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| You are here: 2004 / Workshops, Panels and Seminars / Track 1, Threats: Anticipating Genocidal Violence / Presentation by Dr. Reva Adler | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Report from Workshop Track 1: Anticipating genocidal violence Presentation, Option Paper, by Dr. Frank Chalk Presentation Option Paper, by Ms. Helen Fein Presentation by Ms. Linda Melvern Presentation, Opotion Paper, by Professor Yehuda Bauer Presentation, Option Paper, by Mr. Magnus Ranstorp Presentation, Option Paper, by Alexander Alvarez Presentation Option Paper, by Professor Barbara Harff Presentation by Dr. Reva Adler Presentation, Option Paper, by Ms. Alison Des Forges Presentation by Dr. Reva Adler Presentation by Dr. Reva Adler If I would entitle my intervention here today it would be:
Using the report of the International Commission on Intervention and State Sovereignty (ICISS) as an intellectual template (Evans, and Sahnoun 2001), Stockholm Forum 2004 participants are asked to consider best approaches to genocide prevention within three critical international responsibilities: 1) The Responsibility to Prevent Genocide (to address both the root and direct causes of internal conflict), 2) The Responsibility to React to Genocide (to respond to impending crisis with sanctions, international prosecution, and military intervention), and 3) The Responsibility to Rebuild after Genocide (to provide full assistance with recovery, reconstruction and reconciliation). How To Prevent, React and Rebuild: Health Research and the Prevention of Genocide. In light of the recently published World Report on Violence and Health, an exhaustive document bringing global violence prevention into high relief as an international public health priority (Krug et al. 2002) it is intriguing to note that the key responsibilities outlined in the ICISS report correspond to the central public health constructs of primary, late primary/secondary, and tertiary violence prevention, respectively. It is equally intriguing, therefore, to consider the extension of violence prevention methods to include the prevention of genocide (a form of catastrophic, population-based violence), as well as to ask the question: What roles do health researchers, professionals and organizations have to play in this compelling societal goal? Genocide: Definition and Impact on Health and Health Systems Deaths resulting from genocide are estimated to have exceeded war-related mortality in every historical age (Table 1) (Rummel 1998). The health effects of genocide are catastrophic, and genocide-related mortality in the latter half of the 20th century far exceeded other public health crises of the same period. As a disturbing example, the Rwandan genocide, occurring between April - June 1994, served as the leading cause of death in Rwanda for the entire decade between 1990-1999, resulting in a mortality rate ten times higher than the rate for HIV/AIDS, and 70 times for that for malaria (Table 2). The immediate health sequelae of genocide and the social disruption it creates include increased rates of malnutrition, low birth weights, perinatal mortality, and epidemic infectious disease for surviving victims and non-targeted refugees alike (Table 3). In the longer term, organ system failure, neurological dysfunction, cognitive impairment, post-traumatic stress disorder, depression, and chronic pain syndromes have all been documented to be more prevalent in survivor groups than the general population (Carlson, and Rosser-Hogan 1991; Conn 2000; Eitinger 1980; Sadavoy 1997); (Yaari et al. 1999). Tragically, intergenerational transmission of some of the mental health consequences of genocide has also been documented (Yehuda et al. 1998), conferring an extended burden of disease on already burdened populations. While there is no typical experience from which to assess the health-related economic consequences of genocide, recent events in Rwanda provide some insight into this question. Prior to the violence that began in April 1994, Rwanda spent approximately USD $100 million, or 5% of the country’s Gross Domestic Product (GDP), on health care (World, and Bank 2000). By the end of 1994, a similar level of expenditure was supporting dramatically increased health care needs, but other governments and international NGOs were providing 90% of these funds. In the first year following the genocide, international agencies were spending USD $1,000,000 per day to provide basic food and public health services to the 1.9 million externally displaced Rwandans (Table 3) (Bureau et al. 1995; World, Food, and Programme 1996) largely representing members of the non-targeted cultural majority population fleeing combatant armies. Short run emergency aid amounted to just under half of the entire output of the Rwandan economy in the year before the genocide. The economic consequences of these and other lost opportunities in sub-Saharan Africa, as well as globally, provide another perspective on the enormous costs in question. Risk Factors for Genocidal Behaviour: Societies, Groups, and Individuals Genocide: Structural Risk Factors What is currently understood about the antecedents of genocidal behaviour? Over