Inadequate Medical Care for Cao Shunli Before Her Death Contradicts International Law

April 2, 2014

Human rights organizations have linked the death of Chinese rights advocate Cao Shunli on March 14, 2014, to Chinese authorities’ denial of adequate and timely medical treatment during her pre-trial detention that began in September 2013. Authorities charged Cao with “creating a disturbance” for participating in peaceful demonstrations calling on officials to allow genuine public participation in drafting China’s national report for the October 2013 UN Human Rights Council’s Universal Periodic Review (UPR). Cao also repeatedly requested information from authorities through official channels about the drafting of China’s national reports for the 2009 and 2013 UPRs. The deterioration of Cao’s health while in detention, especially her rapid decline in the last few weeks, and authorities’ unwillingness to be transparent about the details of her care raise concerns that Chinese authorities disregarded international human rights standards in her case. Chinese laws allow, but are vague regarding, the release of ill detainees to receive medical care. As international concern for Cao’s death grows, authorities have detained Cao’s friend and fellow advocate Liu Xiaofang and harassed other supporters.

 

On March 14, 2014, rights advocate Cao Shunli died at the Beijing No. 309 Military Hospital[1] of multiple organ failure linked to tuberculosis,[2] a disease that can be cured with proper antibiotic treatment in the majority of cases.[3] Human rights organizations and Cao’s lawyers have linked Cao’s death to Chinese authorities’ denial of timely and proper medical care.[4] Cao reportedly told one of her lawyers repeatedly that detention center officials were not providing her with adequate medical treatment[5] and had prohibited her from taking the medications she had been carrying.[6] Descriptions of her state of health at the time of her detention in September 2013 vary somewhat, but she reportedly felt well enough to embark on a trip in September to Geneva to participate in a human rights workshop.[7] By at least October, Cao’s family voiced concerns about her health problems in detention, including symptoms of tuberculosis, liver disease, and uterine fibroids.[8] Authorities reportedly ignored several requests by Cao’s family and her lawyer for medical care at a hospital outside the Chaoyang District PSB Detention Center.[9] Cao’s lawyers visited her in October 2013 and January 2014 and during both of those visits, they said Cao appeared ill but not in critical condition.[10] Cao’s health reportedly then rapidly deteriorated.[11] Her lawyers stated that they were surprised that authorities took her to the intensive care unit of Beijing Qinghe Hospital on February 19, 2014, where she fell into a coma.[12] According to one report, a doctor at the military hospital where authorities moved Cao after she fell into a coma and passed away told family members that Cao’s emaciated body, bedsores, and bruising indicated her care had been neglected in detention.[13] Authorities only recently allowed Cao’s family members to see Cao’s body, but authorities have prohibited them from viewing Cao’s medical records.[14] The family reportedly wants to request an independent autopsy done by doctors from outside of China.[15]

 

Inadequate Medical Care for Cao Shunli Contradicts International Law

The deterioration of Cao’s health in detention raises concerns that authorities’ treatment of Cao was not in line with international norms. Numerous international agreements address a prisoners’ right to health,[16] including the Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, which stipulates that state authorities shall provide medical care and treatment to detainees “whenever necessary.”[17] According to the Standard Minimum Rules for the Treatment of Prisoners, “sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals.”[18] An international policy analyst asserts that the right to medical care “in a timely fashion is one broadly supported as a legal requirement…. [I]t is clear from the jurisprudence that medical care for prisoners is only compliant with international law if it is available when needed.”[19] Chinese laws and rules provide for, but only give vague guidance regarding, releasing detainees to receive medical care. Article 65(3) of the PRC Criminal Procedure Law (Chinese) and Article 77(3) of the Security Agency Rules for Handling Criminal Cases provide for bail “guarantee pending further investigation” for “those who have a serious illness and cannot care for themselves” if it does not “endanger society.”[20] Authorities have in the last two years granted bail for medical reasons to other advocates, including rights defenders Hou Xin and Guo Hongxia.

