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Originally published Sunday, June 19, 2005 at 12:00 AM

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Guest columnists

Preventing genocide

With the popularity of the Oscar-nominated movie "Hotel Rwanda," many Americans have become newly aware of the horrors of modern-day genocide...

Special to The Times

With the popularity of the Oscar-nominated movie "Hotel Rwanda," many Americans have become newly aware of the horrors of modern-day genocide. Whether considering the 800,000 people murdered in Rwanda in 1994, or the thousands killed in Sudan in recent months, one question prevails: Why do such atrocities continue? The world would appear to have learned little, if anything, from these human tragedies that might prevent genocide from recurring.

As scientists trained to promote the well-being of entire populations, we propose a new approach — one we believe gives societies more power to prevent genocide. It is an approach grounded in the principles of public health.

Treating genocide as a public-health concern may seem incongruous, simply because we've come to think of it more as a political issue. But genocide — defined by the United Nations as "a specific series of acts committed with intent to destroy in whole or in part, a national, ethnic, racial, or religious group" — has become one of the most-pressing threats to global health over the past century.

In fact, some 192.3 million people died from genocide in the 20th century, far exceeding the 110.9 million killed by war. Genocidal death rates worldwide were 7,700 per 100,000 between 1900 and 2000 — an eight-fold increase over the previous 69 centuries. Genocide now results in the death of more people worldwide than any disease, including malaria and HIV/AIDS. In addition, genocide devastates the economic and health-care infrastructure of societies, harming health for generations to come.

Recognizing genocide's public-health implications, we can begin to develop effective prevention strategies. Similar approaches have proven effective against a wide range of problems, from breast cancer and drunken driving to gang-related youth violence.

The first step is to look at the entire population and determine which factors put people at higher risk. Just as we now recognize that high rates of smoking put populations at risk for lung cancer, we can detect certain factors — totalitarian governments, discrimination against certain groups, economic hardship, and the overlay of war — that put a society at risk for genocide.

Officials using a public-health approach can then develop interventions aimed at changing conditions to eliminate those risks. In the case of smoking, you might have media campaigns to discourage taking up the habit, or "quit lines" where smokers can call for help to stop. In the case of genocide, interventions might include diplomacy, economic-development efforts, or public education in conflict resolution.

Preventing death from genocide is analogous on many levels to preventing death from cancer. If we eliminate the risk factors, we may prevent the disease from growing in the first place. If cancer does occur, early screening allows us to detect a tumor while it's still small and harmless. Once the tumor is removed, the body can recover and be restored to health. But if we turn a blind eye, the cancer may remain undetected for years until some biochemical trigger is switched. Then the cancer begins to spread rapidly, invading one organ system after another. By then, it's too late for intervention; death from cancer is inevitable.

In the same way, we can identify the factors that put a society at risk for genocide. Once those risks are recognized, we can set up systems to screen for trouble and introduce interventions while they can still make a difference, changing attitudes and preventing violence. Or, we can ignore the red flags, allowing fear, hatred, violence and retribution to fester. Then, when some economic and/or political triggers are switched, all hell breaks loose. By that time, it may be too late for intervention; mass execution of large segments of the population may have already begun.

Such a comparison is more than theoretical. Public-health scientists are already applying preventive-care strategies to address problems of violence in the United States. For instance, Harvard University researchers worked with jailed teens in California to identify risk factors that led to violent behavior. The researchers found that the teens often failed to gather facts about a situation before jumping into fights. The teens also had a hard time thinking of alternatives to violence as a way to solve their conflicts. But after a 12-session program that taught new ways to think about conflict, the teens became less impulsive. They also had fewer parole violations than other similar teens after their release from jail.

While the problem of preventing genocide differs in scale and complexity, we believe that applying similar strategies would be helpful. The approach would include four major actions:

• Defining the population at risk and collecting data on incidents of interethnic violence, including the identity of victims and perpetrators, when and where the violence occurs, and the kinds of weapons used;

• Identifying related risk factors — for example, tolerance for crimes, or inequitable treatment against certain disadvantaged groups;

• Developing, testing and implementing interventions; and,

• Measuring the results and making improvements accordingly.

It already is well-established that all genocide is characteristically preceded by warning signs such as escalating hate propaganda, exclusionary legislation and mounting violence. In Nazi Germany, the deportation and mass execution of Jews were preceded by a 10-year campaign of gradually increasing persecution and exclusion. First, qualified individuals lost jobs in key areas such as academia and medicine. Next, Jews and non-Jews were forbidden to intermarry. Then, Jewish businesses were boycotted and soon after, Jews were confined to ghettos.

