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APPENDIX C 171 Mob Violence: Implications for Health and Prevention Victor W Sidel, MD1 Barry S Levy, MD, MPH2 Introduction Mob violence, particularly in the form of armed conflict, is responsible for more deaths and disabilities around the world than many serious diseases. Collective violence destroys families, communities, and sometimes entire cultures. It diverts scarce resources from health promotion and protection, medical care, and other health and social services. Destroy this health-promoting infrastructure of society. It restricts human rights and contributes to social injustice. It leads people and nations to believe that violence is the only way to resolve conflicts. And it contributes to the destruction of the physical environment and the overexploitation of non-renewable resources. In short, collective violence threatens much of our civilization. Definition of “Collective Violence” In 1996, the World Health Assembly, the governing body of the World Health Organization (WHO), passed Resolution WHA49.25, which declared violence “a major and growing public health problem worldwide. world” (World Health Assembly, 1996). The Assembly asked WHO 1Distinguished University Professor of Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Associate Professor of Public Health, Weill Medical College, Cornell University, New York, New York. 2 Associate Professor of Public Health, Tufts University School of Medicine, Boston, Massachusetts.
172 ANNEX C Director General to develop public health activities to address the problem. The resulting World Report on Violence and Health, published by WHO in 2002, was the first comprehensive WHO report on violence as a public health problem (Krug et al., 2002). The WHO report presents a typology of "violence" that defines three broad categories based on the characteristics of those who commit violent crimes: self-inflicted violence, interpersonal violence and collective violence. This document addresses elements of the third category, collective violence, with a focus on collective violence that includes "armed conflict". The three forms of violence overlap in some way. Those who engage in mob violence may engage in self-directed violence as a symptom of post-traumatic stress disorder or as a result of self-hatred arising from acts of war. Collective violence can also be accompanied by interpersonal violence. For example, individuals and groups involved in armed conflict may engage in interpersonal violence, sometimes fueled by racial tensions, or, in the armed forces, conflicts with superiors or fellow combatants in the midst of war. Soldiers may return from war with a battlefield mindset in which they use interpersonal violence to resolve interpersonal conflicts that could have been resolved without violence. Collective violence has been characterized as “the instrumental use of force by persons who identify themselves as members of a group, whether that group is temporary or has a more permanent identity, against another group or group of individuals to achieve political, economic, ideological, or political objectives. or social achievements. objectives” (Zwi et al., 2002). As examples of collective violence, the WHO report cites “violent conflicts between nations and groups, state and group terrorism, rape as a weapon of war, displacement of large numbers of people from their homes, and wars”. The report notes that "all of this happens daily in many parts of the world" and "the health impact of these different types of events in terms of death, physical illness, disability and mental distress is enormous". it contains an extensive discussion of war and other military activities and a brief discussion of 'terrorism' and the 'war on terror' (Levy and Sidel, 2008a). Defining Armed Conflict Conflict is a common feature of most societies, but it rarely evolves into the use of physical violence, and even more rarely into the use of weapons. This article focuses on collective violence involving the use of weapons, which is what we call the use of the term "armed conflict". These weapons are enough
APPENDIX C 173 from knives, bayonets, and machetes to nuclear weapons. In this article, we will mainly deal with "small arms and light weapons", as they are the most commonly used weapons in armed conflicts in low- and middle-income countries, but we will also discuss bombs (both aerial bombs and aerial bombs) - based on and with land-based, such as B. "improvised explosive devices", land mines and artillery shells, which are also in common use. Nuclear, chemical, and biological weapons, sometimes referred to as weapons of mass destruction, are also discussed as they pose a risk of widespread and indiscriminate devastation, injury, and death Definition of “low- and middle-income countries” The World Bank classifies countries countries into economic groups based primarily on the country's gross national income (GNI) per capita (World Bank, 2007). Based on its GNI per capita, each economy is classified as low-income, middle-income (divided into lower-middle and upper-middle income), or high-income. The World Bank tables rank the 185 member countries and all other economies with more than 30,000 people (208 in total). Low- and middle-income economies, the Bank notes, are sometimes referred to as "developing countries," a term we use in this reference document. The use of the term is convenient; it is not intended to suggest that all countries in the group have followed a similar path or that other economies have reached a preferred or late stage of development. Classification by income does not necessarily reflect level of development. The World Bank currently ranks economies according to 2006 GNI per capita, calculated using the World Bank Atlas method. The groups are as follows: low income, $905 or less; lower-middle income, $906 to $3,595; upper-middle income, $3,596 to $11,115; and high income, $11,116 or more. Countries in the low-, lower-middle, and upper-middle income groups can be found on the World Bank website. Examples of low-income economies are the Democratic Republic of Congo (DRC), Haiti, India, Nigeria, Pakistan, Vietnam and Zimbabwe. Examples of lower-middle-income economies are China, Cuba, Egypt, Iran, Iraq, Philippines, Thailand and Ukraine. Examples of upper middle income economies are Argentina, Brazil, Hungary, Mexico, Poland, South Africa and Turkey. World Bank data show a striking relationship between a nation's wealth and its chances of civil war. For example, a country with a gross domestic product (GDP) per capita of $250 has a 15% chance of going to war in the next 5 years, and this chance is halved for a country with a GDP of $600. per person. On the other hand, countries with per capita incomes above US$5,000 have less than a 1% chance of having a civil war.
174 ANNEX Also called equal. In addition to poverty, risk factors for armed conflict can be related to poor health and lack of access to quality medical care, low social status of women, large differences between rich and poor, low development of civil society within a country and people who do not have the right to choose or otherwise participate in decisions that affect their lives, limited education and employment opportunities, improved access to small arms and light weapons, and the failure to meet the basic needs of civilians (deSoysa and Neumayer , 2005). The effects of collective violence on health Armed conflicts have profound direct and indirect effects on health (Levy and Sidel, 2008a,b,c). These are described below. Direct Consequences of War and Military Operations The armed conflicts of the 21st century consist mainly of civil wars (internal conflicts to which other countries sometimes contribute military forces) that continue to wreak havoc in many parts of the world. For example, in early 2007, it was reported that there were 15 significant armed conflicts (1,000 or more deaths reported) and 21 other "hotspots" that are or could become war (Smith, 2007). During the post-Cold War period, from 1990 to 2001, there were 57 major armed conflicts in 45 locations, all but three of which were civil wars (Stockholm International Peace Research Institute, 2002). Some of the effects of war on public health are obvious, some are not. The direct effects of war on mortality and morbidity are evident. Many people, including an increasing percentage of civilians, are killed or injured during war. An estimated 191 million people died directly or indirectly as a result of conflict in the 20th century, more than half of them civilians (Rummel, 1994). Exact numbers are unknown due to the lack of record keeping in many countries and its interruption in times of conflict. War has a direct, immediate and deadly impact on human life and health. "Body counts" and data on people with war-related injuries and disabilities, both physical and mental, document the many people who have been tragically killed and injured as a direct result of military activities. From the early 20th century until the start of World War II, the vast majority of direct war casualties were uniformed combatants, usually members of the national armed forces. While noncombatants suffered the social, economic, and environmental consequences of war and may have fallen victim to what is now known as "collateral damage" from military operations, "civilians" were generally unaffected.
