Research Directorate, Immigration and Refugee Board of Canada, Ottawa

1. Violence Against Doctors
1.1 Killings

In correspondence with the Research Directorate, a representative of the Human Rights Commission of Pakistan (HRCP), an independent Lahore-based NGO that monitors human rights violations throughout Pakistan, stated that there has been "a dramatic surge" in the number of killings of doctors between 2013 and 2016 (HRCP 12 Feb. 2016).

Deutsche Presse-Agentur (DPA), a German news agency, reports that, according to figures from the Pakistani National Dental Medical Council, at least 160 doctors were killed between 2006 and March 2015, primarily in Karachi and Quetta (DPA 17 Mar. 2015).

Reuters reports that, according to police statistics, in 2014, 26 doctors were killed in Pakistan (Reuters 15 June 2015). According to the Pakistani newspaper the Express Tribune, in 2014, 17 doctors died in targeted killings in Karachi and the police attributed the motivation of several of the killings to extortion and some to sectarian violence (The Express Tribune 18 Jan. 2015). The Pakistani newspaper Dawn similarly reports that 17 doctors were killed in Karachi in 2014, while 5 were killed between January 2015 and 3 February 2015 (Dawn 3 Feb. 2015).

In addition to Karachi and Quetta, sources report incidents of killings of doctors between 2013 and 2015 in Lahore (HRCP Mar. 2014, 87; SATP 20 Dec. 2015), Peshawar, Rajanpur (in Punjab), Swabi (in Khyber Pakhtunkhwa, KP), Chenab Nagar (in Punjab) and Islamabad (SATP 20 Dec. 2015).

Sources indicate that doctors are targeted by militants (Reuters 15 June 2015; HRCP 12 Feb. 2016; DPA 17 Mar. 2015; Times of Oman 24 Mar. 2015) and/or criminals (Times of Oman 24 Mar. 2015; Reuters 15 June 2015; DPA 17 Mar. 2015). DPA notes that some criminal groups targeting doctors have political backing (DPA 17 Mar. 2015).

In correspondence with the Research Directorate, a researcher at the Pak Institute for Peace Studies (PIPS) [1] indicated that doctors are not targeted "merely due to their profession"; rather, he said that most targeted attacks of doctors are related to sectarian violence (PIPS 9 Feb. 2016). DPA similarly notes that some reasons why doctors in Karachi may be targeted include religion (Sunni, Shiite [or Shia], Ahmadi, Hindu or Christian) and ethnicity (whether indigenous Sindhi, post-partition migrants from India or Pashtuns) (DPA 17 Mar. 2015). According to the HRCP representative, doctors are being killed in Pakistan due to sectarian differences, for non-payment of extortion money, and for business or professional rivalry (HRCP 12 Feb. 2016).

Reuters reports that a "disproportionate number" of the doctors attacked are Shiite (Reuters 15 June 2015). In its annual report for 2013, the HRCP notes that "many" Shiite doctors were murdered that year (HRCP Mar. 2014, 87). In a list of incidents of doctors being killed between 2001 and 2015, the South Asia Terrorism Portal (SATP), a database on information relating to "terrorism, low intensity warfare and ethnic/communal/sectarian strife in South Asia" (SATP n.d.), reports of several cases of Shia and Ahmadi doctors who were killed between 2013 and 2015 (SATP 20 Dec. 2015).

1.2 Kidnappings and Extortion

According to the Pakistan Orthopaedic Association (POA), "'doctors are being kidnapped and harassed by extortion mafia, especially in Sindh province'" (qtd. in PPI 18 Dec. 2015). The President of the Pakistan Academy of Family Physicians said that doctors face "abduction for ransom, extortion, kidnapping and life threats," particularly in Karachi and Peshawar (qtd. in The Nation 31 Mar. 2015).

