American Public Health Association. Preventing genocide

'Why are we not doing more for them?': genocide prevention lessons from the Kindertransport

OBJECTIVES

Genocide remains one of the most widespread forms of preventable mortality and morbidity for children today. Despite the creation of multiple human rights treaties, genocide has not been eliminated and its effects disproportionally impact children. The Kindertransport was a series of rescue efforts that brought thousands of refugee children to the United Kingdom from Nazi Germany between 1938 and 1940. This qualitative study asks what public health professionals can learn from the prevention efforts of the Kindertransport by examining the experiences and reflections of individuals rescued as children. The specific aims of the study were (1) to analyze qualitatively the impact of the rescue on rescued children; (2) to evaluate the strengths and limitations of the Kindertransport as a prevention effort; and (3) to draw implications for contemporary public health responses to global genocide.

STUDY DESIGN

Qualitative research study.

METHODS

In-depth interviews, using a semi-structured interview guide, were conducted with 27 survivors of the rescue. The data were thematically coded, and excerpts exported and interpreted in reflection of patterns and themes using Dedoose.

RESULTS

Five inductive themes emerged from the data related to the broad spectrum of antisemitic persecution: the breakup of families; integration in the UK via the Kindertransport; the challenges of adapting to a new environment; and the implications for global rescue efforts.

CONCLUSIONS

The results suggest that the public health community should act to prevent genocide through rapid intervention and rescue; at the same time, the effects of persecution must be addressed and sustained social, emotional, and psychological support must be provided to those rescued.

To prevent, react, and rebuild: health research and the prevention of genocide

OBJECTIVE

To develop an approach to the primary prevention of genocide, based on established public health-based violence prevention methods derived from a variety of high-risk settings.

DATA SOURCES

(1) Peer-reviewed literature in the fields of public health, violence/injury prevention, medicine, economics, sociology, psychology, history, and genocide studies, (2) demographic and health data bases made available by governments and international organizations, (3) reports on recent episodes of genocide published by international and nongovernmental organizations, (4) newspaper and journalistic accounts of recent and past genocides, (5) archival testimonies of genocide victims and perpetrators, and (6) court transcripts of international genocide prosecutions.

STUDY DESIGN

The research was conducted as a medical-historical policy analysis synthesizing data within the following framework: (1) Assessment of current violence and injury prevention models for suitability in the prevention of extreme, population-wide violence, (2) analysis of morbidity and mortality data to quantify the impact of genocide on the health of populations, (3) making an inventory of the known societal risk factors for genocidal violence, (4) identification of the theorized, modifiable attitudinal risk factors for genocidal behavior within a population health model, and (5) assessment of existing projects targeting primary violence and injury prevention in high risk jurisdictions, for future adaptation within a structured, public health approach.

PRINCIPAL FINDINGS

Mortality rates due to genocidal violence are far in excess of other public health emergencies including malaria and HIV/AIDS. The immediate and long-range health consequences of genocide include the sequelae of infectious diseases, organ system failure, and psychiatric disorders, conferring an increased burden of disease on affected populations for multiple subsequent generations. The impact of genocide on local health economies is catastrophic, and the opportunity costs of diverting scarce global health dollars toward ameliorating genocide related outcomes are substantial. Structural risk factors for genocide within societies include: totalitarian government, exclusionary ideologies, armed conflict, economic hardship, and inaction of bystander nations. Proposed psychological risk factors for genocidal behavior include: moral exclusion, authority orientation, action in self-interest, desensitization, and compartmentalized thinking. Violence and injury prevention models, incorporating what is currently known about the societal and behavioral risk factors for genocide in high-risk populations, may be modified to address the primary prevention of catastrophic violence on a population-wide scale. A number of existent global peace building initiatives may serve as models for the design of future prevention initiatives in high-risk, pre-genocide jurisdictions.

CONCLUSIONS

Our analysis suggests that genocide is one of the most pressing threats to the health of populations in the twenty-first century. Recent advances in the public health discipline of violence prevention provide a blueprint for approaches to primary genocide prevention based on epidemiological methods.