Dear Editor,

My name is Dr Bassim Dhaif FRCSI, FRCS (Orth), Consultant Orthopaedic Surgeon, Salmaniya Medical Complex, Bahrain, Associate Professor, College Of Medicine, Arabian Gulf University, Past Chairman, Department Of Orthopaedics, Past President, Bahrain Orthopaedic Association, Past President, Bahrain Sports Medicine Association. I am married. I have four children; the eldest is 19, the youngest is 10.

I was arrested on March 19, 2011, two days after the main crisis in Bahrain. My arrest was at home and in front of my whole family. It was violent and aggressive. I was beaten by several persons, approximately 12. They entered all the rooms in my house and destroyed some items. They asked me to open the safe box and stole cash worth us$20,000 that was never returned. They have taken all ownership documents of five properties that I own. In addition, they took two of my cars, which were only returned after three months.

I was back-handcuffed, then pulled down the stairs and taken to an unknown place. There I was subjected to violent physical torture of various kinds. I was kept in solitary confinement for seven days. I was kept standing for the whole day for nearly 12 days. As a result, I developed massive swelling of both legs and feet that resulted now in a loss of sensation of both feet and permanent congestion and swelling.

I was subjected to verbal abuses of all kinds. I was deprived of sleep for nearly 26 days. I experienced aggressive verbal attacks on my religious beliefs.

This seems to be a standard practice against all doctors who are from the Shiate sector.

The physical torture continued for 26 days. During that period I was subjected to lengthy interrogation that lasted eight hours. This was violent and aggressive. No specific charges were read to me. At the end I was forced to sign 20 pages without reading them. During those 26 days, I was blindfolded continuously and back-handcuffed. I came to know subsequently that I was in the CID, Criminal Investigation Directorate.

On the 23rd day, I was taken to a detention centre and the torture continued and was even more violent. This continued for three days, following which, the blindfolding and handcuffing were stopped. In those three days, I experienced the most terrifying moments of my life. This was the torture and the witnessing of the death of two jailed persons.

The circumstances in the detention were very difficult and painful. This lasted nearly four months before things started to ease down. During that period, I was taken again to the CID with many doctors. We were forced to give confessions and stories that had never occurred in real life. For me, I was forced and threatened to say that I had performed fake surgeries to patients that had no injuries and reported that to international media, so as to distort the image of Bahrain.

I was forced to confess that one of my colleagues had weapons. I was forced to say that one of the surgeons opened the chest of a patient, not to take out a bullet, but to make his injury worse. This was a painful experience for all of us. However, the amount of torture and threat I was subjected to forced me to say anything just to save my life.

It’s important to mention that I was sexually harassed during those 26 days. In the detention centre and while I was taken to a medical clinic blindfolded and handcuffed, I was punched on my face and kicked on my legs many times.

Going to the medical clinic was a terrifying experience the first two months in the detention centre. We were not allowed to see the doctor since we were blindfolded. After three months, the visit to the clinic was not with the blindfold. To my surprise, the doctor was one of my former medical students.

On June 6, at 4am, I was taken to an unknown place. I discovered at 9am and for the first time that I was in a military court. Between 4am and 9am, and on the way to that place, I was also back-handcuffed, blindfolded and subjected to physical attacks and verbal abuses by the security personnel.

In the court, and to my surprise, I saw my family for the first time. All throughout my arrest and detention I was denied any access to my lawyer and my family for more than three months. Even during the court sessions, I was allowed only 10 minutes to see my lawyer. I had only one formal meeting with my lawyer and that was in detention and it was at the end of July 2011 — more than four months after my arrest.

Only in mid-June 2011 did I become aware of the charges against me. These included:
1. Occupying a government hospital by the use of force;
2. Attempting to overthrow the ruling Royal Family;
3. Performing fake or sham surgeries and broadcasting false information to international media so as to attempt to overthrow the government;
4. Hiding information about the use of weapons by some of the doctors;
5. Many other charges.

I absolutely denied all these charges. All my confessions actually were never said by myself and, not only that, I was forced to sign papers that apparently contained those confessions. This was obtained under torture and threat and without the presence of my lawyer. I was forced to record these in front of a TV camera, the tape of which to this date has not been broadcasted. The usual trend in this country is to publish or broadcast them on a national TV without a permit.