 

Authorities’ Non-transparency About Cao’s Care Counter to International Norms

Contrary to international norms, Chinese authorities provided only vague and partial information regarding Cao’s condition and treatment in detention. According to the UN Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, authorities shall offer a detainee a medical examination “as promptly as possible” after his admission to a detention facility and provide access to the results of that examination.[21] Under the UN Standard Minimum Rules for the Treatment of Prisoners, authorities “shall at once” inform the nearest relative if a prisoner becomes seriously ill.[22] Chinese authorities reportedly informed Cao’s brother of her condition on February 20, a day after taking her to the emergency room, at which time they asked him to sign for her medical parole.[23] There is no report of Chinese authorities having informed Cao’s relatives that her condition was becoming critical prior to that time. Cao’s lawyers reportedly filed eight open government information requests regarding the detention center’s treatment of Cao’s illnesses,[24] but as of March 29, authorities have not sent responses.[25] In a January 24, 2014, response to letters of urgent appeal about Cao’s condition by several UN special rapporteurs, Chinese authorities wrote that “During her detention period, Cao had access to medical care as provided by the detention centre. According to the medical assessment doctors made, no serious liver disease was diagnosed.”[26] Following her death, a spokesperson for the Ministry of Foreign Affairs reportedly said that Cao had been ill for some time and that “she received proactive, conscientious treatment, and her legal rights were protected.”[27] Authorities did not provide specific information regarding treatment of her liver disease or other ailments. Nor have Chinese officials offered an explanation regarding why they waited so long to allow Cao to obtain medical treatment outside the detention center or to inform Cao’s brother of her critical condition. 

 

Case Background

On September 14, 2013, security officials in Beijing prevented Cao from boarding a plane at the Beijing International Airport to attend a human rights training in Geneva, Switzerland.[28] She reportedly then disappeared and was held incognito by authorities until September 28, when they officially criminally detained her on suspicion of “illegal assembly.” On October 21, authorities arrested her on the charge of “creating a disturbance” (Criminal Law, art. 293), sometimes literally translated as “picking quarrels and provoking troubles”).[29] Cao had advocated for the rule of law, and greater governmental transparency and accountability for many years.[30] In 2013, she and others utilized official channels to request information about the drafting of China’s national reports for the UN Human Rights Council’s Universal Periodic Reviews (UPR) that took place in 2009 and 2013.[31] They also held peaceful demonstrations in Beijing calling for genuine public participation and greater transparency in the drafting of the report for the UPR that took place in October 2013.[32]

 

International Reproach

International organizations, governments, human rights organizations, and rights advocates have issued statements expressing dismay at Chinese authorities’ treatment of Cao and called for an investigation into her detention, medical care, and death. Spokespersons for the UN High Commissioner for Human Rights and Secretary-General Ban Ki-Moon issued public statements.[33] Cao’s case also has prompted numerous government statements, including those from the U.S. State Department,[34] Canada, France,[35] the European Union, Britain, Greece, Germany, Ireland, and the Czech Republic.[36] In addition, multiple human rights organizations and civil society actors have also issued statements and held public commemorative and other activities.[37]

 

Detention and Harassment of Cao Shunli Supporters

Public security officials in Beijing criminally detained rights defender Liu Xiaofang, who was Cao’s friend and fellow advocate, on an undisclosed charge.[38] Chinese authorities also harassed several other supporters of Cao[39] and tried to stop a minute of silence in honor of Cao Shunli during a UN Human Rights Council session in Geneva on March 20, 2014.[40]

 

 



[1] Chinese Human Rights Defenders, “Chinese Government Must Be Held Accountable for Death of Activist Cao Shunli,” 14 March 14. (https://chrdnet.com/2014/03/chinese-government-must-be-held-accountable-for-death-of-activist-cao-shunli/)

[2] Ben Blanchard, “China Denies Dead Dissident Refused Medical Treatment,” Reuters, 17 March 14.  (https://www.reuters.com/article/2014/03/17/us-china-dissident-idUSBREA2G0ES20140317)

[3] National Institute of Allergy and Infectious Diseases, National Institutes of Health, “Tuberculosis (TB),” last visited 24 March 14. (https://www.niaid.nih.gov/topics/tuberculosis/understanding/pages/treatment.aspx) According to an institute of the US National Institutes of Health, most cases of tuberculosis can be cured with proper antibiotic treatment. Chinese officials have not said that Cao carried a resistant strain of the disease.