APPENDIX C 175 were directly targeted and largely spared direct death and disability as a result of the war (Zwi et al., 1999; Levy and Sidel, 2008a). But since 1937, when Nazi troops bombed the town of Guernica, a non-military target in the Spanish Basque Country, military operations have killed and maimed more and more civilians attacking non-military targets. The use of "carpet bombing" and collateral damage from heavy strikes against military targets claimed many civilian lives. Therefore, the percentage of civilian deaths in relation to all deaths directly caused by war has increased dramatically (Levy and Sidel, 2008a). Many of these civilian deaths may have been caused indirectly, rather than directly, by the war. In addition to the direct effects of war and other military activities on health, collective violence can also have serious health consequences, affecting physical, economic, social and biological aspects. environment in which people live. Environmental harm can affect people not just in nations directly involved in mob violence, but in all nations. Much of the morbidity and mortality during war, particularly among civilians, results from the devastation of society's infrastructure, including the destruction of food and water supply systems, health facilities and emergency services. public health, sanitation systems, power plants and networks, and transport and communication systems. The destruction of infrastructure has led to food shortages and consequent malnutrition, contamination of food and drinking water and consequent waterborne and foodborne diseases, and resulting public health and health problems and illnesses (Levy and Sidel, 2005). Preparing for war can also have adverse effects on human health. Some of the effects are direct, such as injuries and deaths during training exercises; others are indirect. As with war itself, preparing for war can divert human, financial, and other resources that could be used for health and social services. It is not just the actual use of weapons that is an issue, but also the threat of using them. This is especially true for weapons of mass destruction, but also for spending on other weapons, from small arms and light weapons to fighter jets and warships. Resources used to prepare for war are often diverted from the resources a country needs for education, housing, medical and social services. War preparations are also destructive to the environment, including the use of non-renewable resources and the use of bombs and grenades in military training and exercises. Perhaps most importantly, preparing for war can encourage potential enemies to prepare for war and make war more likely. Damage to the physical environment - water, land, air and space - and
176 ANNEX The consumption of non-renewable resources can be as much a result of preparing for war as the war itself. Lakes, rivers, streams and aquifers, land masses and the atmosphere can be contaminated by the testing and use of weapons. Space can be damaged by weapon placement. Significant amounts of non-renewable resources can be used in the manufacture, testing and use of weapons (Renner, 2000; Levy and Sidel, 2005; Westing, 2008). The economic environment can also be adversely affected by the diversion of resources from education, housing, nutrition and other human and health services to military activities, as well as by increased public debt and/or taxes. These economic impacts affect both developed and developing countries (National Priorities Project, 2007). Government and society's preoccupation with preparing for war, often referred to as "militarism," can be distracting and undermine efforts to promote human well-being. This concern can lead to policies that promote “preventive warfare” (when an attack is said to be imminent) and “preventive warfare” (when an attack is feared in the future). The diversion of resources to war is a worldwide problem, but it is particularly important in developing countries. Many developing countries spend significantly more on military than on health; For example, in 1990 Ethiopia spent US$16 per capita on military spending and only US$1 per capita on health, and Sudan spent US$25 per capita on military spending and only US$1 per capita on health (Foege , 2000). The social environment can be negatively affected by the rise of militarism, the promotion of violence as a means of resolving disputes, and violations of civil rights and liberties. Furthermore, preparation for war, like war itself, can encourage violence as a means of resolving disputes. Another knock-on effect of war is the creation of many refugees and internally displaced persons. Many of the world's 12 million refugees have fled their home countries as a result of wars. Refugees often flee to neighboring less-developed countries, which often face major challenges in meeting the public health needs of their own populations. Furthermore, the vast majority of the 22 to 25 million IDPs worldwide have fled their homes to escape the war. The vast majority of war refugees and internally displaced people are women, children and the elderly, vulnerable not only to disease and malnutrition but also security threats. These displaced people are often worse off than refugees who have fled their countries, because the displaced often lack easy access to food, clean water, medical care, shelter and other necessities. Approximately 8 million of these IDPs live in the Democratic Republic of Congo, Uganda and Sudan, all in Africa (Roberts and Muganda, 2008). In West Darfur, Sudan, hundreds of thousands of people were internally displaced and hundreds of thousands fled to refugee camps in neighboring Chad.
APPENDIX C 177 as a result of bitter ethnic conflicts (Sirkin, 2008). Refugees and IDPs face much higher rates of mortality and morbidity, largely due to malnutrition and infectious diseases (Associated Press, 2007; Toole, 2008). The biological environment can be disturbed: by conventional weapons during their use in training, in conflict or during their disposal; from ionizing radiation from the manufacture, testing, use and disposal of nuclear weapons and from the use or testing of radioactive weapons, including depleted uranium; biotoxic substances from the manufacture, testing, use and disposal of chemical or toxic weapons and "conventional" weapons during their use in training or combat or their disposal. The spread of infectious diseases can occur as a result of the depletion of protective factors such as safe sanitation and water treatment, or possibly through the manufacture, testing and use of biological weapons. Hazardous waste from military operations is a potential contaminant of air, water and soil. For example, groundwater at Otis Air Force Base in Massachusetts was contaminated with trichlorethylene, a probable human carcinogen, and other toxins; 125 chemicals dumped at Rocky Mountain Arsenal in Colorado over 30 years; and benzene, clearly a human carcinogen, was found in extremely high concentrations at McChord Air Force Base, Washington state (Renner, 2000). Both during war and in the run-up to war, the military consumes large amounts of fossil fuels and other non-renewable materials. Military equipment can consume a significant amount of energy. For example, an armored division of 348 main battle tanks operating in one day uses over 2.2 million liters of fuel, and an aircraft carrier battle group operating in one day uses over 1.5 million liters. . In the late 1980s, the US military was using 18.6 million tons of fuel per year (over 44% of the world total) and emitting 381,000 tons of carbon monoxide, 157,000 tons of nitrogen oxides, 78,000 tons of hydrocarbons and 17,900 tons of sulfur dioxide. (Rener, 2000). Specific warsCivil wars in Africa According to data from the Stockholm International Peace Research Institute, Asia and Africa were the regions with the most armed conflicts in the period 1990-2005. For example, when 26 major armed conflicts were reported in 1998, 11 were in Africa and 8 in Asia, and in 2005, when 16 armed conflicts were reported, 6 in Asia and 3 in Africa. Since 1990 there has been a progressive decline in armed conflicts in Africa, most of which are civil wars.
