lethal in disguise - the health consequences of crowd-control weapons

8/19/2019 Lethal in Disguise - The Health Consequences of Crowd-Control Weapons

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LETHALIN DISGUISE

THE HEALTH CONSEQUENCES OFCROWD-CONTROL WEAPONS


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The International Network of Civil Liberties Organizations (INCLO) is comprised of 11independent, national human rights organisations working to promote fundamentalrights and freedoms by supporting and mutually reinforcing the work of the memberorganisations working in their respective countries, and by collaborating on a bilateral andmultilateral basis. The members of INCLO are: the American Civil Liberties Union (ACLU),the Association for Civil Rights in Israel (ACRI), the Canadian Civil Liberties Association(CCLA), Centro de Estudios Legales y Sociales (CELS) in Argentina, the Egyptian Initiativefor Personal Rights (EIPR), the Human Rights Law Network (HRLN) in India, the HungarianCivil Liberties Union (HCLU), the Irish Council for Civil Liberties (ICCL), the Kenya HumanRights Commission (KHRC), the Legal Resources Centre (LRC) in South Africa, and Libertyin the United Kingdom. Each organisation is multi-issue, multi-constituency, domesticin focus, and independent of government, and advocates on behalf of all persons inits country through a mix of litigation, legislative campaigning, public education, andgrassroots advocacy.

Police brutality and social protest are priority areas for INCLO. INCLO members havepartnered to advocate against government and police repression of social protests andhuman rights activism. INCLO also seeks to promote and protect the right to protest bycombining technical work – compilation of standards and analysis – with the creation ofmaterial intended for a wider audience. In 2013, INCLO published its rst report, “TakeBack the Streets: Repression and Criminalization of Protest around the World.” The reportcompiles case studies describing how police have responded to social protests in dissimilarpolitical contexts. At the same time, it draws out common trends and underlying problemsthat exist around the world and, in doing so, highlights opportunities to inuence legalprocesses at the international and national levels.

The current report has been a collaborative effort between PHR and 10 members of INCLO.The organisations that participated in the elaboration of this report are the ACLU, ACRI,CCLA, CELS, EIPR, HCLU, HRLN, ICCL, KHRC, and LRC. Liberty is not an author or party tothe report.

ABOUT INCLO

For nearly 30 years, Physicians for Human Rights (PHR) has used science and medicine todocument and call attention to mass atrocities and severe human rights violations. PHR isa global organisation founded on the idea that health professionals, with their specialisedskills, ethical duties, and credible voices, are uniquely positioned to stop human rights

violations. PHR’s investigations and expertise are used to advocate for the protectionof persecuted health workers, to prevent torture, document mass atrocities, and holdthose who violate human rights accountable. In 1999, PHR led the effort to develop theinternationally recognised guidelines on the Effective Investigation and Documentationof Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment, known asthe Istanbul Protocol.

PHR has assessed the health effects of crowd-control weapons (CCWs) in a number of places,including Bahrain, Egypt, the Occupied Palestinian Territory (OPT), South Korea, Thailand,and Turkey. PHR studies have documented severe injuries due to birdshot and rubberbullets in Panama and OPT, abuse of tear gas posing risks to health in Bahrain, South Korea,and Turkey, and beatings using batons and sticks. Through direct examination of victims,desk research, and scientic evaluation of weaponry and its potential consequences (both

when used appropriately and inappropriately), PHR has brought relevant information toadvocates and policy-makers seeking to curtail responses by police and security forcesthat not only suppress lawful dissent, but also harm human health.

ABOUT PHR

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EXECUTIVE SUMMARY

ACKNOWLEDGMENTS

1. INTRODUCTION

2. BACKGROUND

3. CROWD-CONTROL WEAPONS AND THEIR IMPACT ON HEALTH

4. CONCLUSION AND RECOMMENDATIONS

ENDNOTES

TABLE OFCONTENTS

3.1 KINETIC IMPACT PROJECTILES

Egypt: The Case of Shaimaa’ El-Sabbagh, Killed by Birdshot

South Africa: The Death of Andries Tatane

Israel: The Prohibition of Rubber-Coated Bullets

Argenti na: Police Use of Rubber Bullets at the Borda Hospital

3.2 CHEMICAL IRRITANTS

Kenya: #OccupyPlayground – Excessive Force in the Quelling

of a Public Demonstration at Langata Road Primary School

Egypt: The Case of the Abu Zaabal Police Van

Hungary: Police Attack on Protesting Refugees

3.3 WATER CANNONS

Israel: The Skunk – a Humiliating Weapon

England: The Campaign against Water Cannons

3.4 DISORIENTATION DEVICES

Canada: Stun Grenade Blinds Student Protester

South Africa: The Use of Stun Grenades at Marikana

3.5 ACOUSTIC WEAPONS

Acoustic Weapons in t he Unite d States: From the G20

Summit to the Black Lives Matter ProtestsCanada: Authorising the Use of LRADs at the G20 Summit

3.6 DIRECTED ENERGY WEAPONS

United States: Militarised Police Response to Protests

in Ferguson, Missouri

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In recent years, there has been a rise in thenumber of popular protests in which peoplehave taken to the streets to express grievancesand claim their rights. In many cases, policeand security forces have responded in waysthat profoundly undermine the fundamentalrights to freedom of peaceful assembly andfreedom of expression, often leading toescalations in violence through unwarranted,inappropriate, or disproportionate uses offorce. Law enforcement throughout the

world is increasingly responding to popularprotests with crowd-control weapons (CCWs).The proliferation of CCWs without adequateregulation, training, monitoring, and/oraccountability, has led to the widespreadand routine use or misuse of these weapons,resulting in injury, disability, and death. There isa signicant gap in knowledge about the healtheffects of CCWs and an absence of meaningfulinternational standards or guidelines aroundtheir use. As a result, the International Networkof Civil Liberties Organizations (INCLO) andPhysicians for Human Rights (PHR) partneredto document the health consequences of CCWsand examine their roles and limitations inprotest contexts and make recommendationsabout their safe use.

This report aims to raise awareness about themisuse and abuse of CCWs, the detrimentalhealth effects that these weapons can have,and the impact of their use on the meaningfulenjoyment of freedom of assembly andexpression. We also seek to foster a globaldebate to develop international standards andguidelines. Ultimately, our goal is to prevent

injury, disability, and death by providinginformation about CCWs and insisting on theirsafe use.

The misuse of CCWs and the human rightsconcerns that arise from this misuse arethe result of a number of factors, the mostsignicant of which are: gaps in internationalstandards and regulations; insufcient testing,training, and regulations; a rapidly-growingindustry; and a lack of accountability.

There are many agrant examples of the misuseof CCWs, some of which are documented incase studies included in this report. In Kenya,

EXECUTIVESUMMARY

ve children and one police ofcer were injuredin a stampede resulting from tear gas beingred directly at schoolchildren protesting theseizure of a playground. In the United States,police intervention in the Black Lives Matterprotests included the indiscriminate use of teargas, disorientation devices, acoustice devices,beanbag rounds, and rubber bullets. In Egypt, apolice ofcer was caught on video deliberatelyring pellets at protesters’ upper bodies in orderto maximise injury. These troubling case studies,and others, are included throughout this reportto put the medical evidence into context.

The report examines six kinds of CCWs usedinternationally: kinetic impact projectiles(KIPs), chemical irritants, water cannons,disorientation devices, acoustic weapons, anddirected energy devices. The health effectsof kinetic impact projectiles and chemicalirritants are described in signicant detail;these are the two weapon types about whichthere is a critical mass of data to analyse.The following systematic reviews evaluatedpublished and grey literature released betweenJanuary 1, 1990 and March 31, 2015.

KINETIC IMPACT PROJECTILES: The ndingsof a systematic review of medical literatureindicate that KIPs cause serious injury,disability, and death. Our study identied 1,925people with injuries from KIPs; 53 of theseindividuals died from their injuries and 294suffered permanent disabilities. Of the injuries,70 percent were considered severe. The datademonstrates that severe injuries are morelikely when KIPs are red at close range; some

types of KIPs have the same ability to penetratethe skin as conventional live ammunition andcan be just as lethal. When launched or redfrom afar, these weapons are inaccurate andstrike vulnerable body parts, as well as causeunintended injuries to bystanders. Therefore,there are signicant doubts that these weaponscan be used in a manner that is simultaneouslysafe and effective.

CHEMICAL IRRITANTS (commonly referred toas “tear gas”) include a variety of chemicalcompounds intended to irritate the senses.The general perception is that these weaponshave mostly short-term effects that include

irritation of the eyes, dermal pain, respiratorydistress, and the psychological effects ofdisorientation and agitation. A systematicreview of medical literature documenting thehealth effects of chemical irritants identied5,131 people who suffered injuries; two ofthese people died and 70 suffered permanentdisabilities. Out of 9,261 documented injuries,8.7 percent were severe and requiredprofessional medical management, 17 percent

were substantial, and 74.2 percent were minor.In a number of instances of injury, and in oneof the two documented deaths, the canisterthat contains the gas form of chemical irritants

was the cause of injury or death. The canisterscaused traumatic injuries to the head, neck, andtorso, as well as neurovascular injuries to theextremities. Eye injuries from the canister allled to permanent vision loss, most often fromglobe rupture. While chemical irritants areoften thought of as causing minimal transientharm, the ndings identify concerning levels ofmorbidity and even instances of death causedby these weapons.

