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PubMed1998

In defence of humanitarianism.

The humanitarian crisis which followed in the wake of the genocidal regime in Rwanda in 1994 generated massive media attention and an unprecedented outpouring of international public and private assistance. In late 1997, the Rwanda refugee population in Zaire was subjected to a disaster of similarly epic proportions as a result of military action. Yet this crisis went relatively under-reported and failed to attract substantial aid funds, particularly from official donors. This paper seeks to document and account for the demise of the humanitarian imperative. It confronts a number of the criticisms of humanitarian action, concluding that, rather than being flawed, traditional humanitarian values remain valid and should be defended wherever there are situations of conflict.

Altruism↗

PubMed2002

The role of research institutions in seed-related disaster relief: Seeds of Hope experiences in Rwanda.

The article describes the efforts of a coalition of agricultural research centres, Seeds of Hope (SOH) in the rebuilding, of Rwanda, after the genocide and war of 1994. Research involvement in emergency relief and rehabilitation was unusual at the time and SOH had to forge its unique complementary role. Focusing on crop and variety development and conservation it: provided technical advice to relief agencies on seed procurement; used its baseline ken to assess the effects of war on seed diversity and seed security; made preparations to restore specific germplasm (which, fortunately, proved unnecessary) and spent substantial effort on rebuilding human resource capacity in research as well as basic scientific facilities. The involvement of SOH highlighted the critical, yet very different, roles for research during emergency versus rehabilitation periods and demonstrated the cost effectiveness of building in a diagnostic component--before massive seed or germplasm distributions are programmed.

Academies and Institutes↗

PubMed2004

Humanitarian action and military intervention: temptations and possibilities.

Although the war in Liberia in July 2003 claimed hundreds of lives, the international community was reluctant to intervene. In this article, the author debates the question: does international military intervention equal protection of populations? The role of humanitarian organisations in military intervention is considered. Aid organisations cannot call for deployment of a protection force without renouncing their autonomy or appealing to references outside their own practices. Such organisations provide victims with vital assistance and contribute to ensuring that their fate becomes a stake in political debate by exposing the violence that engulfs them, without substituting their own voices for those of the victims. The political content of humanitarian action is also outlined and military intervention in the context of genocide is discussed. The author concludes that the latter is one of the rare situations in which humanitarian actors can consider calling for an armed intervention without renouncing their own logic.

Altruism↗

PubMed2005

Dead letter or living document? Ten years of the Code of Conduct for disaster relief.

This paper examines the present value of the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief, in view of discussions on neutrality and the Western bias of the humanitarian aid system, and assesses how it can retain its relevance in future. The Code of Conduct was launched just after the Rwanda genocide of April 1994. A decade later, the crises in Afghanistan and Iraq have sparked renewed interest in humanitarian principles and in whether the code can serve as an instrument to define humanitarianism and guide humanitarian decision-making and coordination. More than 300 organisations have now subscribed to it. This paper is based on the findings of a survey of code signatories and the outcomes of a conference on the value and future of the code, held in The Hague, Netherlands, in September 2004 to mark its tenth anniversary.

Altruism↗

PubMed1995

Radiology in Rwanda.

This account documents some aspects of military radiology in the aftermath of the Rwandan Civil War of 1994. Following the genocidal conflict of April-July 1994, all radiographic services ceased in Rwanda, a nation of some 7,500,000 people. As part of the United Nations Peacekeeping Force, UNAMIR II, the Australian Medical Support Force established and provided, on an ongoing basis, sophisticated medical, surgical and intensivist care for the sick and wounded United Nations personnel, of whom there were up to 7000 deployed in Rwanda; and, as part of its humanitarian outreach, emergency medical and surgical care for Rwandese civilians. The Australian contingent of 308 service personnel established the Australian Military Hospital (the 'United Nations Hospital') in the former Clinic Wing of the Kigali Central Hospital. From August 1994 the Radiology Department of the Australian Medical Support Force provided the first specialist X-ray services as part of the re-building of the stricken nation and, over the ensuing year, provided a diagnostic service for soldiers and civilians with both chronic and recent war wounds, trauma victims in the aftermath of the Civil War, sick and injured soldiers and Rwandese suffering from any of the full range of medical conditions encountered in tropical Africa.

