I thank the Chairman and Members of the Oireachtas for inviting me and my colleagues to today's committee proceedings. We very much welcome the opportunity to state our position and responses to unfolding events over the past year. The continuously evolving situation in Bahrain has been a uniquely challenging one for RCSI. We have never been in this situation, nor do we think have other third level institutions in Ireland, where we have been present in a very volatile and sensitive international environment, with direct responsibility for more than 1,000 students and staff. We have endeavoured to do the right thing, focusing on our core educational mission and we continue to do so.
RCSI is an independent, not-for-profit, health sciences institution. Our primary purpose is the education and training of health care professionals and health sciences research. RCSI is Ireland's truly international centre of higher education. Only 30% of the student population in Dublin is Irish. We are an international organisation; our campus in Dublin has more than 3,800 students and 860 full-time staff. Currently, there are 14,000 RCSI graduates working as medical doctors or in allied disciplines all over the world.
The RCSI is the largest international surgical trainer in the sub-Saharan countries of Ethiopia, Kenya, Malawi, Mozambique, Lesotho, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe. The RCSI runs training programmes throughout the Middle East, with a training campus in Dubai and a university in Bahrain, and we also run undergraduate and postgraduate programmes in the Far East, most notably in Malaysia. The RCSI is a not-for-profit institution, and it is largely self-funding. Any financial surpluses generated from our activities are reinvested in our research and academic programmes.
The RCSI is a significant contributor to the Irish economy. Approximately 8% of our income comes from the Exchequer and the balance is raised from our delivery of undergraduate, postgraduate and continuous professional development education in Ireland and abroad. In Ireland, 70% of our students are non-Irish, amounting to more than 2,000 students. In addition to many non-economic benefits, these students bring jobs and spend in the local economy. Estimates show that each foreign student spends an average of €15,000 per annum.
In Bahrain, students in our campus are drawn from 17 countries around the world. There are currently 1,021 students enrolled in medicine, nursing, and Master's programmes. There are more than 120 academic and administrative staff in Bahrain, who are likewise drawn from all over the globe.
The RCSI has had a relationship with Bahrain for more than 30 years. The college agreed to establish a medical university of Bahrain in 2003. The first students were admitted in 2004 and we graduated our first medical and nursing students in 2010. Today, the college has more than 1,000 students and 120 full-time staff.
The opening of our university buildings in February 2009 by the then President, Ms Mary McAleese, marked the culmination of the RCSI's €70 million investment in Bahrain. This is a substantial investment in line with requirements to fund a well-resourced medical school. The university was funded entirely by RCSI resources and is performing in line with our expectations both from educational and financial perspectives.
Many of us know Bahrain well and have great regard for the people and progress that has been made in the country since its independence in the 1970s, with significant investment in infrastructure, education and health care.
The United Nations human development index, HDI, is a broad definition of well-being. It provides a composite measure of three basic dimensions of human development: health, education and income. Bahrain's HDI rating is 0.806, which ranks it 42nd of 187 countries with comparable data. The average HDI of Arab states is 0.641, placing Bahrain above the regional average. Bahrain, like Ireland, is in the top quartile of countries with the highest HDI.
Although a small country, Bahrain is a profoundly complex one. It is located in a region of enormous geopolitical upheaval; it is possibly the most westernised of all the Gulf states and, critically and unfortunately, almost all differences within the society now crystallise around the sectarian Shia-Sunni divide.
The ongoing events that began in February 2011 are a tragedy for Bahrain. It has been deeply distressing to watch events unfold over the past 12 months. It is critical that the RCSI, as an organisation, help build bridges rather than contribute to greater fracturing. It does this by being non-partisan, non-aligned and restrained in public commentary. Otherwise, it would become part of the problem rather than the solution.
At the RCSI, we are very clear that we are a health sciences institution. Our focus is on medical and health professions, education at all levels, including undergraduate, postgraduate and continuous professional development. Our primary responsibility is to contribute by providing a high-quality education based on internationally recognised ethical principles in medical and health science education in a safe and supportive environment. It is a case of allowing students to reach their potential and maximise their opportunities, irrespective of their background.
