#Act2EndFGM – The relationship between international human rights law and female genital mutilation (FGM)

 

This is the fourth blog in a series written by LLM students on the Human (In)Security course at Edinburgh Law School. This series celebrates the top five blogs selected in a class competition. This blog is by Evelyn Strutynski. Evelyn is  currently reading the LLM in International Law at the University of Edinburgh. She also obtained a Bachelor of Arts degree in Political Science and Law at the Ludwig-Maximilians-Universität München in Germany.

#Act2EndFGM – The relationship between international human rights law and female genital mutilation (FGM)

Over the last decades, much has been achieved to reduce the prevalence of FGM around the world. In 2015, the UN announced new development goals, including the initiative to completely eliminate FGM by 2030. Nonetheless, the procedure still is a highly salient issue. In 2021, more than four million girls are at risk of undergoing FGM and, overall, approximately 200 million girls and women alive today have been subjected to the practice in 31 countries. This blog post will examine the relationship between FGM and international human rights law as well as the global efforts to eliminate FGM.

What is female genital mutilation?

The WHO defines FGM as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”. The procedure is predominantly carried out by traditional circumcisers who use scissors, razor blades or broken glass. Increasingly, trained health care providers perform FGM (‘medicalisation’). The WHO has identified four different types of FGM; one of them is called infibulation which narrows the vaginal opening with a covering seal by, for instance, repositioning the labia minora or stitching.

FGM affects girls and women worldwide, the majority of them are cut before their 15th birthday. It is predominantly practised in Africa; furthermore, it occurs in countries in the Middle East and Asia, and in certain communities in South America. The practice is nearly universal in Somalia, Guinea and Djibouti where more than 90% of girls and women have undergone FGM. The practice is cultural rather than religious, since no religion requires it; nonetheless, religion is often used as a justification. Other reasons for FGM are, inter alia, psychosexual, for example, to control women’s sexuality, or sociological/cultural, to guide a girl into womanhood. FGM causes severe health issues; they range from infections, mental health or menstrual problems to the need for surgeries or even death.

FGM photo

Photo by UNFPA/George Koranteng

The relationship between FGM and international human rights law

FGM “violates a number of recognized human rights protected in international and regional instruments”[1]. Kandala and Komba identified five rights that are breached by the practice:[2]

  1. Child rights – Most girls and women undergo FGM before their 15th birthday. Art. 16 of the Convention on the Rights of the Child, for instance, prohibits any interference with the privacy of children; furthermore, Art. 24 (3) urges states to adopt “measures with a view to abolishing traditional practices prejudicial to the health of children”.
  2. Right to health – FGM causes serious health issues, which breaches, inter alia, Art. 12 (1) of the International Covenant on Economic, Social and Cultural Rights. The provision guarantees the right to the highest attainable standard of physical and mental health.
  3. Right of women to be free from discrimination – According to an Interagency Statement, the procedure is a “manifestation of gender inequality that is deeply entrenched in social, economic and political structures” and it “represents society’s control over women”. Hence, Art. 1 of the Convention for the Elimination of all Forms of Discrimination Against Women is applicable, as well as Art. 2, which urges states to fight discrimination.
  4. Right to life and physical integrity – FGM violates Art. 9 (1) of the International Covenant on Civil and Political Rights (ICCPR), which guarantees the right to liberty and security of a person.
  5. Right to be free from torture – FGM might also amount to torture, which is prohibited by, inter alia, Art. 7 of the ICCPR. The Convention Against Torture has a high threshold for torture; this fact might be problematic, as not all FGM procedures legally qualify as torture.[3]

Supporters of FGM point out that the right to culture, religious freedom and the rights of minorities justify the practice.[4] However, the breaches of the aforementioned human rights are more severe, since FGM undeniably harms the bodily integrity of girls and women and intensifies gender inequality. Furthermore, the conflicting rights are not absolute and may be limited[5] in order to protect girls and women. Generally, there is a lack of jurisprudence regarding FGM and human rights[6]; many cases, such as M.N.N v. Denmark or M.J.S. v. The Netherlands, focus on the risk of undergoing FGM in the event of a deportation.

