Advocacy and Education

Resources to guide your efforts to educate and influence your campus, community, and domestic and national policy.

Dual Loyalty: Should Physicians Always Prioritize The Patient?

The health of my patient shall be my first consideration

— World Medical Association (WMA) Declaration of Geneva

A physician shall owe his patients complete loyalty and all the resources of his science.

— WMA International Code of Medical Ethics

Although these principles are grounded unmistakably in both ancient and modern texts across the globe, there is growing recognition that doctors are too often placed in situations where it is difficult for them to fulfill loyalty obligations to their patients.  Opposing and competing obligations to third parties, such as employers, governments, and insurers, often test the devotion that health professionals are required to give to their patients.  Such conflicts are generally identified as “dual loyalty” issues because the health professional is torn between two different players which often have different or competing aims and objectives.  In many cases, health professionals who succumb to the pressure to fulfill third party needs at the expense of their patients needs end up violating the human rights of the very person who is entitled to the health professional’s strongest loyalty.

An army doctor is charged with managing the care and well-being of a unit under enemy attack. Although all doctors, including military doctors, are required to treat the health of their patients as their primary concern, the battlefield commander places immense pressure on the doctor to return men to combat before they are mentally and/or physically fit. The doctor recognizes that many of the men are still suffering from painful and debilitating wounds as well as PTSD, but he fears that keeping them from battle could jeopardize the safety and survival of the entire unit because the enemy is numerous. The doctor is unsure of whether to abide by his loyalty obligation to provide the best possible care to his patient or to obey the orders of his military commander, who represents both his employer and the government.

Closed environments, such as prisons, jails, detention centers, mental health facilities, and the military, are the most susceptible to breeding dual loyalty conflicts because security concerns tend to run high while transparency and monitoring mechanisms are generally lacking or altogether absent. Additionally, there is often ambiguity, sometime deliberately, about the health professional’s role in closed institutions. Health professionals working in these environments often find it difficult to provide the best possible care for their patients because they feel pressure to participate in institutional security, cost cutting, and helping to meet other institutional objectives.

The loyalty conflicts resulting from third party pressure may be express (e.g. the military commander orders the doctor to clear patients for battle) or implied (the commander frequently reminds the doctors that the enemy outnumbers them), and they may be real (the commander is indeed putting pressure on the doctor), or perceived (the doctor feels it is his responsibility to get the soldiers back on the battleground, even though the commander has not communicated with him at all).  However, regardless of the form the pressure takes, and even if it is only perceived to be real by the doctor, it still has the potential to distract him from providing the best possible care to his patients.  Situations like the one described above frequently draw health professionals into a moral and ethical maelstrom, where they end up second-guessing what they know to be their first and primary duty: giving patients the best possible care.

The health of my patient shall be my first consideration — World Medical Association (WMA) Declaration of Geneva A physician shall owe his patients complete loyalty and all the resources of his science. — WMA International Code of Medical Ethics … Continue reading

The Immigration Oversight and Fairness Act

The Immigration Oversight and Fairness Act

The Immigration Oversight and Fairness Act (H.R. 933) is a bill that would stop the worst abuses that occur in the immigration detention system. Each night, the Department of Homeland Security (DHS) holds tens of thousands of immigrants in a patchwork network of jails, prisons, and detention centers around the country. Inmates include asylum seekers, survivors of domestic violence and torture, and people with severe physical and mental illnesses. The health and well-being of these vulnerable immigrants suffers due to inadequate resources to address their needs and inappropriately harsh, punitive treatment in detention centers.

Improvements in Medical Care

The Immigration Oversight and Fairness Act would protect the health of detained immigrants by ensuring that the care they receive meets high quality and ethical standards, and is subject to rigorous, independent oversight. It would require all facilities to maintain accreditation by the National Commission on Correctional Health Care and the Joint Commission on the Accreditation of Health Care Organizations. Common-sense procedures to guarantee good medical decision-making would become standard practice in the detention system: for example, the medical and mental health screenings which are, at present, sometimes performed by immigration enforcement officers would become the exclusive domain of trained health professionals. Strong informed consent protections in the Act would safeguard against troubling incidents that have occurred in the past, like administration of involuntary psychotropic medication to non-dangerous detainees with no history of mental illness.

Prevention of Sexual Assault

Because of fear of deportation, linguistic and cultural barriers, and personal histories of victimization, immigrants are at heightened risk for sexual abuse in detention, and are less likely than other incarcerated persons to report incidents of abuse to facility staff. In spite of this, the Department of Justice recently indicated that the preventive and responsive measures set forth in the Prison Rape Elimination Act (PREA) of 2003 are not required of immigration detention centers. The Immigration Oversight and Fairness Act would step into this void and direct detention facilities to follow PREA, and to provide comprehensive counseling and medical services to immigrant victims of abuse.

Recognition of Immigrants’ Humanity and Dignity

The Immigration Oversight and Fairness Act would make a strong statement in support of the right of detainees to be treated with basic dignity. It would require DHS to write new laws preventing cruel and degrading treatment of detainees, and placing strict limitations on the use of shackling and handcuffing, tasers, restraint chairs, solitary confinement, and similar control techniques.

The Act would also

  • Guarantee that detainees can effectively file grievances and are not retaliated against for expressing their concerns;
  • Protect detainees’ access to the people and resources they need to manage their immigration cases; and
  • Create a strong preference for releasing particularly vulnerable immigrants into community monitoring programs rather than incarcerating them in prison-like detention centers.