We brought more than 40 witnesses in the trial. Many of them are senior consultant doctors, paramedics, nurses and others. All of those witnesses had testified that the hospital was never under occupation at any moment of the crisis in Bahrain from the period February 17 to March 16.

We showed an official interview with HE the Minister of Health on Bahrain TV on March 9, 2011, stating clearly and strongly that the hospital service was running quite normally and patients were accessing the hospital without any difficulties.

We showed an official statement by the Assistant Undersecretary for Hospital Services at the Ministry of Health, Dr Amin Al-Saati, saying that all the services at the hospital were being carried out normally, except for a scattered five days where there were injured protestors brought to the Accident and Emergency Department.

I myself, a practising surgeon at the hospital, used to run my clinic and do my surgery up until March 13, 2011. Yes, on a few occasions when there was a flood of injured protestors, the hospital administration themselves would stop elective admissions. This occurred only occasionally. Obviously, the number of cases attending the hospital had dropped and the reasons for that was that the country was in crisis and there were days when more than 300,000 protestors gathered in Pearl Square.

I had never interfered with the work at the hospital. I was doing my clinic and my surgeries both at Salmaniya and in a private hospital. I have worked at Salmaniya Hospital since 1987. I am a senior consultant. I am involved in teaching medical students and have been training doctors since 1997.

I treat all sectors of Bahrain equally, Sunni and Shiate. I don’t need to prove that, as the whole country knows who Dr Bassim Dhaif is. I have performed thousands of operations during my career. I operated on many players from various national teams — football, basketball, volleyball and many others.

I was involved in the treatment of many injured protestors who sustained serious injuries as a result of the use of bullets and live ammunition. I reported that to the BBC on February 18, 2011. Obviously such comments disturbed the government. On February 17, the ambulance was not allowed to bring injured protestors from Pearl Square between 6am and 11.30am. The order for this action came from the security forces.

We submitted the voice recording of such orders to the ambulance services to the court, but this was never considered.

In fact, between February 17 and March 16, several doctors, nurses and paramedics were attacked by the security and military personnel. Some of those sustained serious injuries, including head injuries and fractures. All this is documented by videos.

As a result of this, the health professionals were furious. This act is not acceptable and risks the provision of best medical care. The health professional have protested against that. I myself have protested twice.

As regards the aggregation of hundreds of protestors in front of the car park of the accident and emergency department, I have absolutely nothing to do with such acts. I was never involved. On the contrary, I objected to such action. I personally spoke with the chief of medical staff about this issue. Not only this, in a meeting with H.E. The Minister of Health, I opposed such events taking place: never in that time of the crisis that a protest should actually have taken place in the vicinity of the hospital.

Regarding our trials, first it’s a military court and I am obviously a civilian. I was denied any of my basic and simply rights, such as a lawyer and access to my family, access to evidence etc. The torture that I sustained was documented by the Bahrain Independent Commission of Inquiry. This Commission was established by His Majesty the King of Bahrain. The interrogation, confessions were all under threat and torture and in the absence of my lawyer.

Therefore, this trial is illegal and has no basis. I demand the dropping of all charges.

If such a retrial should take place, I urge the international community to monitor and follow these trials. I urge the King of Bahrain to intervene and stop such trials that have distorted the image of Bahrain and have clearly shown to the entire world the extent of human rights violation taking place.

Dr Bassim Dhaif, Frcsi, Frcs (Orth),
Consultant Orthopaedic Surgeon,
Salmaniya Medical Complex,
Bahrain.

The official report of the BICI, which was tasked with investigating and reporting on the events in Bahrain from February 2011 and on allegations of human rights violations, was published in November and can be accessed online at www.bici.org.bh.

Dear Editor,

As I sit in my office on a quiet morning in general practice, I can hear strains of Mr Tambourine Man gently wafting in from the radio speakers in the waiting room next door. This is followed by Pat Kenny talking about something utterly predictable, elucidating an array of opinions on the usual subjects; all of which are presumably in keeping with those of the listening public.

Indeed, the typical nature of my day, with its rather typical opening and somewhat predictable conclusion, causes me to seriously question the pace or the existence of social, cultural or intellectual evolution — at least in an Irish context.

