Since the early days of the occupation of Tahrir Square, physicians immediately found themselves confronted with maimed and injured bodies. Whether working in the field hospitals delivering first aid or in hospitals adjacent to the square, medical personnel witnessed firsthand the violence that punctuated the occupation of the Square. When the conflict escalated on January 28th, doctors began tending to poisoned, torn, maimed, and bullet-ridden bodies, an experience which flew in the face of official statements that the police had used only “crowd control” techniques. The doctors encountered protestors and activists who appeared sincere in their calls for freedom and dignity. These meetings soon contradicted the government’s campaign to discredit the protestors as druggies, spies, or thugs paid off by foreigners wishing to stir trouble in Egypt. Attending to hundreds of wounded protestors, many physicians evoked the idea of medical neutrality as a professional ethos—neutrality understood as both impartiality and immunity. Yet the commitment to neutrality can also function as a potent and radical challenge to political authority, rendering “neutrality” its own political stance.

For some doctors, like Dr. Taha El-Sebaie, this witnessing of violence hardened their views of the military’s actions. Dr. Taha indicated to us, in interviews conducted in 2012 and 2013, that, while he was glad to see Mubarak go, by the time of the demonstrations and sit-in protests on Mohamed Mahmoud Street and the Cabinet in November and December of 2011, he, like many Egyptians, felt fed up with the protestors. Why couldn’t they just go home and let the country move on? Why did they continue to hold everything up? Didn’t they realize that all their demands could not be met overnight? The fear that Egypt faced either recovery or renewed disaster, the increased levels of crime and economic uncertainty—each made most Egyptians unsympathetic to the demonstrators. Many preferred to believe the heroic tale of the army “obeying” the orders of the people after eighteen days of glorious occupation, of the noble and peace-loving protestors of Tahrir Square reigning victorious over the brutal regime. Many, like Dr. Taha, chose to ignore the military’s transgressions or blame the protestors. Yet in November 2011, after receiving text messages reporting that the number of injured at Mohamed Mahmoud Street had increased rapidly and overwhelmed the medics available on site, Dr. Taha felt that his duty as a physician impelled him to rush to the field hospital. It was only then and there—as he watched soldiers severely beat young, unarmed demonstrators and shoot at their eyes, heads, and necks—that Dr. Taha’s sympathies shifted. He returned home, hardened by what he had seen. He was ready to dispute the claims that the protestors were “stalling the country,” words he himself had used only days earlier.

Yet there are countless other stories of physicians who not only witnessed violence and remained unmoved or unsympathetic toward the victims, but of physicians who themselves participated in or helped to deny the violence itself. One army physician carried out the military order to perform so-called “virginity tests” on female protestors; others allegedly tortured and deliberately operated on patients without anesthesia to punish them for their political protest. Given the vast disparities of reactions to military violence, one should read physicians’ narratives of witnessing as a rhetorical practice that furthers their convictions, rather than causing or initiating them. This re-formulation of their accounts re-positions physicians as actors within society who are subject to the same social, economic, and political influences as other members of society. Physicians do not form a special moral class. This view draws on the dominant narrative of science as outside the social world of politics, but also on the “doctor-as-savior-of-lives” narrative based on physicians’ technical expertise.

 

For the first time, physicians themselves became the explicit targets of state violence.

 

This positioning of physicians as morally aloof characters is not only empirically and analytically tenuous; it also puts doctors in precarious situations in times of political unrest. This is particularly true when the “morally upright” physician is represented, tacitly, as one afforded special social privileges in return for his or her services.

For example, contemporary activists who prioritize the call for states to adhere to medical neutrality, most notably Physicians for Human Rights, argue that “attacks [on health care professionals, facilities, and patients] are not a natural part of conflict, but are deliberate violations of the principle of Medical Neutrality.” But is any part of conflict “natural”? Isn’t the attack on civilians, and in this case, the state’s own citizens, already necessarily a violation of the most basic of human rights?

Following Mubarak’s removal from power, the military attacks of November and December of 2011 revealed that the social prestige extended to physicians did not protect them from state violence for long. Assaults on medics in white coats and on field hospitals marked a turn for the worse. Physicians had become more than just witnesses to state violence. They not only gathered information that negated the truth of official statements. For the first time, physicians themselves became the explicit targets of state violence. As physician after physician related his story of military assault—many of them in bandages or recovering from bruises—similar themes emerged: “And I was wearing my white coat clearly.” “And I showed my official ID [in which it is recorded that I am a physician].” “And I was obviously tending to the injured.” They insisted, seemingly in disbelief, that the soldiers had knowingly shot at, beaten, and thrown rocks and tear gas canisters at them, as doctors.