Australia↗

PubMed1997

Military surgery in Rwanda.

BACKGROUND: In April of 1994, a vicious civil was erupted in Rwanda, with more than 500,000 people massacred by extremist militias. The second United Nations Assistance Mission in Rwanda (UNAMIR II) deployed in August 1994 to monitor the ceasefire, with an Australian Defence Force Contingent of Health Service Support consisting of staff for the UNAMIR Head-quarters, and the Australian Medical Support Force (AS MSF). METHODS: A retrospective audit was conducted of all operative surgery performed during the year-long deployment, in the AS MSF operating theatres. RESULTS: Twenty surgeons rotated through in 6-week intervals. A total of 750 operations were performed on 547 patients, of which 636 (84.8%) involved civilians. A total of 558 (74.4%) cases were the result of trauma both accidental (38.4%) and war related (36%). The mean age of patients was 21.7 years. The age distribution was skewed, with 289 (38.5%) cases being performed on children. General surgeons performed a wide range of surgery, covering the majority of surgical specialties. These included cardiothoracic, neurosurgical, vascular and paediatric cases. Orthopaedic surgeons dealt with amputations, debridements and skin grafting in addition to bony injuries and infections. Children formed a substantial number of those treated, and required surgery for war-related injuries significantly more often than adults. CONCLUSIONS: Surgeons involved in future peacekeeping missions should be aware of the broad variety of clinical problems encountered, and undertake refresher training in the sub-specialties. Children are at great risk of violence in war, and if a civilization can be judged by the protection it affords its helpless, the Rwandan genocide and ensuing civil war represents a horrific example of the opposite extreme.

Adolescent↗

PubMed1992

Cultural identification in aboriginal and Torres Strait Islander AIDS education.

The emergence of the disease AIDS in the early 1980s has resulted in a unique response. Medical, sociocultural, political, sexual, moral and racial issues have all been raised. This paper examines the way in which participation of Aboriginal and Torres Strait Islander people has resulted in the culturally appropriate and distinctive approaches evident in health education materials produced in Aboriginal and Torres Strait Islander communities. Specific cultural issues relevant to AIDS education are considered, including the use of visual and narrative communication for AIDS education; the significance of the specific concepts related to communication on sexual issues; perceptions of AIDS as alien and genocidal; the use of the Dreaming in AIDS educational resources; and implications for AIDS education.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Humanitarian responses to mass violence perpetrated against vulnerable populations.

This multidisciplinary review links three areas of legitimate inquiry for practitioners of medicine and public health. The first is occurrences of mass violence or genocide perpetrated against vulnerable populations, with a focus on the failure of national and international mechanisms to prevent or predict such violence. The second is evolving concepts of national sovereignty and an emerging framework in which the imperative to assist vulnerable populations supersedes a state's right to self determination. The last is how medical, public health, and other systems of surveillance and rapid assessment of mass violence can accelerate public awareness and facilitate structured, consistent political decision making to prevent mass violence and to provide international humanitarian assistance.

Altruism↗

PubMed1995

Human gene therapy and slippery slope arguments.

Any suggestion of altering the genetic makeup of human beings through gene therapy is quite likely to provoke a response involving some reference to a 'slippery slope'. In this article the author examines the topography of two different types of slippery slope argument, the logical slippery slope and the rhetorical slippery slope argument. The logical form of the argument suggests that if we permit somatic cell gene therapy then we are committed to accepting germ line gene therapy in the future because there is no logically sustainable distinction between them. The rhetorical form posits that allowing somatic cell therapy now will be taking the first step on a slippery slope which will ultimately lead to the type of genocide perpetrated by the Nazis. The author tests the validity of these lines of argument against the facts of human gene therapy and concludes that because of their dependence on probabilities that cannot be empirically proven they should be largely disregarded in the much more important debate on moral line-drawing in gene therapy.

Advisory Committees↗

PubMed1995

Psychiatric consequences of "ethnic cleansing": clinical assessments and trauma testimonies of newly resettled Bosnian refugees.