Although signicant medical literature on thehealth effects of water cannons, disorientationdevices, acoustic weapons, and directed energy

weapons is not available, case studies involvingthese weapons demonstrate their capacity forcausing signicant harm to protesters.

WATER CANNONS are inherently indiscriminate,particularly at long distances. Practically, theycan make communicating with protestersvery difcult, and their intimidating size andappearance may cause panic and lead to

stampedes amongst protesters. The use ofcoloured dyes or malodorants in conjunction

with a water cannon is a form of collectivepunishment that serves to highlight thepotential for abuse of these weapons.

DISORIENTATION DEVICES, also known as ash-bang or stun grenades, create a loud explosionand/or a very bright ash of light. They aremade of both metal and plastic parts that mayfragment during the explosion, and thereforecarry risks of blast injuries. Explosions thatoccur from close proximity can lead toamputation, fractures, and other seriousinjuries. There are frequent news reports and

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anecdotal evidence of injuries and deaths from these weapons,including reports of injuries to military, corrections, and policeofcers while handling the devices. These weapons have noplace in effective crowd management, intervention, and control.

ACOUSTIC WEAPONS, sometimes called sound cannons or soniccannons, emit painful, loud sounds that have the potential tocause signicant harm to the eardrums and delicate organs of theears, and may cause hearing loss. There is little medical literatureon the effects of these weapons; serious questions remain abouttheir safety and efcacy in crowd-control contexts.

DIRECTED ENERGY WEAPONS are electromagnetic heatingdevices that deliver very high-frequency millimetre wavelengthelectromagnetic rays that heat skin on contact and cause a painful,burning sensation. These have not been used in practice, and

there has been no assessment of their safety in crowd-controlsettings. Existing information identies concerns about tissueinjury, particularly with prolonged exposure or exposure tovulnerable organs such as the eye. Moreover, there are practicalconcerns that the use of an invisible but very painful weaponcould exacerbate mistrust of government forces.

INCLO and PHR believe that the use of CCWs in assemblies shouldbe a last resort and must always meet the tests of proportionality,necessity, legality, and accountability. The fact that an assemblymay be considered unlawful does not justify the use of CCWs.In any event, the explicit goal of any intervention in a protestsituation should be to de-escalate the situation and promoteand protect the safety and the rights of those present.

In light of the evidence gathered in this report, INCLO andPHR have proposed a number of recommendations aboutpre-deployment of weapons, deployment of weapons,and post-deployment. At the pre-deployment stage, ourrecommendations relate to weapon design, manufacture, trade,procurement, selection, testing, and training. Recommendations

for the deployment and use of CCWs include guidelines specicto the six different types of weapons examined in this report.At the post-deployment stage, we make recommendations forensuring medical assistance for those impacted by CCWs, andfor obtaining accountability for the use of CCWs.

The purpose of the recommendations, which can be found insection 4, is to reduce injuries, disabilities, and death caused byCCWs, to encourage the creation of international guidelines forthe use of CCWs, to ensure protection of the rights to freedomof assembly, association, and expression, and to develop safepractices for the occasions where these weapons are deployed.

GALI TIBBON/AFP/GETTY IMAGES

Right: Riot police in Buenos Aires, Argentina use water to enter a cultural centre and end theoccupation of one of the rooms, Sala Alberdi. The room was occupied for close to two months in

protest after a the mayor announced that the centre would be closed. (March 12, 2013) M.A.ƒ.I.A. (MOVIMIENTO ARGENTINO DE FOTÓGRAFXS INDEPENDIENTES AUTOCONVOCADXS)

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ACKNOWLEDGMENTSThe report was written by Rohini J. Haar, MD, MPH, research fellow, HumanRights Center, University of California, Berkeley, and clinical faculty, Departmentof Emergency Medicine, Highland General Hospital and Kaiser Medical Center,Oakland, California; and Vincent Iacopino, MD, PhD, medical d irector, Physiciansfor Human Rights, adjunct professor of medicine, University of Minnesota MedicalSchool, and senior research fellow, Human Rights Center, University of California,Berkeley.

The primary editors of the report were Cara Zwibel (director, FundamentalFreedoms Program, CCLA), Anne Suciu (attorney, Human Rights in East JerusalemProject, ACRI), Karim Ennarah (researcher on criminal justice and policing, EIPR),Luciana Pol (senior fellow security policy and human rights, CELS), and LucilaSantos (program coordinator, INCLO).

This report is based on research conducted by Rohini J. Haar, MD, MPH; NikhilRanadive, MS, medical student, Emory University; Vincent Iacopino, MD, PhD;Madhavi Dandu, MD, MPH, associate professor of medicine, UCSF; and Sheri

Weiser, MD, MPH, associate professor of medicine, D ivision of HIV/AIDS andCenter for AIDS Prevention Studies, UCSF.

INCLO is also grateful to Jennifer Turner (ACLU), Camila Maia (CELS), MarcelaPerelman, (CELS), Manuel Tufró (CELS), Szabolcs Hegyi (HCLU), Pia Janning (ICCL),

Andrew Songa (KHRC), and Michael Power (LRC) for their contributions andreviews to this report.

This report was also reviewed and edited by Physicians for Human Rights leadershipand staff, including Donna McKay, MS, executive director; Widney Brown, JD,director of programs; DeDe Dunevant, director of communications; and ElizaB. Young, MA, former publications coordinator. It was edited and prepared forpublication by Claudia Rader, MS, content and marketing manager.

This report has beneted from external review by Michele Heisler, MD, MPA,Physicians for Human Rights (PHR) volunteer medical advisor, PHR board member,and professor of internal medicine and health behavior and health education atthe University of Michigan Medical School.

INCLO thanks Taryn McKay for design and photo editing and Marg Anne Morrison

for copyediting.

INCLO is grateful to the Open Society Foundations and the Ford Foundation fortheir generous support of its work in this area.

PHR’s research was funded with the generous support of the OpenSociety Foundations.

BRENDAN HOFFMAN/GETTY IMAGES

Left: Berkut riot police shoot rubber bullets toward anti-government protesterson Independence Square on February 19, 2014 in Kiev, Ukraine.

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1.0

INTRODUCTIONRespect for freedom of expression and assembly is one of the key indicatorsof a government’s respect for human rights1, and one of the pillars ofmodern participatory democracy. When people exercising their freedomof expression challenge or criticise government, or demonstrations areorganised to oppose government policy or leaders, or even powerful non-state actors, state respect for the exercise of these fundamental freedomsmay rapidly decline. In recent years, there has been an increase in the numberof popular protests in which people have taken to the streets to expressgrievances and claim their rights. These protests have swept across the globe,leaving no continent untouched. In many cases, police and security forceshave responded in a manner that profoundly undermines fundamentalhuman rights, including freedom of peaceful assembly and freedom ofexpression, among others – often leading to escalations in violence throughunwarranted, inappropriate, or disproportionate uses of force. This trend isnot exclusive to authoritarian governments; democratic governments haveresponded in a similar or problematic manner to acts of protest.

Crowd-control weapons (CCWs) have increasingly been used in the responseby law enforcementa to these popular protests, mainly through interventionsconsisting of large-scale crowd dispersal operations using these weapons

indiscriminately. Also known as “riot-control weapons,” “non-lethal,” “lesslethal,” or “less than lethal” weapons, CCWs include chemical irritants, kineticimpact projectiles, acoustic weapons, water cannons, stun grenades, electricalconduction devices, and directed energy weapons, among others. We employthe term “crowd-control weapons” (CCWs) to denote both the weaponsbeing discussed and the context of their use that is being examined. CCWs

a Throughout this report, we use the term “law enforcement” to encompass a broad denition of police andsecurity forces. In particular, we rely on the denition of “law enforcement ofcials” used in the Basic Principleson the Use of Force and Firearms by Law Enforcement Ofcials, which “includes all ofcers of the law, whetherappointed or elected, who exercise police powers, especially the powers of arrest or detention. In countries where police powers are exercised by military authorities, whether uniformed or not, or by State securityforces, the denition of law enforcement ofcials shall be regarded as including ofcers of such services.”M.A.ƒ.I.A. (MOVIMIENTO ARGENTINO DE FOTÓGRAFXS INDEPENDIENTES AUTOCONVOCADXS)

Left: A woman in the protest against the closure of Sala Alberditries to talk to the anti-riot unit police, March 12, 2013

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are marketed as devices that are less lethal thanconventional weapons, aimed at minimisingthe risk of permanent injury or death whileeffectively maintaining public order. However,the use of these weapons in protests acrossthe world has been shown to result in frequentinjury, disability, and even death. In this regard,CCWs are often wrongly perceived by lawenforcement agencies as being safe and notdeadly, and they are therefore widely condonedfor use to disperse demonstrations. We haveseen many instances in which they are used astools of political repression to deter, demoralise,intimidate, injure, and kill protesters rather thanas tools for safer crowd management.