178 APPENDIX CFor example, in 1990 there were 19 conflicts in 17 locations in the region, of which only one was an interstate conflict (between Eritrea and Ethiopia). The three reported armed conflicts in Africa in 2005 were the lowest number for the region in the post-Cold War period. As in Africa, most recent armed conflicts in Asia have taken place between states within states. In the period 1990-2005 there were four conflicts in Africa that were active in the 16 years of that period: those in India (Kashmir), Myanmar (Karen), Sri Lanka (Eelam) and the Philippines. One conflict in the region was between States, that of India and Pakistan (Stockholm International Peace Research Institute, 2006). A civil war in the Democratic Republic of Congo that started in 1996 and involved the armed forces of other countries between 1998 and 2002 left almost 4 million dead, most of them civilians (Roberts and Muganda, 2008). The majority of deaths in that war, approximately 98% in one analysis, were not directly related to the war but to malnutrition, infectious diseases and other knock-on effects due to damage to society's health-supporting infrastructure (Roberts and Muganda, 2008). The impact of this war on the civilian population was documented by epidemiological surveys carried out by the International Rescue Committee, the results of which were widely publicized in the media and later in professional journals. Although foreign armies officially withdrew in 2002 when a peace agreement was signed, there were difficulties in establishing a functioning central government, especially in the eastern part of the DRC. The following lessons can be learned from this war: 1. This war was the result of the international community's reluctance to arrest and control the perpetrators of the Rwandan genocide who fled to neighboring countries. 2. The international community has done little to respond to Rwanda and Uganda, which invaded the Democratic Republic of Congo in 1996 to overthrow the government. 3. This war has demonstrated the importance of recognizing and preventing the public health and human rights consequences that accompany armed conflict in general. 4. Even intra-state conflicts can transcend national borders, and these conflicts can be more difficult to control, since most conflict control mechanisms are geared towards inter-state conflicts. The Iraq War An important contemporary example of the direct and indirect effects of armed conflict in a lower-middle-income country is the impact of the war in Iraq from 1980 to the present. The 1980-1988 Iran-Iraq war killed between 500,000 and 1 million people and another 1-2 million people
APPENDIX C 179 were wounded. The Iran-Iraq war uprooted 2.5 million people and destroyed entire cities. It cost more than US$200 billion (Levy and Sidel, 2008c). In the 1991 Gulf War, tens of thousands of people died, many were injured, and many were left with chronic illnesses. But the number of deaths and illnesses during the Gulf War was much higher than in the years after the war. UNICEF estimates that between 1991 and 1998 between 350,000 and 500,000 excess children died in Iraq, mainly due to postwar sanctions imposed by the United States and other countries (Levy and Sidel, 2008c). These sanctions prevented food and medicine from entering Iraq for several years, until the start of the oil-for-food program. In March 2003, the United States and other coalition forces invaded Iraq. Two months after the invasion, President Bush declared that most hostilities were over. However, most of the health consequences of that war have happened since then. There were over 3,200 US soldiers killed and over 24,000 wounded as of July 2007. Another 30,000 US soldiers suffered serious injuries or illnesses during the war. There was a high incidence of mental health disorders among US troops; The US Army Surgeon General has estimated that 30% of returning troops have stress-related mental health issues. The tribute to the Iraqis was many times greater than that of the American military. A 2006 study based on a systematic sample of approximately 2,000 households found that approximately 650,000 Iraqis have died since the start of the war, approximately 600,000 as a result of violence, most commonly shooting (Roberts et al., 2004; Burnham et al., 2006). . The Iraq War had a profound impact on Iraq's health and health promotion infrastructure, including water treatment plants, sewage treatment plants, food supplies, and transportation and communication systems. In addition, there were many human rights violations, including cruel punishments and torture of detainees. The war has diverted vast amounts of resources that would otherwise be spent on health care and other human services in Iraq, the United States and elsewhere. And there were many adverse effects of war on the physical, sociocultural, and economic environment, particularly in Iraq (Levy and Sidel, 2008c). Eight million Iraqis - almost one in three - are now in need of emergency assistance, according to the report "Raising the humanitarian challenge in Iraq" by Oxfam International and the Iraq NGO Coordinating Committee (NCCI), a network of organizations that help workers working in Iraq. (Oxfam International, 2007). According to the report, four million Iraqis, or 15%, regularly cannot afford to buy enough to eat.
180 ANNEX C – 70 percent lack adequate water supply, compared to 50 percent in 2003. – 28 percent of children are malnourished, compared to 19 percent before the 2003 invasion. • 92 percent of children Iraqi women suffer from learning difficulties, mainly due to the climate of fear. - More than 2 million people, mostly women and children, have been displaced within Iraq. • Another 2 million Iraqis became refugees, mostly in Syria and Jordan. Weapon Systems Conventional Weapons Conventional weapons consist of explosives, incendiary devices, and weapons of various sizes, from small arms and light weapons (SALW) to heavy artillery and bombs. Small arms and light weapons, including pistols, rifles, machine guns and other portable or easily transportable weapons, are the most widely used weapons in warfare. Although some restrictions have been placed on their use in warfare, such as a ban on the use of "dum-dum bullets", which cause serious injury when they hit a human being, there have been few effective efforts to ban their use (Cukier and Sidel, 2006). . 🇧🇷 In the UN Secretary-General's Millennium Report to the General Assembly, Kofi Annan stated that small arms could be called weapons of mass destruction because of the deaths they cause. "The death toll from small arms exceeds that of any other weapon system" and, in most years, far exceeds the number of atomic bombs that devastated Hiroshima and Nagasaki. Indeed, in terms of the carnage they cause, small arms could be called “weapons of mass destruction”. However, there is still no global non-proliferation regime to limit their proliferation” (Taljaard, 2003). Conventional weapons are responsible for the vast majority of adverse environmental impacts of warfare. For example, during World War II, extensive bombing of cities in Europe and Japan caused not only many deaths and injuries, but also widespread devastation of urban environments. As another example, the more than 600 oil well fires in Kuwait during the Gulf War caused widespread environmental degradation, as well as acute and possibly chronic respiratory illnesses in people exposed to smoke from these fires. As another example, the bombing of mangrove forests during the Vietnam War resulted in the destruction of those forests, and the resulting bomb craters persist several decades later, often filling with standing water.