In Rwanda, the catastrophic Tutsi genocide of 1994 was preceded by periodic mass executions dating back to 1959, when the majority Hutu government took power.

Recognizing that warning signs of future genocide reliably appear, officials should be able to track and analyze such warnings years before the catastrophic violence erupts. Tactics might include calculating the number of one-on-one, interethnic attacks across a country and intervening as soon as it's clear that the number and severity of those attacks are increasing.

This kind of monitoring already is under way in the Gulu province of Northern Uganda, where a Canadian relief organization has developed a program for systematically collecting information on interethnic violence and injuries at 50 schools throughout the province. Just as public-school officials in the United States might track rates of immunization as a way to circumvent a measles epidemic, Ugandans may find that such "early warning systems" can serve as red flags to prevent future genocide.

Analysis of past genocide reveals the specific characteristics that put societies at higher risk for mass killings: a totalitarian government; dominant ideologies that target "outsiders"; recent armed conflict that can obscure genocidal killing; economic hardship; and ambivalence of other influential nations.

History shows these factors were present in Germany prior to World War II. Ruled by the totalitarian Nazi regime, the government promoted an ideology of exclusion against the Jews, blaming them for Germany's defeat in World War I and attributing the country's economic woes to a so-called "Jewish banking conspiracy." The Nazis then used the nation's military personnel, mobilized for the war, to carry out atrocities against the Jews. Historians have shown that intelligence communities in the United Kingdom and the United States knew of the Nazi concentration camps starting in about 1941, but said and did nothing.

A similar set of risk factors was present in Rwanda. The country was ruled for 17 years by a single political party that severely restricted the formation of other parties. Despite a paucity of concrete evidence, Tutsis were being characterized as foreigners who had migrated to Rwanda from Ethiopia some 400 years ago. During the genocide, killers were encouraged to "send the Tutsis back to where they came from," by murdering them and dumping their bodies into rivers flowing north. Rwanda was involved in a war in 1994. At the same time, the bottom had fallen out of the coffee market — the country's main export — so the nation was suffering economically. Despite warnings to the United Nations that atrocities were about to occur, the international community did not respond.

Certain psychological norms among individuals in a population also make societies more vulnerable to genocide. Among these are the tendency to dehumanize victims of violence and to "compartmentalize" thinking. The latter allows people to participate in discrete, genocide-related tasks (gathering weapons, inventorying victims' property, etc.) without confronting the horror and implications of the broader effort to which they're contributing. A classic example is Franz Stangl, the commandant of the Treblinka death camp in Germany. Scholars have noted that although he was responsible for the management of every aspect of the killing process, he did not think of himself as a killer because he did not work directly in the gassing areas.

Once identified, risk factors for genocide can be modified through the development of targeted, populationwide prevention activities. Successful examples include broadcast-based interventions designed to promote peace and reconciliation between traditionally opposing groups in Congo, Burundi and other areas identified as high-risk for genocide.

In Congo, Search for Common Ground, a Washington, D.C.-based organization, has produced a series of programs broadcast on U.N. Radio Okapi, ranging from "The Dialogue Tree," a weekly roundtable discussion among leaders of disparate groups, to a soap opera called "My Neighbor, My Brother," which focuses on two neighboring families from different tribes who are learning to deal peaceably with their conflicts.

In Burundi, Studio Ijambo produces about 100 programs per month, all aimed at fostering communication between conflicting factions and providing credible, nonpartisan information. Created in 1995 by a team of Hutu and Tutsi journalists, Studio Ijambo stands in striking contrast to Radio Mille Collines, the station that fomented hatred and violence in Rwanda prior to the 1994 genocide.

No single solution will rid the world of the complex specter of genocide. Nevertheless, the public-health strategies we advocate can add synergy to political and military interventions that, almost exclusively, comprise today's standard approach.

Success ultimately lies in the ability of all stakeholders — influential governments, nongovernmental organizations, international justice organizations, academics and others — to develop innovative, comprehensive and lasting solutions.

Given the disastrous and widespread health problems that genocide has produced, failure to act is not an option.

Dr. Eric B. Larson is director of Group Health Cooperative's Center for Health Studies in Seattle. Dr. Reva N. Adler is a Fulbright scholar and associate professor of medicine at the University of British Columbia. She is studying public-health approaches to genocide prevention in Rwanda.

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