SECTOR ANALYSES

Unlike virtually every other military medical service in the world, South Africa's armed forces physicians and other health professionals have been organized since 1979 as an entirely separate armed services branch. A three-star general with a medical degree commands the South African Medical Service (SAMS), which provides care to army, navy, and air force personnel, but is constituted as a distinct, administratively co-equal military organization. The SAMS has included doctors, nurses, psychologists, and non-professional, military-trained medics. In theory, this unique administrative structure might be expected to nurture a separate medical culture within the military, respectful of the profession's ethical tradition, including the Hippocratic commitment to keeping faith with patients. In practice, SAMS conceived of its organizational role differently. As the SAMS commander, Major General Neil Knobel, told the TRC's health sector hearings, SAMS' priorities were "firstly, to insure a healthy security environment and secondly, to insure a secure health environment."⁸¹ In theory and in practice, SAMS conflated its health and state security functions, engaging in a wide range of clinical, research, and other activities in support of the apartheid regime's campaign against its opponents.

Like military doctors in other countries, SAMS personnel provided care to soldiers wherever they went. However, this meant that SAMS personnel accompanied South African troops on incursions into Angola and Namibia that violated international law, and on domestic operations against the regime's opponents. In this role, SAMS physicians were almost uniquely well situated to learn of injuries to civilians and combatants suggestive of torture or other abuses. Neither the TRC hearings nor our own inquiries yielded direct evidence that SAMS personnel participated in atrocities during these missions or in other ways breached the duties of medical personnel in armed conflict under the relevant Geneva conventions and protocols.⁸² Neither, however, did we turn up evidence that SAMS personnel ever reported medical evidence of human rights or humanitarian law violations to anyone outside the military command system.⁸³

SAMS personnel played a more active state security role through the primary health care they provided to black civilians in some areas, including within the former homelands. During the 1980s, the security forces shut down private medical clinics in some townships and rural areas in an effort to forestall the development of community institutions into centers of resistance to the regime. SAMS filled the gap, becoming the main provider of health services to blacks in many rural areas⁸⁴ as part of the state's effort to prevent its opponents from gaining local footholds through the development of non-governmental social welfare institutions. This civilian health care program served as both a means for winning rural "hearts and minds" and a window into local community concerns. As SAMS commanders freely concede, these health services did not nearly approach the technological intensity or quality of medical care available to the white population. SAMS also provided medical care to civilians in Angola and Namibia in conjunction with South Africa's military campaigns in these countries.⁸⁵ We were unable to ascertain whether these services were merely incident to military operations in these countries or were part of a larger effort to discourage local civilians from giving safe harbor to the anti-apartheid resistance.

There is evidence that SAMS physicians and psychologists performed biological and chemical weapons research, but the exact extent of the chemical and biological programs and whether they included weapons of mass destruction is unclear. There are also various accounts alleging that SAMS personnel administered drugs and aversive electric shocks to gay conscripts without their consent in an effort to change their sexual orientation and assisted in the interrogation of detainees. The South African military may have used chemical weapons in Mozambique and herbicides in Namibia a decade ago. The former apartheid government apparently investigated the possibility of developing a bacteria that would selective kill or injure black people while leaving white people unharmed.⁸⁶
General Wouter Basson, a cardiologist in the military who was once the personal doctor to the former President, P.W. Botha, appears to have headed a special military program that operated covert laboratories and set up front companies. This unit conducted research and produced both recreational drugs, like Ecstacy, that were sold to make money and a variety of gadgets that gave the apartheid regime undetectable ways of murdering political opponents. The implements included screwdrivers with poison-filled cylinders, rings with spring-loaded compartments hiding deadly powders, vials of whisky laced with the toxic herbicide paraquat, and peppermints spiked with botulism.⁸⁷ At the time of our mission General Basson was still on active duty and registered with the SAMDC as a cardiologist and a practitioner in good standing.

In an interview with our team, General Knobel acknowledged that SAMS personnel had done research with biological weapons and poison gas but insisted that the work had been purely defensive.⁸⁸ General Knobel said SAMS had begun a "command investigation" of the charges concerning the gay conscripts and that court-martial proceedings could follow. He denied that SAMS psychologists or other personnel had ever been "involved in interrogation under the command of the Surgeon General" [the SAMS commander]. He did say though that "certainly psychologists were involved" in training South African special forces "in how to resist special interrogation techniques."

SAMS physicians and other health professionals, in sum, actively supported the apartheid state's struggle to remain in power and understood this to be an important part of their mission. SAMS personnel rendered such support not only by providing medical services to the military but also by operating health care programs for civilians in contested rural areas and putting their technical skills to direct military use, e.g. in the country's chemical and biological weapons programs. SAMS commanders' non-responsiveness to the TRC's detailed inquiries about these activities has made thorough scrutiny of them difficult thus far. We have therefore been unable to ascertain the full extent to which SAMS personnel acted contrary to international human rights and humanitarian law standards, as well as international medical ethics norms, in pursuit of their state security mission. We register our concern, however, that SAMS' expansive conception of its state security mission is at odds with the more limited role of military medicine in most other nations' armed forces. Like the district surgeons, medical personnel in SAMS confronted a situation where their dual loyalties put them at ongoing high risk for complicity in violations of human rights and humanitarian law.

NOTES

⁸¹ Transcript of the Truth and Reconciliation Commission's Health Sector Hearings. June 17, 1997, p. 191.

⁸² There have been multiple allegations that SAMS personnel neglected the medical needs of injured civilians and prisoners of war taken during these military operations. Interviews by Laurel Baldwin-Ragaven, June, 1997. The Geneva Conventions and Protocols governing both international and intra-national armed conflict require medical personnel to prioritize and treat sick and wounded soldiers and civilians on the basis of clinical need, without regard for combatant status and national, racial, ethnic, or other affiliation.

⁸³ To our knowledge, the TRC has received no reports along these lines from SAMS personnel.

⁸⁴ Submissions to the TRC from both SAMS and its critics reported qualitatively on the service's role in providing health care to civilians in rural areas, but we were unable to ascertain, from these submissions, the size and scope of this role.

⁸⁵ Knobel, Neil (Major General). Interview by Gregory Bloche, June 1997.

⁸⁶ "Truth Panel is Told of Bacterial Warfare," The Washington Post, June 12, 1998, A22

⁸⁷ Suzanne Daley, "In Support of Apartheid: Poison Whisky and Sterilization," The New York Times, June 11, 1998.

⁸⁸ Id. General Knobel said that SAMS personnel had experimented with CS gas and other chemical and biological agents only for the purpose of developing masks, protective clothing, and other defensive equipment and strategies. He acknowledged that SAMS General Wonter Basson, M.D., who ran this research program, was still on active duty, but he said President Mandela had personally instructed SAMS to retain Basson in order to discourage him from selling biological and chemical weapons technology to Libya and other countries.