[4] Chinese Human Rights Defenders, “Chinese Government Must Be Held Accountable for Death of Activist Cao Shunli,” 14 March 14; (https://chrdnet.com/2014/03/chinese-government-must-be-held-accountable-for-death-of-activist-cao-shunli/) Amnesty International, “China: Authorities Have ‘Blood on Their Hands’ After Activist’s Death,” 14 March 14; (https://www.amnesty.org/en/news/china-authorities-have-blood-their-hands-after-activists-death-2014-03-14) Front Line Defenders, “Chinese Government Responsible for the Death of Cao Shunli,” 14 March 14; (https://frontlinedefenders.org/node/25405) “China Denies Mistreating Activist Cao Shunli,” Agence France-Presse, reprinted in Australia Network News, 18 March 14. (https://www.abc.net.au/news/2014-03-18/an-china-denies-mistreating-activist-cao-shunli/5327196

[5] Human Rights in China, “Rights Defender Cao Shunli Died in Hospital in Beijing, Lawyer Barred From Viewing Body,” 14 March 14; (https://www.hrichina.org/en/press-work/statement/rights-defender-cao-shunli-died-hospital-beijing-lawyer-barred-viewing-body) Verna Yu, “Inquiry Into Activist Cao Shunli’s Death Sought,” South China Morning Post, 21 March 14. (https://www.scmp.com/news/china/article/1453511/inquiry-activist-cao-shunlis-death-sought)

[6] Verna Yu, “Inquiry Into Activist Cao Shunli’s Death Sought,” South China Morning Post, 21 March 14. (https://www.scmp.com/news/china/article/1453511/inquiry-activist-cao-shunlis-death-sought)

[7] Human Rights in China, “Rights Defender Cao Shunli Died in Hospital in Beijing, Lawyer Barred From Viewing Body,” 14 March 14; (https://www.hrichina.org/en/press-work/statement/rights-defender-cao-shunli-died-hospital-beijing-lawyer-barred-viewing-body) Chinese Human Rights Defenders, “Rebuttal to Chinese Authorities Claims About Death of Cao Shunli, China Human Rights Briefing, March 14–20, 2014,” 20 March 14. (https://chrdnet.com/2014/03/chrb-rebuttal-to-chinese-authorities-claims-about-death-of-cao-shunli-314-3202014/)

[8] “Death in Chinese Custody,” Wall Street Journal, 16 March 14. (https://online.wsj.com/news/articles/SB10001424052702304017604579443170126025350)

[9] Human Rights in China, “Rights Defender Cao Shunli Died in Hospital in Beijing, Lawyer Barred From Viewing Body,” 14 March 14. (https://www.hrichina.org/en/press-work/statement/rights-defender-cao-shunli-died-hospital-beijing-lawyer-barred-viewing-body)

[10] Didi Kirsten Tatlow, “Activist’s Death Questioned as U.N. Considers Chinese Rights Report,” New York Times, Sinosphere (blog), 19 March 14; (https://sinosphere.blogs.nytimes.com/2014/03/19/activists-death-questioned-as-u-n-considers-chinese-rights-report/) “Verna Yu, “Inquiry Into Activist Cao Shunli’s Death Sought,” South China Morning Post, 21 March 14. (https://www.scmp.com/news/china/article/1453511/inquiry-activist-cao-shunlis-death-sought)

[11] Ibid.

