsehoods breed their kind”, in Health for the Mullions, June 1991, pgs. 2-6. Also see, Sofat Rajesh, Saxena D. K., Siddiqui Md. Najeeb, “A Report: An Inquiry into the Causes and Forces behind the Allegations of Massacre of Hindu Patients by Muslim Doctors in JNMC, Aligarh, which Flared up Aligarh Riots in December, 1990”, New Delhi: Delhi Medicos’ Front, January 1991.

Solidarity for Justice, “Human Rights issues emerging from Investigation into the Murder of Sr. Sylvia and Sr. Priya," Bombay: Solidarity for Justice, 1991.

Venkatratnam R., “Medical sociology in an Indian setting," Bombay: MacMillan, 1979.

World Bank, “World Development Report, 1993: Investing in Health”, Oxford: Oxford University Press, 1993.

YUVA, Medico Friend Circle, Women’s Centre et el., “The Jogeshwari Rape Case- A report”, Bombay: MFC, 1990.