International response to FGM

A range of international organisations and institutions takes part in the effort to eliminate FGM. For instance, the UN General Assembly adopted Resolution 67/146, which emphasises that FGM is an “irreversible abuse that impacts negatively on the human rights of women and girls”. The UN Secretary-General published a report, which demands that states should, inter alia, implement legislation that criminalises the procedure. Furthermore, the Committee on the Elimination of Discrimination against Women published General Recommendations Nos. 14, 19, 24 with regard to FGM. In 2020, the UN Human Right Council adopted Resolution 44/L.20, which urges States to condemn all harmful practices that affect women and girls, in particular female genital mutilation”.

#Act2EndFGM logo

UN Photo

Are human rights enough?

The universal recognition that FGM undoubtedly breaches international human rights law is an important step in order to eliminate the practice. Because of human rights, FGM is now part of a broader social justice agenda and of an increasing effort to hold governments accountable[7]; additionally, FGM is “viewed through a prism that recognizes the complex relationship between discrimination against women, violence, health and the rights of the girl child”[8].

However, this recognition alone is not sufficient, the law must be implemented and enforced on a national level. Furthermore, since FGM is such a deeply entrenched practice, a deep-seated social change within each community is needed; the Interagency Statement suggests initiatives like ‘empowering’ education, public dialogue or using alternative rituals. Overall, the efforts so far have been at least partly successful, as the prevalence of FGM declines steadily; however, the progress needs to be ten times faster in order to reach the 2030 goal. Population growth and COVID-19 are further impediments to meeting the target.

 

[1] Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide (Zed Books Ltd, 2000), 20.

[2] Ngianga-Bakwin Kandala and Paul Nzinga Komba, Female Genital Mutilation Around The World: Analysis of Medial Aspects, Law and Practice (Springer International Publishing AG, 2018), 190-192.

[3] Ngianga-Bakwin Kandala and Paul Nzinga Komba, Female Genital Mutilation Around The World: Analysis of Medial Aspects, Law and Practice (Springer International Publishing AG, 2018), 192.

[4] Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide (Zed Books Ltd, 2000), 31.

[5] Ibid., 38.

[6] Ibid., 20.

[7] Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide (Zed Books Ltd, 2000), 39.

[8] Ibid.

Human Insecurity: COVID-19 and Women’s Rights

Photo of the authorThis is the first blog in a series written by LLM students on the Human (In)Security course at Edinburgh Law School. This series celebrates the top five blogs selected in a class competition. This blog is by Alexandra Oancea. Alexandra is current reading the LLM in Human Rights at the University of Edinburgh. She is from Brussels, Belgium, and holds an LLB in European Law from Maastricht University, the Netherlands.

 

COVID-19 and Women’s Rights: The Negative Impact of the Pandemic on Women’s Access to Sexual and Reproductive Health Services

As evidenced by previous global health crises such as Zika and Ebola, pandemics exacerbate pre-existing gender inequalities, and the COVID-19 outbreak is no exception to this trend. The United Nations was warning governments as early as April of 2020 that the impacts of COVID-19 were disproportionately falling on women and urged them to adopt a gender-sensitive response to the crisis. In the field of healthcare, as resources are being diverted and lockdown restrictions tightened, women’s access to adequate health services is being heavily threatened. Within this context, this post will disclose how the current pandemic is endangering women’s access to sexual and reproductive health (SRH) services, how this in turn contravenes their fundamental human right to health, and why a gender-sensitive response to the pandemic is therefore required.