[12] Chinese Human Rights Defenders, “Rebuttal to Chinese Authorities Claims About Death of Cao Shunli, China Human Rights Briefing, March 14–20, 2014,” 20 March 14; (https://chrdnet.com/2014/03/chrb-rebuttal-to-chinese-authorities-claims-about-death-of-cao-shunli-314-3202014/) Didi Kirsten Tatlow, “Activist’s Death Questioned as U.N. Considers Chinese Rights Report,” New York Times, Sinosphere (blog), 19 March 14. (https://sinosphere.blogs.nytimes.com/2014/03/19/activists-death-questioned-as-u-n-considers-chinese-rights-report/)

[13] Chinese Human Rights Defenders, “Rebuttal to Chinese Authorities Claims About Death of Cao Shunli, China Human Rights Briefing, March 14–20, 2014,” 20 March 14; (https://chrdnet.com/2014/03/chrb-rebuttal-to-chinese-authorities-claims-about-death-of-cao-shunli-314-3202014/) Verna Yu, “Inquiry Into Activist Cao Shunli’s Death Sought,” South China Morning Post, 21 March 14.

[14] Didi Kirsten Tatlow, “Family Seeks Independent Autopsy of Activist Who Died in Detention,” New York Times, Sinosphere (blog), 28 March 14; (https://sinosphere.blogs.nytimes.com/2014/03/28/family-fights-for-body-of-activist-who-died-in-detention/?_php=true&_type=blogs&_r=0#) Chinese Human Rights Defenders, “Human Rights Defender Cao Shunli’s Remains Still Missing, Lawyer Wang Yu Threatened” [Renquan hanweizhe cao shunli yiti zhijin xialuo bu ming, lushi wang yu zao weixie], 27 March 14. (https://www.weiquanwang.org/?p=41907)

[15] Didi Kirsten Tatlow, “Family Seeks Independent Autopsy of Activist Who Died in Detention,” New York Times, Sinosphere (blog), 28 March 14. (https://sinosphere.blogs.nytimes.com/2014/03/28/family-fights-for-body-of-activist-who-died-in-detention/?_php=true&_type=blogs&_r=0#)

[16] Rick Lines, "The Right to Health of Prisoners in International Human Rights Law," International Journal of Prisoner Health, March 2008, Vol. 4, No. 1, 11–36. (https://www.hr-dp.org/files/2013/09/22/Right-to-Health-IJPH-2008.pdf)

[17] United Nations General Assembly, Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, A/RES/43/173, 76th Plenary Meeting of the UN General Assembly, 9 December 88, Principle 24. (https://www.un.org/documents/ga/res/43/a43r173.htm)

[18] United Nations, Standard Minimum Rules for the Treatment of Prisoners, adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, Geneva 1955, approved by the Economic and Social Council resolutions 663c (XXIV) 31 July 57 and 2076 (LXII) 13 May 77,  22(2). (https://www.unodc.org/pdf/criminal_justice/UN_Standard_Minimum_Rules_for_the_Treatment_of_Prisoners.pdf)

[19] Rick Lines, "The Right to Health of Prisoners in International Human Rights Law," International Journal of Prisoner Health, March 2008, Vol. 4, No. 1, 22. (https://www.hr-dp.org/files/2013/09/22/Right-to-Health-IJPH-2008.pdf)

[20] PRC Criminal Law [Zhonghua renmin gongheguo xingfa], issued 1 July 79, amended 14 March 97, effective 1 October 97, amended 25 December 99, 31 August 01, 29 December 01, 28 December 02, 28 February 05, 29 June 06, 28 February 09, 25 February 11, art. 65(3); (https://www.cecc.gov/resources/legal-provisions/criminal-procedure-law-of-the-peoples-republic-of-china) Ministry of Public Security, Public Security Agency Procedural Rules for Handling Criminal Cases [Gong’an jiguan banli xingshi anjian chengxu guiding], 13 December 12, art. 77(3). (https://www.mps.gov.cn/n16/n1282/n3493/n3823/n442421/3486957.html)

