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

6
4
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0
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Be for e 91
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A fte r 91
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A fte r A fgh an is tan
A fte r I raq
Las t M ay
Tod ay

• 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.”

“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

•
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

•
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

•
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

• 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

•
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 antipersonnel landmines (destruction of mines)

• 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 (?)

•
•
•
•

•
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

(Garfield, War and Public Health, UNICEF)
100
90
80
70
60
50
40
30
20
10
0
14
WWI
67
75
90
WWII 1980's 1990's

•
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

• 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

• 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)

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

Malaysia Ordered 2 warships from the UK
Safe water for nearly a quarter century to the five million people without safe water
Nigeria
Pakistan
Purchased 80 battle tanks from the UK
Ordered 40 jet fighters and 3 other aircrafts
Immunized all 2 million unimmunized; family planning services to 17 million of the more than 20 million couples without such services
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

• 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

• 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)

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

(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.

• 1.5 to 2 million were killed, starved, or died from diseases
• Most of the population were internally displaced

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

• 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

• Burundi - 1972 - 100-200,000 Hutus were killed
• Sudan - 1983-present - ethnic and religious groups - 2 million killed, 4-5 million displaced

(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”

• 500 men, women, and children were massacred by U.S. troops
• 20 (picture here) were spared, only to be used as landmines detectors

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

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)

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

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)

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

•
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

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

Khmer Rouge Victory:
April 17, 1975

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

• 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

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

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

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

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

• 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)