Genocide Is a Public Health Crisis

Genocide is one of the largest threats to the health of populations, as its immediate and long-range health consequences include psychological trauma and a sequelae of infectious diseases such as malaria, cholera and sexually transmitted diseases.

Yet, the world neglects to recognize genocidal violence as the public health crisis that it is. Learning from genocides in recent history, and the harrowing situation in Palestine today, public health researchers and health professionals can play an important role in aiding susceptible populations and preventing future genocides.

Recent Genocides

In the early 1990s, Bosnia and Herzegovina made headlines by declaring its independence from former Yugoslavia. Days after its independence was recognized globally, Serbian special forces and military bombarded the country’s capital, Sarajevo, as well as the city of Srebrenica, which at the time was declared as a “safe haven” by the U.N. Serbian special forces executed mass killings, beatings, separation of families, lootings, raping of women and girls, and destructions of schools and healthcare facilities.

The genocidal violence in Bosnia was low on politicians’ priority list, despite having sufficient evidence and documentation of Serbian military’s participation in the ethnic cleanings of Bosniaks, Muslim identifying Bosnian civilians. From 1993 to 1995, an estimated 100,000 people died, the majority being Bosniaks, and 1.2 million people were displaced. According to the CDC, survivors of the Bosnian genocide experienced high rates of enteric diseases resulting from inadequate water supply. Additionally, women and girls were reported to have high rates of perinatal mortality. Sexual violence including rape was one of the most used tactics against Bosniak women. However, due to social stigma, many women and girls who survived the genocide did not report instances of sexual assault and violence.

In 1994, Rwanda was also low on the priority list of countries like France, Belgium, and the U.S. After the death of the Rwandan president, the Hutu began a genocidal violence against the Tutsis. Over the course of 100 days, about one million Tutsis and moderate Hutus were killed in the genocide. After the capture of the capital, Kigali, by the Rwandan Patriotic Front (RPF), an estimated 1.2 million Rwandan fled to Zaire (now the Democratic Republic of Congo) — one of the largest mass migrations in history.

Health Implications of Genocide

Often erased from political discussions and human rights platforms are the long-term health impacts of genocidal violence, especially through the destruction of public health infrastructures. After the genocide, countries like Rwanda, Bosnia and Herzegovina and Kosovo were left with destroyed medical facilities, a healthcare professional shortage and interrupted programs for immunizations, preventative medicine, and prenatal care, and poverty. Internally displaced people and survivors of genocide faced inadequate food and water resources, poor sanitation, and psychological trauma.

Genocide is not a new phenomenon. It is a powerful technological tool used to annihilate the essential foundations of life of certain groups of people, and uses terror to create new social identities and relationships for survivors. It is also a lethal symptom of a failed state. Although we claim that much of our ideologies of power have changed since the Holocaust or Rwanda, genocides continue to occur throughout the world. What is most disturbing is not just the death toll due to genocidal violence, but our inability to act against it.

Over the past few weeks, Palestine has been the center of media coverage. Images of bombs exploding, civilians dying, and children crying have been displayed on every news channel and social media outlet. In a matter of 8 days, more than 200 people have died in the Gaza Strip, with the vast majority consisting of Palestinians. The Israeli airstrikes have destroyed hundreds of buildings, left 2,500 Palestinians homeless, and have targeted protestors, journalists, and worship places like the Aqsa Mosque.

Many people across the globe showed their solidarity through protests, however, many world leaders have not condemned the actions of the Israeli State. The Biden-Harris administration wished “Eid Mubarak” to Muslims across the globe, yet they approved a $735 million sale of precision-guided weapons to Israel. The hypocrisy of political leaders reflects the lack of courage they have in serving humanity.

As we learn about the genocide against the Rohingya people in Myanmar, the Neurs in South Sudan, the Kurds in Iraq, the Uyghurs in China, or the people of Palestine, one thing is certain: if the world is unwilling to act despite lessons learned and pledges of “never again,” crimes against humanity with impunity will persist. Moreover, the health of populations will severely decline when we consider the impact of genocidal violence and our global uphill battle of reducing the transmission of COVID-19. What approach must we take to preserve the wellbeing of people who are vulnerable to genocidal violence? How do we gain political courage to prevent genocides?

Taking Action Against Genocide

A complex product such as genocide requires a multidisciplinary approach. Although there’s no one solution, we do propose a few approaches. As public health officials and advocates, we urge the recognition of genocide as a public health issue and encourage a deeper involvement of public health educators and researchers in preventing and mitigating genocidal violence. Throughout history, healthcare professionals — including public health researchers — have played an important role in taking care of civilians in war-torn countries.

Very little information is known about the health impacts of genocidal violence, the policies and strategies used to prevent genocide, and the evaluation of programs implemented to improve the health of civilians in the aftermath of the violence. Public health scientists and health professionals can provide transparency through their research on the epidemiology of genocide to determine the precursors of genocide and the impact it has on people locally and globally.

The healthcare workforce can not only provide health resources to survivors, but also investigate and document human rights violations and case reports. Moreover, public health officials can educate, and help build political will through establishing and evaluating advocacy programs and policies that help global leaders prevent and mitigate genocide. The local and global healthcare workforce must advocate fiercely for immediate action to prevent the mortality of populations vulnerable to genocidal violence.

Ira Memaj, MPH, is a public health educator and researcher of reproductive health and incarceration at Columbia University Medical Center.

Robert Fullilove, EdD, is a professor of sociomedical sciences at Columbia University Medical Center.