Some sources indicate that, in cases of kidnapping and extortion, doctors are targeted because they are perceived to be wealthy (BBC 29 Oct. 2013; DPA 17 Mar. 2015). DPA reports, citing a doctor in Karachi, that almost all doctors working in Karachi's hospitals have received extortion threats (DPA 17 Mar. 2015). The President of the Pakistan Medical Association (PMA)'s Hyderabad chapter said that doctors were leaving Pakistan due to threats of kidnapping and extortion (Dawn 27 Feb. 2015).

2. Violence Against Doctors in Balochistan

In its annual report for 2013, the HRCP notes that 26 doctors have been kidnapped for ransom and that more than 20 doctors have been killed in Balochistan (HRCP Mar. 2014, 135). The same source states that more than 80 doctors have left Quetta due to "deteriorating law and order" (HRCP Mar. 2014, 135). In April 2015, the Karachi-based newspaper Daily Messenger stated that approximately 25 doctors were kidnapped in "the past few years" in Balochistan, mostly for ransom (Daily Messenger 16 Apr. 2015). DPA reports that between 2008 and March 2015, more than 50 doctors and medical professors were kidnapped in Balochistan (DPA 17 Mar. 2015).

The BBC reports on a September 2013 case in which a renowned cardiologist was kidnapped by a group of armed men when leaving his hospital in Quetta, despite the "numerous police and army checkpoints" in the area (BBC 29 Oct. 2013). The source notes that "[c]riminal and militant groups allied to the Taliban and al-Qaeda have kidnapped and killed scores of people" in Balochistan and that these groups "have seemingly operated with impunity" (BBC 29 Oct. 2013). The same source states that in October 2013, as a result of perceived government inaction in the kidnapping, doctors in Quetta "organised almost daily protest rallies, gone on hunger strike and partially boycotted government-run hospitals" (BBC 29 Oct. 2013).

The 2013 HRCP report indicates that doctors, among other professionals, have been kidnapped when travelling through Balochistan on public highways (HRCP Mar. 2014, 78). The PIPS researcher noted that Baloch insurgents have attacked non-Baloch workers in Balochistan, which may include doctors (PIPS 9 Feb. 2016).

In a telephone interview with the Research Directorate, a representative of the Hong Kong-based Asian Human Rights Commission (AHRC), an "independent, non-governmental body which seeks to promote greater awareness and realisation of human rights in the Asian region" (AHRC n.d.), stated, without providing further details, that there have been many cases of violence against doctors in Balochistan, and that they have been targeted because they provided medical care to injured Baloch activists (AHRC 10 Feb. 2016). He indicated that there have been cases of extrajudicial killings and forced disappearances of doctors (AHRC 10 Feb. 2016). Further and corroborating information about the targeting of doctors for providing medical care to Baloch activists could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

3. Targeting of Doctors by the Taliban and Other Militant Groups

According to the HRCP representative, some militant groups with informal links to the Taliban have targeted and killed doctors in Pakistan, "but there are no reported cases of Taliban being directly involved" (HRCP 12 Feb. 2016). The PIPS researcher said that militants generally do not target doctors because of their profession, but because of the sect of the doctor (PIPS 9 Feb. 2016). Some media sources, however, indicate that doctors are targeted by the Taliban (Times of Oman 24 Mar. 2015) or the militant group Lashkar-e-Jhangvi (Reuters 15 June 2015; Scroll.in 6 Dec. 2014).

3.1 Attacks Related to Polio Vaccination

According to the PIPS researcher, doctors who are part of polio vaccination teams have been attacked by militant groups, including the Taliban and Baloch insurgents (PIPS 9 Feb. 2016). Media sources report that the doctor who headed the Expanded Program of Immunization for the Swabi district of KP was assassinated in November 2015 (The News International 7 Dec. 2015; Iran Daily 30 Nov. 2015). Several sources indicate that extremists target polio vaccinators due to a belief that it is a cover for espionage or a plot to make Muslims infertile (HRCP Mar. 2014, 240; AFP 26 Nov. 2014; The News International 7 Dec. 2015). According to the Wall Street Journal (WSJ), the Taliban has banned polio vaccinations in the regions they control, claiming that the polio workers are spying for Western countries (WSJ 26 Nov. 2014).