APPENDIX C 181, which is a breeding ground for mosquitoes that transmit malaria and other mosquito-borne diseases (Allukian and Atwood, 2008; Westing, 2008). Nuclear Weapons Since their development in the 1940s, nuclear weapons have become increasingly widespread. There are currently around 27,000 nuclear warheads in at least eight countries: the United States, Russia, the United Kingdom, France, China, Israel, India and Pakistan, and possibly North Korea as well (Sutton and Gould, 2007). The historic peak in the yield of the world's stockpiles of nuclear weapons was reached in 1960 with a yield equivalent to 20,000 megatons (20 billion tons or 40 trillion pounds) of TNT, which is equivalent to 1.4 million bombs. atomic bombs dropped on Hiroshima (Yokoro and Kamada). , 2000). In the United States, in 1967, the nuclear arsenal reached approximately 32,000 nuclear warheads of 30 different types. In 2003, the US inventory consisted of about 10,400 warheads with a total mass of about 2,000 megatons, equivalent to 140,000 bombs the size of Hiroshima. Five thousand of the nuclear weapons in the United States, Russia and possibly other countries are on high alert and ready to deploy in minutes. The detonation of atomic bombs over Hiroshima and Nagasaki in August 1945 during World War II caused the instant death of an estimated 200,000 people, mostly civilians, as well as the permanent injuries and subsequent deaths of many others, in addition to massive devastation and radioactive contamination. . in these two cities (Yokoro and Kamada, 2000). Atmospheric nuclear weapons tests by the United States, the Soviet Union, and other countries have also resulted in environmental contamination, with increased rates of leukemia and other cancers among populations protected from these tests. The carcinogenic effects in children of exposure to iodine-131, a radioactive isotope of iodine produced during testing, is well documented (Institute of Medicine and National Research Council, 1999). In addition to the potential for the use of nuclear weapons by national forces, as demonstrated in the recent US Nuclear Posture Review, which threatened the use of nuclear weapons in a wider range of circumstances, there is a growing threat to their use by individuals. and groups (Gordon, 2002; Sutton and Gould, 2008). or attacks on nuclear power plants with explosive weapons can disperse highly radioactive materials. Other
182 APPENDIX An example of a radioactive substance used in weapons is depleted uranium (DU), uranium from which the isotope usable in nuclear weapons or fuel rods for nuclear power plants has been removed. The DU is used militarily as a shell for armor-piercing projectiles. Uranium, an extremely dense material used as a projectile, increases the projectile's ability to penetrate tank armor; Uranium is also pyrophoric and bursts into flames on impact. The United States used DU-coated projectiles during the Persian Gulf War, the Iraq War, and the Kosovo War; The UK used similar projectiles in the Iraq war. Depleted uranium, which is radioactive and extremely toxic, has been shown to cause soil and groundwater contamination. The use of depleted uranium is considered legal by the nations that use it, but its use is considered illegal by others according to the Geneva Conventions and other international treaties (Hindi et al., 2005; Bertell, 2006). Chemicals A variety of chemical weapons and related materials have the potential to cause direct health effects during mob violence and also to contaminate the physical environment during war and preparations for war. The potential for exposure exists not only for military and civilian populations who may be exposed during wartime use of chemical weapons, but also for workers involved in the development, production, transportation and storage of these weapons and for local residents who live near the facility. where these weapons are being developed. manufactured, transported and stored. Furthermore, the disposal of these weapons, including their dismantling and incineration, can be dangerous. During the Vietnam War, the US military used defoliants on mangrove forests and other vegetation, which not only defoliated and killed trees and other plants, but also may have caused excessive birth defects and cancers among local residents in Vietnam (Levy and Sidel, 2005). 🇧🇷 🇧🇷 Furthermore, the development and production of conventional weapons involves the use of many chemicals that are toxic and can pollute the environment. Furthermore, there is now a plausible threat from non-state actors to use chemical weapons. A Japanese sect, Aum Shinrikyo, used sarin gas in the underground systems of two Japanese cities in the mid-1990s, killing 19 people and injuring thousands (Spanjaard and Khabib, 2007). The Chemical Weapons Convention (CWC), which came into force in 1997, prohibits any development, manufacture, acquisition, stockpiling, transfer and use of chemical weapons. It requires each State Party to destroy its chemical weapons and chemical weapons production facilities and any chemical weapons it may have left on the territory of another State Party. CWC verification provisions do not just apply to the Armed Forces
APPENDIX C 183 the chemical industry, but also the civilian chemical industry worldwide, through certain restrictions and obligations in relation to the production, processing and consumption of chemicals deemed relevant to the objectives of the Convention. These provisions must be verified through a combination of reporting requirements, routine on-site inspections of declared locations, and short-term challenge inspections. The Organization for the Prohibition of Chemical Weapons (OPCW) in The Hague, established by the CWC, implements the provisions of the CWC. The CWC mandated disposal of chemical weapons has sparked controversy over the safety of two different disposal methods: incineration and chemical neutralization. The environmental and safety controversy delayed the completion of the removal until the date required by the CWC (Lee and Kales, 2008). Biological agents Biological agents consist of bacteria, viruses, other microorganisms and their toxins, which not only directly cause disease in humans, but can also be used against other animals or plants, thereby affecting human food supplies or agricultural resources and affecting indirectly human health. Go. Biological warfare agents have been used relatively infrequently during warfare, but the potential for their use has been around for a long time. These agents have been used as weapons, albeit sporadically, since ancient times. In the sixth century BC. BC Persia, Greece and Rome tried to contaminate drinking water sources with the corpses of the sick. In 1346 CE, Mongols begging at the Crimean port of Kaffa placed the corpses of plague victims in slingshots and hurled them into Kaffa. In the mid-18th century, during the French and Indian Wars, a British commander sent smallpox-infected blankets to the Indians. During World War I, Germany dropped bombs containing plague bacteria on British positions and ushered in the Chole era in Italy. During the 1930s, Japan contaminated the food and water supplies of several cities and sprayed cities with cultures of microorganisms. but there is no evidence that they were used in warfare (Harris and Paxman, 1982; Cole, 1988; Meselson, 1994; Levy and Sidel, 2008b). There is concern that biological warfare agents could be used as terrorist weapons. In the fall of 2001, anthrax spores spread across the United States. Post, which eventually caused 23 cases of inhalational and cutaneous anthrax, 5 of which were fatal. The Centers for Disease Control and Prevention has identified three categories of illnesses caused by biological agents based on their concern that they could be used as terrorist weapons. Category A consists of pathogens that cause anthrax, botulism, plague, smallpox,