The Immigration Oversight and Fairness Act amassed 66 co-sponsors during the Congressional session that ended in December 2010 but has only been endorsed by three lawmakers thus far in the current session: Rep. Lucille Roybal-Allard of California, Rep. Jared Polis of Colorado, and Rep. Barney Frank of Massachusetts.  Please ask your Representative to join these three in standing up for basic fairness and decent conditions in immigration detention!

The Immigration Oversight and Fairness Act The Immigration Oversight and Fairness Act (H.R. 933) is a bill that would stop the worst abuses that occur in the immigration detention system. Each night, the Department of Homeland Security (DHS) holds tens … Continue reading



From Persecution to Prison [4]

Examining Asylum Seekers [3]

Leave No Marks [2]

Dual Loyalty and Human Rights (forthcoming)

Health Stories (forthcoming)

PHR’s Asylum blog series [1]

PHR’s Custody blog series [5]

US Government Reports

Immigration Detention Overview and Recommendations [6], Dr. Dora Schriro, DHS Office of the Inspector General

The US ICE Process for Authorizing Medical Care for Immigration Detainees (Dec 2009) [10], US Immigration and Customs Enforcement

Non-Governmental Organizations

US Detention of Asylum Seekers: Seeking Protection, Finding Prison [9], Human Rights First

Denial and Delay: The Impact of the Immigration Law’s ‘Terrorism Bars’ on Asylum Seekers and Refugees in the United States (2009) [8], Human Rights First

Deportation by Default: Mental Disability, Unfair Hearings, and Indefinite Detention in the US Immigration System [7], Human Rights Watch

Justice for Immigration’s Hidden Population: Protecting the Rights of Persons with Mental Disabilities in the Immigration Court and Detention System [11], Texas Appleseed

PHR From Persecution to Prison Examining Asylum Seekers Leave No Marks Dual Loyalty and Human Rights (forthcoming) Health Stories (forthcoming) PHR’s Asylum blog series PHR’s Custody blog series US Government Reports Immigration Detention Overview and Recommendations, Dr. Dora Schriro, DHS Office of … Continue reading

Advocacy and Education

Resources to guide your efforts to educate and influence your campus, community, and domestic and national policy.

Resources to guide your efforts to educate and influence your campus, community, and domestic and national policy.

Educational Events

Education is fundamental to advocacy.  Before members of your community act, they must first be made aware of human rights violations.  To raise awareness, options include hosting a speaker or a panel, a film screening, or a conference.  Be aware of the advantages of collaboration. Educational events are also a great way to recruit new members and spread the work about your chapter.

Speakers and Panels

Use faculty at your institution or local experts to put together a panel on an issue of importance (e.g. Health/Human rights, HIV/AIDS). Once you have decided on the issue of the panel, enlist speakers to discuss different aspects of the issue. Find a venue at your institution or somewhere locally. Hold a Q&A session after the speakers have finished, so that the audience can ask questions. If needed, draft a series of questions to ask the speakers during the session. Advertise for the event via flyers, internet (facebook, myspace, e-mail), and newspapers. Contact appropriate local human rights organizations to help advertise and sponsor the event.

A presentation by an informed and dynamic speaker is an effective way of motivating students, faculty and the community to become engaged in human rights.  Finding an expert on your issue to address a group is not as hard as you think. There are several sources:

You can find speakers on specific issues by researching relevant organizations, your school’s academic departments, other schools, hospitals, health professional organizations and Google.  An internet search will also turn up a number of speakers’ bureaus, but they tend to represent speakers who command large fees.  For the budget-conscious, look into NGOs and websites dedicated to your specific issue.  PHR can provide useful recommendations as well.

When looking for a speaker, keep the issue paramount:  the most effective presentations feature speakers who are credible on the issue and convey genuine passion and commitment.

  • Before choosing a speaker, film, or presentation topic, set clear goals for your event.
  • When researching a speaker, find out what costs are involved.  Some speakers require an honorarium; others may waive their fee but require that travel and other out-of-pocket costs be covered.  Other may donate their time and cover their own expenses. Be sure that you understand clearly what costs you will need to cover. If your chapter has inadequate funds, plan to raise funds or approach the student activities office or academic departments for sponsorship.
  • Invite your speaker well in advance of your event, at least two months. That way, if your first choice is not available, you’ll have time to find someone else.  Nevertheless, if you must plan your event quickly, it never hurts to ask — your speaker may be available on short notice.
  • Ask about your school’s policy on speakers. Some schools require permits, signatures from the administration, or another form of approval of individual speakers.
  • Create a program flow for the event with set times, roles for event organizers, and time at the end for attendees to take action.  Assign a host or contact person for your speaker(s).
  • Prepare a written introduction on the speaker(s) and the issue and ask the speaker(s) to approve it.
  • Coordinate travel for your speaker(s). Build in extra time in case of travel delays or emergency. If your speaker is not familiar with your campus, provide a map with information about parking, and hang a sign on the door of the building. Ask your speaker to arrive with sufficient time to get settled before the event begins. You are the host: introduce your speaker to the organizers, relevant faculty or advisors, and any other presenters.
  • You may be able to set up meetings between your speaker and smaller groups before or after your event, e.g., with policymakers or faculty.
  • Start publicizing in school and community newspapers, online, etc, two to three weeks in advance and plan for a “publicity blitz” in the five days leading up to the event.
  • Invite the media. Contact reporters and editors, issue a press release; arrange interviews or a press conference if appropriate.
  • Videotape or audiotape the event.  Be sure to get permission from the speaker to use the tape.  It can be a great educational and advocacy tool, and is a good way of documenting your chapter activities.

