This paper proposes a strict authentication watermarking for medical images. In this scheme, we define region of interest (ROI) by taking the smallest rectangle around an image. The watermark is generated from hashing the area of interest. The embedding region is considered to be outside the region of interest as to preserve the area from distortion as a result from watermarking. The strict authentication watermarking is robust to some degree of JPEG compression (SAW-JPEG). JPEG compression will be reviewed. To embed a watermark in the spatial domain, we have to make sure that the embedded watermark will survive JPEG quantization process. The watermarking scheme, including data embedding, extracting and verifying procedure were presented. Experimental results showed that such a scheme could embed and extract the watermark at a high compression rate. The watermark is robust to a high compression rate up to 90.6%. The JPEG image quality threshold is 60 for the least significant bit embedding. The image quality threshold is increased to 61 for 2nd and 3rd LSB manipulations.