Mr Tambourine Man was written and recorded by Bob Dylan in 1965. It was famously re-released by The Byrds sometime later and is included in Rolling Stone magazine’s list of the 500 best songs ever.

It is often described as an ode to the use of drugs such as LSD, which was certainly part of the social experiment that was the hippy 60s. My point here is that whilst Dylan’s muse is of some historical relevance and was clearly of significance in the 60s, why does it remain part of the frozen musical repertoire of RTÉ today?

Fortunately, with the internet and YouTube we have access to a world outside of the ‘Groundhog-day’ that is our national broadcaster, and to my delight and sadness my 14-year-old son almost every night introduces me to a world of music that evolves on a different planet to RTÉ.  Bands like Beirut, Joanna Newsom, Anthony and the Johnsons, Life in Film, Devendra Banhart, M Ward, and many more, all of whom will hardly see the light of day if they are to struggle through the fixed concrete that RTÉ has poured upon the landscape of Irish media.

The interesting thing here is that the artists I have mentioned are not only almost entirely unknown to the Irish mainstream but are, however, known throughout the world. If the numbers of hits on their YouTube videos are anything to go by, they are part of an evolving world of music that is passing Ireland by.

Yet there is also a sinister twist to the artistic stagnation that defines our national media. It is possible that this national ossification is more by design rather than accident. One is not suggesting a conspiracy theory. However, there is at present a massive global evolution occurring on an intellectual as well as an entertainment and artistic front — an evolution of which we in Ireland remain almost entirely ignorant.

Old dogs are being buried around the world; new thinking and new art is awakening. Popular philosophers like Slavoj Zizek are re-inventing democracy, capitalism and socialism, and would be very quick to point towards the brutal irony that Joe Duffy is as much a media millionaire as he is a ‘man of the people’; that he walks in the material footsteps of the developers and bankers of yesteryear, as much as the footsteps of a self-styled James Connolly.

The actual social distance between presenters like Duffy, Kenny, Finucane, or the late Gerry Ryan and the ‘real’ people of Ireland could be measured in light years, and yet theirs is the petrified view that spans the airways and silences all dissent and almost all hope of newness. Not only is RTÉ incapable of evolution and intent upon containing it beneath a thick layer of stone, but it is happy to resurrect the retired in the form of Gay Byrne who, not arguably but definitely, retired years, if not decades ago!  He is now back, presenting a number of shows on radio and television. RTÉ has at least evolved the notion of the job for life into a job for life and beyond retirement!

The newness of thinkers, of artists and of ideals seems to remain an anathema to RTÉ, perhaps because newness is an anathema to the Irish people. That we ourselves continue to ‘play the lotto’ and suffer from the same GPI (General Paralysis of the Insane) which Joyce accused us of in Dubliners and again in Ulysses.

Is this the same GPI that caused Joyce to flee to Trieste, and caused Beckett to flee to Paris? Perhaps it is this same paralysis which causes 1,000 young people to flee Ireland every week. Perhaps the usual palaver about our young having to leave Ireland because of the recession is as untrue as it is true.

We will never know because only the media tells us so.

Perhaps many of the emigrants themselves believe that the sole reason they depart Ireland is economic? And yet despite the media embrace of the recession, there may be more to this. It may be that we Irish have no sense of ownership of our land, no sense of belonging to Ireland.  No real sense of pride in who we are and where we have come from. Is that why we find it easier not only to leave but to litter, to decimate our bogs, despoil our heritage, ignore our language and carve up our countryside with motorways and ghost estates?

I consider myself a middle-class socialist; it is, to my mind, the path of least destruction amongst the by-ways of political philosophy.  I suspect that most in Ireland are of a similar political leaning.

The socialist TD Clare Daly has embarked upon a campaign to ignore the new residential tax. The Left, as usual in Ireland, have missed the banana boat. Their tactics remain unchanged since the water charges and the bin tax a decade ago. Don’t pay — go to jail and hopefully raise the profile of the socialist agenda. Yippee, and here we go again!

But the Government is ahead of Clare Daly and Joe Higgins; the Government has passed legislation to ensure that the socialists will be denied their day in jail, as no-one is to be jailed for non-payment, and the non-payers are to have the residential tax taken at source from their wages. Checkmate to socialism.