With this in mind, when the internal and security situation escalated following protests in February 2011, senior staff in Dublin immediately travelled to Bahrain to monitor and ensure the safety of our students and staff and, if possible, to enable them to continue their education. In the early stages, we closely monitored events, focusing on communications with students, their parents and staff. When the situation further escalated in March, we temporarily suspended teaching. Staff continued to attend the university ensuring it remained a focus for our students. We made contact with all parents, as well as students, keeping them informed of developments, as necessary. We developed an evacuation plan, and when the situation deteriorated we evacuated students and staff who wished to leave. A core group of staff from the RCSI remained in Bahrain to maintain the university and to set up and staff a temporary accident and emergency unit for the local population in Muharraq. We were heartened that all of our students, including many international students, returned when we reopened the campus.
We developed contingency plans, including evacuation to Ireland, to ensure that, irrespective of political unrest, our final medical year students would graduate on time. A delay in graduation for this class would mean a full year of lost employment at a pivotal time in their careers. In June, 53 medical doctors and 70 nurses graduated as originally scheduled. We have been criticised for holding this graduation. In our view, it was important that the graduation take place as a tribute to the commitment and courage of the young people. Many of these students are the first members of their families to attend a university and obtain a degree. The students who graduated come from all ethnic, religious and cultural backgrounds.
As the new academic year started in September 2011, the focus of the RCSI university in Bahrain was contingency planning in the context of volatility and considering the role of the university as being part of the solution rather than the problem. To this end, staff-student working groups, from all communities and political viewpoints, are examining how to live with difference and to remove division and tension from university life and health care provision.
We in the RCSI are in a very different position from advocacy groups, national governments such as those in the United Kingdom and United States, and international organisations such as the European Union and United Nations. We have a unique balance of responsibilities and opportunities. We judged that we could be true to our responsibilities and more effective in advocating for the health care professionals through private advocacy in Bahrain. Our approach has been guided by what we have judged to be most effective in Bahrain. In support of this approach, we have chosen to minimise public statements in Ireland.
We greatly respect the work of various advocacy groups and they do their work in a manner consistent with their role and their opportunities. We have met these groups and anyone who wished to discuss our stance. We have both listened and explained our position.
The Irish Government, as the Tánaiste indicated in a reply to a parliamentary question, has publically stated our national view, as have the European Union and the UK and US Governments. Throughout the period in question, we have stayed in close contact with the Department of Foreign Affairs, which has worked through our embassy in Riyadh. We have repeatedly met senior government officials in Bahrain, outlining our concerns and position. We took the view that a positive influence would be more effectively exerted through dialogue rather than through public advocacy. That said, we unequivocally stated our position in a letter to The Irish Times in June 2011.
The RCSI fully respects the unequivocal right of all doctors to practice as enshrined in the Geneva Convention. We are very aware of and concerned about the plight of those detained in Bahrain.
Medical practice is a privilege that carries rights and responsibilities. Doctors have a responsibility to treat all patients, irrespective of their background, to the highest possible standard, under all circumstances.
Hospitals must be politically neutral. Society has a responsibility to allow doctors and nurses to treat all patients in need. The protection and care of people wounded in conflict is a basic right guaranteed by the Geneva Convention. Punishing doctors or nurses for treating patients, irrespective of their backgrounds, is completely unacceptable. The World Medical Association's International Code of Medical Ethics and its Medical Ethics Manual define the duties of physicians as including the administration of emergency care and adhering to principles of non-discrimination. Governments should not infringe upon the duties of medical professionals and should not target or punish those who seek to uphold these internationally recognised principles.
We believe the future for Bahrain has to be one of dialogue and reconciliation. Our own national story tells us that the problem will not be resolved quickly. We will continue to contribute through education and to advocate for just outcomes. In October 2011, we further reiterated this view, stating that while we were not prepared to pre-judge on the guilt or innocence of any of the medical personnel facing charges arising from the Bahraini protests, we were unequivocal on the need for due process, transparent judicial procedures and the presumption of innocence until one is proven guilty.
Against this tense and volatile background, we believe it was a wise act by His Majesty the King of Bahrain to establish an international commission of inquiry, the Bahrain Independent Commission of Inquiry, BICI. The five members of the commission were international experts on human rights. The chair was Professor Cherif Bassiouni and its members were Judge Philippe Kirsch from Canada, Professor Sir Nigel Rodley from the UK, Dr. Mahnoush Arsanjani from Iran and Dr. Badria Al Awadhi from Kuwait. The commission had the same privileges and immunities as United Nations experts on mission. It started its work in July and presented its report in November. It received more than 8,000 complaints and statements of various human rights abuses relevant to its mandate. In a comprehensive 500 page report, it published the results of its investigation of the events occurring in Bahrain in February, March and thereafter. The report made a series of recommendations.