Film Screenings

Screening a film is a great way to attract a range of people, demonstrate how relevant human rights are to many situations, and help develop awareness of or sympathy for an issue. Choose an interesting topic – for example, asylum and detention, access to health care, HIV/AIDS, clean water, infectious diseases, or a historical or political situation. To find a film that addresses that issue, consult the suggested film list <<link to list of films>>. Choose the number of films that you want to run, and have a film series. Have a weekend film festival, or spread out the films by showing one film at the same time each day for a week, or each week for several weeks. Enlist members of your chapter to help by finding films/documentaries to show, getting the rights to the film if needed, advertising for the event via flyers, posters, the internet (facebook, personal e-mail invitations or listservs), newspapers, and local organizations. Invite fellow classmates, faculty, and local community members. Collect donations or raise money for a cause or organization.

On the day of the screening, give a brief introduction to the documentary and the issues covered. Another option is to collect donations for the cause/theme of the screening.

Symposium or Conference

Host a symposium or conference at your institution on an issue of importance (Global Health Disparities, Access to Medications, HIV/AIDS). Find a venue for the conference at your institution (and be sure to have the appropriate number of rooms for sessions). Choose a keynote speaker, and enlist members of your chapter or outside experts to run workshops and lectures. Advertise for the conference via flyers, internet, and newspapers. Send invitations to your local community, local organizations, and colleges and universities in your region.

Health and Human Rights Education

Want to change the way your school teaches medicine and public health? Want to educate your entire class–and all the classes that come after you? Be a part of PHR’s Health and Human Rights Education Program (HHRE), and start a new course, elective or lecture series at your institution. Check out our HHRE toolkit here [1]for all you need to create lasting curriculum on human rights and health. PHR has HHRE mentors who can also help you plan and strategize: contact Hope at to be connected.

Other Ideas for Education and Engagement

PHR student chapters have always been very creative in identifying opportunities for education. Chapters have held arts shows, talent shows, walks, made AIDS quilts, and more. We encourage you to find new and different ways of mobilizing your campus–let us know about your original efforts and we may feature them in this toolkit!

The Advantages of Collaboration

Collaboration increases the potential to create change by expanding your reach and leveraging resources.  Collaboration can range from co-sponsoring one event with one or more other groups, to forming a coalition to work on a long-term campaign.  Simply put: The more committed individuals and groups you can involve in your campaign efforts, the bigger impact you can make.

  • Widen your reach: Build your attendance at events; increase the number of people willing to take action.
  • Brainstorm: Take advantage of different perspectives- they can lead to a more comprehensive approach to an issue
  • Build credibility: Different communities coming together on an issue can enhance credibility with a wider audience
  • Share resources: Pool your resources and connections to make a greater impact
  • Create a bigger presence for your group: Demonstrate to chapter members and potential members that they are a part of a larger movement

Examples of Collaboration in Action:

  • The recent national Day of Action is a great example of collaboration in action.  Several PHR chapters worked together with the American Medical Student Association (AMSA) and Universities Allied for Essential Medicines chapters to urge local politicians to support a bill that would require all medicines from universities to be accessible to developing countries.
  • Student chapters partnered with their human rights advocacy chapters, Student Global AIDS Campaign chapters, and other campus groups to take action during World AIDS Day.
  • Physicians for Human Rights has worked in the past with Student Global AIDS Campaign, Amnesty International, Human Rights First, the Global Health Council, and the International Federation of Medical Students Association, among others.  You might want to contact these and other like-minded organizations to find out if there are chapters or members on your campus or in your local community.

Education is fundamental to advocacy.  Before members of your community act, they must first be made aware of human rights violations.  To raise awareness, options include hosting a speaker or a panel, a film screening, or a conference.  Be aware … Continue reading

Conditions Of Detention: The Use Of Isolation And Segregation

Inappropriate Use of Segregation to Treat Mental Health Issues in Detention

Unfortunately, a very high proportion of immigration detainees suffer from some form of mental illness, including a range of conditions from to schizophrenia to bipolar disorder, while many others have developmental disabilities, such as Down Syndrome. Although Immigration and Customs Enforcement (ICE) fails to maintain meaningful statistics on the exact number of detainees with mental health issues, it is estimated that at least fifteen percent may have a mental illness[1]. Many of these cases are overlooked, ignored, or inadequately treated, as health professionals working in the rapidly-expanding immigration detention system struggle to provide medical services to their growing caseload. Several recent reports by NGOs have documented the manifest flaws that exist in ICE protocol and practice for treating mentally ill and disabled people in immigration detention, but human rights violations continue to occur on a daily basis to this vulnerable, hidden population for two principle reasons: 1) most detention center staff are inadequately trained to deal with people with mental disabilities, and 2) these detainees are generally unable or afraid to advocate for themselves.

A well-known metaphor posits that “the squeaky wheel gets the grease”, but immigration detainees are well aware that “the squeaky wheel” in detention is far more likely to get segregation[2] as a punishment than to receive positive attention from security or medical staff.  Detainees who complain or act out due to mental conditions beyond their control are frequently sent to segregation units or held down in restraints because staff is unable or unwilling to help them control their behavior. In many cases, security or even medical staff send mentally disabled people to solitary confinement for prolonged periods of time, where they deteriorate without access to mental health professionals or even to other detainees.

