Dr. Gearóid Ó Cuinn:

I thank the committee for the opportunity to make this presentation. Today I will speak on the issue of the Royal College of Surgeons in Ireland facility in Bahrain, with regard to which Ceartas has committed to taking legal action on international human rights issues from Ireland. As the RCSI facility in Bahrain awards Irish medical degrees as a result of section 88 of the Medical Practitioners Act, there is an obligation on the Irish Medical Council to monitor and accredit RCSI Bahrain and its programmes of education. For the purposes of accreditation, the Irish Medical Council has adopted the World Federation for Medical Education standards, also known as the WFME standards, which I will refer to throughout the presentation. These standards provide a mechanism for quality improvement in medical education and recognise the practical dimensions of medicine and the requirement for hands-on experience in clinical tuition. Therefore, they demand that the locations of clinical tuition must be safe, appropriate and able to deliver training in the core competencies of medicine, including medical ethics.

These are the same standards applied to medical education programmes in Ireland. Many of the human rights abuses documented in Bahrain over the past two years have involved medical personnel and facilities, public and private, utilised by RCSI Bahrain. As the committee may already know, Dr. Ali Al-Ekri, an RCSI fellow, is one of the medics who continues to serve a prison sentence for what the Physicians for Human Rights termed "treating protesters and giving interviews". From the perspective of Ceartas, there was an overlap between the human rights violations in hospitals and the WFME standards used by the Irish Medical Council.

I will sum up three major areas of concern that we have identified, much of which is already detailed in our distributed report. The first is access and provision of health care. During the Arab Spring protests in 2011, numerous medical personnel were tortured and imprisoned, and today injured protesters and those affected by indiscriminate use of force by the Bahrain authorities fear using hospitals and clinics used by RCSI in the training of students. We have documented consistent allegations of abuse in this regard, including accounts from reputable sources of patients being picked up from RCSI-utilised hospitals and subsequently tortured.

The second is a restriction on freedom of expression and matters related to health care. Medical personnel have consistently reported on a fear of speaking out and I direct the committee to the annexes of our report, showing communiqués instructing doctors to pass information on suspected activists to security forces. In some cases, patients are vetted before they are treated and doctors who complain of human rights abuses are targeted. I would be happy to supplement accounts in our report with more ongoing examples that have occurred recently. In sum, the continuing detention of Dr. Al-Ekri and the targeting of doctors and violations of medical neutrality have all had a chilling effect on the medical system that interfaces with the political system.

Third, turning to discrimination, the heads of hospitals and clinics have been replaced with doctors from the Sunni sect. We have also documented how 30 RCSI students were denied work placements simply for being Shia. The examples are too numerous to mention but they have been documented at length in our report. For more information on discrimination in access to appropriate health care, I direct the committee to the report of the Bahrain Centre for Human Rights on the politicisation of sickle-cell disease, which makes for grim reading; sickle-cell disease mostly affects the Shia population.

As I mentioned already, the WFME standards adopted by the Irish Medical Council require that the facilities used in clinical tuition should be safe, appropriate and able to deliver on core competencies, including medical ethics. We submit that the facilities used by RCSI Bahrain are not an environment living up to Irish standards, and these allegations are of such a consistent and serious nature that they overshadow any claims of medical excellence.

We also wish to highlight the fact that RCSI Bahrain is not immune from the political order that is prevalent in Bahrain at present. Members might already know that the conference on medical ethics which it tried to organise in association with Médicins san Frontières was blocked. This resulted in the resignation of Professor Tom Collins, the head of RCSI Bahrain, who also confirmed the militarisation of the health care system and the hapless position of RCSI Bahrain in its ability to influence the situation there. RCSI Bahrain's strategic plan for the next few years fails to mention the unrest that has swept Bahrain and how it has disrupted the health care system, but it has mentioned things such as the economic downturn. RCSI Bahrain's open days are now sponsored by the Bahrain Defence Force.

With regard to the future, what we consider to be of particular importance to the committee is the fact that until RCSI's education programme is evaluated by the Medical Council, the use of Bahraini hospitals is deemed to be approved by section 88 of the Medical Practitioners Act 2007. This undermines the integrity of Irish standards and Irish medical degrees. The Medical Council taking a stance in line with international standards should not be done in an à la cartefashion. The Medical Council should proactively embrace these standards and apply them as it would in Ireland. This is explicitly required under the Medical Practitioners Act.

In terms of recommendations for action, we respectfully suggest that the committee recommends to the Minister for Education and Skills that RCSI Bahrain falls short of Irish accreditation standards and that this situation prompts appropriate action in accordance with the Medical Practitioners Act 2007. Likewise, the committee should bring to the Minister's attention the adequacy of other streams of Irish accreditation, including the National University of Ireland and Quality and Qualifications Ireland. We urge the committee to invite the Medical Council to explain how it intends to approach the accreditation of RCSI Bahrain and the human rights concerns affecting the sites of clinical tuition used by RCSI Bahrain.