During the period of the commission's work, it took steps to address existing issues of human rights violations. This was accomplished by communicating with Government of Bahrain officials where there were immediate interventions. Subsequently, more than 300 detainees were released and special medical attention was provided to injured persons. Hundreds of dismissed public and private sector employees and suspended students were reinstated.
The commission indicated that there was no doubt that what occurred in February and March and subsequent related events were the result of an escalating process and that the Government of Bahrain and the opposition have their share of responsibility in letting events unfold as they did.
It was suggested in one Irish commentary that the commission referred to the Royal College of Surgeons in Ireland, RCSI, in its report. The Bahrain Independent Commission of Inquiry, BICI, does not mention the RCSI. It discusses events at the University of Bahrain and Bahrain Polytechnic, neither of which is connected with the RCSI. The BICI was saddened to see violence break out among students in places of learning. In sharp contrast, there was no violence at the RCSI's campus and no students were expelled or suspended for political activities.
In response to the report, his majesty King Hamad accepted that the commission identified serious shortcomings on the part of some organs of the Government, particularly in failing to prevent instances of excessive force and the mistreatment of persons placed under arrest. The King has undertaken to implement the commission's recommendations.
The RCSI unequivocally welcomes the BICI report, which is comprehensive, wide-ranging and unflinching in its findings and conclusions. We are deeply concerned at the findings, including those of human rights abuse and intimidation. We welcome the decision of his majesty King Hamad to pursue those who abused their authority in this way and the decision to move all trials to civil courts. In particular, we welcome the decision to set aside confessions obtained under duress.
Following the publication of the report and with an understanding that these outstanding legal cases were a block to meaningful dialogue and the rebuilding of society, the RCSI formally wrote to his majesty in December asking him to drop all outstanding legal charges against those who were charged, including medical personnel.
The college has also written to Professor Bassiouni, chair of the commission, pointing out that the medical profession in Bahrain has become deeply polarised to the extent that public trust in the profession is now seriously compromised. To rebuild trust, several actions need to be taken. The outstanding charges against the medics need to be dropped. These charges are a major obstacle to progressing any reform initiative and only serve to fuel hostility and division. In addition, a health sector forum should be created to bring the different positions and opposing groups together towards a common project of building reconciliation and mutual understanding among health care professionals in Bahrain. The RCSI has offered to assist in every way.
The situation in Bahrain remains challenging. Our hope is that, in this week one year after the start of these events, people will reflect on what has been achieved in Bahrain and what is at risk if the process of dialogue and reconciliation does not continue.
As Irish companies and universities increase their activities abroad, which we all must do in the national interest, we will find ourselves working in countries with different political systems and cultures than our own. To work in those countries, we must find a way to be true to ourselves and our core missions while being respectful of their cultural, judicial and political norms. The RCSI welcomes the work led by Chancellor Dr. Maurice Manning of the National University of Ireland in developing a charter for universities working overseas. While the RCSI has been traditionally acknowledged as the lead in attracting international third level students to Ireland and bringing Irish education to international settings, this is now an important aspect of many higher education institutions' work and a key part of Ireland's development as a knowledge economy. Thus, we all need to consider how to respond to the inevitable challenges illustrated by the Bahraini unrest of the past year. As we sit here today, RCSI people are listening and working in Africa, the Middle East, the Far East and Ireland. I want them to know that I greatly respect the work they do. They are a credit to Irish education and are great ambassadors for our country.
To Bahrain, I say that we at the RCSI are with you and we will continue to contribute by providing high quality medical and nursing education in a non-sectarian environment. It is our belief that we can contribute to the future of Bahrain through education. The priority for the RCSI is ensuring quality health care through the provision of high quality education. Our approach in this unprecedented year in Bahrain has been to focus on our health care education mission and to ensure that events did not compromise a safe, non-sectarian, respectful educational environment for our students and staff.
I thank the committee for its patience in listening to me and for inviting us to attend today.