184 ANNEX ctularemia and multiple viral hemorrhagic fevers. Category B includes substances that cause brucellosis, glanders, melioidosis, psittacosis, Q fever and threats to food safety (such as Salmonella and Shigella species and Escherichia coli O157:H7) and the toxin Clostridium perfringens epsilon, the ricin toxin from castor bean and the staphylococcal enterotoxin B Category C includes pathogens that cause emerging infectious diseases such as Nipahvirus and Hantavirus (Levy and Sidel, 2008b). Antipersonnel Landmines There are currently around 80 million landmines in use in at least 78 countries around the world. These landmines were labeled "one person at a time, weapons of mass destruction". They were often placed in rural areas, posing a threat to residents of those areas and often disrupting agriculture and other activities. Civilians are most likely to be injured or killed by landmines, which continue to injure and kill between 15,000 and 20,000 people a year. It is estimated that half of all landmine victims die from their injuries before receiving adequate medical attention. More than 90% of landmine victims are civilians, mostly poor people living in rural areas. A quarter of landmine victims are children, making landmines one of the top six preventable causes of child death worldwide. While a mine may cost as little as $3 to produce, it can cost as much as $1,000 to clear, and its adverse economic impact on human health and well-being is much greater. Mines not only maim and kill people, they also render large areas of land uninhabitable. Because they remain in effect for many years, they pose a long-term threat to people, including refugees and internally displaced people, returning to their homes after long periods of war. Since the Anti-Personnel Convention on Landmines came into force in 1997, landmine production has been significantly reduced and some of the mines planted in the ground have been cleared. Many of the mines are still buried and additional resources are needed to continue excavating and destroying, tasks that pose an inherent risk to mine clearance personnel (International Campaign to BanLandmines, 2006; Sirkin et al., 2008). Genocide Genocide was formally defined by the Convention for the Prevention and Punishment of the Crime of Genocide proclaimed by the United Nations, which entered into force on January 12, 1951. This Convention defines genocide as any of the following acts committed with intent to destroy, in the in whole or in part, a national, ethnic, racial or religious group:
ANNEX C 185 - Killing members of the group - Causing serious physical or mental harm to members of the group - Deliberately inflicting conditions on the group that could lead to its physical destruction in whole or in part - Imposing measures to prevent births within the group ⢠Forced transfer of children within the group to another group Acts of genocide are often difficult to prosecute, as intent and evidence of a chain of responsibility must be established. International criminal courts and tribunals function mainly because the States involved are unable or unwilling to prosecute crimes of this magnitude on their own. An International Criminal Court (ICC) was established in 2002 to have jurisdiction when international courts are unwilling or unable to investigate or prosecute genocide. The United States refused to ratify the statute establishing the International Criminal Court (Sewall and Kaysen, 2000). Groups commonly considered to have suffered genocide include people in Armenia, Nazi Germany before and during World War II, whistleblowers in Yugoslavia, Rwanda, and Darfur (Power, 2002; Sirkin, 2008). The genocide in Germany during World War II, commonly known as the Holocaust, involved the systematic murder of mostly Jews, as well as Roma, accused of being homosexuals and others. Genocide trials, among other things, took place in Nuremberg from 1945 to 1949. The first was the largest war crimes trial conducted by the four German occupying powers. The second trial is known as the doctors' trial and was conducted by the United States. Genocide in the former Yugoslavia since 1991 has been investigated by the International Criminal Tribunal for the former Yugoslavia, based in The Hague. Among those convicted of genocide or crimes against humanity was Radislav Kristic, general of the Bosnian Serb army, sentenced to 35 years in prison for genocide in Srebrenica, crimes against humanity and violation of the laws or customs of war (Milanovic, 2007). 🇧🇷 Widespread killings in Rwanda, dubbed “genocide,” began in April 1994. The International Criminal Tribunal for Rwanda, a UN-sponsored court, concluded 19 trials and convicted 25 people on charges of genocide and related crimes. In 2004, the US Secretary of State declared the conflict in Darfur, Sudan, which began in 2003, a genocide. Sirkin, 2008).
186 APPENDIX C Terrorism and the "War on Terror" Since September 11, 2001, there has been growing concern in the United States and other countries about violence used by individuals and groups to incite fear and advance a political agenda, a way of violence commonly referred to as “terrorism” (Levy and Sidel, 2007). Terrorism is often defined in partisan terms: those labeled "terrorists" on the one hand in a conflict may be seen as "patriots", "freedom fighters" or "ministers of God" on the other. The term terrorist "generally applies to one's enemies and opponents, or those with whom one disagrees and would prefer to ignore" (Hoffmann, 1998). Relatively powerless groups against very powerful enemies often employed terrorist tactics, believing these tactics to be effective weapons against superior forces. Therefore, the use of the term depends on one's point of view. The term terrorist implies a moral judgment; if a group can associate the term with its opponent, it can persuade others to adopt its moral perspective (Jenkins, 1980). Terrorism aims to have psychological effects that go beyond the immediate victims in order to intimidate a wider population, such as a rival ethnic or religious group, a national government or political party, or an entire country (Hoffmann, 1998). It is often a question of creating power where there is none or consolidating it where there is little. Although many nations, including the United States, differentiate between terrorism and war, especially a war formally declared by a nation, we see little difference between terrorism and a war directed primarily against the civilian population. U.S. law defines terrorism as "deliberate, politically motivated violence committed by subnational groups or covert agents against noncombatant targets" (22 U.S.C. 2656(d)(2)). Based on this definition, the National Counterterrorism Center reported that in 2006 there were 14,352 terrorist attacks worldwide that killed 20,573 people (13,340 in Iraq) and injured another 36,214. There were nearly 300 incidents that resulted in 10 or more deaths, 90% of them in the Middle East and South Asia. Armed attacks and bombings resulted in 77% of deaths in 2006. The attacks on the World Trade Center in 1993, on the Alfred P. Murrah Federal Building in Oklahoma City in 1995, and on US military and diplomatic agencies. The January 11, 2001 attacks on the World Trade Center and the Pentagon, and the anthrax-tainted letters sent to two US senators and various news organizations were deemed "acts of terrorism" (National Counterterrorism Center, 2007). Rather, the term terrorism is interpreted by some analysts to include the use by countries of weapons designed to inflict mass casualties among the civilian population, sometimes referred to as "state terrorism". attacks
APPENDIX C 187 cited above as examples of wartime attacks designed to inflict mass casualties on civilians, including the Guernica bombing and the mass bombing of urban centers during World War II, are also, in our opinion, examples of mass terrorism. condition. Therefore, we define terrorism as “politically motivated violence or the threat of violence, particularly against civilians, with the intent to incite fear” (Levy and Sidel, 2007). This definition includes acts of violence against civilians with the intent to instil fear, committed by nation states, as well as acts committed by individuals and subnational groups. The term 'terrorism' has significant overlap with the term 'war' and many acts carried out during war fall within our definition of terrorism. Starting a war on terror, rather than using education, law enforcement, financial aid and other methods to deter such acts, has led some analysts to include the "war on terror" as an example of collective violence. Since the September 11, 2001 attacks, US federal, state and local governments have spent billions of dollars preparing for emergencies and responding to potential terrorist attacks as part of the "war on terror". “While some of this money was used to improve public health opportunities, the work to prepare for low-probability events diverted too much attention and resources away from widespread public health problems (Rosner and Markowitz, 2006). Furthermore, the “war on terror” has provoked attacks on civil rights and liberties that affect well-being, a public health problem (Sidel, 2004; Levy and Sidel, 2007). We believe there must be a balanced approach to strengthening systems and protecting people in response to the threat of terrorism that strengthens a broad spectrum of public health resources and upholds civil liberties. We believe public health professionals should support efforts to ensure emergency preparedness, not only for potential terrorist attacks, but also for chemical emergencies, radiation emergencies, natural disasters, severe weather events, and outbreaks of serious disease. The Centers for Disease Control and Prevention (CDC) website provides useful information on emergency preparedness (CDC, 2007). As part of its "war on terror", the United States has taken measures that threaten not only civil liberties within the United States, but also human rights and peace around the world. Indiscriminately attacked self-described "terrorist" civilians in Afghanistan, Iraq and Somalia; denied detainees in Abu Ghraib and Guantanamo Bay habeas corpus (a court action or injunction allowing detainees to seek release from their illegal detention) and the right to legal representation and a speedy trial; and has “transferred” detainees to other countries to be tortured. These actions violate human rights and threaten peace.
