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PHR Account Details Violations of Humanitarian Principles by Protesters at Bangkok Hospital May 4, 2010
Physicians for Human Rights (PHR) mobilizes the health professions to advance the health and dignity of all people by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.
Benjamin Greenberg (email@example.com)
Richard Sollom (firstname.lastname@example.org)
Adam Richards (email@example.com)
Actions by anti-government protesters who first blockaded and later forcibly entered and searched a major hospital in central Bangkok last month (April 2010) were a gross violation of humanitarian principles. Physicians for Human Rights (PHR) endorses an independent investigation into the incident to ensure that all parties to the ongoing turmoil in Thailand understand the importance of maintaining neutrality.
"Our ethical responsibility as doctors requires that we first ensure our patients' personal security and freedom from harm," says Adam Richards, a physician and PHR board member who investigated recent events at King Chulalongkorn Memorial Hospital in Bangkok. "Society shares in our responsibility, and together we must adamantly resist and vehemently speak out when political events threaten to transform a hospital from a center of healing into a battlefield."
A core humanitarian principle is that medical personnel be granted unimpeded access to people who require their help, and that they be afforded complete independence to render aid impartially and without regard to political affiliation or other kind of status.
"Despite threats to their personal security, hospital staff and administrators upheld their ethical duties to their patients by evacuating them to safety and by providing impartial care to all," says Richard Sollom, PHR's director of research and investigations, who was also on the PHR team.
At the invitation of staff at Chulalongkorn Hospital, Richards and Sollom interviewed senior hospital administrators, physicians, nurses and house staff in Bangkok over several days in early May (2010). Their independent accounts all detailed the occurrence of many humanitarian violations in or around the hospital during April (2010).
Among the incidents related to the PHR team by hospital personnel:
In early April, protesters erected barriers of tires and bamboo poles along a road separating the hospital grounds from their encampment in adjacent Lumpini Park, leaving only a single lane open for patients, visitors and medical personnel.
Over the next several weeks, protesters armed with knives and sharpened bamboo staves began stopping and searching vehicles entering the hospital — including ambulances transporting acutely ill patients. The protesters were said to be checking for weapons possibly hidden by soldiers in such vehicles.
On April 28, (2010) hospital administrators decided to evacuate all hospital buildings within 200 meters of propane tanks positioned by the protesters near a post supporting the elevated railway. Their assumption was that anyone near the tanks might be injured if the protesters decided to try to explode a section of the railway.
The next day, more than 100 protesters, some armed with staves, demanded to be admitted to the hospital buildings to search for Thai security forces whom they suspected of taking up positions overlooking the protesters' encampment. No such forces were found.
On at least one occasion, a protester claiming to be a physician demanded that the house staff change the medical record of a patient to make it appear that the injury was the result of a fall rather than of a blow to the face. Feeling intimidated, the house staff acquiesced to this change.
All these incidents, individually and collectively, intimidated physicians, nurses and other hospital staff, as well as patients and their families. As a result, hospital administrators evacuated all 1,200 patients over several days.
The PHR team was unable to interview police officials or leaders of the anti-government movement, known as "red shirts." But red shirt leaders quickly apologized for the invasion of the hospital grounds and for interfering with medical operations. Said one: "It is not our policy to obstruct hospital operations."
PHR strongly urges all stakeholders in the current political crisis in Thailand to ensure that all political entities and institutions understand the importance of maintaining the neutrality of medical care and safeguard unhindered access to medical facilities for patients and staff.
Chronology of Events in Detail
King Chulalongkorn Memorial Hospital, named after the current king’s grandfather, is owned and managed by the Thai Red Cross Society. Located near Bangkok’s central shopping and banking district, the sprawling complex of more than 80 buildings includes medical and other health professional schools and a 1,500-bed tertiary hospital that provides specialized care to patients referred from all regions of Thailand.
