Very good project

1. War, Public
Health &
Human Rights

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

3. Before and After
-6
-4
-2
0
2
4
6
Before 911
A
fter 911
A
fter Afghanistan
A
fter Iraq
Last M
ay
Today

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)
14
67
75
90
0
10
20
30
40
50
60
70
80
90
100
Percentage
of
All
Deaths
WWI WWII 1980's 1990's

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
Area Mined Human Rights Impact Health Impact
Land Food shortage, hinder
income, movement,
poverty
Malnutrition, deficiency
diseases, famine
Roads Movement, livelihood Immunization and public
health campaign
Water source Food shortage, quality of
life
Diarrhea, waterborne
diseases
Schools Education, community
activities
Illiteracy  Poverty 
Health Problem
Home Shelter, security Vulnerability to diseases
Forest Natural resource,
movement
Waterborne diseases,
food born diseases

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

39. Khmer Rouge Victory:
April 17, 1975

40. Consequences
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

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)