188 APPENDIX C Public Health Approaches The environmental and health problems caused by mob violence can seem overwhelming. However, standard public health principles and implementation measures can be successfully applied to address these issues, including (1) monitoring and documentation, (2) education and awareness, (3) advocacy for sound policies and programs, and (4) the implementation of specific policies and programs. programs and prevention, as well as the provision of acute and long-term care. Surveillance and Documentation Surveillance and other activities can document health problems caused by war and terrorism. While the number of deaths, injuries, and injuries among uniformed combatants is generally well documented, deaths, injuries, and injuries among civilians are more difficult to document. During the Iraq war and the civil war in the Democratic Republic of the Congo, household surveys were used to estimate civilian casualties. Engineering surveillance approaches can include environmental monitoring and biological monitoring to document and assess human exposure to environmental contaminants and their adverse health outcomes. Non-technical approaches may include information from medical reports, media reports and government agency assessments. Education and awareness Much can be achieved by educating and making health professionals, policy makers and the general public aware of the problems caused by war and terrorism. A multifaceted approach, involving publications from community groups and professional associations, mass media communications, and face-to-face communications, is often valuable. In addition, efforts should be made to help people distinguish and prioritize between correct and inaccurate information. Advocate for strong policies and programs Advocating for better policies and programs can help prevent mob violence and minimize the public health impact of war and terrorism. Public health professionals can address the root causes of war and terrorism and promote a better understanding of these issues. These causes include the historical, political, economic, social, philosophical and ideological roots of war and terrorism. Public health professionals should encourage programs and other activities that promote better understanding and tolerance for one another.
APPENDIX C 189people from different backgrounds and nations. They must work to ensure that basic human needs are met and human rights are protected. They can deal with threats to freedom through government-imposed restrictions on civil rights and liberties (Annas & Geiger, 2008). Levels of prevention Those involved in health promotion and protection classify preventive interventions into four basic categories: pre-primary (or primary) prevention, primary prevention, secondary prevention and tertiary prevention. Prevention includes measures to avoid consequences for health, eliminating the causes that originated them. Primary prevention includes measures to prevent the health consequences of a specific disease or injury by preventing its occurrence in a specific person or group. Secondary prevention includes measures to prevent or limit the health consequences of illness or injury, or to limit the spread of an infectious disease to others after the disease process has begun. Tertiary prevention consists of efforts to rehabilitate and reintegrate the injured into society or, in the case of collective violence prevention, to prevent it from recurring. Preschool prevention In general, preschool prevention requires political and social will. Preschool and primary prevention can be difficult to achieve because the causes of illness or injury may be unknown and, when known, prevention methods may be technically or politically difficult to implement. Acts of war or terrorism and their health consequences can be prevented or mitigated through preschool prevention, but this requires partnerships between civil society (non-governmental) organizations and governmental or intergovernmental entities. The underlying causes of collective violence include poverty, social injustice, negative effects of globalization, shame and humiliation. The persistence of socioeconomic disparities and other forms of social injustice are among the main causes of war and terrorism. The gap between rich and poor is growing. In 1960, the per capita GDP of the 20 richest countries was 18 times that of the 20 poorest countries; This difference increased 37 times in 1995. Between 1980 and the late 1990s, inequality increased in 48 of the 73 countries for which reliable data are available, including China, Russia and the United States (Marmot and Bell, 2006). Inequality is not limited to personal income, but also affects other important areas of life, including health status, access to health care, education and employment opportunities. In addition, abundant national resources such as oil,
190 APPENDIX C Minerals, metals, precious stones, medicinal plants and wood have fueled many wars in developing countries. Globalization is also a double-edged sword. To the extent that globalization leads to good relations between nation-states and the reduction of poverty and inequalities within and between nations, it can play an important role in preventing collective violence. On the other hand, if globalization leads to the exploitation of people, the environment and other resources, it may be one of the causes of war. The Carnegie Commission on Deadly Conflict Prevention has identified the following factors that place nations at risk of violent conflict, including: • Lack of democratic processes and unequal access to power, particularly in situations where power stems from religious identity or ethnicity, and leaders are repressive or human rights abuses Social inequality, characterized by markedly unequal distribution and access to resources, particularly where the economy is in decline and, as a result, there is more social inequality and more competition for resources Control over a pool of natural resources valuables such as oil, timber, drugs or gems ¢ Demographic changes are so rapid that they are outpacing the nation's ability to provide needed basic services and employment opportunities (Carnegie Commission, 2007) Wealthy nations can play an important role in prevention of violence collective responsibility, increasing the end funding for humanitarian assistance and supporting viable development programs that address the root causes of collective violence, such as hunger, illiteracy and unemployment. Promoting multilateralism Since its founding in 1946, the United Nations has sought to fulfill the objective set out in its charter: “to save and protect future generations from the scourge of war”. human rights, promote international justice and help people around the world achieve sustainable standards of living. Its affiliated programs and specialized agencies include the United Nations Children's Fund (UNICEF), the WHO, the Food and Agriculture Organization, the International Labor Organization (ILO), the United Nations Development Program and the Office of the High United Nations Commissioner for Refugees, among others. others. 🇧🇷 These UN affiliated organizations and the UN itself have greatly changed people's lives over the last half century.
