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Preventing genocide
By Eric B. Larson and Reva N. Adler
Special to The Times
Dr. Eric B. Larson
Dr. Reva N. Adler
With the popularity of the Oscar-nominated movie "Hotel Rwanda," many Americans have become newly aware of the horrors of modern-day genocide. Whether considering the 800,000 people murdered in Rwanda in 1994, or the thousands killed in Sudan in recent months, one question prevails: Why do such atrocities continue? The world would appear to have learned little, if anything, from these human tragedies that might prevent genocide from recurring.
As scientists trained to promote the well-being of entire populations, we propose a new approach one we believe gives societies more power to prevent genocide. It is an approach grounded in the principles of public health.
Treating genocide as a public-health concern may seem incongruous, simply because we've come to think of it more as a political issue. But genocide defined by the United Nations as "a specific series of acts committed with intent to destroy in whole or in part, a national, ethnic, racial, or religious group" has become one of the most-pressing threats to global health over the past century.
In fact, some 192.3 million people died from genocide in the 20th century, far exceeding the 110.9 million killed by war. Genocidal death rates worldwide were 7,700 per 100,000 between 1900 and 2000 an eight-fold increase over the previous 69 centuries. Genocide now results in the death of more people worldwide than any disease, including malaria and HIV/AIDS. In addition, genocide devastates the economic and health-care infrastructure of societies, harming health for generations to come.
Recognizing genocide's public-health implications, we can begin to develop effective prevention strategies. Similar approaches have proven effective against a wide range of problems, from breast cancer and drunken driving to gang-related youth violence.
The first step is to look at the entire population and determine which factors put people at higher risk. Just as we now recognize that high rates of smoking put populations at risk for lung cancer, we can detect certain factors totalitarian governments, discrimination against certain groups, economic hardship, and the overlay of war that put a society at risk for genocide.
Officials using a public-health approach can then develop interventions aimed at changing conditions to eliminate those risks. In the case of smoking, you might have media campaigns to discourage taking up the habit, or "quit lines" where smokers can call for help to stop. In the case of genocide, interventions might include diplomacy, economic-development efforts, or public education in conflict resolution.
Preventing death from genocide is analogous on many levels to preventing death from cancer. If we eliminate the risk factors, we may prevent the disease from growing in the first place. If cancer does occur, early screening allows us to detect a tumor while it's still small and harmless. Once the tumor is removed, the body can recover and be restored to health. But if we turn a blind eye, the cancer may remain undetected for years until some biochemical trigger is switched. Then the cancer begins to spread rapidly, invading one organ system after another. By then, it's too late for intervention; death from cancer is inevitable.
In the same way, we can identify the factors that put a society at risk for genocide. Once those risks are recognized, we can set up systems to screen for trouble and introduce interventions while they can still make a difference, changing attitudes and preventing violence. Or, we can ignore the red flags, allowing fear, hatred, violence and retribution to fester.anyone want to talk about anti-semitism awakening in the US? http://www.usmessageboard.com/forums/showthread.php?t=21934 Then, when some economic and/or political triggers are switched, all hell breaks loose. By that time, it may be too late for intervention; mass execution of large segments of the population may have already begun.
Such a comparison is more than theoretical. Public-health scientists are already applying preventive-care strategies to address problems of violence in the United States. For instance, Harvard University researchers worked with jailed teens in California to identify risk factors that led to violent behavior. The researchers found that the teens often failed to gather facts about a situation before jumping into fights. The teens also had a hard time thinking of alternatives to violence as a way to solve their conflicts. But after a 12-session program that taught new ways to think about conflict, the teens became less impulsive. They also had fewer parole violations than other similar teens after their release from jail.
While the problem of preventing genocide differs in scale and complexity, we believe that applying similar strategies would be helpful. The approach would include four major actions:
Defining the population at risk and collecting data on incidents of interethnic violence, including the identity of victims and perpetrators, when and where the violence occurs, and the kinds of weapons used;
Identifying related risk factors for example, tolerance for crimes, or inequitable treatment against certain disadvantaged groups;
Developing, testing and implementing interventions; and,
Measuring the results and making improvements accordingly.
It already is well-established that all genocide is characteristically preceded by warning signs such as escalating hate propaganda, exclusionary legislation and mounting violence. In Nazi Germany, the deportation and mass execution of Jews were preceded by a 10-year campaign of gradually increasing persecution and exclusion. First, qualified individuals lost jobs in key areas such as academia and medicine. Next, Jews and non-Jews were forbidden to intermarry. Then, Jewish businesses were boycotted and soon after, Jews were confined to ghettos.
In Rwanda, the catastrophic Tutsi genocide of 1994 was preceded by periodic mass executions dating back to 1959, when the majority Hutu government took power.
Recognizing that warning signs of future genocide reliably appear, officials should be able to track and analyze such warnings years before the catastrophic violence erupts. Tactics might include calculating the number of one-on-one, interethnic attacks across a country and intervening as soon as it's clear that the number and severity of those attacks are increasing.
This kind of monitoring already is under way in the Gulu province of Northern Uganda, where a Canadian relief organization has developed a program for systematically collecting information on interethnic violence and injuries at 50 schools throughout the province. Just as public-school officials in the United States might track rates of immunization as a way to circumvent a measles epidemic, Ugandans may find that such "early warning systems" can serve as red flags to prevent future genocide....
Dr. Eric B. Larson is director of Group Health Cooperative's Center for Health Studies in Seattle. Dr. Reva N. Adler is a Fulbright scholar and associate professor of medicine at the University of British Columbia. She is studying public-health approaches to genocide prevention in Rwanda.