COVID-19 and Women’s Access to SRH Services

While ensuring access to SRH services to women has always been a challenge, COVID-19 intensifies the issue in many ways. As acknowledged by the World Health Organisation, following the outbreak, health systems around the world became overloaded, causing governments and health facilities to prioritise certain health services, while scaling back others. This has led to a reallocation of funding and resources for SRH services to the pandemic response. For example, in countries such as Romania and Slovakia, the breakout of the pandemic led governments to deprioritise abortion services, no longer deemed as essential. Furthermore, the measures imposed by States to limit the propagation of the virus meant that women in various contexts were no longer able to physically access time-sensitive services. Indeed, travel restrictions and stay-at-home orders deprived women

Two women in facemasks

Photo by Tim Douglas

and girls of family planning services, and in countries where abortion is illegal or strongly restricted, prevented women and girls from travelling to neighbouring countries to undergo a procedure.[1] According to Marie Stopes International, a NGO providing contraception and abortion services around the world, the pandemic has prevented 1.9 million women to access their services between January to June 2020. The pandemic also disrupted supply chains, resulting in shortages in contraceptive products and unavailability in pharmacies. Additionally, the pandemic has been leveraged in some countries to limit access to services such as abortion.[2] In Poland and Texas, lockdown was used to introduce abortion restrictions and ban procedures.[3]

These recent developments highlight the lack of attention that is currently afforded to SRH services by governments around the world. This neglect has dire consequences for women’s health: it can lead to a rise in maternal and new-born mortality, unwanted pregnancies, sexually transmitted diseases such as HIV, and unsafe abortions.[4] In addition, a failure to address women’s SRH needs goes against States’ international human rights law (IHRL) commitments, and more specifically their obligation to protect, respect, and fulfil women’s right to health and provide them with adequate access to healthcare.

Access to SRH Services as a Fundamental Human Right

The right to health is protected under various IHRL documents being widely ratified. For example, the United Nations International Covenant on Economic and Social Rights (ICESCR) recognises “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. The United Nations Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) further reiterates the importance of this right by placing a duty on states to eliminate discrimination against women in the field of healthcare. According to the CEDAW Committee, the body monitoring the implementation of CEDAW, this duty requires states to ensure that women have timely and affordable access to healthcare services, including SRH, and to eliminate barriers in accessing such services. Considering the developments outlined above, such duty seems to have been disregarded by governments when fighting COVID-19. However, while states are allowed to derogate from some of their human rights obligations in emergency situations such as the current pandemic, there are limitations. Under international law, emergency measures must, among others, reflect the principles of equality and non-discrimination. In other words, states are under a duty to provide women with access to SHR services, and this is true even during a global pandemic. Failing to do so would be discriminatory and would run counter to states’ international law commitments. In order to fully observe women’s rights, states therefore need to be mindful of this legal framework when designing measures to stop the spread of the virus. As evidenced below, this will require them to incorporate a gender-sensitive perspective into their COVID-19 responses.

The Way Ahead: A Gender-Sensitive Approach to Tackling the Virus

As declared by the United Nations, “states have a responsibility to ensure that everyone is protected from the virus and its impact” and “this may require special measures and protection for particular groups most at risk or disproportionately impacted”. In the context of women, protecting them requires governments around the world to integrate a gender perspective within their COVID-19 responses, something advocated by the World Health Organisation. This would allow states to better understand women’s needs and the negative impacts they experience during this pandemic. To do so, UN Women recognises the need for governments to issue policies protecting women’s SRH rights. One step in that regard is making sure that SRH services are identified as high-priority categories when deciding which services will be prioritised during the pandemic. Additionally, in order for women to physically access those services despite lockdown and travel restrictions, various measures could be taken by governments. Those include allowing women in need

Women holding a sign reading 'The future is equal'

Photo by Flavia Jacquier

of SRH services to be temporarily exempted from travel restrictions in order to ensure access. Furthermore, legal barriers to telemedicine services and at-home abortion pills should be removed, and their use should be promoted by States.[5] This step has been taken in the United Kingdom where women are now able to receive tele-consultation and to self-administer abortion drugs at home. Another way to promote women’s SRH rights is to remove any unnecessary requirements to access SRH services such as multiple provider authorisation, waiting periods and third-party consent for abortion procedures.[6] Finally, states need to include women at the decision-making table. Indeed, as reiterated by the UNFPA, women are more likely to have less decision-making power regarding the policies and decisions taken to respond to the pandemic, leading their SRH needs to be largely unmet. It is therefore essential for them to be included and to ensure their equal participation in all policy and decision-making regarding the crisis, something that was stressed by the CEDAW Committee in its Guidance Note on COVID-19.

