TABLE OF CONTENTS

Title Page

How to Order

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Organizational Descriptions

Glossary of Abbreviations

Preface and Acknowledgments

Executive Summary

Recommendations

1. Elimination of racial discrimination in the health sector
2. Adoption of human rights standards for health professionals
3. Reform of societies of health professionals
4. Reform of professional regulation
5. Human rights education
6. Human rights monitoring of the health sector
7. Addressing the legacy of apartheid for mental health services
8. Medical documentation of torture and ill-treatment

Introduction

1. Background of the Report
2. Health and Human Rights: The Role of Health Professionals
3. Health and International Human Rights Law
4. International Medical Codes of Ethics

Historical Background

1. Apartheid Structures that Affected Health Status
2. Fragmentation, Privatization, and Access to Care
3. Segregation in Medical Education
4. Political Detainees, Health, and Human Rights
5. Deaths in Detention

Patterns of Human Rights Violations

1. Violations of Commission
   1. Legislation and government policies that resulted in the torture and maltreatment of prisoners
   2. Government policies that resulted in the failure to provide appropriate health care to detainees
   3. Failure of district surgeons and other health professionals to protect the health of detainees
   4. Results of coercive population policies
   5. Interference with the privacy and confidentiality of medical information
2. Violations Related to Discrimination
   1. Failure to grant true personhood and autonomy to blacks as patients and professionals
   2. Systematic differences in the provision of health care
   3. Race bias in health research
   4. Inadequate and discriminatory training of black health workers
   5. Differential health outcomes
3. Violations of the Obligation to Protect
   1. Failure to protect against non-state violence or prosecute perpetrators
4. Violations of Omission: Failure to Fulfull Minimum Core Obligations
   1. Failure to respond to serious health problems
   2. Racially directed allocation of public money for health care
   3. Failure to provide basic health services
   4. Failure to respect women's reproductive rights

Sector Analyses

1. The Role of Professional Health Organizations
   1. The Medical Association of South Africa
   2. The National Medical and Dental Association
   3. Psychology
   4. Nursing
2. Health Professional Regulatory Bodies
   1. The Medical and Dental Council
   2. South African Nursing Council
3. Education and Training in the Health Sector
4. District Surgeons and Prison Medicine
   1. District surgeons and South African law
   2. District surgeons' behavior during apartheid
   3. Factors contributing to district surgeons' inadequate performance
5. Mental Health
   1. Human rights, mental illness and mental retardation
   2. The psychological legacy of apartheid
6. Military Medicine in South Africa
7. Civilian Health Services for the Poor: District Surgeons and Public Hospitals

Underlying Causes of Human Rights Violations in the Health Sector

1. A. The Primary Cause: Racism in the Society
2. Racism in the Health Care System
3. Other Factors
   1. Limited conceptualizations of health and human suffering
   2. Ineffective leadership of health sector organizations
   3. Power without adequate accountability
   4. Lack of independence in the health sector
   5. Lack of adequate human rights and bioethics education

Recommendations

1. Elimination of Racial Discrimination and Disparities
2. Adoption of Human Rights Standards for Health Professionals
3. Professional Societies
   1. Support legislation to assure the protection of human rights in the health professions
   2. Investigate abuses committed by individual practitioners in the past
   3. Incorporate human rights education and cross-cultural understanding to professional training
   4. Undertake affirmative efforts to alter the leadership structure of the organizations
   5. Demonstrate commitment to health equity
   6. Elevate human rights concerns within the organizations
   7. Incorporate human rights into professional journals
4. Professional Regulation
   1. The record of the Councils must be thoroughly and independently examined
   2. Members of the Councils who advanced the policies of apartheid should be replaced and all members should receive training in human rights
   3. Legislation should be enacted to increase community participation in the work of health professional regulatory bodies and assure the Council's commitment to human rights
   4. Legislation should be enacted to create special procedures for the investigation and prosecution of human rights violations by health professionals
   5. Legislation should establish effective sanctions for human rights violations by health professionals
   6. Human rights violations of the past that the Councils failed to address must be addressed now
   7. Data collection procedures should assure an accurate record of the work of the Councils or their successor organizations
5. Human Rights Education in the Health Sector
   1. General recommendations
   2. Incorporate specific objectives into human rights education
   3. Human rights education campaigns
   4. Structural considerations
   5. Curricular reforms and training in human rights and bioethics in the health sector
   6. Professional support for human rights and bioethics educators
   7. Monitoring implementation of human rights and bioethics education
   8. Licensing linked to human rights and bioethics education
6. Monitoring and Reporting on Health and Human Rights in South Africa
7. Mental Health
   1. Human rights and mental health
   2. The psychological legacy of apartheid
8. Military Medicine
9. Medical Documentation of Torture and Ill-Treatment

Concluding Postscript: Implications for the United States

Appendix A:
South Africa Consultative Team Members

Appendix B:
Standards for the Effective Documentation of Tortur and Ill-Treatment

Appendix C:
Findings and Recommendations of the TRC on the Health Sector