A detainee who was held in a Texas detention center for nine months, more than half of that time spent in solitary confinement, explains the horror he felt in segregation: “When they put you in ‘el pozo’ [the hole or solitary confinement] you only have a little space.  You have a toilet and a little space where you can sleep.  And there is a little place where they put the food, but they throw it without caring.  If you don’t take it rapidly, they throw it, whether it is hot or cold.  They don’t care.  They throw it as if you were an animal.  It makes you lose control mentally.  That is why I did not come out so well, mentally.  I would lose my mind – I would lose my mind severely.  I even wanted to commit suicide.”[3]

Health professionals should always try to implement the least restrictive measures necessary to control a patient’s behavior, and assignment to a segregation unit is not appropriate in the absence of a therapeutic goal (related to time spent in segregation) for the patient.  Sending detainees to segregation is not meant to be a solution for dealing with troublesome patients, but reports from NGOs have affirmed that this occurs far too frequently in understaffed and undertrained detention centers across the country – segregation has even been used as a punitive measure for detainees with mental health issues.  Obviously, the punitive use of segregation creates a significant disincentive for detainees to seek help for mental health issues, and it widens the chasm between the patients and health professionals working in detention settings.  Furthermore, it effectively silences any questions or concerns that detainees might wish to raise in regard to their human rights. Even more serious, however, is that the use of segregation on people who have suffered torture and other grave human rights abuses severely exacerbates the mental anguish they feel on a daily basis, particularly if placement in solitary confinement was part of their torture experience.  Therefore, reintroduction of this devastating method of control, this time at the hands of US detention center staff, frequently re-awakens their trauma and serves to greatly worsen their mental health issues.

[1] [1] Justice for Immigration’s Hidden Population. p.11. [2]

[2] [3] There is a great deal of variance in the terminology dealing with this issue.  Clinicians and security staff use the terms “segregation”, “isolation”, “seclusion” and “solitary confinement” to describe the situation where a detainee is placed alone in a small cell for 23 hours per day, separated from other people, and frequently in the dark.  This scenario may be distinguished from “administrative segregation” (when detainees may be temporarily separated to prevent them from collaborating) or “medical isolation” (when a detainee is physically separated from the rest of the population because he has a contagious disease, but is kept in a glass-walled room so that he can continue to have human interaction).

[3] [4] Justice for Immigration’s Hidden Population. p.22 [5].

Inappropriate Use of Segregation to Treat Mental Health Issues in Detention Unfortunately, a very high proportion of immigration detainees suffer from some form of mental illness, including a range of conditions from to schizophrenia to bipolar disorder, while many others … Continue reading

Respect Medical Neutrality

All health professionals are required to treat any individual in need of medical assistance, regardless of the patient’s background or identity. This standard, known as medical neutrality, adheres to the guidelines of the Geneva Conventions, and is widely respected by international medical organizations. However, US immigration policy does not respect medical neutrality for health professionals seeking asylum within the US. Under current policy, immigration officials can deny asylum to any health professional that has previously treated any individual considered to be part of a terrorist organization. This is known as the “material support to terrorism” exclusion ground, and can result in permanent ineligibility for asylum or any form of legal status in the US.

In the past decade, the US government has expanded its definition of a terrorist organization; many groups that were not previously considered terrorist organizations now fall into this category, including groups who have collaborated with the US in civil conflicts. Definitions of “providing material support” have also expanded, and include offering food, having property stolen at gun point, or providing urgently needed medical care to any member of an alleged terrorist organization.

Consider the story of B.T., a Nepalese nurse who spent several years waiting for a decision on his asylum petition because he was forced to provide health care to rebel forces. In Nepal, B.T. was kidnapped twice by Maoist rebels, led blindfolded to their hideout, and forced at gunpoint to provide care to guerillas suffering from burns and gunshot wounds. B.T. chose to treat the rebels rather than be executed by them.

The Nepalese army then arrested him on two occasions under the accusation that he supported Maoist rebels. While in jail in Nepal, government soldiers beat B.T. with sticks and the butt of a gun, put pins in his fingertips, cut his fingers and hands with knives, and threatened to kill him. He decided to seek protection in the US.

Eventually, B.T. was able to secure a tourist visa to the U.S. and was granted asylum upon his arrival. However, the Department of Homeland Security appealed to revoke his asylum status, alleging that the health care he had provided to the Maoist rebels constituted material support to a terrorist group. For several years, B.T. was separated from his wife and children while he awaited a decision on his case.

While in some circumstances health professionals are forced to provide care under duress, others act voluntarily in accordance with their duty and commitment to treat any individual in need of medical care. Health professionals who have acted in the best interest of their patients should not be denied asylum or refugee status and forced to return to their countries of origin where they face persecution, torture, or death. PHR urges the United States to restore its respect for medical neutrality and to end the denial of asylum and other legal status to persecuted health professionals.

All health professionals are required to treat any individual in need of medical assistance, regardless of the patient’s background or identity. This standard, known as medical neutrality, adheres to the guidelines of the Geneva Conventions, and is widely respected by … Continue reading

Addressing Health Disparities in MA

H.1517 and the Office of Health Equity

Background/Bill Info

In January 2011, State Representatives Jeffrey Sanchez and Byron Rushing introduced bill H.1517 to the General Court of Massachusetts. Bill H.1517 would establish an Office of Health Equity in the Office of Health and Human Services. The bill was referred to the Joint Committee on Public Health in February 2011.

