Repression, health care and ethics under apartheid.

Over the past twenty-five years torture by state security forces has escalated in South Africa. The scale of this abuse has impacted on the health professions, both medical and psychological, which have unavoidably been exposed to the casualties. Individual doctors and psychologists and the country's professional bodies have been forced to confront crucial ethical choices. This paper is about some of those choices and the schisms which they opened in the South African health professions. A brief contextual outline of the sociopolitical context within which repression, resistance and torture arose in South Africa will be followed by discussion of the challenges which civil rights abuses, including torture, have posed for health professions in this country; and how the professions have responded. Torture in South Africa emerged as a logical development within an abusive social control system. This system-widely known as apartheid-was intended legally to entrench power and economic advantage in the hands of the white minority. South Africa had been settled from the mid-seventeenth century onwards by Britain and Holland. Wars of subjugation waged against the black peoples of the country were followed in the 20th century by coercive measures intended to bring blacks into the economy as cheap labour. When the Afrikaner Nationalist government came into power, after World War II, they instituted a rigorous formalisation of the loose racial discrimination practised previously. The apartheid system inflicted enormous institutional violence on the black population of South Africa. In pursuit of racial separation without loss of cheap labour, millions of blacks were relocated to barren homelands where in order for families to survive physically they had to be fragmented by the migrant labour system. Those blacks permitted to live in 'white' areas were forced by the Group Areas Act to live in overcrowded soulless dormitory townships, prey to high levels of crime and violence, and far from their workplaces. In these circumstances blacks have succumbed in huge numbers to the diseases of poverty-such as tuberculosis or kwashiorkor-these effects aggravated further by inferior health and social services (1). They have been trapped in these circumstances by a separate education system overtly designed to disadvantage blacks as 'hewers of wood and drawers of water'; and for decades they were prevented by the Job Reservation Act from taking up any but the lowest-paying work. Constructed within this system as 'untermenschen', blacks were slighted, patronised and psychologically undermined (2,3). A vast and obstructive bureaucracy …