However, the above-mentioned proposed measures merely constitute short-term ways to alleviate the issues women are facing during this pandemic, and it is still essential for States to engage in larger-scale reforms. In fact, the inequalities discussed in this post were already prevalent pre-COVID-19 and were simply exacerbated during the pandemic. In this way, the current situation reinforces the call for government to not only adopt a gender-sensitive response to the current global health threat, but also to develop a well-developed system to fight similar crises in the future in a way that is mindful of women’s experiences. Only this approach, which ensures the inclusion of women and acknowledges the different ways they experience the pandemic, can ensure that States will design measures impacting both men and women in an equal and non-discriminatory way, in accordance with their obligations under IHRL. While promising gender-sensitive practices are emerging, they are far from being uniform, and as lockdown measures and COVID-19 restrictions remain the norm around the globe, it is essential for States to take more active steps to acknowledge and respond to women’s specific needs.

 

[1] Julia Konowrocka, ‘Let’s Talk About Sexual and Reproductive Health and Rights Not Fully Implemented Before Covid-19 & Suspended during the Pandemic’ (Equinet, 14 September 2020) <https://equineteurope.org/2020/lets-talk-about-sexual-and-reproductive-health-and-rights/> accessed 26 February 2021.
[2] Center for Reproductive Rights, ‘Sexual and Reproductive Rights During COVID-19: Response and Beyond’ (June 2020) 2.
[3] Audrey Lebret, ‘Covid-19 pandemic and derogation to human rights’ (2020) 7(1) Journal of Law and the Biosciences 14.
[4] United Nations Population Fund (UNFPA), ‘Covid-19: A Gender Lens’ (March 2020) p. 7; Organisation for Economic Co-operation and Development (OECD), ‘Women at the core of the fight against Covid-19 crisis’ (2020).
[5] Amnesty International, ‘Exposed, Silenced, Attacked: Failures to Protect Health and Essential Workers during the COVID-19 Pandemic’ (2020).
[6] Center for Reproductive Rights (June 2020) 1.

Off the Record: Medical Records in the 9/11 Military Commission

This post continues the blog series by Dr Kasey McCall-Smith which examines some of the contentious legal issues raised in the US v. Khalid Shaikh Mohammad, et. al. military commission proceedings against the five men charged with various war crimes and terrorism in relation to the 11 September 2001 attacks on the US. The series is a continuation of her project ‘Torture on Trial’ which was funded by a grant from the Royal Society of Edinburgh and is supported by the Edinburgh Law School.

Personal Data and National Security: Medical Records in the 9/11 Military Commission

Almost since the inception of the 9/11 military commissions, defense lawyers have fought to obtain the full medical records of their clients. In any normal court, a client’s ownership and access to their personal medical records would go unchallenged. The right to privacy is fairly clear on this. Whether relying on the Fifth and Fourteenth Amendments of the US Constitution or article 17 of the ICCPR, individuals have the right to control their personal medical information with some exceptions (notably those outlined in HIPAA in the US). However, in the largest criminal justice trial in US history, access to medical records is shrouded in secrecy and national security privilege is reinforced through redactions to files covering even the simplest of medical treatment, such as providing ibuprofen for pain relief.

Joint Task Force Guantánamo, the cross-branch military force created by the US Department of Defense to run detention operations in Guantánamo, is responsible for assessing and delivering care for the medical needs of all detainees. As a result, it maintains full medical records on the 40 men still held in the detention facility. Government prosecutors also have copies of the full records. However, neither the defendants, nor their attorneys, are able to gather a full account of their medical information because full access is consistently rejected by the Government in the name of national security.