According to the International Crisis Group, between December 2012 and September 2015, 78 people were killed as a result of attacks against polio vaccinators (International Crisis Group 23 Oct. 2015, 4). Similarly, Deutsche Welle (DW) reports that "almost 80" health workers were killed between December 2012 and June 2015 as a result of violent attacks against them by the Taliban and other militant groups (DW 25 June 2015).

In its annual report for 2013, the HRCP notes that extremists threatened and attacked polio vaccination teams that year, resulting in the deaths of 20 polio vaccination workers and 9 police guards (HRCP Mar. 2014, 240). The same source notes that most of these attacks occurred in the Federally Administered Tribal Areas (FATA), KP province and Karachi (HRCP Mar. 2014, 240).

According to statistics in the PIPS database, between January 2014 and January 2016, there were 34 attacks by the Taliban (or other militant groups with similar objectives) targeting polio health workers or polio facilities across Pakistan, which resulted in 56 deaths and 37 injured (PIPS 9 Feb. 2016). In addition, there were five attacks against polio workers by Baloch insurgent groups during this time period, resulting in four deaths (PIPS 9 Feb. 2016). Of the 39 attacks, 8 reportedly took place in Balochistan, including 2 in Quetta (PIPS 9 Feb. 2016).

Sources report that on 26 November 2014, militants attacked a polio vaccination team in Quetta, killing four polio workers, including three women (PIPS 9 Feb. 2016; The Frontier Star 27 Nov. 2014; WSJ 26 Nov. 2014). Two men on motorbikes reportedly opened fire on the team (WSJ 26 Nov. 2014; AFP 26 Nov. 2014). According to the PIPS researcher, the militant group Jundullah, an affiliate of Tehreek-e-Taliban Pakistan (TTP), claimed responsibility for the attack and accused the victims of being "agents of Jews and Christians" (PIPS 9 Feb. 2016).

Sources report that in February 2015, polio workers from Zhob, Balochistan, were kidnapped and killed (RFE/RL 18 Feb. 2015; PIPS 9 Feb. 2016), by the TTP's Abdul Qadir Qurbani group (PIPS 9 Feb. 2016). According to sources, there were four people killed (PIPS 9 Feb. 2016; RFE/RL with AFP and BBC 18 Feb. 2015).

Media sources report that in January 2016, there was a suicide bombing targeting a polio vaccination centre in Quetta, which killed at least 14 people, most of whom were law enforcement officers guarding the centre (VOA 13 Jan. 2016; The Seattle Times 14 Jan. 2016; AP 13 Jan. 2016). The media source Voice of America (VOA) reported that a spokesman for Tehreek-e-Taliban claimed responsibility for the attack (VOA 13 Jan. 2016). The Associated Press (AP) stated that Jundullah claimed responsibility for the attack (AP 13 Jan. 2016).

4. Violence Against Female Doctors

According to a senior leader of the PMA, approximately 30 percent of female doctors in Pakistan have left the profession for various reasons, including "security issues" and "threats of kidnapping," as well as due to marriage, family restrictions and "other social barriers" (qtd. in PPI 11 Feb. 2015).

The AHRC representative said that the Taliban and other militant groups are against female doctors and medical students, and that there have been cases in which they were abducted or had acid thrown on their faces (AHRC 10 Feb. 2016). He noted that in Islamabad, there is a militant group called "Lal Masjid," that has a "women squad" that attacks female students and doctors (AHRC 10 Feb. 2016). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

According to the International Crisis Group, 80 percent of all polio vaccination teams have some women as part of the teams, and they are "often targeted by misogynist Islamic extremists" (International Crisis Group 23 Oct. 2015, 14). The same source reports that between 2012 and October 2015, militants killed 14 female polio vaccinators (International Crisis Group 23 Oct. 2015, 14). In addition, the International Crisis Group reports that female vaccinators are often subjected to "verbal abuse and sexual harassment" (International Crisis Group 23 Oct. 2015, 14). According to a 2016 appeal by the AHRC, a female health care worker was gang-raped in her home in KP province after being threatened because of her work with polio vaccination, and then had difficulties getting the police to investigate the crime because the main perpetrator was "well placed and influential" (AHRC 5 Jan. 2016).

