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(Tunis) - Libyan government forces mistreated medical staff and patients during an unlawful six-week occupation of a hospital in Yafran, a town in Libya's western mountains, Human Rights Watch said today.

Government forces placed about 30 staff and three patients at grave risk by preventing them from leaving and deploying military weapons in the hospital compound, Human Rights Watch said. The failure to respect and protect the hospital violated international humanitarian law.

"Occupying a hospital and terrorizing the patients and staff is illegal and inhumane," said Joe Stork, deputy Middle East and North Africa director at Human Rights Watch. "To minimize the horrors of war, hospitals need to be kept free of fighters, and doctors and nurses need to be assured of their safety."

Government forces occupied Yafran General Hospital from April 19, 2011, until the beginning of June. By then most Yafran residents had fled the town, following at least two weeks of government shelling. The approximately 30 doctors and nurses at the hospital, most of them Bangladeshi or Ukrainian, remained largely because they did not feel safe enough to leave. Three patients were also unable to leave due to their medical conditions.

Hospital staff told Human Rights Watch that the hospital was initially occupied by a paramilitary group known as Haras al-Shabi (the Civil Guard), which had engaged in looting after it captured Yafran on April 18. A doctor told Human Rights Watch that the Civil Guard aggressively entered the hospital and broke down locked doors in a fruitless search for rebel fighters. He said he saw the soldiers beat a wounded Egyptian worker they had found in the intensive care unit. "We were astonished how they dealt with him," the doctor said.

The Civil Guard refused to let the hospital staff leave, the hospital workers said. Over the course of six weeks, the hospital staff primarily treated injured Libyan government forces. Hospital workers described a climate of fear from abuses and threats by the Civil Guard.

One of the patients who was getting medical care at the hospital when the Civil Guard arrived said the fighters entered his room and threatened to torture him and shoot him if he left the hospital. "They did that all the time," he said. "I was scared that one of them would come back at nighttime and shoot me, so sometimes I would change which bed I slept in."

In May, the Civil Guard arrested a nurse, who was then detained for more than three weeks, including time in Tripoli's Abu Salim prison, and on occasion was tortured. "They told me they captured me because I had treated rebel fighters at the hospital," the nurse told Human Rights Watch.

Witnesses said the Civil Guard moved military weapons into the hospital compound, including automatic weapons, machine guns, and anti-aircraft weapons. One doctor said that three large-caliber weapons were positioned in the compound: one at the front gate, one next to the kitchen, and one near the main entrance. Human Rights Watch viewed a video filmed by a medical worker on his cell phone in late April that showed a high-caliber machine gun mounted on a jeep in the hospital compound.

In late April or early May, at least 14 soldiers from the army's Reda Brigade assumed control of the hospital from the Civil Guard. The treatment of medical workers and patients improved with the arrival of the regular armed forces, hospital staff said, but food and water remained in short supply. The soldiers gave the staff and patients two cups of water a day, as well as rice in the morning and pasta in the evening. The army allowed the nurses and doctors to leave the compound with permission, they said, but they could not go far because of the government forces in town. The Reda Brigade soldiers mainly had small arms, but a doctor said that one day in mid May they twice fired high-caliber machine guns from the hospital gate at an unknown target.

Human Rights Watch found about two dozen 7.62 mm bullet casings, which are used in AK-47 assault rifles, in various parts of the hospital grounds, including one in a position overlooking the hospital entrance. Medical staff said they had already removed other bullet casings from the grounds. The glass doors at the hospital's entrance and the exterior gate had bullet holes, apparently from fighting between government and anti-government forces in the beginning of June.

Government forces fled Yafran when rebels took the town on June 2. As of June 24 rebel fighters kept three to five armed guards outside the hospital, though they occasionally went inside the building with their weapons. The hospital staff, interviewed in private, said they had not experienced any threats or violence from the rebel fighters.