[21] United Nations General Assembly, Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, A/RES/43/173, 76th Plenary Meeting of the UN General Assembly, 9 December 88, Principles 24, 26. (https://www.un.org/documents/ga/res/43/a43r173.htm)

[22] United Nations, Standard Minimum Rules for the Treatment of Prisoners, adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, Geneva 1955, approved by the Economic and Social Council resolutions 663c (XXIV) 31 July 57 and 2076 (LXII) 13 May 77, 44(1). (https://www.unodc.org/pdf/criminal_justice/UN_Standard_Minimum_Rules_for_the_Treatment_of_Prisoners.pdf)

[23] Human Rights in China, “Rights Defender Cao Shunli Died in Hospital in Beijing, Lawyer Barred From Viewing Body,” 14 March 14; (https://www.hrichina.org/en/press-work/statement/rights-defender-cao-shunli-died-hospital-beijing-lawyer-barred-viewing-body) Office of the High Commissioner for Human Rights, “Deadly Reprisals: UN Experts Deplore the Events Leading to the Death of Chinese Human Rights Defender Cao Shunli, and Ask for Full Investigation.” 18 March 14. (https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=14394&LangID=E)

[24] Ibid.

[25] Didi Kirsten Tatlow, “Family Seeks Independent Autopsy of Activist Who Died in Detention,” New York Times, Sinosphere (blog), 28 March 14. (https://sinosphere.blogs.nytimes.com/2014/03/28/family-fights-for-body-of-activist-who-died-in-detention/?_php=true&_type=blogs&_r=0#)

[26] Chinese Human Rights Defenders, “Rebuttal to Chinese Authorities Claims About Death of Cao Shunli, China Human Rights Briefing, March 14–20,  2014,” 20 March 14. (https://chrdnet.com/2014/03/chrb-rebuttal-to-chinese-authorities-claims-about-death-of-cao-shunli-314-3202014/) This article provides a link to a pdf copy of  the Chinese government’s January 24, 2014,  reply to a letter of urgent appeal sent by several UN special rapporteurs about Cao Shunli’s condition. (https://www.chrdnet.com/wp-content/uploads/2013/09/China_24.01.14_11.2013_13.2013_trans.pdf)  CHRD translated text as follows:  “[a]fter Cao’s detention on the criminal charge and subsequent to her arrest, her family was duly informed in accordance with the regulations in force. During her detention period, Cao had access to medical care as provided by the detention centre. According to the medical assessment doctors made, no serious liver disease was diagnosed.”

[27] Ben Blanchard, “China Denies Dead Dissident Refused Medical Treatment,” Reuters, 17 March 14.  (https://www.reuters.com/article/2014/03/17/us-china-dissident-idUSBREA2G0ES20140317)

[28] Human Rights in China, “Cao Shunli: UPR Submission and Other Documents,” 8 October 13. (https://www.hrichina.org/en/content/6961)

[29] Chinese Human Rights Defenders, “Cao Shunli Several Serious Ailments Go Untreated, Case Transferred to Procuratorate” [Cao shunli shenhuan duo zhong yanzhong jibing de budao yizhi, anjian yijiao dao jianchayuan], 23 December 13. (https://weiquanwang.org/?p=39830)  

[30] Human Rights in China, “Cao Shunli: UPR Submission and Other Documents,” 8 October 13. (https://www.hrichina.org/en/content/6961) Human Rights in China translated and summarized documents requesting information about China’s human rights reports to the UN sent by Cao and others as well as the responses from government organizations. For more information on Cao’s background, previous rights defense activities, and detentions, see Cao Yaxue, “The Life and Death of Cao Shunli (1961–2014),” China Change, 18 March 14. (https://chinachange.org/2014/03/18/the-life-and-death-of-cao-shunli-1961-2014/)

[31] Ibid. Cao and others filed open government information requests seeking information about public participation in drafting China’s reports for the UPR. When authorities denied the information requests, on the grounds that the information was “secret,” Cao and others filed applications for administrative reconsideration of their requests. They later filed an administrative complaint against the Ministry of Foreign Affairs requesting that the Beijing Intermediate People’s Court order the Ministry to provide the information requested.