The real charge that Daly and Higgins and the entire Leopold Blooming nation of ours should be rejecting with heartfelt enthusiasm is our TV licence, as it is this money that pays for the concrete that is being poured upon the intellectual and artistic landscape of Ireland every single day. And yet it is hard for us to see the trees or the forest, or even the wolves and the sheep, when all is concrete and we must contend with our GPI.

Dr Marcus de Brun,
Rush,
Co Dublin.

Dear Editor,

I would like to thank Dr Ruairi Hanley very much for the support he and people like Prof Damian McCormack and others in Ireland are expressing locally and internationally on Bahrain (Irish Medical Times, January 27, 2012, http://bit.ly/A2qbzd). I am very pleased with Dr Hanley’s enthusiasm, which unfortunately some of our colleagues in Bahrain are standing against.

I am one of the medics who was sentenced to 15 years’ imprisonment, for nothing but doing my job in helping my fellow Bahrainis who where injured by the Bahraini and Saudi troops attacking peaceful protestors who were asking for reforms.

I was in Ireland in the summer and autumn of 1983 in University College Dublin, worked in Our Lady’s Hospital for Sick Children in Crumlin, and obtained my Diploma in Child Health from UCD. I am a consultant neonatologist.

I was one of the medics who was arrested and tortured by the Bahraini and Saudi security forces, both physically and psychologically, and sexually harassed for nothing except for doing my job.

The sad side of the story is that the government is accusing us of occupying a hospital in which all of my colleagues have worked throughout our entire lives, for treating the injured there as well as in the Pearl Roundabout medical tent, offering our services for the people there during the crisis in February-March 2011.

The RCSI-Bahrain also played an unfortunate role during the crisis, suspending some students as well as a Bahraini lecturer.

Dr Nader Dawani MBChB (honors), DCH, MRCP (UK), MRCPCH (UK),
Consultant Paediatrician and Neonatologist,
Salmaniya Medical Complex,
Former Assistant Professor — Paediatrics,
Medical School, the Arabian Gulf University, Bahrain.

I didn’t suspect I had a dickie ticker,
If  I did, I may have gone to A&E quicker,
The pain came on slowly, not all of a sudden,
So, thankfully, I’d time to finish the black and white puddin’.

But, despite my profound wish, the chest pain persisted,
When it radiated to the neck, I knew I’d have to be shifted,
Straight to A&E, without a GP letter —
A rare occasion, when to do so is better.

In WRH, just up the road, and very efficiently indeed,
I was examined, troponind and multi-ECGd,
The staff, working flat-out, were most helpful and kind,
But the medical Reg was the hero to my fretful mind.

After 10 hours wired up in Cubicle 3,
Observing the wonderful crew in my A&E,
He put his head round the curtain: “Blood tests and ECGs show
nothing amiss”,
I asked, a little bashfully, could I give him a kiss?

He politely declined and professionally advised,
An ECHO and stress test would of course be required,
Three days later, in MAU, when the treadmill I mounted,
The ticker, stout fellow, held up when it counted.

What was the diagnosis? Stress was suspected —
An overburdened GP, working too hard, I reflected,
Increased workload, decreased resources, cuts left, right and centre,
Medical card ‘Central’, patient and GP tormentor.

But, let it be said, the health service has a heart that’s still beating,
And great staff doing their job without bleating,
So, in these hard times, what is the master plan?
Pension-off the most experienced, as many as they can.

The moral of this tale, if one can be found,
Patients well cared for by staff on the ground,
Staff and the system all increasingly stressed,
Just about managing to give of their best.

Dear Dr Reilly, fellow GP and health service master,
Please now do your best to avert a disaster,
Support the front line; It’s what we’re all about,
So cop on, shape up and if your heart’s not in it… step out!

Dr Cyril Murray,

Waterford.

Dear Editor,

It is with some sadness that I comment on two recent letters in Irish Medical Times regarding the tragic situation in Bahrain (IMT, January 13, 2012, http://bit.ly/wKawzG). I believe your readership deserves to know a little more about the authors of same.

The first was from the Bahraini lobbyist Dr Omar Al-Hassan, former ambassador to the Arab League in London. His abortive attempts to have Charles Haughey start an Irish-Arab bank via Senator Noel Mulcahy in 1980 were revealed in State papers published here in December 2010. He also formed the Gulf Center for Strategic Studies in London, where he is the current Chairman.