the past fifty years, the eminent members of panels in Track One have ascertained that the risk of catastrophic violence is increased when a destructive amalgam of autocratic government, malevolent ideology, grave social conditions, and psychological conditioning is present. Circumstances increasing the likelihood of genocide include: ·NON-DEMOCRACY. Genocide is carried out by governments holding a “high degree of centralized authority” (Chalk, 1990). Many authors characterize genocide as a crime of ruling powers (Fein 1993; Harff, and Gurr 1989; Kuper 1981; Rummel 1995). ·IDEOLOGY. Ideologies alleging the superiority of a single societal group are particularly pernicious. Racist, ethnocentric, and religious doctrines targeting “outsiders” fall into this category (Fein 1984; Harff 1993). ·ARMED CONFLICT/WARFARE. While genocide is a crime distinct from warfare, armed conflict obscures genocidal killing, obstructs victims’ calls for assistance, desensitizes bystanders to cruelty, and impedes intervention from outside states (Fein 1984). Concurrent warfare confuses international observers about the nature of genocidal conflict. Finally, governments may conflate warfare and genocide into a single function, utilizing a trained military for both purposes (Markusen, and Mirkovic 1999). ·ECONOMIC HARDSHIP. Harff points out that in times of economic decline or scarcity, non-democratic governments may feel permitted to increase inequitable treatment of disadvantaged groups (Harff 1993). ·AMBIVALENCE OF PATRON NATIONS. When empty threats of intervention or punishment are made by influential nations, governments may believe that there is nothing to lose by committing genocide within domestic borders (Fein 1993; Harff 1993). Impunity has led perpetrating governments to repeat and intensify atrocities against their own civilians. Genocide: Psychological Risk Factors Psychological risk factors, defined as the cognitive and attitudinal characteristics facilitating genocidal behaviour or the condoning of genocidal violence, are theorized to increase the probability of genocide in societies with conducive structural characteristics. All documented genocide has been preceded by long-term programs of hate propaganda, exclusionary legislation and mounting violence lasting years. The proposed psychological predictors of hands-on killing during genocide have been derived by a variety of researchers from retrospective review of this historical record, as follows: ·EXCLUSION FROM THE UNIVERSE OF OBLIGATION, as discussed by Helen Fein in her option paper for this symposium. ·AUTHORITY ORIENTATION, predisposing individuals and groups to seek personal safety in times of social turmoil by following the orders of charismatic leaders promising a hopeful future (Staub 1999; Waller 2002). ·SELF-INTEREST ORIENTATION, inducing individuals to engage willingly in genocidal acts for career, financial or socio-political advancement (Lifton 1986; Staub 1999). ·THE DESTRUCTIVE CONTINUUM. Gradual escalation of cruelty during campaigns of genocide desensitizes perpetrators to victims’ suffering (Staub 1999). Despite variation in methods of genocide across geographic and historical boundaries, each of these attitudinal characteristics has been well documented in numerous occurrences of modern genocide, including but not limited to the Nazi, Cambodian, Bosnian, and Rwandan episodes. Violence Prevention: A Template for Genocide Prevention The significance of identifying the structural and behavioural precursors of genocide becomes clear when viewed through the lens of contemporary public health violence prevention theory and practice. In recent years, the Haddon Matrix has been used more frequently as a method of analyzing and preventing physical and psychological injury after potentially catastrophic events. Developed in 1968 by Dr. William Haddon, Jr., a public health physician with the New York State Health Department, a Haddon Matrix divides each potentially injurious event into Human Factors, Agent Factors, and Environmental Factors leading to injury, and considers each of these factors in order to develop a thorough plan of injury prevention (Haddon 1980). Focusing on the time periods before, during and after each incident with injury potential, the Haddon Matrix has recently been applied to a number of problems involving prevention of injury associated with extreme violence (Baker, and Runyan; National et al. 2003), thereby providing a useful framework for the design of future genocide prevention efforts. Figure 1 demonstrates what a possible Haddon Matrix for genocide prevention might look like when translated into the language of the ICISS Final Report. (The tables shown by Reva Adler in connection with this presentation can be found at page XX) Figure 1: The Haddon Matrix Adapted for an Approach to Genocide Prevention