[32] Chinese Human Rights Defenders, “Chinese Government Must Be Held Accountable for Death of Activist Cao Shunli,” 14 March 14.

[33] Office of the High Commissioner for Human Rights, “Deadly Reprisals: UN Experts Deplore the Events Leading to the Death of Chinese Human Rights Defender Cao Shunli, and Ask for Full Investigation.” 18 March 14; (https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=14394&LangID=E) Office of the High Commissioner for Human Rights, “UN Experts Alarmed by Reprisals Against Activists Linked to China’s International Human Rights Review,” 16 October 13. (https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=13860) For additional UN responses to Cao’s death, see Human Rights in China, “UN Responses to Cao Shunli’s Death,” last visited 25 March 14. (https://www.hrichina.org/en/un-responses-cao-shunlis-death)

[34] U.S. Department of State, “Death of Chinese Activist Cao Shunli,” 15 March 14; (https://www.state.gov/r/pa/prs/ps/2014/03/223542.htm) Human Rights in China, “Government Responses to Cao Shunli’s Death,” 14 March 14. (https://www.hrichina.org/en/government-responses-cao-shunlis-death)

[35] “China Denies Mistreating Activist Cao Shunli,” Agence France-Presse, reprinted in Australia Network News, 18 March 14; (https://www.abc.net.au/news/2014-03-18/an-china-denies-mistreating-activist-cao-shunli/5327196) Human Rights in China, “Government Responses to Cao Shunli’s Death,” 14 March 14.  (https://www.hrichina.org/en/government-responses-cao-shunlis-death)

[36] Human Rights in China, “Government Responses to Cao Shunli’s Death,” 14 March 14. (https://www.hrichina.org/en/government-responses-cao-shunlis-death)

[37] Human Rights in China, “Civil Society Responses to Cao Shunli’s Death,” last visited 25 March 14. (https://www.hrichina.org/en/civil-society-responses-cao-shunlis-death)

[38] “Cao Shunli’s Colleague Liu Xiaofang Criminally Detained” [Cao shunli de dadang liu xiaofang bei xingshi juliu], 19 March 14. (https://www.canyu.org/n86113c6.aspx)

[39] Chinese Rights Defenders, “Rights Defender Cao Shunli’s Body Remains Missing, Lawyer Wang Yu Threatened” [Renquan hanweizhe cao shunli yiti zhijin xialuo buming, lushi wang yu zao weixie], 26 March 14; (https://wqw2010.blogspot.com/2014/03/blog-post_6978.html) Chinese Human Rights Defenders, “Police Label Tianjin Petitioners Gathering To Mourn Death of Cao Shunli ‘Disturbers of the Peace’” [Tianjin fangmin jihui daonian cao shunli nushi zao jingfang chuanhuan ganrao], 21 March 14; (https://wqw2010.blogspot.com/2014/03/blog-post_7967.html) Chinese Human Rights Defenders, “Beijing Rights Defender Ma Xinli Detained Again for Raising Banner” [Beijing weiquan renshi ma xinli yin jupai zai ci zaodao juya], 16 March 14; (https://wqw2010.blogspot.com/2014/03/blog-post_8448.html)”Chinese Activists Who Protested Dissident’s Death Under House Arrest,” Radio Free Asia, 18 March 14. (https://www.rfa.org/english/news/china/activist-03182014200659.html

[40] Didi Kirsten Tatlow, “U.N. Delays Action on China’s Rights Report,” New York Times, Sinosphere (blog), 20 March 14. (https://sinosphere.blogs.nytimes.com/2014/03/20/u-n-delays-action-on-chinas-rights-report/)