Functions of the Office of Health Equity

The proposed Office of Health Equity (OHE) would deal with the many issues that impact health outcomes and cause health disparities by1:

  • coordinating and monitoring Department of Public Health (DPH) activities regarding disease prevention, health promotion, service delivery, and research concerning racial and ethnic minority populations
  • participating in decision making and policy development regarding priority areas for the DPH
  • providing assistance to the DPH and the community on data about the health status of racial/ethnic minority populations
  • serving as an active link between the DPH and racial/ethnic minority communities

Why is an Office of Health Equity Necessary?

To make gains that are both substantive and sustainable toward the elimination of health disparities will require political will and coordinated oversight, which the Office of Health Equity is uniquely positioned to provide. The proposed OHE would create a permanent place in state government to spearhead efforts to eliminate health disparities in the Commonwealth. The OHE would fill an important and currently unfulfilled role in coordinating statewide efforts and evaluating state progress in eliminating health disparities to improve public health statewide.

Advocacy Opportunity: Tell your Rep. to Address Health Disparities in MA

Your Representative needs to hear from you! Visit the Student Chapter Toolkit’s Advocacy page [1] for more information about how to:

  • Call your representative
  • Write a letter
  • Attend a district meeting or public hearing

As a health professional student, your support is essential in the effort to eliminate health disparities. Make sure your voice is heard! [2]

H.1517 and the Office of Health Equity Background/Bill Info In January 2011, State Representatives Jeffrey Sanchez and Byron Rushing introduced bill H.1517 to the General Court of Massachusetts. Bill H.1517 would establish an Office of Health Equity in the Office … Continue reading

Advocacy: Demanding Change

Throughout the year, both during National Actions and at other strategic times, you will have opportunities to help pass important legislation and influence policy. Here are a few advocacy tactics your Chapter can use – either individually or together.

Power Mapping

Be strategic when selecting the target of your advocacy.  You may want to provoke legislative change, demand corporate social responsibility, or shift public opinion.  This power mapping process will help you decide.

As your student chapter plans advocacy initiatives—and as you build your own capacity as an advocate—it is critical to analyze the power structures involved in the policies and processes you are advocating for or against. This kind of analysis will ensure your action is as effective as possible in both moving policy and in moving people:

  • Who has the power to make the change you want, and is most vulnerable to the kinds of pressure you can mount?
  • Who are your allies? Who could be your active supporters?
  • Who will actively oppose you?
  • How can we reach the people in power?

One process tool for this is called power mapping. Power mapping allows advocacy groups to systematically lay out power dynamics across your campaign so you can focus in on your main target—the one who can make the change you want to see—while also illuminating other potential connections and recognizing opposition so you can minimize it. Power mapping is used by organizations across the globe to: forge alliances; build support; do the most targeted actions; be politically relevant and strategic; and build awareness and legitimacy of your group.

Step One: Setting the Stage

To begin the process of power mapping, identify all of the stakeholders and actors involved in your particular issue. One helpful matrix to do this mapping is the power mapping table included below—it helps you map out your campaign allies, beneficiaries, opponents, decision makers, and those who influence the decision makers—all key power relationships to win a campaign.

  • Allies: People who are “on your side” either because they will benefit directly or because they share the same objectives and want to help bring about these changes as part of a broader movement. These are the people and groups who are already active on your issue or those you want to enlist and you think you can get on board. Ask yourself: who can you bring into this campaign as stakeholders and supporters?
  • Beneficiaries: People whose lives will be improved by the successful achievement of your advocacy goals. They can also be called “allies” but without additional organizing, a beneficiary is often a more passive stakeholder than an ally.
  • Opponents: People who are opposed to what you’re trying to do and are likely to actively oppose you. Some of these people could become allies in time, with greater understanding of the issues, or could be standing in the way of what you’re trying to do. Adversaries can become targets of your advocacy project if you are planning a series of activities to “win them around.” Also, it is useful to not allow your campaign to get distracted by passive opponents—those who will not actively oppose you, or who do not have the ear of your targets. Ask yourself: how can you ensure the opposition stays at least neutral—and that your actions do not necessarily inflame them to put opposing pressure on policy makers? Can you make any opponents into allies with specific outreach strategies?
  • Decision Makers: Those with the authority or power to make the desired change. Look at your list of decision makers and compare it to your objective and the policy/budget you are trying to change, and find the targets you have the greatest number of routes to reach. Ask yourself: are they vulnerable to influence? Accessible or accountable to your constituency or allies?
  • Influencers: Those who through their position, relationship, knowledge, or status are able to influence those with the power of decision making, or the direction of policy changes. Ask yourself: who do you know who has the ear of your target? How can you influence them to move the target towards your position?

Step Two: Identifying Targets

Now that you have mapped out the overall power dynamics in your campaign, it is time to focus on mapping out your targets. A “target” is the person who has the power to give you what your group wants in your campaign. A target is a person, not a faceless institution. Your constituency can easily imagine and express power over a person—but how can anyone have power over “the government” or “the International Monetary Fund”? In addition, individual decision makers have more incentive to respond to actions targeted at them directly, versus at a committee, or a larger government body—their names and their position are on the line, so they are more likely to respond.