The second letter was from Mr Mohammed Al-Muharraqi, a lecturer in RCSI Bahrain and member of staff at the BDF military hospital in Bahrain (http://bit.ly/xCYw5n).  That hospital had to operate on a friend of mine, Abdulhadi Al-Khawaja, former President of the Bahrain Center for Human Rights and former Mid-East Protection Coordinator with Frontline Defenders in Blackrock.

Abdulhadi was abducted and beaten until comatose on April 9, 2011, following his return to Bahrain. The regime denied that he was injured during interrogation. However, his broken mandible was fixed at that military hospital in Manama.

We have credible reports that Abdulhadi was chained to his bed in the BDF hospital and was comatose for weeks. He still cannot open his mouth properly, according to his family.

Abdulhadi’s picture is currently displayed proudly on a 2,500sqft banner on a building on St Stephen’s Green. He is one of Ireland’s bravest human rights defenders. He remains in detention in Bahrain having received a life sentence in a military court. His daughter Zainab Al Khawaja, who was also assaulted and subsequently arrested, has continued to expose the daily brutality of the regime in Bahrain. Her husband is also incarcerated and her sister is in exile.

Both letters respond to articles written by Prof Eoin O’Brien. He accompanied me to Bahrain in July 2011. Our delegation, which included MEP Marian Harkin, Senator Averil Power and signatory to the Good Friday Agreement Mr David Andrews, found and reported on heinous human rights abuses, including the militarisation of hospitals by government militia, torture, including sexual assault, of consultant surgeons and physicians, senior lecturers and tutors, including some working at the RCSI Bahrain, medical students and nurses, ambulance drivers and porters.

Our efforts greatly annoyed many within the Bahrain regime and many pro-government lobbyists and loyalists. Our efforts also greatly annoyed and ‘distressed’ some closer to home.

The Bahraini regime paid for their own investigation into events via a Royal Commission of Inquiry. Contrary to Mr Al-Muharraqi’s assertion that this was a UN-style commission, it was anything but. In fact, the royal inquiry had a number of fatal breaches of the standards of the UN High Commissioner for Human Rights, specifically:
1. The commission was not established by the principle of ‘national choice’;
2. Selection of members of the commission was by the King and not by or from the wider society;
3. There was no formal consultation with NGOs, despite the assertion by the UN High Commissioner that national NGOs have a key role in any truth commission; and
4. The usual role of the UN in establishing and assessing such truth commissions was circumvented.

Nevertheless, the Bassiouni report confirmed what we had reported, and the Bahraini regime was forced to admit to serious breaches of human rights.
However, little has changed in Bahrain. For instance, despite the fact that the report declared weapons charges against Salmaniya medics “unfounded” (para 84) those medics still face those charges in a prolonged and utterly shameful legal battle to void lengthy sentences already handed down by a military court prior to the release of the report itself.

The truth, as they say, is out. The truth is available for all to see on Twitter and Facebook and YouTube. Recent events speak to the truth in Bahrain. For instance, the deportation of Dr Richard Sollum of Physicians for Human Rights and Mr Brian Dooley of Human Rights First from Manama Airport, despite the reassurance of Bahrain’s Foreign Minister Sheikh Khalid Al Khalifa that NGOs would have “unfettered access” to Bahrain.

The recent assault of Nabeel Rajab, Chairman of the Bahrain Center for Human Rights, and the deaths of numerous innocent people by CS gas suffocation, the detention of dentists, teachers, journalists, university students and anyone who dares speak out against the regime all speak to the reality of life in Bahrain today.

The UN High Commissioner for Human Rights Navi Pillay has called for the unconditional release of all detainees imprisoned by military trial. In reality, the regime continues to delay the appeal trials of those accused, including the trials of Irish-trained surgeons Ali Al Ekri and Bassim Dahif.

Society in Bahrain is not split by religious beliefs, as Dr Al-Hassan suggests. It is split by fear; a fear emanating from a brutally oppressive element within the regime — a fear which suppresses normality and facilitates conscienceless, corrupt and dangerous behaviour by individuals and organisations.

As I write this letter, more sad news has emerged from the village of Sanabis, of a mother who died by self-immolation in protest at the assault and detention of her son in April. Her death is another act of frustration and despair in a land where brave men and women of good will are punished for speaking out; where ordinary people live in fear.

