War, Public Health & Human Rights

1. War, Public Health &Human Rights

2. Contents • Before and After • An act of war? • International Human Rights vs. Humanitarian Law • Historical Perspective • Consequences • Landmines • Genocide, War Crimes, Crime Against Humanity • Personal Experiences - Cambodia • Roles of Humanitarian Organizations and Public Health Professional

3. Before and After

4. Dignity • What is dignity? • Webster defines dignity as the quality or state of being worthy, honored, or esteemed • Violation of personal dignity has immediate and long term health consequences, although we don’t know how to measure it. • Even though it is difficult to define and measure, one thing is certain as stated by the late Jonathan Mann “we know when our dignity is violated.”

5. “Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed…” -- Former U.S. President, Dwight D. Eisenhower, in a speech on April 16, 1953

6. An Act of War? • 1928 - Kellog-Briand (Pact of Paris) Pact renounced war as a national policy ratified by 62 nations, entered into force in 1929 • In 1945, the United Nations Charter banned the “first use of force” which put an end to the declaration of war • “Act of Aggression” is the modern term

7. International Human Rights and Humanitarian Law • Both seek to protect fundamental rights of the individual • Human Rights law applies to all circumstances - peace, armed conflict, restoration of peace • Humanitarian law applies to situations of armed conflict

8. International Human Rights and Humanitarian Law • Human rights law concentrates on rights of individual to treatment or protection from government abuse • Humanitarian law indicates how a party to a conflict is to behave in relation to people at its mercy • Humanitarian law is generally dominant in conflict situations

9. International Humanitarian Law • 1925 - Geneva Convention: Banned chemical and biological warfare • 1945 Nuremberg Charter: Prosecution and punishment of war criminals • 1945 UN Charters: Banned the “first use of force” • 1948 Genocide Convention: Prevention and punishment of the crime of genocide

10. International Humanitarian Law • 1949 Geneva Conventions – Amelioration of the wounded and sick • 1980 Convention on Conventional Weapons - Prohibited or restricted the use of Certain CWs that may cause excessive injuries or to have indiscriminate effects • 1993 Chemical Weapons Convention - Prohibited production, stockpiling, and use of chemical weapons • 1997 Ottawa Treaty - Prohibited the use, stockpiling, production and transfer of anti-personnel landmines (destruction of mines)

11. Weapons of War • Conventional weapons (restrictions) • Biological weapons (banned) • Chemical weapons (banned) • Landmines (banned) • Nuclear weapons (? non-proliferation treaty) • New technological weapons such as blinding laser, smart mine, depleted uranium (?)

12. Since WWII • 160 wars and armed conflicts • 30 million deaths • 90 million people injured • 50 armed conflicts currently around the world

13. Consequences • Direct assaults on civilians • Ethnic cleansing, Genocide and other war crimes • Indiscriminate weapons & tactics (landmines, cluster bomb) • Violation of medical neutrality • Destruction of country infrastructures including market, school, civil service, medical facilities • Destruction of historical and cultural buildings and monuments • Diversion of resources from health and other human development programs

14. Civilian Casualties(Garfield, War and Public Health, UNICEF)

15. Children • 2 million killed between 1985 to 1995 • 4-5 million handicapped or disabled • 12 million homeless • 1 million orphaned • 10 million are psychologically traumatized UNICEF

16. Women • Direct casualty increases due to change in war strategy since WWII • Psychological and economic impact • Maternal and child health due to destruction of health care systems • Refugees - women and children make up 80% • Rape and sexual exploitation • Prostitution • AIDS and STDs • Landmines

17. Refugees • 20 million currently under UNHCR care • 80% are women and children • Crude death rate can be as high as 30 times the baseline rates in their country of origin • Most deaths were caused by preventable conditions (diarrhea, measles, respiratory infection, exacerbated by hunger and malnutrition)

18. China Purchased 26 combat aircrafts from Russia Safe water for 140 million of the 200 million people without safe water for one year India Ordered 20 MIGs from Russia Basic education to all the 15 million girls out of school South Korea Ordered 28 missiles from the US Immunized all the 120,000 un-immunized children and provided safe water for three years to the 3.5 million people without safe water Human Development Cost 1992 Sidel, BMJ