The complete medical records sought begin with those documenting the intake of the defendants in 2006 when they arrived in Guantánamo following years on CIA black sites. The records covering the medical treatment of the five 9/11 defendants is crucial to the case due to the systematic torture they endured at the hands of the CIA and the statements of guilt some are alleged to have given to the FBI shortly after arriving in Guantánamo. The physical and psychological impact of the enhanced interrogation techniques on the men, as documented in the Senate Intelligence Committee Study on CIA Detention and Interrogation Program (SSCI Summary Report) further speaks to a range of issues that are highly relevant to the trial, not the least their ability to participate in their own defence and their competence to even be in the dock.

A primary point of contention comes in response to the public availability of the record of torture, inhuman and degrading treatment the defendants suffered on black sites. The SSCI Summary Report is very clear on the issue of the defendants’ treatment. The CIA shredded all pretence in terms of legality with regard to the treatment of these five men and many others. Constructing an understanding of their physical and mental states in the lead up to the FBI interrogations in January 2007 will shed light on whether those statements may be excluded as torture evidence, an issue that remains unclear at the close of the 35th round of pre-trial hearings.

Redacted medical records

While there is a great amount of writing and authority on the issues of confidentiality, privacy and security of medical records, those discussions are predominantly focused on keeping personal records closed for the benefit of the patient. In the 9/11 case, the reverse is true. Defense teams have spent years trying to gain full access to their clients’ personal medical files. In many instances it is not only about their variable litigation strategies but also about helping explain their client’s individual health issues to them more fully. As has often been raised in court, a number of the defendants suffer conditions akin to post-traumatic stress disorder and there have been suggestions of brain damage following MRI scans, all indicia of the ill-treatment they endured in CIA captivity.

Trial counsel for the government has turned over 47.000 pages of medical history to the defendants relating to medical, psychological, dental or therapist visits since their arrival in Guantánamo. The problem is that all of the documents are redacted to some extent and predominantly it is medical personnel identifiers that are removed. With the exception of seven real name examples Government counsel acknowledged as ones he had ‘missed’ in error, all names have been replaced by unique medical identifiers (UMIs) or redacted to obscure the identification. The UMIs include designators such as Dr Shrek, SMO (Senior Medical Officer) and Dr 10. More vexing for defense counsel is the fact that several of the UMIs are not unique at all. As counsel argued before the commission, in the course of their examination of the records provided by the Government, it has become clear that the same UMI was used by different medical professionals in some cases and in others individuals had used different UMIs in a haphazard way. This inconsistency frustrates defense efforts to piece together a clear picture of their clients’ physical and mental states when they arrived fresh from their years on black sites as they are unable to corroborate the information derived from the incomplete reports.

Persistent threats to medical personnel?

The Government contends that these men pose a direct threat to the safety of medical personnel and their families. It is an interesting argument considering the defendants’ long-term address in the top-secret, maximum security Camp 7 where the very limited communication they have with the outside world is subjected to extensive security and classification reviews. Government counsel went as far as to claim that threats against medical personnel are made ‘practically every day, certainly at least once a month’, suggesting that they were made by the men for whom the military medical corps has provided care for roughly 11 years. It is unlikely that evidence of these ‘threats’ will ever be seen by the public. Such evidence, if it exists, may be proffered through ex parte submissions to the judge anytime prosecution invokes the national security privilege. Defense efforts to substantiate claims of the threats have been fruitless and, according to counsel, none of the few medical personnel that have been tracked down have suggested that they were ever threatened in the course of their treatment.