I disagree with the opinions and assertions of these two previous writers, but I would defend their right to make such comments in our free press, in our free and democratic land. Many millions have died to secure the democracy and freedoms codified in the Geneva Conventions and International Declarations of Human Rights. Those countries that sign up to those conventions must respect them. Sadly, such freedoms of expression and assembly are not available in Bahrain today.

Prof O’Brien was recently described by Robert Ballagh as a national treasure. He is, in my opinion, a moral exemplar; one willing to speak up for the oppressed and vulnerable despite the cost, personal or professional.

His reports are neither “insufficient” nor “inaccurate”. If they were, he would not attract the attention of lobbyists and loyalists.

Prof Damian McCormack, FRCS Orth,
69 Eccles Street, Dublin.

Dear Editor,

I am writing to highlight the amount of medical card patients lost to my panel since November last year. At least 50 patients have been removed as a result of their medical cards not being renewed.

Any patient we have spoken to has told us that they received no notification to let them know their card needed to be renewed. The majority of these patients are on long-term medication for heart disease, diabetes, high blood pressure, cancer, et cetera, and their circumstances have not changed, and if anything their circumstances have worsened due to the austere times we live in.

I have offered some patients private prescriptions, but they have refused on the basis they can’t afford to pay for the medications due to the severe recessional times.

This is very serious as patients may be up to three months waiting for a medical card application to be processed. I know this, as many of my patients have already been waiting on decisions since September last year.

We as doctors have already been hit with huge financial cuts. As a result of these 50 patients being removed from my panel, I now effectively have taken another 8 per cent pay cut each month.

This again really affects the viability of my practice and my pension. As a solo practitioner, the viability of my practice is very much affected as a result of these stealth cuts, which may possibly force me to give up my practice.

The nature of this situation is extremely serious and will ultimately lead patients to have to turn to our local hospitals for treatment, which as we all know are already under severe pressure. In the long run, the health services will be put under even greater financial pressure.

We have tried repeatedly to contact the PCRS regarding this matter and have yet to receive any explanation for the problem outlined above.

Dr Conor O’Neill,
Waterford.

Open Letter to Minister Róisín Shortall,
Minister of State, Department of Health

A Aire,
There is €120 charge for a private patient presenting to an emergency department (ED) without a GP letter; a medical card patient is seen at no charge.

A patient must therefore attend an out-of-hours GP and pay a lesser charge of €60 (in my area) to avoid the full charge. This discriminates against the private patient.

This can also cause unnecessary pain and suffering as the out-of-hours services are busy and there may be a delay before the doctor can see the patient.

The other night, a young man with severe abdominal pain had an 80- to 90-mile round trip and a delay of at least three hours before he got to hospital. I was on call and was asked to see him. It was obvious that he needed to go directly to the ED from the phone call from the triage nurse. He could have been there in 30 to 45 minutes after a journey of 30 miles. The only reason for the delay was the apparent need to save the patient €60.

I am a practical person and would like a simple solution to this obviously unfair and inequitable situation, especially in the current economic climate.

One obvious remedy would be to increase the GP or out-of-hours fee to the same as the fee for the ED. I reject this as doubly unfair to the already financially-penalised private patient. It appears then that the EDs need to reduce their fees.

I would be grateful if you, as Minister, could give this matter your attention and consideration.

Dr Mary Rogan,
Annaghdown, Co Galway

Dear Editor,

In my letter previous to Irish Medical Times (December 2, 2011, http://bit.ly/suuWMa), I said that the effect of the ‘money follows the patient’ initiative leading to a more intensive use of hospital beds would result in cost increases. This is because, by implication, additional resources — especially human resources — would be required to cope with more very sick patients on any one day.

Existing staff can be stretched to work more intensively, but only up to a point. Beyond that, in order to use beds more intensively within the bounds of existing resources, beds would need to close and that appears to be now happening.

In such an extreme scenario, the throughput is not increased and so the pressure from the emergency department and waiting lists persists. There is less margin to deal with unexpected events and, in addition, the already scarce step-down facilities also now appear to be closing, creating additional back pressure on the discharges, which are vital for such an intensive system to function.