OBJECTIVE: The authors describe the psychiatric assessments and trauma testimonies of 20 Bosnian refugees of "ethnic cleansing" who have recently resettled in the United States. METHOD: Refugees referred from agencies managing refugee resettlement underwent systematic, trauma-focused, clinical interviews that included standardized assessment scales. RESULTS: The traumatic experiences of ethnic cleansing in these Bosnian refugees were genocidal in nature. The number of types of traumatic experiences correlated positively with age. Posttraumatic stress disorder (PTSD) was diagnosed in 65% of the refugees, and depressive disorders in 35%. PTSD severity scores were correlated with the number of types of traumatic events experienced. CONCLUSIONS: Ethnic cleansing has caused high rates of PTSD and depression, as well as other forms of psychological morbidity, in this group of resettled Bosnian refugees. The longitudinal sequelae of ethnic cleansing as a form of massive psychic trauma remain to be studied.

Adolescent↗

PubMed1998

Testimony psychotherapy in Bosnian refugees: a pilot study.

OBJECTIVE: The authors sought to describe the use of the testimony method of psychotherapy in a group of traumatized adult refugees from genocide in Bosnia-Herzegovina. METHOD: The subjects were 20 Bosnian refugees in Chicago who gave written informed consent to participate in a case series study of testimony psychotherapy. All subjects received testimony psychotherapy, averaging six sessions, approximately 90 minutes, weekly or biweekly. Subjects received standardized instruments for posttraumatic stress disorder (PTSD), depression, traumatic events, global functioning, and prior psychiatric history. The instruments were administered before treatment, at the conclusion of the treatment, and at the 2- and 6-month follow-ups. RESULTS: The posttreatment assessments demonstrated significant decreases in the rate of PTSD diagnosis, PTSD symptom severity, and the severity of reexperiencing, avoidance, and hyperarousal symptom clusters. Depressive symptoms demonstrated a significant decrease, and there was a significant increase in scores on the Global Assessment of Functioning Scale. Two-month and 6-month follow-up assessments demonstrated further significant decreases in all symptoms and an increase in scores on the Global Assessment of Functioning Scale. CONCLUSIONS: This pilot study provides preliminary evidence that testimony psychotherapy may lead to improvements in PTSD and depressive symptoms, as well as to improvement of functioning, in survivors of state-sponsored violence.

Adult↗

PubMed2003

"I wish he hadn't told me that": methodological and ethical issues in social trauma and conflict research.

Undertaking research on individuals who have experienced social traumas, such as being a victim or perpetrator of genocides and wars, presents difficult decisions for qualitative researchers. Deciding how to deal with these issues becomes more problematic when the researcher is a member of the society in conflict. To do this work, and to work collaboratively with researchers from the other side, sensitive ways to collect data have to be chosen. Interpretations of the materials can be no less difficult: Analyses often lead to information and understandings that may be difficult for the researcher to deal with from ethical, moral, and personal standpoints, especially when he or she is a member of the society and culture under study. In this keynote address, the author explores methodological and ethical issues connected to these topics. She brings examples from her work on the Palestinian-Israeli conflict and focuses on use of the life story methodology.

Arabs↗

PubMedDate not supplied

Hospice care or assisted suicide: a false dichotomy.

In this paper, the author argues that making assisted suicide available is not a contradictory position to espousing hospice care. He draws on historical and political examples to explain the ethical basis for this assertion. By defining the issue at stake as one of personal autonomy (the loss or gain thereof), the author challenges the argument that making assisted suicide available leads to a slippery slope towards euthanasia, eugenics, or genocide. He asserts that narrowing choices by preventing people from seeking assistance in suicide is more likely to lead us down the slippery slope towards coercive medical and state intervention in our lives.

Attitude to Death↗

PubMed2004

Dangerous and endangered youth: social structures and determinants of violence.