In-court exchanges suggest that all government explanations of medical records are to be taken at face value despite multiple proffers of error by defense counsel. The more bizarre fact is the Government admission in previous commission exchanges that medical records including the names of medical professionals, is not classified material. Even if classified, or marked as sensitive, the legal team members all have the clearance to view the full documents. In a case heavily dependent on classified material, it is not uncommon for the cleared lawyers to access materials for investigation purposes without sharing the information with their clients. It, therefore, boggles the mind that the Government continues to deny defense counsel information necessary to fully investigate each defendant’s case. It seems solely obstructive that defense counsel is forced to argue for access to full medical records bit by bit as the responsive records provided after each successful motion provides only a bit more information than before. Very simply, the Government should provide unclassified information when requested through discovery.

The tussle over complete medical records appears to be a circular exercise. No logic can explain the stalemate in relation to complete medical records for the 9/11 defendants. And with a third judge due to assume control of the case at the 36th round of hearings in June 2019, the issue is likely far from over.

Human Rights and Making Change: Looking Backwards and Moving Forwards from the Northern Ireland High Court Decision on Abortion

This post first appeared on the Centre for Criminal Justice and Human Rights blog from the Faculty of Law at University College Cork.

Dr Catherine O’Rourke is Senior Lecturer in Human Rights and International Law at Ulster University Transitional Justice Institute. She is currently also co-coordinator of the Gender Stream of the DFID-funded Political Settlements Research Programme, where she is investigating how international law norms for gender equality influence domestic power-brokering.

In the aftermath of last week’s High Court judgment declaring Northern Ireland’s prohibition of abortion to be incompatible with UK human rights legislation in specific instances, there has been much valuable consideration of the judgment’s legal and political implications, for this jurisdiction and others.  In this contribution, I reflect on what the litigation and judgment say about human rights advocacy in Northern Ireland.

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Northern Irish Abortion Law Incompatible with the European Convention on Human Rights

This post first appeared on the European Futures Blog.

In this extended article, Jane Rooney analyses the recent Northern Ireland High Court decision that current abortion law is not compatible with the European Convention on Human Rights. She suggests that the judgement could have gone further in testing the compatibility of the legislation with the ECHR, and that possible appeals are unlikely to take the politics of Northern Ireland as closely into account.

On 30 November 2015 in the case of The Northern Ireland Human Rights Commission’s Application [2015] NIQB 96, the High Court of Northern Ireland found that Northern Irish law regulating abortion was incompatible with Article 8 (right to private life) of the European Convention on Human Rights (ECHR). This was an historical judgement made possible through the conjoined efforts of many, including women directly affected by the legislation, the Northern Ireland Human Rights Commission and Amnesty International.

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Pregnancy, Choice, and the Lessons of the Past

Mikki headshotDr Michelle Brock is an Assistant Professor of History at Washington and Lee University, specialising in British History. In this second guest post for the Global Justice Academy, Mikki tackles the current controversy in the US around abortion and the politicisation and policing of women’s bodies – drawing striking parallels with early modern Europe. 

In the United States, the last decade has witnessed a growing cacophony of calls from pro-life advocates seeking to overturn Roe v. Wade, the Supreme Court’s 1973 decision to legalise a woman’s right to an abortion. Every single current Republican candidate for president, fourteen men and one woman, has declared his or her opposition to abortion in most or all cases.

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Ebola: Judging Reactions and Responses. What Happens Next?

LG Ebola 27 Oct 2014

The University of Edinburgh’s Global Academies have announced their Autumn 2014 Ebola Series in response to the current global crisis. In this short post, Dr Harriet Cornell from the Global Justice Academy reflects on how the global response to Ebola has unfolded in the press, and criticisms that have been voiced by experts in the field.

This evening’s Ebola headlines are divided between pleas for world help from Liberia’s President, Ellen Johnson Sirleaf, and blame for the spread and devastation of the outbreak been laid squarely at the doors of the world’s supranational bodies: the World Health Organisation, and the United Nations. Then there is the intersect between the outbreak of the disease in West Africa, and the western media response, with The Guardian running a comment piece entitled The problem with the west’s Ebola response is still fear of a black patient’.

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