19. Malaysia Ordered 2 warships from the UK Safe water for nearly a quarter century to the five million people without safe water Nigeria Purchased 80 battle tanks from the UK Immunized all 2 million unimmunized; family planning services to 17 million of the more than 20 million couples without such services Pakistan Ordered 40 jet fighters and 3 other aircrafts Safe water for two years for all 55 million people, family planning to 20 million couples, and essential medicine to 13 million without access to healthcare, and basic education to 12 million children out of primary school Human Development Cost

20. Landmines • 110 million landmines buried world wide, 250 millions stockpiled • 70 countries are affected • Cost as little as $3 to plant, but as much as $1000 to remove one • 800 people are killed each month • Most victims are civilians • Male between 16-35 made up a majority of the victims • Increasingly, more women and children are falling victims

21. Landmines: Ethical Issues • International Humanitarian Law • Principal of Distinction • Law of Proportionality • Unnecessary suffering and superfluous injury • Use responsibly? • Military usefulness? (one-third of 58,000 U.S. troops killed in Vietnam fell victims to landmine, and 40% of the 153,000 wounded)

22. Landmines Impact on Health and Human Rights

23. Genocide(UN Convention 1948) Any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial(social) or religious group, as such: • killing members of the group; • causing serious bodily or mental harm to members of the group; • deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part; • imposing measures intended to prevent births within the group; • forcibly transferring children of the group to another group.

24. Holocaust, Europe, WWII • 5 million Jews • Millions of other

25. The Killing Fields, Cambodia, 1975-1979 • 1.5 to 2 million were killed, starved, or died from diseases • Most of the population were internally displaced

26. Rwanda, 1994 • 500,000 were killed, mostly Tutsis • Role of the local Media in inciting the killings

27. Genocide (others) • Turkey - 1915-23 - 1.5 million Armenian Christians were killed • Former Soviet Union - 1918-21; 1930-38 - 100-200,000 Jews, 5 million Ukrainians, 14-15 million Soviet peasants; 3 million “enemies of the people” were killed • Indonesia & East Timor - 1965-66, 1972, 1999 - 500,000 were killed in Indonesia; 200-300,000 in East Timor

28. Genocide (others) • Burundi - 1972 - 100-200,000 Hutus were killed • Sudan - 1983-present - ethnic and religious groups - 2 million killed, 4-5 million displaced

29. War Crimes(Nuremberg Charter 1945) “Violations of the laws or customs of war,”including murder, ill-treatment, or deportation of civilians in occupied territory; murder or ill-treatment of prisoners of war; killing of hostages; plunder of public or private property; wanton destruction of municipalities; and devastation not militarily necessary”

30. War Crime:My Lai, Vietnam • 500 men, women, and children were massacred by U.S. troops • 20 (picture here) were spared, only to be used as landmines detectors

31. Extrajudicial Execution Due process rights(Geneva Convention 1949) • Be told of crime being accused of • Presumed innocent • Impartial trial • Present a defense • Not required to testify against oneself

32. Crimes Against Humanity Murder, extermination, enslavement, deportation, and other inhumane acts committed against civilian populations, before or during the war; or persecutions on political, racial or religious grounds in execution of or in connection with any crime within the jurisdiction of the Tribunal, whether or not in violation of the domestic law of the country where perpetrated. (Nuremberg Tribunal 1945)

33. Torture • 12,500 were tortured and killed • Including 2000 children (Document Center of Cambodia) Khmer Rouges torture victims at Tuol Sleng High School, Cambodia

34. Rape • WWII - 100,000 to 200,000 Asian women and girls were abducted by Japanese soldiers • 9-month war for independence in Bangladesh in 1971- 250,000 to 400,00 women and girls were raped leading to 25,000 pregnancies • In the early 80’s in Uganda, a health worker reported that 70% of the women in her community were raped, some were gang raped • Bosnia - 10,000 to 60,000 women and girls were systematically raped as part of the war strategy (first time rape is viewed in the framework of war crimes)