In early April 2010, members of the United Front of Democracy against Dictatorship (UDD), commonly known as the “red shirts,” began to erect barricades of bamboo poles and tires along Rajdamri Road between the hospital and the adjacent Lumpini Park, leaving only a single lane open for patients and visitors to access the hospital. About 20 protesters began squatting in the hospital each night. Senior hospital officials told PHR that they contacted police and military officials within the first few days of the UDD protests to express concern about hospital access and patient safety, but were told that additional security would not be provided. The hospital administration’s request of the Thai authorities comports with humanitarian principles and international standards on medical ethics, which require that medical personnel be granted necessary protection to carry out freely their responsibilities.
Tensions mounted between hospital staff and the UDD over several weeks, as UDD security forces, some wielding knives and sharpened bamboo staves, began to inspect vehicles entering the hospital. On several occasions, protesters searched ambulances with acutely ill patients, hospital officials said, claiming that soldiers could hide weapons in those vehicles. No weapons were found. Hospital staff described being taunted and verbally harassed as they passed UDD protesters on their way to the hospital. UDD leaders violated core humanitarian principles, which affirm that medical transport be respected and protected at all times and that access for health personnel to sick and injured patients be free and unhindered.
Despite these tensions, hospital staff continued to treat UDD protesters for acute traumatic injuries and exacerbations of chronic illnesses. For example, a medical resident assigned to the emergency room described treating a protester for a face laceration and asthma. Such non-discriminatory treatment adheres to medical ethics, which state that, even during emergencies, physicians must give the required care impartially and without consideration of sex, race, nationality, religion, political affiliation or other status.
On at least one occasion a red shirt protester claiming to be a physician is reported to have demanded that the house staff modify the medical record of another protester to make it appear as if that person’s facial wound had resulted from a fall. According to house staff, the physician-protester became belligerent when the treating physician initially wrote that the laceration was consistent with a glancing blow to the face. In response to the intimidation, the house staff acquiesced and modified the medical record. Such coercion violates international standards of medical ethics, which mandate that physicians be afforded complete independence in conducting their professional duties.
On 22 April, five M79 grenades exploded near the Dusit Thani Hotel, less than 200 meters from the Chulalongkorn Hospital, killing one person and wounding at least 75. Chulalongkorn clinicians treated 19 blast victims. PHR was shown photos of three hospital windows damaged by projectiles later that night. Hospital staff independently described to PHR how these events contributed to their heightened state of fear for their own safety and that of the public. An emergency room nurse told PHR she started sleeping at the hospital so she would be available to help with the hospital’s response in case of massive casualties.
On 26 April, approximately 60 UDD protesters demanded entrance to the hospital to search for a pro-government physician [Dr.Tulya Sithisomwong, a lecturer in Obstretics & Gynecology]. Administration officials told PHR investigators that they notified the police when UDD protesters entered the first floor of the hospital, that the police arrived in less than 10 minutes, and that the police and hospital security guards successfully convinced the protesters to leave peacefully. Following this incident, senior hospital administrators contacted government officials to express their concern for the safety of approximately 1,200 patients, but were told not to expect any further protection. This decision constitutes a second instance in which Thai security forces refused to give medical personnel the protection they needed to carry out freely their ethical responsibilities to care for patients.
A senior hospital administrator recounted to PHR how two days later (28 April) he found five liquid propane tanks the protesters had arrayed within 50 meters of the emergency room entrance. According to the administrator, one of the protesters threatened “If I were you, I would move your patients.” Assuming that an explosion of the propane tanks would have a blast radius of 50 to 200 meters, the administration evacuated all hospital buildings within 200 meters of the tanks. By early afternoon over 200 patients, including some 120 children, were relocated to recently constructed buildings in a more distant area of the hospital compound. PHR was shown photos of patients lying on mattresses on the floor, with the explanation that the wards in these new buildings had not been scheduled to open for several months.
The tense mood increased throughout the day, as the afternoon brought news of increased fighting in the north, and several explosions were heard outside the hospital. Later that day, the protesters extended a clear plastic tube from one of the propane tanks toward the hospital basement and, according to two key informants, threatened to burn the building. They later withdrew the plastic tube after negotiating with the hospital security guards.