Despite such parallel advances in violence prevention methods, only a small number of health and social science researchers have turned their attention to the prevention of genocide, a form of population-based, catastrophic violence. For those who have, the most frequently advocated preventive approach and calls for surveillance of socio-political risk factors (“Early Warning”), triggering intercession by the world community when genocide seems imminent (“Prevention”) (Association 2001; Gellert 1995; Willis, and Levy 2000). This approach is analogous to the emergency treatment of ischaemic heart disease in a comparative model, where an early myocardial infarction (“Early Warning”) is treated with thrombolysis or coronary artery bypass surgery (“Prevention”). Constituting “secondary prevention’, this form of intercession is intended to thwart untoward outcomes when a critical process is long-standing, well-established, and already underway. Corresponding to the ICISS much of the dialogue surrounding genocide prevention has centered on this crisis-based stage of intervention, conflating the Responsibilities to and into a single, synonymous, late-stage function. However, a second, novel approach to genocide prevention is suggested by contemporary violence prevention research, warranting definitional accuracy, scrutiny and testing. This approach employs sophisticated genocide-prediction instruments to identify societies at high risk for genocide, years before catastrophic violence actually erupts. Dr. Barbara Harff will present the best of such instruments in the next session in this track. In a departure from other models, vulnerable societies are then studied for specific cognitive and psychological risk factors for hands-on killing, and interventions are consequently developed, implemented, and tested. Corresponding the ICISS (i.e. , this approach is synergistic to crisis-phase , and seeks to foster durable public attitudes that are resistant to genocidal provocations, years before incitements escalate. Using the ischaemic heart disease analogy, this strategy corresponds to long-range, population-wide efforts to modify such risk factors as smoking and saturated fat intake in the primary prevention of coronary heart disease. Similar approaches have proven effective elsewhere, and are consistent with repeated calls for the study of genocide within a community health model (Charny 1986); (Kleinman 1999). Thus, the Haddon Matrix presented earlier may be expanded to reflect a synergistic model of primary through tertiary genocide prevention, synthesizing our current understanding of best practices into an interlocking program. One such model for a comprehensive approach to the prevention of catastrophic violence is summarized in Figure 2. (The tables shown by Reva Adler in connection with this presentation can be found at page XX) · · · · · · ·
The Responsibility to Prevent vs. React: The Need for Definitional Clarity
Despite such parallel advances in violence prevention methods, only a small number of health and social science researchers have turned their attention to the prevention of genocide, a form of population-based, catastrophic violence. For those who have, the most frequently advocated preventive approach and calls for surveillance of socio-political risk factors (“Early Warning”), triggering intercession by the world community when genocide seems imminent (“Prevention”) (Association 2001; Gellert 1995; Willis, and Levy 2000). This approach is analogous to the emergency treatment of ischaemic heart disease in a comparative model, where an early myocardial infarction (“Early Warning”) is treated with thrombolysis or coronary artery bypass surgery (“Prevention”). Constituting “secondary prevention’, this form of intercession is intended to thwart untoward outcomes when a critical process is long-standing, well-established, and already underway. Corresponding to the ICISS Responsibility to React, much of the dialogue surrounding genocide prevention has centered on this crisis-based stage of intervention, conflating the Responsibilities to Prevent and React into a single, synonymous, late-stage function. However, a second, novel approach to primary genocide prevention is suggested by contemporary violence prevention research, warranting definitional accuracy, scrutiny and testing. This approach employs sophisticated genocide-prediction instruments to identify societies at high risk for genocide, years before catastrophic violence actually erupts. Dr. Barbara Harff will present the best of such instruments in the next session in this track. In a departure from other models, vulnerable societies are then studied prospectively for specific cognitive and psychological risk factors for hands-on killing, and interventions are consequently developed, implemented, and tested. Corresponding the ICISS Responsibility to Prevent (i.e. to address both the root and direct causes of internal conflict), this approach is synergistic to crisis-phase reaction, and seeks to foster durable public attitudes that are resistant to genocidal provocations, years before incitements escalate. Using the ischaemic heart disease analogy, this strategy corresponds to long-range, population-wide efforts to modify such risk factors as smoking and saturated fat intake in the primary prevention of coronary heart disease. Similar approaches have proven effective elsewhere, and are consistent with repeated calls for the study of genocide within a community health model (Charny 1986); (Kleinman 1999). Genocide Prevention and the Haddon Matrix:
Thus, the Haddon Matrix presented earlier may be expanded to reflect a synergistic model of primary through tertiary genocide prevention, synthesizing our current understanding of best practices into an interlocking program. One such model for a comprehensive approach to the prevention of catastrophic violence is summarized in Figure 2. (The tables shown by Reva Adler in connection with this presentation can be found at page XX) Thus, the Haddon Matrix presented earlier may be expanded to reflect a synergistic model of primary through tertiary genocide prevention, synthesizing our current understanding of best practices into an interlocking program. One such model for a comprehensive approach to the prevention of catastrophic violence is summarized in Figure 2.
Study effective methods of protection of minorities at risk
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Develop geo-mapping of potential targets and community resources. Provide intensive support to those areas.
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Develop official “warning networks” with influential outside governments to facilitate warning escalating crisis
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Provide satellite and radio communications equipment for key organizations to warn of genocide escalation in high-risk countries
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Disseminate video cameras for targeted victims to document and disseminate evidence of escalating human rights violations to the outside world
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Support minorities at risk with funds for education & economic development
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Improve international support and criteria for emigration of minorities at risk to less dangerous venues.
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Train health personnel in mental and physical first aid training and health support
Fund research to identify modifiable risk factors for genocidal behaviour in individuals and groups
Develop and implement long-range mental health education media campaigns on intercultural tolerance and conflict resolution
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Develop and implement of school curricula on intercultural tolerance and peaceful conflict resolution
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Establish intercultural youth and adult peace building groups in every major religious denomination in high-risk societies
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Establish intercultural peace building steering committees in all professional organizations and trade unions
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Support victims of pre-genocide violence medically, psychologically and financially to avoid severe traumatization and later retaliatory violence
Fund research looking for modifiable structural risk factors for genocide
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Use early warning tools to target high risk jurisdictions
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International pressure/ aid for democratization of single-party governance
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Pressure/Aid for improved social determinants (education, distribution of resources, economic opportunity) in high-risk societies
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Create the UN Special Rapporteur for Genocide Prevention
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Aid/pressure for improved human rights policies in high-risk societies
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Influence/aid religious organizations to promote tolerance and peacebuilding
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Improve children’s and women’s rights in high risk jurisdictions
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Influence international corporations doing business in high-risk counties to promote minority rights and equal access to jobs
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Prosecute all relevant pre-genocide human rights violations through the international criminal court
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Jam radio and television signals inciting genocide in high risk societies
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Embargo weapons, communications equipment and funds tagged for genocidal governments
Mandate influential International Organizations (e.g. UN, IRC) to establish effective and defendable “safe havens” for targeted victims in times of escalating crisis
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Airlift targeted victims to safe areas outside the high-risk venue
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Train health personnel in mental and physical first aid training and health support
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Target prevention of sexual assault of women in genocide as a critical priority
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Target prevention of forcible transfer of children to families in the cultural majority
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Provide for outside medical/psychological support to be inserted into high-risk areas.
