BMJ No 7070 Volume 313

Editorial Saturday 7 December 1996

Preventing genocide

Episodes must be exposed, documented, and punished

Shortly before Germany invaded Poland in 1939, Adolf Hitler made a secret speech which set the scene for the cycle of genocide in the second world war. Addressing his top military advisers at the"wolf's lair" at Obersalzberg, Hitler set out his plans for the settlement of Poland after the successful completion of the military campaign (see p 1416).(1) "Poland will be depopulated and settled with Germans," he said. Just as Genghis Khan had "sent millions of women and children into death knowingly and with a light heart," he had ordered the SS death's head formations to kill without mercy "many women and children of Polish origin and language." Only thus "can we gain the living space we need." And, referring to the lack of international condemnation of massacres of the Armenians in Turkey in the first world war, he went on to say, "Who after all is today speaking about the destruction of the Armenians?" The speech so shocked a member of the audience that a copy was smuggled out to the British Embassy and hence to the files of the Foreign Office in London. There it has lain more or less undisturbed.(2)

Genocide - the deliberate wiping out of one race or ethnic group by another - is the extreme form of abuse of human rights. Until recently, the term has tended to be associated with a single historical event, the so called "holocaust" - the attempted extermination by Nazi Germany of the Jews throughout Europe. But more immediate events in Bosnia and in Rwanda and Burundi suggest that the urge within a group to "cleanse itself" of others (whether differing in colour,creed, or ethnicity) is much more general. Indeed, it may be that a latent impulse towards genocide is as old as the human race itself.

I believe that the seeds of genocide lie latent within each of us,ready to germinate when an appropriate climate has been fostered, and that these tendencies should be more openly acknowledged. Analyses should also be made of the factors which turn these tendencies from unexpressed feelings, through unplanned group violence, to premeditated policies involving intimidation, forced migration, and, at the extreme, mass extermination. It is also vital to bear in mind the dire effect that lack of international condemnation and action concerning the Armenian massacres had on Adolf Hitler. I consider that, if recurring cycles of genocide are not to continue, each episode must be publicly acknowledged and punished.

But first a word on why I should feel it appropriate to write on a topic with implications far beyond medicine. I spent July 1992 to April 1993 leading the World Health Organisation's contribution to the United Nations humanitarian relief effort in Bosnia. It has since been reliably documented that, even during that first year of the war, all the worst aspects of genocidal activity - forced emigration under the euphemism of ethnic cleansing, mass rape, and massacre - were taking place around us as we carried out our work.(2) Through all this we were enjoined to practise the strictest possible neutrality. This was essential in allowing us to pass freely across the front lines to support the health of refugees and other civilians whether they were Croat, Muslim, or Serb. Unfortunately, this neutrality was interpreted by some as imputing moral equivalence to aggressors and victims. In common with other organisations that provide humanitarian relief, WHO had not solved the problem of how to "combine the moral imperative to alleviate suffering with the moral imperative not to let aggression pay."(3)

Two particular incidents during my time in the Bosnian war are relevant. The first was a conversation I had on a train from Geneva to Zagreb in July 1992. It was with a Croat expatriate engineer of about my own age, who claimed to have fought with Tito's partisans in the second world war. He made three points. First, he said that American military intervention would bring about an immediate end to the war. Second, and with great courtesy, he said that, in the absence of an effective political initiative to find peace, providing humanitarian aid in such places as Sarajevo was immoral - simply fattening the lambs for the slaughter. Third, he confidently predicted that there would be a series of terrible massacres in Bosnia if the war continued. The first point was undoubtedly correct. The second is open to debate if for no other reason than that the effectiveness of a peace initiative can be judged only in retrospect. But the third point is most relevant here - that my acquaintance, an intellectual with a wide international experience who had spent his formative years in Yugoslavia, was able to predict with certainty the terrible tragedies which were about to unfold in Bosnia.