There are two kinds of targets: primary targets and secondary targets. The primary target is the person or institution with the ultimate power. This may include Senators and Congressmen, Medical School Deans, local elected officials, or others who hold the power to make the change you want to see.

Secondary targets are people who can influence your primary target. The opinions and actions of these “influencers” are important in achieving the advocacy objective in so far as they affect the opinions and actions of the decision makers. Some members of a primary audience can also be a secondary audience if they can influence other decision makers. For example, the President and the Secretary of State might influence one another’s opinions. Therefore, they are both a primary audience (“targets”) and a secondary audience (“influencers”). In addition, your secondary audience may contain oppositional forces to your objective. If so, it is extremely important to include these groups on your list, learn about them, and address them as part of your strategy.

Some secondary targets may include:
  • Relatives
  • Leaders of target’s party
  • Business associates of the target
  • Personal Assistants or staff
  • Formal/informal advisors to the target
  • National opinion leaders
A special note on targets

What does it mean to say target? The term “target” does NOT always imply that we are attacking them—but that they are the decision makers who are key and around whom you should focus your efforts. Advocacy can often be most effective when you approach your targets as colleagues versus adversaries: you are still targeting them and their power, but in a collaborative light. Or, to make change, you may have to use more aggressive tactics towards your target—either way, the target is the person who has the power to give you what you want, and it may or may not be strategic to treat them as an adversary.

You can have more than one target for a campaign, although in general, fewer are better and allow you to be more focused. There will often be a progression of targets on the way to victory in a complex campaign. If a “primary target” is determined too hard to reach, but critical for your issue, you can make your secondary target your main target—so if you can’t reach, say, the President, but you know he listens to a certain cabinet member, target that person primarily to reach the President.

Power mapping is an art, not a science. And things change. So think about the criteria listed in this power-mapping worksheet [1], but know they can be flexible. Targets totally depend on your objective, so targets in one campaign might be allies in another. Be flexible and ready to shift your targets and allies as the situation changes.

NSP National Actions

Three times a year, the PHR National Student Program leads a nationwide advocacy event known as a National Action. National Actions are opportunities for coordinated action on one of PHR’s key campaigns. National Actions generally seek to change U.S. policy to address an urgent human rights concern. Chapters that choose to participate are part of a coordinated nationwide advocacy effort that magnify the voice of health professional students and help change the health and human rights landscape.

Previous National Actions have introduced advocacy in tandem with an internationally observed day, like World AIDS Day and Human Rights Day.  The Global Health Week of Action is linked to World Health Day.

Current or upcoming National Actions:

2011 Global Health Week of Action – May 1-7, 2011

Engage Your Congressional Representatives

Extend the fight for health and human rights by speaking with your congressperson.  Call your congressperson’s office to set up an appointment. When scheduling a meeting, underline the magnitude of your issue(s), and say that it is important to you (and your officer team) as future health professionals.You can achieve a number of goals through interacting with your representatives:  you will be letting the policymaker know that his or her constituency cares about the issue at hand; you can educate the policymaker about the issue and explain why his or her support is important; you may be able to gain a commitment for some specific action, such as voting for a piece of legislation, and you can thank participants for prior support.  Even if you are not successful gaining a commitment, you will have established a dialogue, raised awareness, and set the stage for follow-up communication.

To identify your local and state representatives, go to’s website. [2]

Letters to Congress

A letter-writing campaign can be a great way to urge your representatives or senators to back a major legislative issue or champion a cause crucial to health and human rights. Gather your chapter members, as well as faculty, classmates, and local community members, to write letters on a given issue. Bring sample letters for everyone to replicate or use as a draft. Then, send the letters out to your representative or senator. Follow-up the letter writing campaign with a phone call to your representative’s or senators’ offices.

Petitions and postcard campaigns demonstrate to your representatives, university president, or other official that there is substantial agreement in your PHR chapter, campus, or larger community on an issue. Collect signatures on issues ranging from implementing HHRE on campus to health care issues in Congress, and submit them with a cover letter explaining your position. If you collect signatures for a PHR campaign, mail them to the National Student Program Coordinator.

To learn about the process by which a bill becomes a law, see this chart [3] or view this highly educational film [4].

District Meetings

Schedule a meeting with your local representatives and senators by calling their national or district office and speaking with the scheduler. Call the Capitol Switchboard at (202) 224-3121 and ask to be connected to your Member of Congress’s office. Allow sufficient lead time when calling for an appointment. The more advance notice the office has, the more likely that a representative will attend.  Try to schedule your visit to coincide with a milestone: a report that has just been released, recent media coverage of an issue, a bill that is being deliberated, etc. Don’t bring a large group—three or four people should suffice.  Be sure your group includes people from the legislator’s district, are from constituencies the member cares about (religious or civil groups, for example), and are articulate and confident. Practice what you will say beforehand, and keep your presentations brief and to the point.

Town Halls

An informal public event with the community, where attendees can voice their opinion and ask questions of their elected officials. Ask your representatives if they would be willing to meet with members of the community regarding a topical issue. This is also an excellent format in which to hear the viewpoints of community members without a representative present, and a way to form coalitions and decide on further action.

House Parties

Many house parties are organized around televised debates during election season. Alternatively, some representatives are too busy to meet in person, but would be willing to have a call-in meeting with a group of constituents. House parties are also excellent vehicles when lobbying for a local or regional candidate, who may be willing to come speak to those assembled.