There are many agrant examples of the misuseof CCWs. In 2015, ve children and one policeofcer were injured in a stampede caused whentear gas was red directly at schoolchildrenat the #OccupyPlayground protest against theseizure of a playground by private developers inKenya.2 In 2014, in the Black Lives Matter protestsin Ferguson, Missouri, United States, the policeintervention included the indiscriminate use oftear gas, disorientation devices, acoustic devices,beanbag rounds, and rubber bullets, causinginjuries to protesters and journalists coveringthese events.3 In 2013, rubber bullets were redagainst protesters inside a psychiatric hospitalin Argentina, causing serious injuries amongjournalists, legislators, hospital workers, andpatients residing in the hospital. The infamous“Eye Sniper” case in Egypt in 2011, in which apolice ofcer was caught on video deliberatelyring pellets at the upper bodies of protestersin order to maximise injury, demonstrates

the problems associated with kinetic impactprojectiles.4 Other forms of misuse include theexcessive deployment of tear gas canisters forseveral days or weeks at a time, and the use oftear gas in water cannons, among others.

These cases and others point to a growingtrend of law enforcement using CCWs againstcrowds in inappropriate, unnecessary, anddisproportionate ways, causing serious andeven fatal injuries. However, there is verylittle information on how these weaponsshould be used and on their potential healthimpacts. Despite their long-standing presence,the use and misuse of these weapons, and

the health consequences thereof, have notbeen systematically studied or documented.Manufacturers provide limited information onthe intended use of CCWs and their possibleadverse health effects and most law enforcementagencies collect only limited information onuse-of-force incidents involving CCWs. If theydo collect data, it is rarely publicly available.

Against this background, the InternationalNetwork of Civil Liberties Organizations (INCLO)and Physicians for Human Rights (PHR) havepartnered to document the health consequencesof CCWs. PHR applied its deep medical andscientic expertise to the systematic review ofthe published medical literature and producedan analysis of the weaponry and its potentialconsequences. INCLO, through its networkof national civil liberties and human rightsorganisations, contributed its broad knowledgeof police brutality, social protest issues, and on-the-ground human rights challenges.

The present report is the result of this partnership.It gathers and analyses the existing medicalliterature on CCWs in order to contribute to thesignicant gaps in knowledge and informationon this issue. The report reviews different typesof CCWs, how they work, and the impact of theiruse on human health. Each section includescase studies from INCLO member countriesdescribing instances when CCWs have beenutilised against protesters and/or duringdemonstrations. METHODOLOGY AND LIMITATIONS

The ndings in this report are based onresearch conducted by PHR from September2014 to May 2015. PHR sought to triangulateexpert eld experience on the use of CCWsand the legal frameworks under which these

weapons are used with medical literature onrelated injuries. First, PHR conducted a semi-structured survey among INCLO memberorganisations and other civil liberties andhuman rights experts. The survey identiedthe weapons commonly employed, assessedthe conditions under which these weaponsare used in different countries, and identiedthe key concerns of stakeholders. Second,PHR conducted extensive research on six

commonly used CCWs: chemical irritants,kinetic impact projectiles, acoustic weapons,

water cannons, stun grenades, and directedenergy weapons.b Research topics included ahistory of the weapons’ use, how they work,and an analysis of the harms produced by theiruse. Finally, PHR conducted a literature reviewof publications on the health impacts of these

weapons published over the past 25 yearsand analysed all relevant data, including theseverity of the injuries caused by the weaponsand different factors affecting their severity.c

A systematic review was conducted for themost commonly used weapons: chemicalirritants and kinetic impact projectiles.d Titles and abstracts of all identied articles

were reviewed and several hundred full textarticles were read to identify all injury datathat met the inclusion criteria and that were ofsufcient quality. Injury data from the selectedstudies (31 studies on chemical irritants and24 studies on kinetic impact projectiles) wascollected for analysis. For the other weaponscategories, there is limited published data forreview; in these cases, additional case-seriesanalysese were used in documenting theirhealth effects. Analysis was conducted withthe understanding that the published literaturedoes not document the entire scope of injuriesfrom CCWs, but provides insight into the rangeof potential injuries.

The absence of a systematic reportingrequirement for deaths and injuries in crowd-control settings makes it likely that the healthoutcomes in the medical literature and in case

studies largely underestimate the prevalenceof deaths and injuries.

This report has multiple goals and objectives:

• To protect the rights to life (Art. 6), libertyand security of the person (Art. 9), dignity(Art. 10), and freedom of expression (Art.19), assembly (Art. 21), and expression (Art.22), as provided for in the InternationalCovenant on Civil and Political Rights (1966);

• To raise awareness about the misuse and/or abuse of CCWs and the detrimentalhealth effects that these weapons can have;

• To foster a global debate in order to developinternational standards and guidelinesand promote appropriate domestic stateregulations on the proper use of CCWs;

• To promote the establishment ofregulations for manufacturers; and

• Ultimately, to prevent injury, disability,and death by providing information andinsisting on the safe use of CCWs.

This report is the rst of which we are awarethat closely examines the medical knowledgeon the effects of CCWs; it also highlights howmuch is still not known, not reported, and notbeing studied in this area.

b Tasers are one of the most commonly used less lethal weapons. However, they were not included in this study because while they have beendeployed in protest contexts, they are generally used for the purposes of subduing and detaining an individual and not for the purposes ofmanaging or controlling a crowd.c The injuries were classied as minor, moderate, or severe, based on the acuity and the resources required to manage that injury. Minorinjuries were transient symptoms that may not have been present on physical exam or were expected side effects of the weapon (for example,lacrimation, mild respiratory distress, sore throat, or nausea caused by chemical irritants). Moderate injuries were those that were unexpectedfrom previous published data on the weapon, were evident on physical exam, or lasted longer than expected, but may not have required healthprofessional management (for example, persistent skin rashes, rst-degree burns or persistent respiratory symptoms caused by chemicalirritants). Severe injuries were injuries that required professional medical care (for example, lacerations requiring sutures, second- or third-degree burns, airway obstruction, or severe ocular trauma caused by chemical irritants). Injury data was only included if it was documented bya medical professional. Injuries reported by patients, without any documentation, were excluded.d A systematic review of the literature is a rigorous methodology to identify literature on a subject. The PHR team adhered to standard guidelineson the development of a systematic review protocol. PHR used multiple search engines to identify all possible relevant data on injuries andhealth impacts of CCWs.e This refers to review and analysis of compilations of injuries prepared by other groups, and found in other sources, including news reports,government reports, and medical literature.

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BACKGROUNDIn order to understand why crowd-control weapons are being misusedin a manner that violates basic human rights, multiple factors must beconsidered. The most important factors that we have identied are: gapsin international standards and regulations; insufcient testing, training,and regulations; a rapidly growing commercial weapons industry; andlack of accountability.

GAPS IN INTERNATIONAL STANDARDS AND REGULATIONS

Unfortunately, international mechanisms have not kept pace with the rapiddevelopment of crowd- control technologies and techniques.5 Internationalstandards addressing the use of CCWs are very limited and there are nolimitations on the kinds of weapons that may be used in demonstrations,or on the manufacture and trade of CCWs.6 The lack of evidence-based regulations on the use of CCWs is exacerbated by the relativelyunderdeveloped standards on: how to effectively police protests; how toisolate small pockets of protesters who may turn violent without resorting tothe use of indiscriminate force; how to prevent escalation and confrontationbetween protesters and the police or security forces; and how to mitigate anyharm or injury when it is necessary to use force – among other issues relatedto the policing of protests.

Most weapons conventions do not specically deal with CCWs, and thosethat do mention CCWs do not provide necessary guidance and regulationsas to their use. For example, although the Chemical Weapons Convention(CWC)7 prohibits the use of riot-control agents (RCAs) in warfare, their useis permitted for “Law enforcement including domestic riot control purposes… as long as the types and quantities are consistent with such purposes.”Unfortunately, neither the CWC nor the Organisation for the Prohibition ofChemical Weapons clarify what restrictions are placed on the use of RCAsin riot settings, and the use of these agents is not included in current CWCmonitoring and reporting practices.

Left: “Day of Rage” protest against the Israeli government plan to displace more than40,000 Bedouin from the Negev (“Prawer-Begin Plan”), Hura, Israel, November 30, 2013ACTIVESTILLS

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Existing international standardsf outlineprinciples on police interventions, particularlyon the use of force, and are applicable to socialprotests. However, these are not sufcient:while the United Nations

Basic Principles on the Use of Force andFirearms by Law Enforcement Ofcials (“UNBasic Principles”)8 and the Code of Conduct forLaw Enforcement Ofcials (“Code of Conduct”)9 provide some basic and general principles onthe use of force, these standards are largelyoutdated and do not account for the rapiddevelopments in crowd-control technology.g The UN Basic Principles have also been criticisedfor lacking “clarity and precision, and that theirbroad provisions are not easily translatable intoconcrete, practical guidelines that can be readilyapplied at the domestic level.”10 In addition, theydo not benet from an ofcial commentary, asdoes the Code of Conduct. As noted by the UNSpecial Rapporteur on extrajudicial, summary,or arbitrary executions, Christof Heyns: “Someof the principles are also redundant. It has beenpointed out that the [UN] Basic Principles do notdene concepts such as ‘force’ or ‘rearms’, andpose general standards, as opposed to concreteaction guidelines.”11