5. State Protection

According to the DPA, perpetrators of violence against doctors are "seldom" apprehended (DPA 17 Mar. 2015). Furthermore, a doctor who was leading doctor protest rallies in Quetta in October 2013 told the BBC that "there is growing evidence that security forces often turn a blind eye to kidnapping allegedly because they get paid off by the abductors" (BBC 29 Oct. 2013). The POA has criticized the government for not providing security to doctors (PPI 18 Dec. 2015).

According to Dawn, in February 2015, the PMA called for a strike of doctors across the country to protest against the targeted killings and kidnappings of doctors (Dawn 2 Feb. 2015). The Central President of the PMA stated that authorities in Sindh and Balochistan were not arresting the perpetrators of these crimes and that "the government did not provide security and protection" to the doctors who were killed (Dawn 2 Feb. 2015). According to a 2016 article by the Pakistani newspaper the News International, the striking doctors had called for

four points, including urgent payment of support money to martyred doctors' families, effective security for doctors, immediate issuance of arms licenses to doctors who wish for one and permission to carry the weapon legally, and actions against all extortion groups. (The News International 3 Feb. 2016)

The same source reports that, according to the president of the PMA, the government accepted these demands but as of February 2016, the government had only partially met two of the four demands (The News International 3 Feb. 2016). The source indicates that the government had approved compensation of 2 million Pakistani rupees (PKR) [approximately C$26,000] to the families of victims, although the PMA had demanded 10 million PKR [approximately C$131,000], that doctors had not received licenses to carry arms, and that cases involving the murder of doctors were not being sent to military courts as agreed upon (The News International 3 Feb. 2016). Corroborating and further information on the implementation of security measures for doctors could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

Sources report that Pakistani authorities have provided police guards for polio vaccination teams (HRCP Mar. 2014, 240; International Crisis Group 23 Oct. 2015, 14-15). International Crisis Group states that each door-to-door vaccination team usually consists of two vaccinators and two police officers (International Crisis Group 23 Oct. 2015, 14-15).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

Note

[1] The PIPS is an independent think tank composed of Pakistani scholars, researchers and journalists who research the political, social and religious conflicts that impact national and international security (PIPS n.d.).

References

Agence France-Presse (AFP). 26 November 2014. Maaz Khan. "Four Polio Vaccinators Shot Dead in SW Pakistan." (Factiva)

Asian Human Rights Commission (AHRC). 10 February 2016. Correspondence from a representative to the Research Directorate.

Asian Human Rights Commission (AHRC). 5 January 2016. "Pakistan: Call for Justice to a Lady Health Care Worker Raped for Administering Polio Drops." [Accessed 4 Feb. 2016]

Asian Human Rights Commission (AHRC). N.d. "About Us." [Accessed 25 Feb. 2016]

Associated Press (AP). 13 January 2016. Abdul Sattar. "Suicide Attack on Pakistan Polio Vaccination Center Kills 15." (Factiva)

British Broadcasting Corporation (BBC). 29 October 2013. Shahzeb Jillani. "Pakistani Doctors Angered by Failure to Halt Abductions." [Accessed 8 Feb. 2016]

Daily Messenger. 16 April 2015. "Doctor Abducted in Balochistan." (Factiva)

Dawn. 27 February 2015. "LUH Doctors Approach Police for Security." (Factiva)

Dawn. 3 February 2015. Faiza Ilyas. "Patients' Suffering Aggravates as Doctors Observe Strike." (Factiva)

Dawn. 2 February 2015. "PMA Calls for Countrywide Strike Today." (Factiva)

Deutsche Presse-Agentur (DPA). 17 March 2015. Subel Bhandari. "Pakistan's Doctors Are Regular Targets of Kidnappers." (Factiva)

