Johns Hopkins doctors have set up shop and worked in Saudi Arabia, treating its citizen’s health needs, since at least 2010.
The Baltimore medical system has thrived in the Middle Eastern nation under the auspices of spreading good health care throughout the world, but done so against a backdrop of human rights complaints about which Hopkins officials have largely stayed quiet .
Khashoggi, who contributed columns to The Washington Post critical of the Saudi regime, was strangled at the Saudi Consulate in Istanbul Turkey in September, prosecutors there have said. His body has not been found.
Hopkins’ silence about the incident came as some other businesses have halted projects in the country or denounced the actions.
“We continue to closely monitor the recent developments in Saudi Arabia,” Johns Hopkins spokesman Kenneth Willis said in an emailed statement.
The hands-off approach raises questions about how much Johns Hopkins and other American businesses and nonprofits are obligated to speak out against less desirable and inhumane practices in the countries where they choose to operate.
Hopkins’ footprint in Saudi Arabia is large. It partnered in 2014 with Saudi Aramco, the government-owned oil company, in running a health system for some 360,000 beneficiaries. It has also collaborated since 2010 with a 250-bed hospital that specializes in ophthalmology. For years before Hopkins set up shop in the country, wealthy Saudi Arabians have traveled to Baltimore for care.
While there is no legal obligation to respond to human rights issues, some argue that there is a moral one and that some atrocities become so egregious that it is harmful, and even hypocritical, to remain silent.
Businesses at some point need to decide if core human values matter to them, said Michael Runnels, associate professor of law and social responsibility at Loyola’s Sellinger School of Business, who specializes in business ethics and international business. Hopkins’ silence seems to go against its mission of being a healing organization that helps people, Runnels said.
“I understand that they can make a business decision to be silent,” Runnels said. “But we are in a political age where you should understand your actions matter. Johns Hopkins can play a leadership role as an organization in calling out against this ghastly, nihilistic behavior.”
Hopkins officials are well aware of the dilemma posed by working in a country that is routinely criticized by human rights watchdogs for its repressive culture and government.
Pamela Paulk, president of Johns Hopkins Medicine International, told The Baltimore Sun last year that she gets questions from her own family about how Hopkins could work in Saudi Arabia.
Paulk said Hopkins tries to stay out of local politics, and focuses instead on what she calls the universal need for good health care.
"It is important for us when we are going some place to make sure we can be helpful, " she said. "It is not important for us to be involved in politics. Our mission is to provide health care, education and research."
Willis also said the medical system sticks to its health care mission.
“Aligned with our health care mission in the United States and around the world, Johns Hopkins Medicine International’s joint health care venture with the Saudi Aramco corporation focuses on helping patients by providing the best possible care,” Willis said in his statement.
The watchdog group Human Rights Watch on its website criticizes Saudi authorities because they arbitrarily arrest, try, and convict peaceful dissidents. It reports that dozens of human rights defenders and activists are serving long prison sentences for criticizing authorities or advocating political and rights reforms. The group also said the Saudi regime systematically discriminates against women and religious minorities. In 2017, Saudi Arabia carried out 146 executions, 59 for non-violent drug crimes, according to the group.
Paulk said in the past that Hopkins has established programs in Saudi Arabia aimed at empowering women, including a doctorate of nursing and a half-day conference called A Women's Journey during which Saudi women could interact with doctors from Baltimore.
Hopkins strategy mirrors the blind eye approach that the U.S. in general has taken when it comes to the oil rich country, which uses its wealth as a tool, said Peter G. Danchin, a human rights lawyer and director of the International and Comparative Law Program at the University of Maryland Carey School of Law.
Canada’s Foreign Ministry caught the ire of the Saudi government last summer when it called for the release of women’s rights activists arrested in the country. United States officials urged Canada and Saudi Arabia to work out their differences, but did not take a strong stance against the arrests.
President Trump was at first reluctant to link the Saudi leadership to Khashoggi’s execution and only called it the “worst cover up ever” after Turkey’s strong repudiation of the crime.
Hopkins officials could tell the regime privately that it disagreed with its human rights actions, Danchin said. They also could take a public stance, which would be stronger, but riskier. A statement could focus on the killing of a journalist violating international law.
“The risk is the regime retaliates and threatens to cancel the joint venture,” Danchin said. “As a human rights lawyer, I would think that is a risk worth taking. There is a question about complicity. If you are doing business in a country with human rights violations, at some point there is a moral and ethical question that arises about what you should do.”
Johns Hopkins is not the only entity doing business in Saudi Arabia, nor is the country the only one with human rights violations that hosts American businesses and nonprofits. And Hopkins is not the only one to avoid controversial topics.
“There are companies operating all over the world in various countries with different human rights (histories), ” said Nienke Grossman, co-director of the Center for International and Comparative Law at the University of Baltimore. “There is no legal obligation they speak out against anything.”
It would be impractical for companies not to operate in these countries, said Jonathan Moreno, a professor of medical ethics at the University of Pennsylvania’s Perelman School of Medicine. But they can help create a dialogue around issues and enlighten people, he said.
“I have a general view that it is better to have some contact,” Moreno said. “But there should be limits. I don’t think they should be involved in capital punishment or interrogations.”
Some fear that when companies stay silent, they further foster bad behavior.
“We turn a blind eye to egregious violations of human rights in the name of profits and over time that leads to a gradual authoritarian culture where human rights go unaddressed,” Danchin said.