After any interaction with a representative, write a thank you note to all meeting attendees and send them follow-up materials from PHR to respond to any questions that came up during the meeting. If the policymaker was unsupportive or noncommittal, ask constituents to write letters on the issue; if the member is supportive, urge constituents to send thank you notes.

Hosting Call-In Events

Organizing a Call-In Day can be a very effective way to advocate to policy makers and to engage your campus. Congressional staffers keep track of who calls in to their offices every day, and what issues are on their mind. Make sure your issue rises to the top by getting 20, 50, or hundreds of your classmates to call your Senators’ or Congressperson’s office in one day.

Organizing a Call-In Day is easy.  First, create materials about your issue. You’ll need a call-in script for people to follow, so they have the facts right there in front of them. These scripts should be short, just a few sentences–calls to offices usually last less than 2 minutes, so the script should be concise and powerful. You may also want to prepare a one page fact sheet. A fact sheet will teach potential callers more about your issue, and why they should care—and what impact their action can have on health and human rights. Finally, you need the phone number to the office–DOUBLE CHECK to make sure it works before you move forward.

Once you have the phone number, script and facts, its time to plan an outreach strategy. Got an active email list? Send out an elert. For more immediate impact, set up a table in a busy area of campus, and ask everyone to pull out their cell phones and make a call. Have PHR chapter members make the same ask in every class they are in on the call-in day–this will generate many calls. Work with other groups: reach out to AMSA or other campus groups and see if they want to join the call in day. Blog about it. Be creative—there are many ways to publicize a call-in day to ensure maximum exposure and impact.

Follow-up is important too. Within a few days of the call-in day, make official contact with your target policy maker’s office. See if they want or need more information. You will be on their radar screen—offer yourself as a resource and help make sure your issue remains at the top of their list!

Throughout the year, both during National Actions and at other strategic times, you will have opportunities to help pass important legislation and influence policy. Here are a few advocacy tactics your Chapter can use – either individually or together. Power … Continue reading


Classification of Status

Asylum Seeker

Persons already in the United States may seek asylum if they are unable or unwilling to return to their home country due to persecution or a well-founded fear of persecution based on race, religion, nationality, membership in a particular social group, or political opinion.  Those granted asylum are able to live and work in the United States.  One year after the granting of asylum they may apply for permanent resident status.


Refugee status may be requested by persons outside the United States who are unable or unwilling to return to their home country due to persecution or a well-founded fear of persecution based on race, religion, nationality, membership in a particular social group, or political opinion.  Typically a person must already be outside their home country to be eligible for refugee status, although a few exceptions apply. Each year the United States resettles a limited number of refugees based on specifications made by the United States government or referrals made by the United Nations High Commissioner on Refugees (UNHCR) or a U.S. Embassy.


The Detainee Treatment Act of 2005 (DTA)

Part of the Department of Defense Appropriations Act of 2006 (Title X, H.R. 2863), the Act prohibits the “cruel, inhuman, or degrading treatment or punishment” (acts that violate the Fifth, Eighth, and Fourteenth Amendments) of detainees and provides for “uniform standards” for interrogation (it limits the military to interrogation techniques authorized by the Army Field Manual). The Act also removed the federal courts’ jurisdiction over detainees seeking to challenge the legality of their detention, stating that “no court, justice or judge shall have jurisdiction to hear or consider” applications on behalf of Guantanamo detainees.

Fifth, Eighth and Fourteenth Amendments to the Constitution of the United States of America

The Supreme Court has stated that the protection of human dignity is a primary function of the Fifth, Eighth and Fourteenth Amendments, and that violations of “human dignity” can be unconstitutional even absent any pain or injury. The Supreme Court has long considered prisoner treatment to violate the Fifth and Fourteenth Amendments if the treatment “shocks the conscience.” The Eighth Amendment standards have been incorporated into the Fifth and Fourteenth Amendment due process analysis by the Court, which determined that individuals detained by the state who have not been convicted by a court enjoy at least the same level of rights as convicted criminals do.

Geneva Conventions

The Geneva Conventions are a series of four international treaties (and three additional protocols) that set the standards in international law for humanitarian treatment of the victims of war. Ratifying States agree to protect vulnerable and defenseless individuals during times of war.  Established in 1949, the Conventions cover armed forces on land and sea, prisoners of war, and civilians, and aim to reduce the suffering of those inflicted with sickness, wounds, or those in captivity, regardless of whether or not they have taken direct part in the conflict. The Geneva Conventions created a protective status for the emblem of a red cross on a white background, which to this day is used to signify protection of medical personnel and materials covered by the Conventions.

Illegal Immigration Reform and Immigrant Responsibility Act of 1996

The 1996 Act constricted the asylum process, especially for those asserting an asylum claim at the port of entry, in several ways. Since the enactment of a restrictive 1996 immigration law and new restrictions after September 11, 2001, most asylum seekers arriving without proper documentation are imprisoned with little opportunity for judicial review and with increased frequency, some remaining in detention for months or even years. The law’s expedited removal mechanism gives an immigration inspector the power to deport any non-citizen who arrives at any port of entry with either false or no documents, a power previously entrusted only to trained immigration judges. The law calls for, but does not make mandatory, detention of asylum seekers after they pass out of the expedited removal mechanism. Additionally, the law instituted a one-year filing deadline that stipulates that asylum seekers must file their application within a year, with limited exceptions, or lose their chance for asylum. Many immigrants are unaware of this technicality.