However, these standards, coupled with caselaw, do provide some limited guidance on theuse of force. For example, any use of force mustalways be limited by the principles of necessity,proportionality, legality, and accountability.h Further, all actions must aim to protect andpreserve human life and dignity.12 Moreover,before law enforcement ofcials resort to force

when dealing with protests, they must attemptto use nonviolent means – such as presence,dialogue, information, and de-escalation.Another basic principle that is, unfortunately,too often violated during assemblies states thatin the dispersal of assemblies, law enforcementofcials shall avoid the use of force, or, wherethat is not practicable, shall restrict such forceto the minimum extent necessary.13

In addition, the UN Basic Principles, whichproblematically refer to CCWs as “non-lethalweapons,” thereby failing to acknowledge theirpotential lethality, encourage states to adoptCCWs in order to enable a graduated response

in the use of force and to offer a less injuriousalternative to more deadly equipment currentlyin use. However, these recommendations fallshort of outlining appropriate guidelines fortheir use, including when and how to use, ornot use, CCWs. In this regard, Resolution 25/38,adopted by the UN Human Rights Council in

April 2014, went a little further on this issueby encouraging “States to make protectiveequipment and non-lethal weapons availableto their ofcials exercising law enforcementduties, while pursuing international efforts toregulate and establish protocols for the trainingand use of non-lethal weapons.” 14

In fact, this same resolution on promotion andprotection of human rights in the context ofpeaceful protests acknowledges the gap onstandards and guidelines on policing protests;it thus requests that the Special Rapporteuron the rights to freedom of peaceful assemblyand of association, Maina Kiai, and the SpecialRapporteur on extrajudicial, summary, orarbitrary executions, Christof Heyns, compilepractical recommendations for the propermanagement of assemblies, based on bestpractices and lessons learned, and submitthis compilation at the Council’s 31st sessionin March 2016. This initiative promotes thecreation of stronger, detailed standards andguidelines on the use of force in the context ofsocial protest, providing a unique opportunityfor human rights and civil liberty organisationsto make recommendations based on their

years of monitoring violations of the right topeaceful assembly.

INSUFFICIENT TESTING, TRAINING,AND REGULATIONS

While CCWs may theoretically offer an optionfor reduced force, in practice, and perhapsbecause of the assumption that they are alwaysless lethal, the weapons are often used in anindiscriminate manner, without exhausting allother possible peaceful means rst. This is due,in large part, to inadequate pre-deploymenttesting, insufcient training, lack of regulations,and poor accountability mechanisms.

Training of law enforcement ofcials shouldinclude training not only on how to use

CCWs but also on how to use these weaponsin the context of a demonstration, whereconditions can be more adverse and sensitive.Crowd dynamics are often chaotic and lawenforcement ofcials should be trained to deal

with these conditions. Regulations and operational guidelines orprotocols are also an important aspect ofgood police practice. In principle, these mayexist, but they may not be publicly available,may be outdated, and may lack provisions fornewer CCW technologies. In other cases, nosuch regulations exist. Moreover, guidelinesand standard operating procedures are oftenindustry-driven and the people designing(and proting from) weapons are the onesdetermining how they should or should notbe used. RAPIDLY GROWING COMMERCIALWEAPONS INDUSTRY

While the absence of standards, guidelines,and regulations remains static, the supplyand demand for CCWs continues to grow andexpand. CCW development has spread acrossthe globe during the last two decades and thenumber of companies that manufacture andtrade in these weapons has greatly increased.15

While traditional manufacturers continue todevelop CCWs (in France, Germany, Israel,the United Kingdom, and the United States),new companies are emerging globally, withproduction now occurring in more than 50countries. The increase in the use of forceduring protests may be explained by the

rapidly growing supply of CCWs, which makes weapons cheaper for various law enforcementunits to purchase and then utilise withlittle provocation. As CCWs are becomingincreasingly affordable, law enforcementunits and governments are demanding moremunitions, further expanding the market.16 In

this regard, the report submitted by ChristofHeyns on April 1, 2014, notes that “the growing,largely self-regulated market of ‘less lethal

weapons’ cannot solely determine policing weapons technology, especially when it couldinvolve unacceptable human cost.”17

LACK OF ACCOUNTABILITY

An effective accountability mechanism is akey element in promoting appropriate crowdmanagement techniques and the proportionateuse of force by law enforcement. Unfortunately,in most cases, there are no efcientaccountability mechanisms in place. Even incountries in which an external police oversightagency exists, it is usually too weak and lacks thenecessary powers, resources, independence,and transparency to be effective.

The prosecution and conviction of lawenforcement ofcials who use CCWs in anunlawful or excessive way is rare. In addition,there has been a dearth of administrativedisciplinary measures taken against lawenforcement ofcials who misuse CCWs. InSouth Africa, for example, there were 204crowd-control-related complaints lodgedagainst law enforcement between 2002 and2011, but only 85 cases were investigated, andonly one police ofcer was convicted.18 Theperception of CCWs as non-lethal mechanismsresults in weaker controls on their use: weaponsand munitions registries are often not keptor they are concealed. In some cases, post-incident documentation is limited to recordingmunitions discharge, while detailed recording

of incidents and of injuries is absent. Mostof this information, if available, is concealedfrom the public or from independent expertsand monitors. This renders accountabilitymeasures impossible or ineffective.

f According to the Omega and Amnesty International report: “Restrictions on the use of force derive from the Convention against Torture (CAT)and the International Covenant on Civil and Political Rights (ICCPR), as well as in the BPUFF, the UN Code of Conduct for Law Enforcement Of-cials (CCLEO), and the UN Standard Minimum Rules for the Treatment of Prisoners (SMRs). Such treaties and standards play a key role in settingout universal guidelines for the use of weapons and restraints by police and correctional ofcers.”g The UN Basic Principles and the Code of Conduct were approved in 1990 and 1979, respectively.h The four basic principles are included in various national codes of conducts and standard operating procedures for police forces. The prin-ciple of necessity emphasises that use of force should always be considered an exceptional measure. Proportionality means that use of forcemust be proportionate to the lawful objective to be achieved and to the seriousness of the offence. Law enforcement agencies must ensurethat their actions conform to national laws and regulations, and to international human rights standards, and that they are accountable throughadequate reporting and review procedures.

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Kinetic impact projectiles (KIPs), oftencalled rubber or plastic bullets, are regularlyused in crowd-control settings around the

world. These weapons, initially designedby the military, were developed in an effortto allow security and law enforcementpersonnel to keep physical distancebetween them and the individual or groupthey were trying to control.

Early forms of KIPs used in protests weresawed-off pieces of wooden broom handlesthat were shot at rioters in Singapore in the1880s. In the 1960s, slightly more advanced

wooden bullets were developed by Britishcolonialists and used against protestersin Hong Kong, Malaysia, and Singapore.The British then developed rst wooden,then plastic polyvinyl chloride (PVC) andrubber bullets for use in Northern Ireland.The United States began using rubber andplastic bullets during Vietnam War protests,but, after a fatality in 1971, halted their usein protest settings until the early 1980s,

when they were gradually reintroduced.

Over the past 30 years, production of KIPshas spread from a few manufacturers inthe United States and United Kingdom todozens of producers throughout the world.Manufacturers now develop more than 75different types of bullets and launchers in a

variety of locations.19

Projectiles are made from combinationsof rubber, plastic, PVC, various metalsincluding lead and steel, wood, hard foam,and wax. Some bullets are designed to bered as a single missile, while others arered as a group of pellets. The latter aresometimes known as “shot,” where manysmall- to medium-sized pellets are redat a broad target, or as “bean bag rounds,”

where small lead pellets are stitched intoa synthetic cloth bag. Newer weaponsinclude projectiles with a hard outershell coating tear gas or pepper spray thatexplodes upon impact, or “attenuatedenergy projectiles,” where a hollow tip canlimit the risk of ricochet or penetration.

WEAPON PROFILE

3.1

KINETICIMPACTPROJECTILES ILLUSTRATION BY KALE VANDENBROEK

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MECHANISM OF ACTION A projectile weapon works by transferring kineticenergy (i.e., energy from movement) from a

weapon into a person. KIPs are purportedlydesigned to inict pain and incapacitate anindividual without the projectile penetrating intothe body; however, as described below, their usehas resulted in serious injury, permanent disability,and, in some cases, death. The effect of the KIP

will vary depending on the ty pe of projectile andthe type of launcher used; there is a wide varietyof both in the general category of KIPs. Projectilescan be classied as high- or low-energy, exibleor non-exible (rigid), single or multiple, direct-or indirect-re, or by method of delivery. Thosecommonly used in crowd-control settings globallyinclude: rubber bullets, plastic bullets, bean bagrounds, birdshot, buckshot, rubber-coated metalbullets, and sponge bullets.

The projectile’s force depends on a number offactors, including its size and speed. In addition,the shape of the projectile, its ability to breakapart, the number of projectiles red at once, andthe direction in which they are red can all impacthow the projectile functions. The projectile canbe designed with a large surface area to reducethe chances of skin penetration, or as a lighterobject that will quickly lose speed while in ight.

A launcher or gun can propel the projectile at acertain speed or change its rotation or ight pathto reduce its force on impact. However, some of

these projectiles have muzzle velocities similar tothat of live ammunition. As a result, close-rangering of a KIP results in injury patterns similar tothose seen with live ammunition, causing severeinjuries and disabilities. It is important to notethat while factors such as a large surface area mayreduce the risk of skin penetration, they increasethe inaccuracy of the weapon. KIPs, therefore,are not only likely to be lethal at close range, butare likely to be inaccurate and indiscriminateat longer ranges, even those recommended bymanufacturers for safety.