APPENDIX C 191 The funds allocated to the United Nations by its member states are grossly inadequate. The annual budget for the main functions (the Secretariat in New York, Geneva, Nairobi, Vienna and five regional commissions) is US$1.25 billion. That's about 4% of New York City's annual budget and nearly $1 billion less than the annual cost of the Tokyo Fire Department. The entire United Nations system (excluding the World Bank and International Monetary Fund) spends $12 billion a year. By comparison, annual global military spending ($1 trillion) would fund the entire UN system for over 65 years. The UN has no army or police. It depends on the voluntary contribution of troops and other personnel to stop conflicts that threaten peace and security. The United States and other Security Council member states decide when and where to send peacekeepers. Long-term conflicts such as those in Sudan and Kashmir and the Israeli-Palestinian conflict boil over, while conflicting national priorities paralyze the UN's ability to act. Indeed, when vetoed, the organization has little power beyond the tyrannical pulpit. The United States and United Kingdom significantly weakened the ability of the United Nations to prevent mob violence with their unauthorized and illegal invasion of Iraq in 2003. The United States also failed to support the International Tribunal on War Crimes in signing and ratifying the Criminal Court Statute (Sewalland Kaysen, 2000). Ending Poverty and Social Injustice Poverty and other manifestations of social injustice contribute to the conditions that lead to collective violence. Growing socioeconomic and other inequalities between rich and poor within countries and between rich and poor nations also contribute to the likelihood of armed conflict. By addressing these underlying conditions through policies and programs that redistribute wealth within and among nations, and by providing financial and technical assistance to less developed countries, countries like the United States can minimize poverty and other forms of social injustice that lead to collective violence. The Commission on Social Determinants of Health was created in 2005 to promote action on the social causes of disease and will recommend the best ways to address the social determinants of health and adopt protective measures to help poor and marginalized populations (Commission, 2007; Marmota and Bell, 2006). Creating a Culture of Peace People in the health and environment sectors can do much to promote a culture of peace that uses non-violent means to resolve conflicts.
192 ANNEX CA The culture of peace is based on the values, attitudes and behaviors that form the deep roots of peace. They are somewhat the opposite of the values, attitudes and behaviors that reflect and inspire collective violence, but they should not be equated with just the absence of war. A culture of peace can exist in the family, work, school and community, as well as at the state level and in international relations. Health and environmental professionals and others can play an important role in promoting the development of a culture of peace at all these levels. The Hague Civil Society Appeal for Peace Conference was held in 1999 to commemorate the centenary of the 1899 Hague Peace Conference. The 1899 conference, attended by government officials, was devoted to finding methods of making war more human. The 1999 conference, which was attended by 1,000 people and representatives of civil society organizations, was dedicated to finding ways to prevent war and establish a "culture of peace". of the 21st century, has been translated by the UN into all its official languages and distributed worldwide. Its 10-point action agenda addressed education for peace, human rights and democracy; the adverse effects of globalization; sustainable and equitable use of environmental resources; elimination of racial, ethnic, religious and gender intolerance; child protection; reduction of violence; and other issues (The Hague Appeal, 2007). This includes not only wars between nations, but wars within nations as well. Strengthening Nuclear Weapons Treaties Unlike the implementation of chemical and biological weapons treaties, there is no comprehensive treaty prohibiting the use or ordering the destruction of nuclear weapons. Instead, a series of overlapping and incomplete treaties were negotiated. The 1963 Partial Test Ban Treaty (PTBT), spurred in part by concerns about radioactive contamination, banned nuclear testing in the atmosphere, underwater, and in space. The extension of the PTBT, the Treaty of Complete Prohibition of Nuclear Tests (CTBT), an important step towards nuclear disarmament and the prevention of proliferation, was opened to the firm in 1996, but still not enough signatures or ratifications have been received to come into force. Prohibits nuclear explosions, both for military and civilian purposes,
However, APPENDIX C 193 does not prohibit computer simulations and subcritical testing, which some nations rely on to maintain the possibility of developing new nuclear weapons. The CTBT has been signed and ratified by 140 nations. Entry into force requires ratification by all 44 nuclear-capable nations, which has yet to be achieved. The United States has not yet ratified the Comprehensive Nuclear-Test-Ban Treaty. The Nuclear Non-Proliferation Treaty (NPT) was opened for signature in 1968 and entered into force in 1970. A total of 189 contracting states (nations) have complied with the treaty. The five nuclear-armed states recognized by the NPT (China, France, Russia, the United Kingdom and the United States) are parties to the treaty. The NPT seeks to prevent the proliferation of nuclear weapons by restricting the transfer of certain technologies. It is based on a control system of the International Atomic Energy Agency, which also promotes nuclear energy. In exchange for non-nuclear-weapon states' obligation not to develop or acquire nuclear weapons, the NPT requires nuclear-weapon states to negotiate nuclear disarmament in good faith. Since 1970, States parties have held a review conference every 5 years to assess the implementation of the treaty. The 2000 Review Conference identified and approved practical steps towards the complete elimination of nuclear arsenals. In a 2006 advisory opinion, the International Court of Justice (World Court of Justice) required nations possessing nuclear weapons to move swiftly towards nuclear disarmament, as required by Article VI of the NPT (Weapons of Mass Destruction, 2006 ). The Anti-Ballistic Missile (ABM) Treaty between the United States and the Soviet Union was signed in 1972 and entered into force. The ABMT treaty was seen as the basis for strategic nuclear engineering, restricting defense systems that would otherwise encourage an offensive arms race, and the Arms Reduction Treaties. In late 2001, President Bush announced that the United States would withdraw from the ABM Treaty within 6 months, stating that this is undermining our government's ability to develop ways to protect our people from future missile attacks by terrorists or rogue states. ... The United States announced plans to deploy a ballistic missile defense system in Eastern Europe in 2007, prompting Russia to threaten to increase its nuclear arsenal. Nuclear-weapon states must help stop the proliferation of nuclear weapons by actively supporting and complying with these treaties and sending a signal to the rest of the world to refrain from the first use of nuclear weapons and to develop new nuclear weapons. It must work with Russia to dismantle nuclear warheads and increase funding for nuclear material security programs to keep them out of the reach of individuals and groups.