International humanitarian law - the laws of war - applicable in the armed conflict in Libya, provides special protection for hospitals and medical workers. The occupation of the hospital and mistreatment of the medical workers by the government forces violated the duty to respect and protect medical facilities and personnel in all circumstances. It was also unlawful to deploy military weapons in the hospital. Preventing medical workers, who are civilians, from leaving the hospital violated the prohibition against placing civilians at unnecessary risk and may have amounted to "human shielding," which is a war crime. Specific acts of abuse against medical workers and patients, including arbitrary arrest and physical abuse, are laws-of-war violations that may also amount to war crimes.

"Government forces committed a long list of international law violations in their abusive occupation of Yafran hospital, putting a lot of lives at unnecessary risk," Stork said. "All parties to Libya's conflict need to protect, hospitals, medical workers, and patients under all circumstances."

Witness Accounts from the Hospital

Human Rights Watch visited Yafran General Hospital from June 19 to 24, and interviewed four doctors, six nurses, and a patient present during the hospital's occupation by government forces. All but one asked that their names not be used because they feared that government forces might return. Human Rights Watch also interviewed in private a captured government soldier who had taken part in the hospital occupation.

A hospital patient in his 40s from the nearby town of Zintan said:

No one could leave the hospital, especially me, since I was locked up inside my room for seven days because I am from Zintan. They threatened that if I went outside my room, they would shoot me. They came to my room with guns. They would shoot from inside the grounds, just outside my window, with a Kalashnikov [AK-47 assault rifle]. They never actually hurt me but they would insult me, threaten me, say they would cut off my ears or my fingers. They did that all the time. I was scared that one of them would come back at nighttime and shoot me, so sometimes I would change which bed I slept in.

A foreign doctor who had brought his family to the hospital for safety after the Civil Guard looted the town told Human Rights Watch:

When the Haras al-Shabi came [to the town], they robbed and destroyed all the homes. We were terrorized. They stole my television, fridge, washing machine, everything. We couldn't move, leave or sleep. They were in the hospital, and I was afraid they would be violent to our wives and daughters.

A nurse told Human Rights Watch that, on May 1, Civil Guard forces returned to the hospital and took him away. They detained him for 24 days in several places, including in Abu Salim prison in Tripoli, he said, and tortured him during interrogation:

On May 1 three guys from Haras al-Shabi in forest camouflage came to the hospital in a car at 2 p.m. They entered the hospital and asked the military commander for permission to take me out of the hospital for investigation. They said they would then bring me back. They took me to [the nearby town of] al-Milayeb. The second day, they started beating me with iron rods and giving me electric shocks. At night, there were about six people who came and beat me up, punching me, kicking me, hitting me with a stick on my head.

The third day in the morning, they took me and 20 other people in the back of a truck and transferred us to Camp 77 [apparently a training camp for government security forces] in Tripoli. The driver told one of the Haras al-Shabi guys that he had a nurse, so the guy kicked me in my testicles. I was in my green hospital uniform, and one of the Haras al-Shabi guys came to me and started kicking me in the face and in the eyes. My left eye was swollen for seven days. The first two days I couldn't see, then I started recovering. At 11 p.m. the same day, they transferred us to Abu Salim prison [in Tripoli]. Eventually they told me they captured me because I had treated rebel fighters at the hospital.

A nurse who stayed in the hospital during the military's occupation explained the atmosphere of intimidation for female hospital staff:

It was Friday [in mid-May] around 3:30 a.m. My friend and I were sleeping in my room. Some person knocked on my door. When I said, "Who is there," no one answered. We thought maybe it was Bangladeshi nurses, but two men in uniform entered the room, and one of them sat on my bed. We were afraid of these army people because sometimes they did bad things. The way they looked at us around the hospital was not good. Sometimes they said something we didn't understand, but we knew it was not good. [Afterward] we talked to the director about what happened, and he said that the army commander said sorry and that it would not happen again. He said he had punished the men. We didn't see those guys after.