Broadcast messages explaining consequences to perpetrating soldiers, militia members and citizens
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Broadcast messages on radio, television and the internet encouraging potential perpetrators to resist incitements to genocidal violence
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Encourage religious, corporate, humanitarian, and professional leaders, bystanders and moderates to convince potential perpetrators to resist or refuse participation in genocidal events
Respond to early warning predictive models with appropriate modalities
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Mobilize international military forces with the mandate to stop genocidal activity with force as necessary
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Apply severe economic, governmental, social, legal and religious sanctions against perpetrating governments
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Jam perpetrating forces’ communications and domestic broadcasts inciting citizens to participate in genocidal violence
Conduct urgent individual, group and population needs assessments
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Triage and treat physical and psychological injuries as needed
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Prevent or mitigate distress, psychiatric illness, and adverse behavioural change
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Mobilize international resources to support survivors and refugees and prevent further short and long-term harm
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Protect women, children and other vulnerable populations from further assault, injury and harm
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Reunite forcibly transferred children with their birth families
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Support individuals, families and communities
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Provide women victims with treatment for sexually acquired through genocide-related sexual assault.
Bring perpetrators to appropriate justice, graded to the severity of each crime
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Provide injured perpetrators psychological and physical care.
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Assist perpetrators with psychological and physical rehabilitation as needed
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Support released perpetrators who are returning to society with re-integration training
Evaluate crisis response and retool, as needed
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Assist with building or rebuilding democratic structures in post-genocide society
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Provide financial and hands-on assistance with rebuilding medical, educational, financial, governmental, agricultural, and civil engineering infrastructure
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Develop strategies to maintain community cohesion
Conclusion:
: Albert Einstein in quoted as once having said that “Genocide prevention is one thing that should not be oversimplified. Drawing from a number of critical disciplines in establishing robust definitions and action plans for each of the key Responsibilities mandated in the ICISS Final Report can only enhance the ability of the international community to eradicate the most destructive and intractable forms of collective human violence. The Public Health models developed over the past half century and discussed here have much to contribute to this compelling societal goal, particularly with regard to expansion of longer-range, primary approaches to the prevention of genocide and other forms of catastrophic violence. (The tables shown by Reva Adler in connection with this presentation can be found at page XX) Albert Einstein in quoted as once having said that “Things should always be made as simple as possible, but no simpler.” Genocide prevention is one thing that should not be oversimplified. Drawing from a number of critical disciplines in establishing robust definitions and action plans for each of the key Responsibilities mandated in the ICISS Final Report can only enhance the ability of the international community to eradicate the most destructive and intractable forms of collective human violence. The Public Health models developed over the past half century and discussed here have much to contribute to this compelling societal goal, particularly with regard to expansion of longer-range, primary approaches to the prevention of genocide and other forms of catastrophic violence. Table 1
Mortality for War and Democide: 5000 BC to 2000 AD (Rummel, 1998)
Mortality for War and Democide: 5000 BC to 2000 AD (Rummel, 1998)
Table 2
Mortality Rates for Selected Public Health Emergencies in Sub-Saharan Africa: 1990-2000 (Caplan, 2000; WHO, 1999a; WHO, 1999b) Mortality Rates for Selected Public Health Emergencies in Sub-Saharan Africa: 1990-2000 (Caplan, 2000; WHO, 1999a; WHO, 1999b)
Table 3
Highest Morbidity and Mortality Rates: Rwandan Refugees in Zaire and Burundi May – September, 1994 (Goma Epidemiology Group 1995; MMWR 1996) Highest Morbidity and Mortality Rates: Rwandan Refugees in Zaire and Burundi May – September, 1994 (Goma Epidemiology Group 1995; MMWR 1996)
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| For information about this production and the Stockholm International Forum Conference Series please go to www.humanrights.gov.se or contact Information Rosenbad, SE-103 33 Stockholm, Sweden | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||