Indeed, bed-blocking has long been blamed for creating congestion and, in that context, the P&A Consultants were paid a very large sum of money over five years ago to review acute bed use in this country (and theirs was not the only study of this issue).  They found, with surprise, that only 17 per cent of patients had an estimated date of discharge and thus their primary recommendation was the introduction of discharge planning (a standard practice elsewhere), as well as an increase in non-acute step-down facilities.

One can legitimately ask to what extent the recommendation (as well as others from their report) has been implemented, considering especially that at the time, funding was not a problem.

Michael Kaliszer,
Lecturer in Health Statistics (retired) at the Department of Public Health and Primary Care,
Trinity College Dublin.

Dear Editor,

In response to Ambassador Dr Omar Al-Hassan’s letter to you (IMT, January 13, 2012, http://bit.ly/wKawzG) criticising my analysis of events in Bahrain in The Irish Times (November 29, 2011) and in your newspaper (December 9, http://bit.ly/rqXZec), I am heartened to learn that  the King who “courageously” ordered the establishment of the Bahrain Independent Commission of Inquiry (BICI) to investigate the claims of human rights abuses, “has already begun implementing various judicial and security reforms in light of the BICI report’s findings, in an attempt to reconcile fractious divisions within Bahrain society”.

Dr Al-Hassan will no doubt be aware that the commissioners had no hesitation in accusing the Public Security Forces of violating human rights by forcibly entering and sometimes ransacking houses without arrest warrants and terrifying the occupants. There is an abundance of documented evidence that detainees were subjected, among many abuses, to blindfolding, enforced standing for prolonged periods, electrocution, sleep-deprivation, and threats of rape with the purpose of obtaining incriminating statements or confessions. Taken with forensic medical evidence, the BICI adjudged that torture was common and that such practices were a flagrant disregard both of Bahraini and international human rights laws.

However damning this aspect of the report may be, the most worrying aspect for the many doctors and others in Bahrain who still stand accused and who face harsh sentences is the serious criticism of the Bahrain judicial system, which must call into question the validity of sentences passed. The commission viewed the “lack of accountability” of the judicial and prosecutorial personnel in the National Safety Court as “a subject of great concern”, compounded by the acceptance of forced confessions in criminal proceedings in both special courts and ordinary criminal courts.

Can Dr Al-Hassan assure me that given what were clearly miscarriages of justice under international (and Bahraini) law, that those accused will be pardoned by the King and compensated?

Mr Mohammed A Al-Muharraqi in his letter to you (January 13, 2012) states that medical personnel were involved in political expression and there are indeed ‘unproven’ suggestions that in a time of political upheaval and unprecedented events in the Salmaniya Medical Complex, some doctors and nurses did express their concern and abhorrence for what was happening.

However, Mr Al-Muharraqi (himself a doctor with the Bahrain Defence Forces) in his many utterances does not condemn the kidnapping, detention without trial and torture of doctors as an unreasonable response to freedom of speech and protest. He has to realise that international democracy cannot tolerate such a primitive attitude, and he would do well to refer to the BICI report, in which the Commissioners recommended that charges should be dropped, or at least reviewed, for those charged with offences involving political expression, or victims of torture, ill-treatment or prolonged incommunicado detention, and that victims of human rights abuse be compensated and that dismissed employees be reinstated and compensated.

In particular, I would direct him to pay particular attention to the warning from the Commissioners that “the state should never again resort to detention without prompt access to lawyers” and access to the outside world.

Bahrain, once renowned as the idyllic ‘Island of Dilmun’, must now to be seen to respond by implementing without further delay all the recommendations of the Independent Commission of Inquiry.

Eoin O’Brien,
DSc MD FRCP (Lond) FRCP (Edin)
Professor of Molecular Pharmacology,
Conway Institute,
University College Dublin.

Dear Editor,

I can still see the anguish on the face of my 79-year-old mother after she opened the post from the Revenue the other week. The letter was not addressed to her but to my father; he was buried 10 days previous, having died suddenly during Christmas week. All his tax affairs were in order.

What bright spark came up with that idea to do a blitz mail to the elderly? I am certain there are other families who received the same letter, having been recently bereaved.

Is there no awareness in other Government departments of positive mental health and promoting it during an extremely vulnerable time of the year to an extremely vulnerable group of people? What was the urgency?

Whatever happened to communication and collaboration?

Dr Deirdre Forde,
Naas, Co Kildare.