The other incident, some months later, was a conversation with a retired schoolteacher in a street in Sarajevo. He said that he was both mystified and devastated by what was happening in Sarajevo because, for 40 years in an integrated educational system, he and his colleagues in the city had taught that people of the communities living there - Croat,Jewish, Muslim, and Serb - had equal rights. He also said that, before the current war, there had been no intercommunal violence within the city for at least 40 years.

These and other experiences in former Yugoslavia resonate with some aspects of the situation of my childhood and upbringing in a Protestant family in Belfast, Northern Ireland. I was born three years after the end of the civil war that led to the partitioning of Ireland. Although there was little violence in Belfast, it was a deeply divided city. Those at the top of the social heap were generally Protestant, and those at the bottom were Catholic. There was widespread discrimination in respect both of public housing and employment.

Although the term had not been invented, ethnic cleansing - in the sense of people of one religious persuasion being forced out of a neighbourhood by intimidation or arson by those of another persuasion - occurred sporadically. Underlying all this was fear by the party on top that their privileged position might be swept away by a differential birth rate or immigration. At the other end of the social scale people felt deep frustration and anger that they had been excluded from opportunity. Over this scene presided a parliament with constitutional machinery which for 60 years gave little encouragement to the involvement of the political minority in government. Although the bitter fruits of this situation have led to organised violence in the form of terrorism rather than genocide, the underlying social and political causes have points in common.

I conclude that genocide is the final stage in a three stage deterioration in social relationships. Imagine a society in which one group (A) is in control - usually but not always in the majority - and another (group B) regards itself or is regarded as the underdog and is usually in the minority. In addition to socioeconomic differences,group A is ethnically different from B in terms of language, skin colour, or social history. Group A perceives Group B as a present or future challenge, not only to its superior social and economic position but to its cultural identity. This leads to a sense of insecurity with fear for the future. On the other hand, group B perceives itself as excluded from social and economic opportunity and the right to express its cultural heritage, which leads to frustration and anger.

The resultant first stage of social deterioration is so common that few countries in the world can claim complete immunity from it.There is discrimination on a personal or group basis against group B by group A, often including some degree of segregation. There is also intimidation, with conscious or unconscious fostering of prejudice in private attitudes and the mass media. The second stage involves sporadic, often cyclical, unplanned violence including shop smashing,looting, arson, and riots. Fortunately, in most countries this is as far as such situations deteriorate.

The final and dreadful step, which leads to attempted genocide,involves a crucial additional factor. This is the active participation,either openly or in secret, of the state itself. It goes without saying that this also implies the involvement of individual politicians. In the 20th century the state may become involved not only through using the police and armed forces to seek out and destroy the group in question, but by misusing the records of the social welfare system to identify them. The mass media are often a crucial factor, manipulated by politicians to inflame public opinion by, for example, fanning tribal memories of long past victories and defeats. But we must not make the mistake of placing all the blame on politicians, for no act of genocide - whether in Auschwitz or Srebrenica - has taken place without a substantial measure of public consent.

So what of the role of the medical profession? Worldwide it can exercise an important influence in the prevention of genocide. It should insist that episodes of genocide are fully exposed, documented, and punished. But it should also use its powerful potential in advocacy to support the United Nations charter, the Helsinki Declaration on Human Rights, and all public policies that work to reduce social or political discrimination on the basis of race, colour, or religion whether by education, legislation, or other means.

Donald Acheson
Former special representative of WHO's regional director for Europe in former Yugoslavia

International Centre for Health and Society,
University College London,
London WC1E 6BT

References

1 Documents on British foreign policy 1919-1939, 3rd series, VII. London: HMSO, 1954: 257-60. (Original text as sent to the Foreign Office, 25 August 1939.)

2 Gutman R. A witness to genocide. The first inside account of the horrors of ethnic cleansing in Bosnia. Shaftesbury: Element Books, 1993.

3 Hong J W, Norbert B. Srebrenica; record of a war crime. London: Penguin, 1996.

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