Abdorrahman Boroumand Center

The involvement of doctors has prompted global outcry from rights groups and medical organisations. Sharmila Devi reports.

Medical and human rights groups have expressed “horror” over Iran's use of a guillotine machine in the medical clinic of a Tehran prison to amputate the fingers of two men convicted of theft. At least eight more men are awaiting a similar sentence. Under Iran's Islamic penal code, four fingers on the right hand are completely cut off for certain types of theft.

The use of amputation as punishment, although rare, remains in the legal framework of countries including Saudi Arabia, Yemen, Brunei, Indonesia, Nigeria, Qatar, and Sudan. Under Islamic law, hudud punishment includes amputation of hands and feet for theft and robbery, flogging for drinking alcohol, stoning for adultery, and death for murder. The Taliban, which seized power in Afghanistan a year ago, has said it will resume judicial amputations, which it enforced when it ruled the country between 1996 and 2001.

Overall, judicial amputations appear to be on the decline globally. Rights groups say that few cases have been recorded over the past decade or so, although they do not track the practice in the same way that they do for capital punishment, for example.

Inhumane punishments such as amputation are considered torture and a crime under international law and are prohibited under Article 7 of the International Covenant on Civil and Political Rights, to which Iran is a state party. Compliance with the covenant, which has been ratified by more than 170 countries, is monitored by the UN, which can only issue concerns and observations. Non-governmental organisations can also submit their recommendations to the UN. Amnesty International urged states to prosecute Iranian officials.

“We understand that amputation sentences are usually carried out in the presence of multiple officials, including judicial and prison officials and a doctor from the prison clinic”, Mansoureh Mills, Amnesty International's Iran researcher, told The Lancet. Clarisse Delorme, Senior Policy Advisor at the World Medical Association, said Iran, which is not a member, should abolish all corporal punishment, which includes flogging and blinding. “We try to exert moral pressure and publicly denounce what is happening”, she said. “Doctors are expected to refuse to take part in torture and to oppose and denounce it, but this can put their lives in danger.”

Since 1979, Iranian courts have issued at least 356 sentences of amputation and implemented 192, but the real numbers are probably higher, Roya Boroumand, Executive Director of the Abdorrahman Boroumand Center for Human Rights in Iran, a US-based group, told The Lancet. “Many of the victims are very poor, can't afford a lawyer, and don't like to talk, while news from small towns and villages is hard to get”, she said. “Amputation isn't a common practice and it should be called dismemberment, because amputation implies some kind of medical need.”

Iranian public opinion is widely opposed to amputation, but political repression has swamped such opposition, Bijan Baharan of the League for the Defence of Human Rights in Iran, a member of the International Federation for Human Rights, told The Lancet. He pointed to a letter expressing concern sent by Iraj Fazel, a former health minister and president of the Iranian Association of Surgeons, to the Iranian Government on June 18, 2022. “Doctors have refused to oversee amputation in the past. But the regime can occasionally find doctors who oversee it”, said Baharan.

Hadi Ghaemi, Executive Director of the Center for Human Rights in Iran, told The Lancet that he had spoken with lawyers in Iran who said many coroner's offices and state medical offices are also against amputations. “Iran claims amputations are done in the name of crime prevention, but there's no data to back it up”, he said.

The uptick in amputations might be linked with a wider crackdown on dissent in Iran, but it could also be a bureaucratic response to clear a legal backlog and prison overcrowding, Tara Sepehri Far, Iran researcher at Human Rights Watch, told The Lancet. “I'm not confident there is coordinated decision making in Iran”, she said. “What is clear is that international opposition to corporal punishment does have an effect in pressuring the regime.”

Global data on judicial amputations should be collected, Ranit Mishori, Senior Medical Advisor for Physicians for Human Rights, told The Lancet. “To think that medical colleagues of mine are overseeing and supervising amputation is really disturbing from an ethical point of view. It's against every kind of oath that doctors take”, she said.

Kristine Beckerle, a researcher for Human Rights Watch, told The Lancet that she had not heard of any state-sanctioned amputations in the Persian Gulf region over the past decade or in Yemen since the civil war started in 2014, but that the practice was likely to remain legal under Saudi Arabia's forthcoming first written penal code for discretionary crimes—those for which punishments are not specified in Islamic law. “Capital punishment is on the rise in Saudi Arabia as are other forms of repression in the Gulf that don't get so much attention