36. 2002 Estimates (WHO) Total population: 13,810,000 GDP per capita (Intl $, 2001): 1,563 Life expectancy at birth m/f (years): 51.9/57.1 Healthy life expectancy at birth m/f (years): 45.6/49.5 *Child mortality m/f (per 1000): 149/124 **Adult mortality m/f (per 1000): 400/298 Total health expenditure per capita (Intl $, 2001): 184 Total health expenditure as % of GDP (2001): 11.8 *probability of dying before age 5 **probability of dying between 15 and 59 years

37. Personal Experiences from the Killing Fields • 1972 – Born in Chambok, Takeo Province, Cambodia • 1975 –The Khmer Rouges ousted the US-backed Lon Nol’s government and took control of Cambodia • 1975-1979 “Killing Fields” • Forced labor, Murder, disease, starvation, malnutrition • 1979 – Vietnamese Invasion • Persecution, hunger, poverty, malnutrition, landmines, internally displaced • 1979-1981 Refugee Camps (Cambodia-Thailand border) • Temporary shelter • Found missing brother living in US • 1981 – Immigrated to US • 1997 – Returned to Cambodia for the first time after 16 years

38. Ongoing Conflict (1979-1993) 1950 1960 1970 1980 1990 Year Zero 1953 - Independence from France 1979 Vietnamese Invasion 1969 - 1973 Secret US Bombing 1979-1989 150,000 Cambodian Refugees Immigrated to the US 1975 - 1979 Terror and Genocide under the Khmer Rouge 1960 - Khmer Rouge emerged Cambodia Population: Pre-1975 approximately 8 Million By 1979 - approximately 1/3 were killed, starved or died from diseases or malnutrition

39. Khmer Rouge Victory: April 17, 1975

40. US Bombing (1969-1973) US, under Nixon and Kissinger approval, dropped 540,000 tons of bombs in Cambodia between 1969-1973 Directly affected civilian population (150,000-500,000 Cambodian civilians death) Unexploded Ordinances Killing Fields (1975-1979) 1.5 to 3 million were killed, starved, or died from diseases Most of the population were internally displaced Social, healthcare infrastructures destroyed Destruction of country infrastructures including market, school, civil service, medical facilities Ethnic cleansing, Genocide and other war crimes Refugees Consequences

41. Landmines Burden • 4-6 Million (Cambodian Mine Action Center) • 40,000 amputees • 61% of mine victims went into debt to pay for their medical treatment. • Without landmines agricultural production could more than double in both Afghanistan and Cambodia • The vast majority of casualties are men, often soldiers ­ 87% in Cambodia

42. Survey of 993 Cambodian adults in a Thai Refugee Camp: Mollica and Colleagues (1998) • 85% - lacked food, water, shelter, medical care, experienced brainwashing, forced labor • 54% - witnessed the murder of family member of friend • 36% - experienced torture • 18% - experienced head injury • 18% - experienced rape or sexual abuse

43. Mental Health Status of Cambodian Refugees in the US Cambodians are the most traumatized among Southeast Asian Refugees in the US • Depression - 80% • Anxiety - 88% • PTSD - 86% (Calrson & Rosser-Hogan, 1993)

44. Roles of Humanitarian Organizations and Public Health Professionals • Ameliorating the suffering causes by war by applying public health tools and practices (e.g., surveillance, documentation, preventing abuses, facilitation of ph activities such as sanitation, water supply, maintaining medical supplies) • Prevention of war through conflict resolution and promotion of peace and trust • Advocate and educate about health and human rights

45. First they came for the Communists, and I didn’t speak up, because I wasn’t a Communist. Then they came for the Jews, and I didn’t speak up, because I wasn’t a Jew. Then they came for the Catholics, and I didn’t speak up, because I was a Protestant. Then they came for me, and by that time there was no one left to speak up for me. Rev. Martin Niemoller 1945

46. More Info • www.globalissues.org • www.wagingpeace.org • www.icbl.org • www.amnesty.org • www.hrw.org • www.un.org • www.unhcr.org • www.who.org • Aun Lor (Alor@cdc.gov)