By Anthony Robbins, MD, MPA

Every day we see and hear another grim and gruesome story from Bangui, but perhaps that is because we are working in Paris this winter, and there are French soldiers who been into the old colonial domain. Yesterday The New York Times captured the horror on its Editorial Page, under the title “As Genocide Looms”: “The Central African Republic is on the verge of being torn apart by the rampages of Christian and Muslim militias and civilian mobs… In Bangui, the Muslim population has largely fled. Christian militias have taken advantage of the chaos to engage in horrific ethnic cleansing of Muslims.”

Five years ago, we asked an old friend, Elihu Richter (a nephew of the late Irving Selikoff) to expand on a conversation we had had about public health and genocide by writing a commentary for the Journal of Public Health Policy.  We probably asked for too much. But when we revised the request and asked him to write a book review of Paul Rusesabagina’s No Ordinary Man, about the Rwandan genocide, we received a fabulous essay that went well beyond our earlier conversation.

Richter starts, “The big question, of course, is why did it all happen? Rusesabagina, after telling us “it happened because of ethnic hatred” directed against the Tutsis, descendants of the ruling classes of Rwanda, then asks: “What caused this to happen? Very simple. Words”.

Our friend Ellie Rubin provided us a wonderful image to accompany the Commentary:

The story of the Rwandan genocide is grim, but it provides the argument for early public health intervention. The Central African Republic, although it is very late, surely needs such help right now.

Richter concluded his piece, “What can we in public health and epidemiology do to prevent genocide?”

• First, epidemiologists should ensure that standards similar to those for rapid investigation of reports of communicable disease outbreaks are applied to reports of atrocity crimes and incitement – clearly the next role for WHO’s Injury Prevention Programs. Previously, the UN’s sloppy investigation of the genocide in Darfur had the effect of manufacturing doubt concerning the results of a far more rigorous investigation by the US State Department, a study that did find that there was a pattern of organized intent to destroy a population “in whole or in part”.

• Second, we in public health should be vigilant against the hijacking of medical metaphors to dehumanize – a highly specific early warning sign. Epidemiologists should lead the way in setting up an international surveillance network modeled after the systems for monitoring and reporting warning signs of epidemic diseases for monitoring hate language and incitement in state-sponsored media, textbooks, and places of worship. These systems need to be insulated from political pressures and use standardized diagnostic criteria that are defined in advance.

• Third, we in public health should aim to broaden classic definitions of genocide to include ecocide – the destruction of life, reproductive capacity, and habitat of populations resulting from wanton or reckless industrial practices. Should ecocide be classified as a crime against humanity?

• Fourth, we have a responsibility, as individuals, and as organized professionals, to not be passive bystanders, but to speak out publicly on genocidal threats. I take strong exception to the notion that speaking out on such threats, if based on a careful review of the evidence, is somehow a slide down the slippery slope of politicization. Not to speak out is to slide down that slippery slope. One lesson of the Holocaust: silence makes one a complicit bystander to genocide.

Richter’s Commentary is worth re-reading today.

Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy.  He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Program.