Structural violence is violence that is permissible, even encouraged. It refers to the invisible social machinery of inequality that reproduces social relations of exclusion and marginalization via ideologies, stigmas, and dangerous discourses (such as "youth violence" itself) attendant to race, class, sex, and other invidious distinctions. Structural violence "naturalizes" poverty, sickness, hunger, and premature death, erasing their social and political origins so that they are taken for granted and no one is held accountable except the poor themselves. Structural violence also refers to the ease with which humans are capable of reducing the socially vulnerable (even those from their own class and community) into expendable non-persons, thus allowing the licence--even the duty--to kill them. I exemplify this through two ethnographic critical case studies: the operation of a virulent death squad in Northeast Brazil that mobilized the support of ordinary people in an almost genocidal attack against Afro-Brazilian street kids and young "marginals"; and the uneasy truce with, and incomplete integration of "dangerous and endangered" youth still living in squatter camps and shack communities of urban South Africa.

Adolescent↗

PubMed2003

An analysis of empirical research on the scope of justice.

The scope of justice has been defined as the boundary within which justice is perceived to be relevant. The empirical literature on this topic is primarily aimed at predicting when a target will be excluded from the scope of justice and at examining potential consequences of exclusion, from accepting a target's suffering to active harm-doing such as mass internment and genocide. The concept of the scope of justice is interesting and heuristically useful, but there are several problems with the empirical literature that impede its progress. For example, the proposed mediator often has not been measured, or operationalizations of the scope of justice have been confounded with other constructs. Also, although the scope of justice remains one possible explanation for results obtained in various experiments, there are equally compelling alternatives that do not implicate exclusion from the scope of justice. We offer suggestions about how to study scope of justice issues in the future and identify points that need to be clarified regarding the conceptualization of the scope of justice.

Concentration Camps↗

PubMed2005

Meeting threats to global health: a call for American leadership.

Although the application of major biomedical advances has yielded spectacular results for individual health, there has been little improvement in the health of whole populations. There is a "back to the future" irony in the fact that at the inception of the 21st century, the eruption and spread of a multitude of "old" and "new" infectious diseases has become the most serious global threat to the health of humankind. At this historical juncture, the United States is the country with the most potential for favorably influencing global health and health care. Although there are historical, cultural, economic, and political factors that impede the United States from rising to this challenge, there is both a moral imperative and a rational long-term self-interest basis for the U.S. medical profession and government to exercise leadership in facing the health challenges of tragic and genocidal proportions that threaten everyone in an increasingly interdependent world.

Forecasting↗

PubMed1998

Embodiment of terror: gendered violence in peacetime and wartime in Croatia and Bosnia-Herzegovina.

Gendered violence is not a special type of torture used only in war. Its roots are well established in peacetime. This article discusses parallels between the patterns of everyday domination and aggression during times of peace and war. Further, it discusses how metaphors and acts of rape in peacetime are transformed into symbols and acts of rape for wartime purposes. During peacetime the individual body, especially its essence--sexuality and reproduction--becomes the symbol of everyday domination and aggression. Wartime transforms individual bodies into social bodies as seen, for example, in genocidal rapes or ethnic cleansing, which are thought to purify the bloodlines. Then, institutions--that is, medical, religious, and government establishments--further reinforce the wartime process by manipulating the individual/social body into the body politic by controlling and defining "human life" and using political rapes to entice military action by the West. The final transformation (at the war's conclusion) is the reformation of the social body back into the individual body, making the individual body once again the focus of dominance and aggression as the acceptable social "order."

Adolescent↗

PubMed1991

The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community.

The Tuskegee study of untreated syphilis in the Negro male is the longest nontherapeutic experiment on human beings in medical history. The strategies used to recruit and retain participants were quite similar to those being advocated for HIV/AIDS prevention programs today. Almost 60 years after the study began, there remains a trail of distrust and suspicion that hampers HIV education efforts in Black communities. The AIDS epidemic has exposed the Tuskegee study as a historical marker for the legitimate discontent of Blacks with the public health system. The belief that AIDS is a form of genocide is rooted in a social context in which Black Americans, faced with persistent inequality, believe in conspiracy theories about Whites against Blacks. These theories range from the belief that the government promotes drug abuse in Black communities to the belief that HIV is a manmade weapon of racial warfare. An open and honest discussion of the Tuskegee Syphilis Study can facilitate the process of rebuilding trust between the Black community and public health authorities. This dialogue can contribute to the development of HIV education programs that are scientifically sound, culturally sensitive, and ethnically acceptable.

Acquired Immunodeficiency Syndrome↗