The Torture Act

(18 U.S.C. §§ 2340 and 2340A) Also known by its longer form title, the Torture Convention Implementation Act of 1994, the Torture Act implements the United States’ obligation under the UNCAT to criminalize acts of torture, subject to the United States’ reservation that it interprets its obligations in accordance with U.S. Constitutional standards. The Torture Act’s definition of “torture” requires that an individual specifically intend that his act inflict severe physical or mental pain and criminalizes conduct by U.S. nationals that occurs outside the United States.

United Nations Convention Against Torture (UNCAT)

The convention was adopted and opened for signature and ratification by the General Assembly on December 10, 1984, and it came into force on June 26, 1987. UNCAT prohibits torture, as well as cruel, inhuman or degrading treatment, committed by state actors or those acting with  the consent or acquiescence of the state, “for the purpose of obtaining information or a confession, or to punish on suspicion of a crime, or to intimidate or coerce.” UNCAT does not permit the use of torture in any “exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political instability or any other public emergency.”

War Crimes Act (WCA)

The WCA criminalizes “torture” and “cruel or inhuman treatment.” Amended by the MCA to criminalize defined “grave breaches” of Common Article 3, the WCA applies to acts committed “inside or outside the United States” in any circumstance “where the person committing such war crime or the victim of such war crime is a member of the Armed Forces of the United States or a national of the United States.” To date, no individual has been prosecuted under the WCA.

Medical Glossary

Bipolar Disorder

Bipolar disorder is a serious mental illness in which people experience extended periods of overly energetic or irritably mood, known mania, interspersed with periods of depression and feelings of sadness and hopelessness. Bipolar disorder can run in families, and usually starts in late adolescence or early adulthood.


Depression is a serious medical illness where the person experiences intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual’s social functioning and/or activities of daily living. Symptoms can include sadness, loss of interest or pleasure in activities previously enjoyed, weight change, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and thoughts of death or suicide. Extreme depression can culminate in its sufferers attempting or committing suicide.

Peritraumatic Dissociation (i.e. amnesia, depersonalization, and derealization)

Peritraumatic dissociation is characterized by disassociative responses that occur at the time of trauma, such as depersonalization, derealization, amnesia, or fugue states. Theorists suggest that it is a defensive process in which an individual develops the capacity to separate himself from the psychic and physical pain associated with exposure to trauma. This disassociative capacity is thought to be later used by the individual in future painful circumstances such as activated trauma memories to down-regulate the experience of acute psychological stress.

Posttraumatic Stress Disorder (PTSD)

PTSD is a term for certain severe psychological consequences of exposure to stressful, highly traumatic events. Clinically, such events involve actual or threatened death, serious physical injury, or a threat to physical and/or psychological

integrity, to a degree that usual psychological defenses are incapable of coping with the impact. PTSD symptoms can include the following: nightmares, flashbacks, emotional detachment or numbing of feelings (dissociation), insomnia, avoidance of triggers, loss of appetite, irritability, hypervigilance, memory loss, excessive startle response, depression, and anxiety. It is also possible for a person suffering from PTSD to exhibit clinical depression (or bipolar disorder), general anxiety disorder, and a variety of addictions. PTSD may be triggered by violent personal assaults, natural or human-caused disasters, accidents, or military combat.


is a generic psychiatric term for a mental state involving a loss of contact with reality. It is a mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning. People experiencing a psychotic episode may report hallucinations or delusional beliefs (e.g., grandiose or paranoid delusions), and may exhibit personality changes and disorganized thinking. Psychosis is a loss of contact with reality, typically including delusions (false ideas about what is taking place or who one is) and hallucinations (seeing or hearing things which aren’t there), an impairment in the ability to carry out daily activities.

Psychotropic Medication

Psychotropic medications are used to exert an effect on a person’s mental state and are mostly commonly used in treating mental disorders. Psychotropic medications act by inducing changes on consciousness, emotions, mood, or behavior.


Schizophrenia is a severe, lifelong mental disorder. Individuals with schizophrenia may experience unusual thoughts or perceptions, movement disorders, difficulty speaking or expressing emotion, and problems with organization, memory, and attention. Individuals may also experience delusions or visual and auditory hallucinations.  Medicines can relieve many of the symptoms, but it can be difficult to find the correct medication.


Somatization disorder is a chronic condition where physical symptoms are caused by psychological problems, and no underlying physical problem can be identified. The disorder is marked by multiple physical complaints that persist for years, involving any body system. Most frequently, the complaints involve chronic pain and problems with the digestive system, the nervous system, and the reproductive system. The symptoms often are severe enough to interfere with work and relationships.


CIA: Central Intelligence Agency

CIDT: Cruel, Inhuman, or Degrading Treatment

DoD: Department of Defense

DTA: Detainee Treatment Act of 2005

FBI: Federal Bureau of Investigation

HRF: Human Rights First

ICRC: International Committee of the Red Cross

OLC: Office of Legal Counsel, Department of Justice

PHR: Physicians for Human Rights

POW: Prisoner of War

PTSD: Posttraumatic Stress Disorder

SOP: Standard Operating Procedure

TVPA: Torture Victims Protection Act of 1991

WCA: War Crimes Act

ICE: Immigration and Customs Enforcement

Classification of Status Asylum Seeker Persons already in the United States may seek asylum if they are unable or unwilling to return to their home country due to persecution or a well-founded fear of persecution based on race, religion, nationality, … Continue reading