KIPs are intended to allow law enforcement or securitypersonnel to gain control of a situation, or over anindividual or group, while minimising the chanceof death. The nature of the weapon and projectileis supposed to limit penetrating or life-threateninginjuries; however, the designs that are required toslow down the projectile before it hits a person usuallymake the weapon less accurate. Unlike a traditionalbullet, KIPs tend to be oddly shaped or large, whichcauses tumbling rather than d irect forward movement.Put simply, while losing speed (to lessen the risk ofpenetrating injury) KIPs often also lose accuracy.

There is little or no published research on the safetyof KIPs, how they were designed, or the type ofsafety testing they have undergone and under whatconditions. Overall, there is a lack of transparency bythe manufacturers. There are dozens of weapon typeson the market, including projectiles and launchers,each with their own safety features and requirements.This variety of weapon types can generate considerableconfusion about their proper use. Lack of transparencyon the part of manufacturers also limits informationthat health care providers can use in assessing injuries.

KIPs are marketed to military, police, and private securityforces in nearly every country, with little or no regulatoryoversight or accountability. Guidelines on the use ofKIPs, from police and military or by manufacturers, arenot usually publicly available. Use-of-force guidelinesthat are available generally recommend that KIPs beused only for individual force-control rather than ongroups of people. They also indicate that when KIPs areused, they should not target vital areas of the body, and,instead, should be aimed at the legs . Firing these weaponsin the air or at the ground should also be avoided, as thiscould result in ricochet and lead to injuries. Evidence

from photographs, video cameras, and testimonialsin many countries identies the frequent violationof these guidelines. There are examples of KIPs beingaimed at the upper body or face, being red from veryshort distances, being used against non-threateningindividuals, and being red indiscriminately at crowds.

Left: A Turkish student is injured after riot police uses rubber bullets againststudents at Istanbul University during an anti Turkish Higher Education Legislationdemonstration on November 6, 2015.OZAN KOSE/AFP/GETTY IMAGES

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KINETIC

IMPACT

PROJECTILES

ALTERNATIVE

NAME(S)

COMPOSITION/DES CRIPTION MECHA NISM OF A CTION RANGE A ND USA GE

Rubber orPlastic Bullets

Baton roundsRiot rounds

Solid, spherical orcylindrical projectiles of variable sizes made solelyof hard rubber, plastic, orpolyvinylchloride (PVC)May be red as single shotsor in groups of multipleprojectiles within a cartridge

Less dense than metalbullets to limit force onimpact

Intended to only re at target’slegs Muzzle velocity and forceon impact are dependent onvariable shapes and lls withincartridges that can affect ightpatterns

Plastic-metalcompositebullets

(misleadinglycalled) plastic orrubber bullets

A composite of plasticand metal fragments, orsmall shards of metal (leador steel) within a rubber,

plastic, or PVC base

Have higher densitythan solid plastic butless than metal bulletsdesigned to extend

ring range or force onimpact from traditional

Intended to only re at target’slegs Similar to solid batonrounds with higher speedand force on impact possible

Variable shapes can affect ightpatterns and force on impact

Rubber-coated metalbullets

(misleadinglycalled) plastic orrubber bullets

Spherical or cylindricalprojectiles with solid lead ormetal core surrounded bya 2 mm coating of plastic orrubber (Core weight: about16 g; diameter: 15.75 mm)May be red as single shotor in groups up to 15

Outer coating madeof rubber to limitpenetrating traumabut dense metal coreaugments force onimpact.

Intended to only re at target’slegs Similar to solid batonrounds with higher speedand force on impact possiblePrimarily used in the OccupiedPalestinian Territory by Israeliarmy

Flexible batonround

Bean bag rounds Synthetic cloth bag lled with about 45 g of smallmetal pellets (100 pelletsof #9 lead shot is mostcommon) Greatest diameterfor the bag is usually 6 cm.

A cartridge has wadding meant toexpand and drop the wadding as it travels,creating a widersurface area blow

Intended to only re at target’slegs Expansion of the bag isproblematic at short distancesleading to injuries

Sponge rounds Foam roundsSponge grenadePlastic-tippedbullet

Projectile with a hard foamnose and a high denistyplastic body Fired from agrenade launcher specicfor these projectiles

Large surface area andsoft tip intended tolimit penetrative injury

Minimum engagement rangeis 10 – 15 m, and maximumeffective range is 50 m Designedas “direct re” at target’s less vulnerable anatomy (legs)

P el le t r ou nd s B uc ks ho t/birdshot

Cartridges lled with smalllead, steel, or plastic/rubberpellets that disperse/spread

out when red Birdshotconsists of hundreds ofsmaller pellets (1.27 mm –4.57 mm); buckshot rangesfrom 5 mm to 25 mmand may require stackingin a xed geometricarrangement.

Smaller pellets mayhave wider dispersalpatterns and lessaccurate aim; largerpellets may have higherkinetic energy

Causes an indiscriminate sprayof ammunition that spreads widely and cannot be aimed

AttenuatedEnergyProjectile (AEP)

AEP Hard plastic body and ahollow nose

Hollow tip is designedto collapse on impact,limiting penetrativeinjury

Intended to only re at target’slegs Specic weapon usedprimairly in the UK

Figure 1: Selected types of Kinetic Impact Projectiles*

*Note: this table is not comprehensive and only includes some common types of KIPs and data gleaned from accessible sources(manufacturer data is commonly unavailable)

“

”

KIPS, THEREFORE, ARE NOT ONLY LIKELY TO

BE LETHAL AT CLOSE RANGE, BUT ARE LIKELY

TO BE INACCURATE AND INDISCRIMINATE AT

LONGER RANGES, EVEN THOSE RECOMMENDED

BY MANUFACTURERS FOR SAFETY.

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The health impacts of KIPs depend on a numberof factors, including: the type of projectile; theweapon it is shot from; the distance from whichthe shot is red; the user’s skill; and the inherentinaccuracy of the weapon itself. Although KIPsare designed to minimise penetrating injuriesand limit the force of blunt trauma, both typesof injuries are possible.

The ndings of a systematic review of medicalliterature i indicate that KIPs cause seriousinjury, disability, and death. In the 26 studiesselected for analysis j, we identied 1,925 peoplewith injuries, 53 of whom died as a result of

their injuries (3 percent), and 294 individualswho suffered permanent disabilities (15percent), the vast majority of which consistedof permanent vision loss (84 percent of eyeinjuries resulted in permanent blindness,usually requiring complete removal of the eye).Of those injured, 70 percent had injuries thatwere considered severe.k Permanent disabilityand severe injuries often resulted from strikesto the head and neck (49 percent of deathsand 84 percent of permanent disabilities).Those with injuries to the torso were also atrisk of severe injury. Specically, one of everyve people with abdominal injuries suffereda permanent disability. In addition, ring

distance and timely access to medical care were correlated with injury severity and risk ofdisability. While these ndings do not enableestimates of the prevalence of morbidity andmortality associated with KIPs, they indicatethat KIPs have resulted in signicant morbidityand mortality despite their status as “less lethal

weapons.”l

Just under a quarter of the deaths (23 percent)resulted from blunt injury to the brain, spine,or chest. Many body systems can be injuredas a result of KIPs, and both bullet penetrationand blunt injury may result in severe acuteinjuries requiring surgery or medical careas well as chronic disabilities. Signicantly,most of the severe injuries and permanentdisabilities were from bullets that had a metalcore or were otherwise composed of metal(discussed in more detail below).

According to the review, several factors affectedthe severity of the injuries that resulted frompeople being hit with a KIP, including ringdistance, timely access to health care, and thecomposition of the bullet being red.

HEALTH EFFECTS

i The review looked at literature over the past 25 years. The researchersidentied 2,666 articles in a rigorous search of the medical and publichealth literature, out of which 24 articles met inclusion criteria, hadclear causation by KIPs, contained health impact data, and were ofsufcient quality to include. j Nine of the articles focused on protests, two on criminal arrests,and one on a riot (some of the articles presented information onmore than one context). The remaining 14 articles did not specicallydescribe the context of use or had documentation of injuries fromindividuals in a variety of contexts.k Out of 1,878 people referenced in the study who survived KIP injuries,there were 2,055 injuries. In some cases, individuals sustained morethan one injury, either because of multiple bullets or because theysuffered contiguous organ injuries from a single bullet.l Morbidity is the state or incidence of illness or disease, whilemortality is the state or incidence of death.m The ring distance of the weapon was specically noted in seven ofthe articles as less than designated, or as directly related to the severityof injury. Exact distance was impossible to assess in most cases, butforensics and case data suggested that the ring distances were lessthan those recommended by manufacturers.