Deutsche Welle (DW). 25 June 2015. Gabriel Domínguez. "The 'Bin Laden Hunt Doctor' Case and Its Impact on Polio Vaccinations." (Factiva)

The Express Tribune. 18 January 2015. "Point-blank Range: Fourth Doctor Shot Dead in Targeted Attack." (Factiva)

The Frontier Star. 27 November 2014. "Attack on Polio Team 3 Women Among 4 Dead, 3 Injured." (Factiva)

Human Rights Commission of Pakistan (HRCP). 12 February 2016. Correspondence from a representative to the Research Directorate.

Human Rights Commission of Pakistan (HRCP). March 2014. State of Human Rights in 2013. [Accessed 8 Feb. 2016]

International Crisis Group. 23 October 2015. Winning the War on Polio in Pakistan. Asia Report No. 273. [Accessed 8 Feb. 2016]

Iran Daily. 30 November 2015. "Assailants Gun Down Senior Health Official in NW Pakistan." (Factiva)

The Nation. 31 March 2015. "PAFP Vows to Resolve Health Practioners’ Grievances." [Accessed 1 Mar. 2016]

The News International. 3 February 2016. "Doctors Remind Government of Unfulfilled Promises." (Factiva)

The News International. 7 December 2015. Mushtaq Yusufzai. "Lack of Ownership, Indifference May Stymie Efforts to Eradicate Polio." (Factiva)

Pak Institute for Peace Studies (PIPS). 9 February 2016. Correspondence from a researcher to the Research Directorate.

Pak Institute for Peace Studies (PIPS). N.d. "Concept Note." [Accessed 1 Mar. 2016]

Pakistan Press International (PPI). 18 December 2015. "POA Condemns Doctors Harassment." (Factiva)

Pakistan Press International (PPI). 11 February 2015. "30% Female Doctors Quit Job Due to Various Social Problems." (Factiva)

Radio Free Europe/Radio Liberty (RFE/RL) with Agence France-Presse (AFP) and British Broadcasting Corporation (BBC). 18 February 2015. "Kidnapped Polio Workers Found Dead in Pakistan." [Accessed 8 Feb. 2016]

Reuters. 15 June 2015. Syed Raza Hassan. "Pakistan Doctors Live in Fear After Spike in Deadly Attacks." (Factiva)

Scroll.in. 6 December 2014. Saim Saeed. "The Essential Guide to Militant Groups in Pakistan." (Factiva)

The Seattle Times. 14 January 2016. Zulfiqar Ali and Shashank Bengali. "Blast Targets Polio Center in Pakistan." (Factiva)

South Asia Terrorism Portal (SATP). 20 December 2015. "Doctors Killed in Pakistan: 2001-2015." [Accessed 15 Feb. 2016]

South Asia Terrorism Portal (SATP). N.d. "South Asia Terrorism Portal." [Accessed 1 Mar. 2016]

Times of Oman. 24 March 2015. "Medics Under Threat as Kidnappings, Killing Rise in Pakistan." (Factiva)

Voice of America (VOA). 13 January 2016. Ayaz Gul. "Suicide Bombing Kills 14 at Pakistan Polio Immunization Facility." (Factiva)

The Wall Street Journal (WSJ). 26 November 2014. Syed Shoaib Hasan. "Polio Workers Killed, Injured in Pakistan; Gunmen on Motorcycles Open Fire on Polio Workers." (Factiva)

Additional Sources Consulted

Oral sources: Human rights activist, London, UK; professor, Habib University; professor, Lahore University of Management Studies; professor, University of Bath Spa; research fellow, Middle East Research Institute.

Internet sites, including: Amnesty International; Doctors Without Borders; ecoi.net; Factiva; Fédération internationale des ligues des droits de l’homme; Freedom House; Human Rights Watch; International Committee of the Red Cross; IRIN; Pakistan Medical Association; Physicians for Human Rights; UN – Refworld; US – Department of State.