That evening protesters returned to the emergency room, saying they were looking for soldiers and policemen. They also spoke lewdly to physicians, nurses, and other hospital staff, and threatened to return the following day to take them hostage. These events impeded medical professionals from carrying out their humanitarian tasks, and are similar to breaches of medical neutrality during armed conflict.
Around 6 p.m. on 29 April, UDD leader Phayap Panket and some 25 red shirt guards appeared at the gate of the emergency department with more than 100 protesters, some of them openly carrying sharpened bamboo stakes, to demand that they again be allowed to search the building for the police and soldiers they believed had stationed themselves inside the hospital. The UDD protesters shouted threats and made lewd comments, and grabbed the shirts of several hospital guards. The protesters refused to believe the senior administrators who assured them that soldiers were not permitted in the hospital. Hospital administrators immediately called police, who at that time had not established a formal police presence near the hospital.
UDD leaders persisted in their demand to search the hospital, and the hospital administrators felt compelled by the large number of protesters to accede to their demand. Despite the request to limit the number of searchers, several hundred stormed the hospital compound and began to search two of the previously evacuated larger buildings. When police arrived, they accompanied UDD leaders in their search of other hospital buildings, while other UDD protesters walked throughout the hospital and surrounding grounds in small groups. Physicians and nurses expressed shock at the brazen attitude of the UDD protesters and their disregard for fundamental humanitarian principles and core ethical obligations of health personnel. Said one: “We are neutral.… Maybe they don’t understand about the principles of the Red Cross.”
For safety reasons, the hospital administration decided that evening to close the emergency room and pharmacy and moved most hospital staff to buildings further away from the UDD encampment. Hospital administrators held an emergency meeting of senior leadership to discuss the implications of the recent incursion into the hospital, and consensus was reached around 9 p.m. to evacuate the entire hospital early the next morning, 30 April. The decision to evacuate was based on concern for the safety and security for the patients, which the administration did not feel could be guaranteed, despite the presence of 100 policemen dispatched earlier that day to guard the hospital. Around 10:30 p.m. a text message was sent to all leadership in the hospital to prepare transfer summaries for all patients, and staff began to communicate with other hospitals to see whether they would accept the patients.
By 7 a.m. 30 April, staff began to transfer and discharge the remaining 600 patients. By that evening only the Supreme Patriarch (Thailand’s most revered Buddhist monk) remained as a patient in the hospital. The next day, after His Holiness was transferred to Siriraj Hospital, the hospital had no patients.
Several red shirt leaders quickly apologized for the raid, calling it a mistake. Weng Tojirakarn, a physician and protest leader, was quoted as saying that “the situation got out of control. It is not our policy to obstruct hospital operations.”
Ronayos' comment: Actually, there were exchanges of calls between the red-shirts leaders and the hospital administrators several times, throughout several weeks of violations of Chulalongkorn hospital. The red leaders arrogantly never paid attention to the hospital polite requests. Not until the raid by Payap on April 29, 2010, that it caught public's attention and harshly condemn such inhumane acts of the reds which eventually brought unsincere apologies of the red-shirts leaders.
On April 10, 2010 as well as April 22, 2010 when there were pick-up trucks and ambulances transporting seriously injured officers or patients to hospitals, a lot of armed red-shirts were ambushing, obstructing and beating up the vehicles, including some injured.
After April 10, 2010, when there were already some people killed in the clash at Kok Wua junction, near the Democracy Monument, red-shirts stormed into Hua Chew hospital and Central (Klang) Hospital to rob corpses of their comrades to parade their coffins.
The umbrella organization representing five of Thailand’s professional health associations has condemned anti-government protesters for storming Chulalongkorn Hospital. The umbrella group includes the Medical Council, the Nursing Council, the Pharmaceutical Council, the Council of Medical Laboratory Scientists, and the Council of Physical Therapists.