Figure 3: People Injured by Rubber-Coated MetalBullets vs Other Types of KIPs

Figure 2: Severity of Injuries Caused by KIPs FIRING DISTANCE

The medical literature documenting injuriesfrom KIPs suggests that deployment of theseprojectiles often occurs from distances muchcloser than those deemed safe. Safe shootingranges are not well validated and vary agreat deal between weapons, countries, andmanufacturers. Firing distance, while hardto assess in many cases, correlates with theseverity of injuries.m One study suggested thatpenetrating injuries in parts of the body withhigh elasticity or viscosity indicated very closering ranges in 42 patients.22 In another study,the injuries documented resulted from ringdistances of 2.4 – 3 metres, markedly less thanthe typical recommended safe ring rangesof 9 – 14 metres.23 Another study noted thatmore than half of the cases studied involvedring ranges of less than six metres.24 Someof the literature specically noted that ringdistances in instances resulting in injury

were less than those recommended by KIPmanufacturers, and it highlighted that thering distance was difcult to assess not onlyforensically, but also by law enforcementagents working in dynamic and fast-changingconditions.25 Further, one study pointed outthat KIPs can be extremely dangerous to eyeseven when deployed at theoretically safedistances.26

Different KIPs have different ring rangesand safety protocols. Depending on thedischarging weapon and the bullet, theseweapons should be red from at least 6 to60 metres away; however, they may lose

their effectiveness or accuracy if red fromtoo great a distance. To provide but onetroubling example, regulations identied inIsrael actually indicate that minimum ringdistance should be 50 metres for the rubber-coated metal bullet, but that after 60 metresthe projectiles are ineffective, allowing foronly a 10-metre range of acceptable use.27

Other regions use a wide variety of launchersand bullets, each of which has its ownspecic safety and effectiveness ranges. Suchconicting and complicated guidelines canexacerbate the potential for misuse.

A police officer wearing riot gear walks in the centre of Buenos Aires,Argentina, during a protest on March 12, 2013.

M.A.ƒ.I.A. (MOVIMIENTO ARGENTINO DE FOTÓGRAFXSINDEPENDIENTES AUTOCONVOCADXS)

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SOUTH AFRICA:THE DEATH OF ANDRIES TATANE

On April 13, 2011, the community of Ficksburg – arural town in Free State, South Africa – embarkedon a planned peaceful protest to voice its frustrationregarding the lack of service delivery from theirlocal municipality. Andries Tatane, a 33-year-oldcommunity activist, took part in the protest alongsidethousands of other community members.

During the course of the protest, members of theSouth African Police Service (SAPS) attempted todisperse the protesters by ring rubber bullets andusing water cannons. Tatane intervened in the SAPS’sdispersal operation by standing in front of a watercannon truck, and was subsequently surrounded bymembers of the SAPS, who beat him repeatedly withpolice batons and tore open his T-shirt. Witnesseslater stated that Tatane, who was unarmed, tried tostop the water cannon because elderly and vulnerablepeople were involved in the protest action.

While trying to defend himself, Tatane was shot twicein the chest from a range of approximately 1.5 metreswith rubber bullets contained in a standard 12-boreshotgun cartridge. The cartridges were discharged bya member of the SAPS from what is thought to havebeen a Musler 12-gauge shotgun. Tatane was permittedto walk a short distance away from the scene of theshooting, and he collapsed with visible rubber bulletwounds to his chest. He died on the scene 20 minuteslater, before he could be taken to a local hospital.

As a result of Tatane’s death, eight police ofcerswere charged in a local magistrate’s court. All were

acquitted. A subsequent inquiry by the South AfricanHuman Rights Commission, a constitutionallymandated institution tasked with investigating andreporting on the observation of human rights, found,among other things, that the members of the SAPSfailed to comply with the provisions of the Regulationsof Gatherings Act by using excessive force, whichresulted in the injury and/or death of Tatane. It alsofound that the police used a degree of force that wasdisproportionate to the circumstances of the case.

Right: Andries Tatane stands after he was beaten andshot by the police with rubber bullets on April 13,

2011 in Ficksburg, South Africa. BEELD/GALLO IMAGES/GETTY IMAGES

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n Of the 2,055 injuries studied, only 33 percent were in the lower extremities. Injuries in other parts of the body include common contusions,bone fractures, internal bleeding, penetration of the projectile into vital organs, severe brain and eye trauma, and death.o Several articles noted that delays to medical care from not recognising the severity of the injuries, and overburdened hospitals, as well ascheckpoints, military curfews and fear of arrest or reprisals contributed to morbidity. Balouris notes that of 35 patients attending a specialtyhospital directly, “only 9 were seen within 24 hours of injury.”

Figure 4: Severity of Injuries Causedby KIPs by Body System

SITE OF IMPACT

While KIPs are touted as causing minor bluntinjuries, the medical literature identies manysevere and often penetrative injuries requiringprofessional medical care and management.The location where the projectile hits thebody is directly related to the severity of theinjury. Despite guidelines calling for weaponsto be aimed at lower extremities, the medicalliterature identies many major injuriesthroughout the body, including to the headand trunk.n Injuries above the legs have thecapacity to cause severe internal injuries,including ruptured solid organs, penetration tothe abdomen or thorax, heart and lung injuries,injuries to the major vessels and nerves, andlethal head and neck injuries.

DELAYED ACCESS TO MEDICAL CARE

Delays in access to medical care can contributeto the risk of permanent damage as a result ofKIPs as well.o Delays may be caused by medicalpersonnel not immediately recognising

the severity of injuries, overburdenedhospitals, checkpoints, military curfews, andfear of arrest or reprisals associated withparticipating in a protest. This is signicant,as one study noted that frequent curfewsand evacuation times worsen the salvage ratefrom eye injuries,28 and another found earlymanagement of vascular injuries allowedlimbs to be salvaged, while late presentation

with greater than six hours of delay had an 86percent salvage rate.29

BULLET’S COMPOSITION

There is evidence that specic bullets may bemore dangerous than others. The literature

identied a large proportion of severeinjuries secondary to rubber-coated metalbullets and those with composites of metaland plastic, suggesting that they may bemore lethal than bullets composed of plasticalone. Heterogeneity in the cu rrent literature,however, limits the ability to statisticallycompare different types of bullets. Whilethere is some evidence that newer “attenuatedenergy projectiles” (with a soft sponge tipor a hollow plastic tip that collapses onimpact) may mitigate some injuries fromricochet or deep penetrative injury, theseand other KIPs are more prone to instabilityand unpredictable trajectories. Defective orpoorly produced beanbag rounds have alsobeen shown to cause severe or fatal injurieswhen they fail to expand during ight or

when the bag ruptures upon impact.

The gures highlighted above show thatwhile KIPs are sometimes described as “lesslethal” than conventional ammunition, thenumber of deaths, serious injuries, andpermanent disabilities that they can cause ina crowd-control setting is of serious concern.

At cl ose distances, some types of KIPs havethe same ability to penetrate the skin asconventional live ammunition and can be just as lethal. When red or launched fromafar, these weapons are inaccurate, whichraises the possibility of striking vulnerablebody parts or causing unintended injuries tobystanders. These factors call into questionthe appropriateness of these projectilesfor crowd-control purposes. (For specicrecommendations on KIPs, see page 89).

ISRAEL: THE PROHIBITION OFRUBBER-COATED BULLETS

The proven lethal nature of rubber-coatedmetal bullets led the Israeli authorities

to prohibit their use within Israel as acrowd-control weapon, except in extremecircumstances with special approval by thechief of police. This decision was made adecade ago following the recommendationof a commission of inquiry, known as the“Or Commission,” that was establishedby the government after 12 Arab-Israelicitizens were killed and hundreds moreinjured during clashes between securityforces and Arab-Israeli civilians in October2000. The commission report, released in2003, criticised the Israeli police for beingunprepared for the riots and for usingexcessive force to disperse the protesters.The commission concluded that rubber-coated bullets are lethal weapons andrecommended they be prohibited asa means to disperse demonstrations.Unfortunately, these recommendations

have not been applied in the OccupiedPalestinian Territory, where the bulletsare widely used and have caused dozensof deaths and many injuries, to bothprotesters and bystanders, since 2000.

”“

THE MEDICAL LITERATURE DOCUMENTING INJURIES

FROM KIPS SUGGESTS THAT DEPLOYMENT OF THESE

PROJECTILES OFTEN OCCURS FROM DISTANCES MUCH

CLOSER THAN THOSE DEEMED SAFE. SAFE SHOOTING

RANGES ARE NOT WELL VALIDATED AND VARY A

GREAT DEAL BETWEEN WEAPONS, COUNTRIES,

AND MANUFACTURERS.

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p Resolution by the Ombudsman’s Ofce for the city of Buenos Aires, April 30, 2013.

On April 25, 2013, the Metropolitan Police ofthe city of Buenos Aires red rubber bulletsat patients, nurses, doctors, and journalists atthe Borda Psychiatric Hospital. That morning,the city’s Minister of Urban Development hadordered the demolition of one of the hospital’sfacilities, despite a court order that hadsuspended any type of eviction or demolitionon the premises. The minister had requesteda police deployment to guard the demolitionprocess. Several hospital workers went out totake a stand against the demolition, and this

incited a violent response by the MetropolitanPolice, who attempted to disperse the protesterswith batons, rubber bullets, and pepper spray.Several people were injured as a result of ringrubber bullets at close range. Footage showsthe police ring from an estimated distance of10 to 15 metres and at 90-degree angles.

