November 24/25, 2019 "Information Clearing House" -   We write this open letter, as medical doctors, to express our serious concerns about the physical and mental health of Julian Assange. Our professional concerns follow publication recently of the harrowing eyewitness accounts of Craig Murray and John Pilger of the case management hearing on Monday 21 October 2019 at Westminster Magistrates Court. The hearing related to the upcoming February 2020 hearing of the request by the US government for Mr Assange’s extradition to the US in relation to his work as a publisher of information, including information about alleged crimes of the US government.

Our concerns were further heightened by the publication on 1 November 2019 of a further report of Nils Melzer, the United Nations Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, in which he stated: ‘Unless the UK urgently changes course and alleviates his inhumane situation, Mr Assange’s continued exposure to arbitrariness and abuse may soon end up costing his life.’

Having entered the Ecuadorian Embassy in London on 19 June 2012, Mr Assange sought and was granted political asylum by the Ecuadorian government. On 11 April 2019, he was removed from the Embassy and arrested by the Metropolitan Police. He was subsequently detained in Belmarsh maximum security prison, in what Mr Melzer described as ‘oppressive conditions of isolation and surveillance.’

During the seven years spent in the Embassy in confined living conditions, Mr Assange was visited and examined by a number of experts each of whom expressed alarm at the state of his health and requested that he be allowed access to a hospital. No such access was permitted. Mr Assange was unable to exercise his right to free and necessary expert medical assessment and treatment throughout the seven-year period.

A chronology, based on information available to the public, of relevant visits, events and reports from a medical perspective follows:

• On 31 July 2015, a dentist reported that Mr Assange’s ‘upper right first premolar (UR4) tooth had fractured along with the filling that was in it and the dental pulp of the tooth was exposed’ and ‘that failure to treat this promptly would lead to infection of the root leading to a dental abscess and pain.’ The dentist advised ‘saving this tooth would require root canal treatment’, however, ‘due to the specialised equipment and radiographic requirements this treatment could not be completed in the domiciliary setting.’ ‘Extraction of the tooth’ was identified as ‘another option but […] it may need a surgical extraction.’ This was ‘not recommended in a domiciliary setting especially as we would need preoperative radiographs to assess the root shape and the proximity of the root to the floor of the maxillary sinus. Extractions in this area carry a risk of creating a communication between the mouth and the sinus which could need surgical closure hence radiographs would be essential to assess this risk.’ The dentist ‘advised Mr Assange he should seek treatment in a clinical setting to prevent further progression of his symptoms as soon as possible.’¹

• On 4 December 2015, an opinion of the United Nations Working Group on Arbitrary Detention (UNWGAD) was formally adopted and it was published on 5 February 2016. It concluded that Mr Assange was being arbitrarily detained by the governments of the UK and Sweden. Crucially, it was made clear at the time that any continued arbitrary detention of Mr Assange would constitute torture. The group concluded that ‘the Embassy of Ecuador in London is far less than a house or detention centre equipped for prolonged pretrial detention and lacks appropriate and necessary medical equipment or facilities — it is valid to assume, after five years of deprivation of liberty, that Mr Assange’s health could have deteriorated to such a level that anything more than a superficial illness would put his health at a serious risk, and he was denied access to a medical institution for a proper diagnosis, including a magnetic resonance imaging test.’²

• On 8 December 2015, a doctor who saw Mr Assange reported: ‘progressive inflammation and stiffness affecting his right shoulder. This requires an MRI scan to determine the exact diagnosis in order to inform a suitably qualified physiotherapist as to how best to treat him in an appropriately equipped medical facility. His current circumstances significantly compromise the ability to satisfactorily investigate and treat him.’³ Mr Assange was refused access to a hospital by the Foreign and Commonwealth Office.⁴

• On 11 December 2015, a further doctor, a trauma and psychosocial expert, reported: ‘Mr Assange scored 15 out of 20 on the Patient Health Questionnaire […] a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. […] A score of 15 indicates that Mr Assange suffers from Major Depression (moderately severe)’; ‘At a minimum, it is recommended that his urgent medical complaints regarding the pain in his shoulder be investigated with appropriate equipment’; ‘The Embassy is not a medical setting. The only way Mr Assange can access either urgent medical care or investigations would be to place himself in the hands of the British authorities. Mr Assange is in an invidious position of having to decide between his physical health and the risk of being extradited to the United States. His inability to access proper medical care and assessment – without placing himself into the hands of the authorities – transforms each physical complaint no matter how simple into something that could have catastrophic consequences either for his health or his liberty. He lives in a state of chronic health insecurity’; and ‘The unusual circumstances place Mr Assange in a precarious situation. The effects of the situation on Mr Assange’s health and well-being are serious and the risks will most certainly escalate with the potential to becoming life threatening if current conditions persist.’⁵

• In October 2017, Doctors Sondra S. Crosby, Brock Chisholm and Sean Love visited Mr Assange.⁶ The group examined him for 20 hours over Three days.⁷ In an article for the Guardian published on 24 January 2018 they wrote: ‘We examined Julian Assange, and he badly needs care – but he can’t get it’; ‘We call on the British Medical Association and colleagues in the UK to demand safe access to medical care for Mr Assange and to oppose openly the ongoing violations of his human right to healthcare.’⁸