194 APPENDIX C Strengthening the Chemical Weapons Convention The CWC is the strongest of the arms control agreements that prohibit a single class of weapons. Inspection and verification of compliance with its standards is the responsibility of the OPCW in The Hague, established by the CWC (Spanjaard and Khabib, 2007). The CWC has been signed and ratified by 182 nations. The controversies over safety and environmental protection of the elimination of chemical weapons requested by the CAQ have delayed the completion of the elimination, and large reserves remain in several countries around the world, which represents a constant threat to health and safety of the environment. The United States and other nations have been unable to fully support the OPCW in its difficult inspection tasks and in urging nations to comply with the CWC (Lee and Kales, 2008) on biological weapons through the Biological and Toxin Weapons Convention. (BWC) 1975 signed. and ratified by 158 nations, several nations are believed to have stockpiles of such weapons. The verification measures contained in the BTWC are weak and attempts to strengthen them have not been successful. In 2002, the United States blocked attempts to increase the BWC's detection measures and announced that such measures could lead to the disclosure of US military or industrial secrets. The United States and other nations should be asked to agree to support the international community's efforts to develop rigorous inspection and verification protocols for the BWC. Efforts must be made to persuade all nations to support the strengthening of the BWC, and all nations must refrain from clandestine activities, often described as "defensive", that could fuel a biological arms race. Perhaps most importantly, global public health capacity to deal with all infectious diseases needs to be strengthened. The best individual and collective efforts to diagnose and treat disease outbreaks can be overwhelmed by any natural or deliberate epidemic. Consequently, supporting strong global public health preventive capabilities provides the best defense against ever-evolving threats. Significant vulnerability to persistent global reservoirs of endemic disease in impoverished and underserved populations could be the source of future pandemics. For example, in India, in 1999, there were 2 million new cases of tuberculosis, causing about 450,000 deaths. An annual investment of US$ 30 million for a few years, compared to the current contribution of US$ 1 million from India for this purpose, could practically eradicate the disease. In addition, the UN estimates that US$ 10 billion in investments in clean water supply could save up to a third of the current 4 billion cases of diarrhea.
APPENDIX C 195 worldwide, resulting in 2.2 million deaths per year. Strengthening the BWC and preventing suspected man-made infections will help alleviate the fear that sometimes impedes action to prevent natural infections, as ratified in the Ottawa Mine Ban Treaty of 1997, also known as the anti-personnel landmines convention. Unfortunately, more than 30 countries have not signed, including China, India, Iran, Iraq, Israel, Russia and the United States. Resources are urgently needed to clear the currently deployed land mines. All nations of the world should be asked to allocate more resources to this task (Hindi et al., 2005; Bertell, 2006; Sirkin, 2008). Secondary prevention The consequences of collective violence can also be prevented or mitigated through secondary prevention: when war breaks out, preventing military and civilian casualties and environmental degradation, and seeking an end to the war. Secondary prevention methods include strengthening compliance with the Geneva Conventions and other treaties that mitigate the effects of war; reduction of military activities, including preparation for war; and negotiate effective agreements to mitigate environmental damage. Tertiary prevention Post-armed conflict efforts to rebuild damage and prevent further conflict and collective violence are extremely important. The onset of World War II was caused in part by the Allies' failure to resolve the problems of Germany defeated after World War I. need to rebuild the environment after the end of the war; and demand adequate compensation for damage to property and the environment. The role of non-governmental organizations An important role for public health workers in preventing and mitigating the consequences of collective violence lies in working with non-governmental organizations (NGOs) (Loretz, 2008). These organizations are increasingly known as "civil society organizations" and focus on warfare from medical and public health perspectives in a variety of ways:
196 APPENDIX C • Responding to mitigate the consequences of armed conflict • Research on the effects of war • Educating the public and decision makers about the health and environmental impacts of war and more dangerous weapons and war practices • Changing the social, economic and political determinants of war collective violence Other NGOs provide direct humanitarian assistance to victims of collective violence. These organizations are usually dedicated to secondary and tertiary prevention, but some, such as the Red Cross, have also begun to play a role in primary prevention in recent years. Humanitarian agencies can also play a role in the primary prevention of certain acts of violence and atrocities. They can be powerful advocates for the civilian populations they live among and provide them with humanitarian assistance (Waldman, 2008). As the preamble to the Constitution of the United Nations Educational, Scientific and Cultural Organization (UNESCO) states: “Since wars begin in the minds of men, the defense of peace must be built in the minds of men” (Unesco , 2007). Acknowledgments The authors thank Mark Rosenberg and James Mercy for their insightful comments on the draft of this document and their persuasive suggestions for improvements. References Allukian, M. Jr. and PL Atwood. 2008. The Vietnam War. In War and Public Health. 2nd ed., edited by B. S. Levy and V. W. Sidel. New York: Oxford University Press. P. 313-336. Anas, G.J. and H.J. Geiger. 2008 War and Human Rights. In War and Public Health. 2nd ed., edited by B.S. Levy and V.W. Sidel. New York: Oxford University Press. pg. 37-50. Associated Press. 2007. UN: Malnutrition on the rise in Darfur. http://enews.earthlink.net/channel/news/print?guid=20070831/36d8e3c0_3ca6_1552620070 (accessed September 2, 2007). International Journal of Health Services 36(3):503-520 Burnham G, R Lafta, S Doocy and L Roberts. 2006. Mortality after the 2003 invasion of Iraq: a cross-sectional survey by cluster sampling. Lancet 368:1421-1428. Carnegie Commission. 2007. Carnegie Commission for the Prevention of Deadly Conflict. http://www. wilsoncenter.org/subsites/ccpdc/index.htm (Accessed September 3, 2007) Centers for Disease Control and Prevention (CDC). 2007. http://www.bt.cdc.gov (accessed June 4, 2007).
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