Once word of the incidents got out, a numberof members of the city legislature went to thesite to initiate negotiations, at which point thepolice retreated. However, late in the day theprotesters attempted to tear down the fencesurrounding the workshop area upon learningthat the demolition had already started. Theremaining police forces reacted by “openingre indiscriminately, at short range andaiming at the body.”p This second instance ofuse of force resulted in injuries to more than40 people, including journalists, legislators,hospital workers, and patients. The injuries

were caused mostly by rubber bullets andincluded lesions to the chest and arms, amongothers. One person sustained 21 impacts fromrubber bullets on his body. Other peoplerequired medical attention because of theeffects of tear gas.

The city government never notied hospitalauthorities that the demolition was going totake place, so that they could have taken thenecessary preventive measures. The ofcerspresent were armed and wearing protectivegear suited for an operation that might pose apotential risk to the forces; 12/70-caliber rieswere used to re anti-riot munitions and teargas cartridges. Some people were shot in the

face and the back, and, in some cases, with twodifferent types of weapons.

The city government and the MetropolitanPolice Chief jointly defended their actions at theBorda Hospital, pointing out that police ofcers“defended themselves” and that the operation

was carried out according to the protocol forthese cases.30 This is despite the fact that theMetropolitan Police did not have at that timea protocol in place for handling protest andsocial conict of that nature. The investigation

of the Borda events was inadequate. The onlyofcer prosecuted for causing “mild injuries”

was the commissioner in charge of thespecial operations brigade that acted on thehospital premises. At the same time, the caseagainst seven protesters accused of “resistingauthorities” has already been taken to trial.

Police actions at Borda Hospital should not beconsidered an isolated event. In the last years,federal and provincial police forces have usedrubber bullets in an indiscriminate way withthe aim of dispersing manifestations across thecountry. In October 2014, National Gendarmeriashot at the workers of the company LEAR,

who were protesting for the dismissal ofsome of them. At least 10 people requiredmedical attention, one person counted 10bullet impacts on his arm. In September 2015,Tucumán Police Force shot again at unarmedprotestors who were trying to run away from

the repression in Plaza Independencia. InDecember 2015 and January 2016, two moreof these events happened in the rst days ofthe new national administration in Argentina.The workers of bankrupt company CrestaRoja suffered the widespread use of rubberbullets again by Gendarmería to disperse theirprotest. A few days later, similar actions weretaken by the Buenos Aires Police Force againstcivil servants in La Plata, where a woman washit by nine bullets in her back. These casesshow that the use of rubber bullets to disperseprotests is widely used in Argentina, usually

without previous warning, even towardsunarmed people who are running away fromthe violence.

Top: Metropolitana Police push back people trying to prevent the demolition of a work space inside the Borda Mental Hospital in Buenos Aires,Argentina, April 26, 2013.Bottom: A person present at the Borda Mental Hospital in Buenos Aires, Argentina, shows the casings of bullets used against protesters inside thepremises on April 26, 2013.

ARGENTINA:POLICE USE OF RUBBER BULLETS AT THE BORDA HOSPITAL

M.A.ƒ.I.A. (MOVIMIENTO ARGENTINO DE FOTÓGRAFXS INDEPENDIENTES AUTOCONVOCADXS)

M.A.ƒ.I.A. (MOVIMIENTO ARGENTINO DE FOTÓGRAFXS INDEPENDIENTES AUTOCONVOCADXS)

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3.2

CHEMICALIRRITANTS

Chemical irritants are a group of CCWs thatinclude a variety of chemical compoundsintended to produce sensory irritation.

Conventionally referred to as “tear gas,”chemical irritants come in a variety offormulations, sizes, concentrations, anddelivery mechanisms, depending on themanufacturer and the context for whichthey are intended. Historically categorisedas non-lethal or less lethal, the generalperception is that the weapon does notcause permanent injury or death, butinstead has mostly short-term effects suchas transient lacrimation (owing of tears),ocular irritation and pain, blepharospasm(eyelid spasm), dermal pain, respiratorydistress, and the psychological effectof disorientation and agitation.q This

perception is now being challenged, withmore evidence of associated moderate andpermanent injuries.

Chemical irritants include a wide rangeof agents that have been developed anddeployed for many decades in addition toones that are currently under development,but there are four chemical compoundsthat are most frequently cited in reports:chlorobenzalmalononitrile (agent CS),chloroacetophenone (agent CN), oleoresincapsicum (agent OC, known as pepperspray), and OC’s synthetic form, PAVA. Ofthese four, the two most commonly usedby law enforcement agencies in recent

years are agents CS and OC.

WEAPON PROFILE

q M. M. Stark, “CS Spray,” Journal of Accident & Emergency Medicine 15, no. 4 (July 1998): 288.

ILLUSTRATION BY KALE VANDENBROEK

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Agent CS was developed in the 1920s in theUnited States, and was introduced as a weaponby the U.S. military to replace CN in the 1950s.r It then became a frequently used weapon inthe second half of the twentieth century andwas famously deployed in the Vietnam Warby the U.S. military.s Now it is widely used bylaw enforcement agencies in many countries– often as the rst weapon of choice in thecontext of protest. The United States used tobe the main manufacturer of CS, but recentlyother countries have been producing andexporting the weapon. Despite the UnitedStates remaining the biggest producer of CS, theU.S. Environmental Protection Agency (EPA) hasnot set a minimum threshold of concentrationat which the general population couldexperience “notable discomfort, irritation,or certain asymptomatic, non-sensory but

transient effects,”31

because even the lowestconcentrations cause these symptoms. Thevolume of chemical in each spray and gasvaries considerably among manufacturers andcountries.32

Agent OC, the second most-commonly citedagent, is essentially a highly concentrated formof hot pepper. Agent OC and its synthetic form,

PAVA, have recently increased in popularity aspotent and effective crowd-control agents. Alsodeveloped by the United States and originallyused as a deterrent against wild animals (andby the U.S. Postal Service against dogs), OCbecame a law enforcement weapon in the late1980s.33 It is now available both as a spray andin gas form, with lower concentrations beingavailable as a self-defence “pepper spray” forthe public, while variants that are more potentare developed for military and law enforcementagencies. These more potent variants are alsoincreasingly becoming a weapon of choicefor crowd control. The potency of the weaponis not just contingent on the concentration ofOC within the solvent, but particularly on thestrength of the “capsicum” – the active chemicalthat makes pepper hot. It is worth noting thatOC may also potentially include toxic chemicals,

such as alcohol, halogenated hydrocarbons,and propellants such as Freon. While severalcountries have limitationst on the possessionand use of OC, in either spray or gas form, it isunregulated in most countries.34

r Ben B. Corson and Roger W. Stoughton, “Reactions of Alpha, Beta-Unsaturated Dinitriles,” Journal of the American Chemical Society 50, no. 10(October 1, 1928): 2825–37, doi:10.1021/ja01397a037; Martha Lenhart, ed., Medical Aspects of Chemical Warfare (Ofce of the Surgeon General.Department of the Army, United States of America, 2008), chap. 13, http://www.cs.amedd.army.mil/borden/Portlet.aspx?id=d3d11f5a-f2ef-4b4e-b75b-6ba4b64e4fb2s E. J. Olajos and H. Salem, “Riot Control Agents: Pharmacology, Toxicology, Biochemistry and Chemistry,” Journal of Applied Toxicology: JAT 21,no. 5 (October 2001): 355–91.t Limitations vary by country. Some countries have limitations on use by law enforcement, especially regarding concentration, amount ofvolume carried, etc. Many other countries have limitations on possession/use by the general population.

”“

CHEMICAL IRRITANTS ARE AN INDISCRIMINATE WEAPON

BY DESIGN; BECAUSE OF THEIR INDISCRIMINATE

NATURE –ESPECIALLY WHEN DELIVERED BY FIRING A

GRENADE OR A CANISTER – LIMITING THE EXPOSURE

TO INDIVIDUALS OR SMALL GROUPS IS DIFFICULT, AND

THE RISK OF AFFECTING BYSTANDERS AND INDIVIDUALS

OTHER THAN THE INTENDED TARGETS IS HIGH.

MECHANISM OF ACTIONChemical irritants are utilised for crowddispersal or for individual control orincapacitation. They are typically deployed intwo ways: in the form of spray or as a canister/grenade. However, mechanisms of delivery

vary: these include pellets and pepper balls,used in targeting individuals, as well as watercannons, which, along with grenades andcanisters, provide more indiscriminate meansof crowd control. Newer forms include plasticballs lled with chemical irritants that act as acombination of plastic bullet and gas weapon.

The spray variant for CS, OS, and other gases isusually available in the form of an enclosed unitunder pressure and is released as a ne sprayby means of a propellant gas. These aerosolisedforms of chemical irritants typically are releasedfrom 0.3 to 3 metres from the target, and thespray pattern can be variable depending on the

design of the weapon, pressure of the spraymechanism, and wind conditions. Gas forms ofchemical irritants are contained in canisters orgrenades and typically are triggered to conducta thermal explosion and disperse widely in thesurrounding area.

JEMAL COUNTESS/GETTY IMAGES

Right: Police use smoke bombs to disperse protestors at arally outside the temporary G20 police detention center,where over 500 people were being detained on June 27,

2010 in Toronto, Ontario, Canada.

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* Table adapted from Carron and Yerson, Management of the Effects of Exposure to Tear Gas, 2009. 39 The Median Incapacitating Dose (ID50) isthe amount of agent expected to incapacitate 50 percent of a group of exposed, unprotected individuals. The Median Lethal Dose (LD50) is theamount of agent expected to kill 50 percent of a group of exposed, unprotected individuals.