Yet even though some doctors expressed surprise or outrage that they, as doctors, were subject to state violence, they were also on the scene precisely because of the state’s use of excessive force. Furthermore, there were many physicians who initially joined the street demonstrations as protestors with their own grievances. They drew attention to the unaffordable and precarious lives of young generations of highly educated medical professionals, to the rights of poor patients, to the dismal state of government spending on health, and to their own rights to political freedom of expression.

 

A physician treating opponents, from the perspective of the state, is a physician facilitating, enabling, condoning, justifying, and normalizing the very opposition that it seeks to suppress.

 

One example of this is Tahrir Doctors, a group founded in February, 2011, following the eighteen-day uprising against Mubarak. It was mostly comprised of young and middle-aged doctors who found each other in the makeshift hospitals in Tahrir Square that they spontaneously erected and staffed. They decided to form a non-profit organization to provide first aid to protesters. They volunteered to see patients from the surrounding neighborhood for a symbolic fee of ten Egyptian pounds (roughly $1.50 USD). The rest of their funding comes from membership dues and private donations. They rented two small apartments in a somewhat rundown building in Lazoghli, not far from Tahrir Square.

When I (SB) last visited their offices in June 2013, in the lead-up to the June 30th demonstrations, the desk at the entrance was covered with heaps of copies of several pamphlets. Most conspicuous among them was one published by the International Committee of the Red Cross, in Arabic, English, and French, about the principle of medical neutrality and the protection of medical staff in times of conflict. The walls were mostly covered with now-famous revolutionary posters and stencil prints. “Revolution is an art,” read one of them. “Be with the Revolution,” read another, “glory to the martyrs.” There were multiple anti-Mubarak and anti-Morsi posters. I paused for a minute to reflect on the link between what I saw on the desk and on the walls. When I (SB) asked Ahmed Mahdi, one of the Tahrir Doctors’ paramedics and a founding member of the organization, about his role, he hesitated for a moment, then looked at one of the doctors and asked him “Shall I tell her?” When the doctor shrugged, probably not knowing exactly what he was referring to, Mahdi told me, “Honestly, whenever there are confrontations, I divide my time between being in the field hospital giving first aid to injured protesters, and being at the front line, hurling rocks myself with my fellow protesters at the police.”

The logic of medical neutrality rests on the notion that one should prioritize the physician’s safety because it enables the safety of many other civilians and, conversely, the dwindling of medical facilities and capacity endangers more lives. Yet a physician treating opponents, from the perspective of the state, is a physician facilitating, enabling, condoning, justifying, and normalizing the very opposition that it seeks to suppress. A physician appealing to medical impartiality is a disobedient citizen, hindering the consolidation of authority in times of crisis. Indeed, from the aggressor’s point of view, if not wholly disciplined within the military regime, doctors are always a potential threat. They can save lives and therefore return protestors to the frontline. Medical neutrality, even when explicitly invoked by physicians on the frontlines, is not an accurate description of how they practice or of how the state responds to them. Rather, by invoking the notion of impartiality or neutrality, medics counter claims to subsume them as mere tools of power, and attempt to model for wider society a belief in common humanity often sorely needed in times of political and civil strife.


Sherine Hamdy is an anthropologist and author of Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt (University of California Press, 2012) and works on medicine, religion, health and global bioethics. She is currently co-authoring, with Soha Bayoumi, Doctors of the Revolution: Health and Social Justice Activism in Egypt. She is an Assistant Professor in the Department of Anthropology at Brown University.

Soha Bayoumi is a political philosopher, and works on the question of justice at the intersection of political philosophy, intellectual history, and Science and Technology Studies. She is currently co-authoring, with Sherine Hamdy, Doctors of the Revolution: Health and Social Justice Activism in Egypt and working on a book manuscript on the normative links between liberalism and socialism. She is a Lecturer in the Department of the History of Science at Harvard University.

 

Image of Tahrir Square from Flickr via Hossam el-Hamalawy

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  1. Ben Danner

    Medical neutrality in a combat zone is something I have always wondered about ethically, especially when doctors violate the creed “to do no harm” and append their political views into their treatment of patients. This piece portrays the difficulty in distinguishing neutrality. Brilliant read. Thank you.

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