Julian Assange, the founder of WikiLeaks, has not stepped outside the heavily surveilled confines of the Ecuadorian embassy in London since he entered the building almost six years ago. Naturally, much of the media attention has focused on his international legal drama and threats to his safety, including arrest and possible extradition to the US. In contrast, ongoing violations of his human rights, including his fundamental right to healthcare in the context of his unusual confinement, have received less coverage.
As clinicians with a combined experience of four decades caring for and about refugees and other traumatised populations, we recently spent 20 hours, over three days, performing a comprehensive physical and psychological evaluation of Mr Assange. While the results of the evaluation are protected by doctor-patient confidentiality, it is our professional opinion that his continued confinement is dangerous physically and mentally to him, and a clear infringement of his human right to healthcare.
Packing a stethoscope and blood pressure cuff, and after being conspicuously photographed entering the embassy, we performed our examinations in a poorly ventilated conference room. The reason for examining Mr Assange in these conditions is that he has no access to proper medical facilities. Although it is possible for clinicians to visit him in the embassy, most doctors are reluctant to do so. Even for those who will see him, their capacity to provide care is limited. At the embassy, there are none of the diagnostic tests, treatments and procedures that we have concluded he needs urgently.
As clinicians, it is our ethical duty to advocate for the health and human rights of all people as promised under international law, and to call on our colleagues to hold our professional societies, institutions and governments accountable. In 2012, Ecuador, in accordance with its right as a sovereign state, formally determined that Mr Assange meets the requirements enshrined by the 1951 convention and 1967 protocol relating to the status of refugees. Regardless of the allegations against Mr Assange, he remains a citizen of Australia and a refugee, and, as the Guardian reported last week, he is now also a citizen of Ecuador.
In 2016 the UN human rights council working group on arbitrary detention found that Mr Assange’s situation within the Ecuador embassy had become a state of “arbitrary deprivation of liberty”. It is the opinion of the working group that the embassy is not equipped for prolonged detention and lacks the necessary medical equipment or facilities to provide a reasonable environment for Mr Assange – a determination with which we concur. Experience tells us that the prolonged uncertainty of indefinite detention inflicts profound psychological and physical trauma above and beyond the expected stressors of incarceration. These can include severe anxiety, pathological levels of stress, dissociation, depression, suicidal thoughts, post-traumatic stress disorder and chronic pain, among others.
Mr Assange is surrounded by credible personal threats from various governments and individuals. He is also unable to avail himself of his right to access medical institutions due to the threat of imminent arrest should he step outside the embassy, even for a medical emergency. It is unconscionable that Mr Assange is in the position of having to decide between avoiding arrest and potentially suffering the health consequences, including death, if a life-threatening crisis such as a heart attack were to occur. Further, our assessment reveals that he has had no access to sunlight, appropriate ventilation or outside space for over five and a half years. This has taken a considerable toll. It is our professional opinion that Mr Assange’s physical and psychological circumstances at the embassy are in violation of the spirit of the UN standard minimum rules for the treatment of prisoners.
We must ask: why does Mr Assange remain unable to exercise his human right to health services? Are states allowed to choose who is entitled to this fundamental right and who is not?
We call on the British Medical Association and colleagues in the UK to demand safe access to medical care for Mr Assange and to oppose openly the ongoing violations of his human right to healthcare. As tensions between the UK and Ecuador escalate over Mr Assange’s unsustainable situation, the international press has now reported new efforts to resolve the situation diplomatically through a mediator. Any such discussions must include a fair and transparent discussion of his access to healthcare. It is, we believe, the only correct and ethical course of action, and we champion the few clinicians who have sought to care for Mr Assange in these difficult circumstances.
• Sondra S Crosby, Brock Chisholm and Sean Love are doctors
• The opinions expressed in this article are solely the authors’ and do not reflect those of their employers