Figure 5: Physical and Chemical Characteristics of Selected Chemical Irritants*

u In pharmacology, the margin of safety is the range between the usual effective dose and the dose that causes severe or life-threatening side

effects. Agent CS has a lower effective dose and a higher toxicity dose than agent CN, resulting in a wider margin of safety.

Chemical irritants are an indiscriminate weaponby design; because of their indiscriminatenature –especially when delivered by ring agrenade or a canister – limiting the exposure toindividuals or small groups is difcult, and therisk of affecting bystanders and individuals otherthan the intended targets is high. In addition,the diagnosis and treatment of chemicalirritant exposure is complicated because of thecombination of different chemicals and thelack of transparency about the agents used.

Agent CS, the most commonly used chemicalirritant, is not actually a gas but rather a powderat room temperature that is aerosolised bya triggered thermal explosion and disperses

widely from a canister. A gas canister isestimated to have between 80 and 120 grams ofCS, usually in concentrations between 0.1 and10 percent, but much higher concentrationsare also commercially available.35 Theconcentration of CS, however, can besignicantly increased by the ring of multiplecanisters in the same location, which is oftenthe case in crowd-control situations and whichfurther complicates analysis of the toxicity ofthe chemical in practice.

Several newer agents of CS are currently beingdeveloped, including agent CS1 and CS2.36 Thosenew developments are expected to reducedegradation and extend the shelf life of CS or, inthe case of CS2 in particular, to increase weather

resistance and ow into the respiratory systemby microencapsulating the CS in silicone.

In order to understand accurately the effect ofexposure to CS, a measurement of density orconcentration (milligrams per cubic metre) forexposure time is necessary. Based on animaland human models, it is estimated that anexposure to agent CS at a concentration of 140mg/m3 for 10 minutes or 11 mg/m3 for one hour,or as little as 1.5mg/m3 for four to eight hourscan be lethal.37 Individuals exposed to highconcentrations in closed spaces or for extendedamounts of time, for instance, can suffer serioushealth consequences and even death. Whenused outside, a CS grenade or canister producesa cloud of chemicals, usually within 60 seconds,

with the highest CS concentration of 2,000to 5,000 mg/m3 detected at the centre of thecloud. Because of the nature of the weapon, itis difcult to measure these concentrations inpractical situations of deployment or to haveaccurate estimates in retrospect.

Agent OC, most commonly found in sprayform, is available in different concentrationsfrom 1 to 10 percent of capsaicinoids as oil ina solvent. Studies suggest that even very low(0.003 mg/m3) concentrations can lead toocular irritation.38 Because of the complexitiesin measuring concentrations of agent OC, lethaldose levels are difcult to verify.

JABIN BOTSFORD/THE WASHINGTON POST VIA GETTY IMAGES

Left: Officers pepper spray people near West North Avenue and Pennsylvania Avenueduring a protest for Freddie Gray in Baltimore, MD on Monday April 27, 2015.

NAME CHARACTERISTICS TIME TO ACTIVATION

(SECONDS)

DURATION OF ACTION

(MINUTES)

LD50 (MG/MIN PER M3) -

INCAPACITATING DOSE

LD50 (MG/MIN

PER M3) -

LETHAL DOSE

Agent CN Apple odour; powder oremulsion; aerosol

3-10 10-20 20-50 8,500 – 25,000

Agent CS Pepper odour;dispersing effect(grenades)

10-60 10-30 4-20 25,000 –

100,000u

Agent OC Pepper odour; persistsfor long periods

1-5 30-60 Unknown Unknown

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A systematic review of medical literaturedocumenting the health impact of differentchemical irritants was carried out for thisreport in order to identify documented casesof injuries, deaths, and permanent disabilityover the past 25 years. A total of 31 studieswere included in the analysis. v Further analysisof the frequency, context of injuries, and riskfactors was undertaken.

The review identied 5,131 people whosuffered injuries or died; of these, two peopledied and 70 people (1.7 percent) sufferedpermanent disabilities. The majority of peoplewho were injured (5,059) fully recovered

from their injuries (98.6 percent). Out of9,261 documented injuries, (many people hadmultiple injuries), 8.7 percent were severe andrequired professional medical management,while 17 percent were moderate, and 74.2percent were minor.

Severe injuries surveyed included injuriesto multiple body systems, with the majorityof injuries being to the skin, eyes, andcardiopulmonary system (lung, heart, andchest). Two deaths were documented in theliterature review; one as a result of respiratoryarrest after CS was red inside a home andone from traumatic brain injury sustained

after the victim was directly hit by a canister.No cases of death associated with OC werefound. Reviewed studies also included casesof 70 people with documented permanentdisabilities, which included globe (eyeball)ruptures and blindness (four people), traumaticbrain injury resulting in a vegetative state (oneperson), limb amputations (three people), andfunctional loss of limbs (ten people). Persistentpsychiatric symptoms were found in 14 peopleand persistent symptoms of asthma and otherrespiratory conditions were reported in 32people.

The study also found that the majority ofpeople injured are young adults (mean

age: 25.7 years), consistent with traditionalprotest demographics.40 Though most reportsindicate that young men are more likely toincite violence, our study notes a more equalgender distribution of injuries, which isconsistent with the indiscriminate nature ofchemical irritants (57 percent male, 43 percentfemale).41 Thirteen of the 31 studies reviewedfor this report included injury data on children(some as young as three months old). Studiessuggest that children are more vulnerable tosevere injuries from chemical toxicity.42 Theelderly and those with chronic diseases mayalso be more prone to worse outcomes fromchemical irritants.43 The studies revieweddocumented injuries in people over 65, withsome as old as 90 and 94. The data identiedchronic respiratory conditions and allergicskin conditions in people who had previousmedical conditions.

The psychological impact of the use of CCWshas not been well studied or documented in themedical literature, but cases documented inthis review indicate that exposure to chemicalirritants may result in signicant psychologicalsymptoms and long-term disability. In onestudy of 297 individuals seeking care and/or evaluations of injuries following the 2013Gezi Park protests in Turkey, 117 psychiatricevaluations were conducted. Some 43 percentof the victims had diagnostic criteria for acutestress disorder, 23 percent had diagnosticcriteria for post-traumatic stress disorder(PTSD), and 7.7 percent had diagnostic criteriafor major depressive disorder.44

HEALTH EFFECTS

Figure 6: Severity of InjuriesCaused by Chemical Irritants

v Articles were included in the review if they documented injuries, deaths, or other health consequences of chemical irritantson human subjects and were published between January 1, 1990 and March 30, 2015. The selected studies included datafrom 11 countries and were published between 1993 and 2000. The most common context of injuries surveyed was protests(10 studies), but the review also included injuries sustained in the context of arrests/police duty, military or police trainingexercises, accidental exposures, and a detention unit riot.

”“

THE REVIEW IDENTIFIED 5,131 PEOPLE WHO

SUFFERED INJURIES OR DIED; OF THESE, TWO

PEOPLE DIED AND 70 PEOPLE (1.7 PERCENT)

SUFFERED PERMANENT DISABILITIES. THE MAJORITY

OF PEOPLE WHO WERE INJURED (5,059) FULLY

RECOVERED FROM THEIR INJURIES (98.6 PERCENT).

Figure 7: Severity of Injuries Caused by Chemical Irritants by Body System

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On January 19, 2015, the children of LangataRoad Primary School, together with theirparents and teachers, members of civil society,and legislators of the National Assembly andCounty Assembly of Nairobi gathered peacefullyto protest the seizure of their playground byprivate developers. During the Decemberschool holidays, a private developer haderected a perimetre wall and gate around theplayground and taken control of it. On this day,the children left their classes alongside otherprotesters and marched to their playgroundcarrying placards and chanting “Haki Yetu!”(“It’s Our Right!”). At the playground, 108 policeofcers had been deployed in anticipation ofthe protest and were under the command ofthe ofcer in charge of Langata Police Division.The police were armed with AK-47s, G-3 ries,tear gas canisters, and a dog unit. The policedescribed their task as safeguarding life andproperty while also ensuring the safety of theschoolchildren.

Upon reaching the playground, the childrenand other demonstrators began to push on theerected gate to gain access to the playground.As the pressure on the gate escalated, it wasopened by the police ofcers, who immediately

red tear gas canisters directly at the childrenand the other protesters. This action caused astampede as the children, demonstrators, andother members of the public nearby scrambledfor safety. Five children and one police ofcerwere injured and taken to hospital. The injurieswere related to tear gas exposure as well asthe ensuing stampede. Most of the injurieswere described as soft tissue injuries. Whilefour children were treated and released fromhospital, one child was admitted for chestpains and difculty breathing. The police alsoarrested three activists, who were subsequentlyreleased on bail.

Having received widespread local andinternational media coverage, the incident

was swiftly condemned by the public, whodenounced the use of tear gas and dogs onchildren. The matter was eventually investigatedby the Commission on Administrative Justice(the Ofce of the Ombudsman). The actinginspector general of police also announcedthe suspension of the commander as animmediate consequence of the incident. Theofcers directly responsible for lobbing thetear gas were not identied.

In its investigation of the case, the ombudsmanfound the county police commander and

lethal in disguise - the health consequences of crowd-control weapons

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