TERROR, DEMOCIDE, MASS VIOLENCE: EPIDEMIOLOGIC APPROACHES TO CAUSATION, EARLY WARNING SYSTEMS AND PREVENTION

Abstract

ISEE-296 Objectives: (1) Review role of epidemiology in distinguishing between terror and war. (2) Examine role of epidemiologic tools for defining and assessing causes, risks, and impacts and developing interventions for prevention. (3) Examine temporal associations and time lines for exposure to official incitement and deaths from political violence. (4) Examine interrelationships between environmental crises, poverty and terror. (5) Examine role of epidemiology in implementing recent recommendations for Early Warning Systems (Stockholm 2004 Intl Conference on Prevention of Genocide) Background: Previous ISEE sessions have assessed the environmental and public health impacts of war and violence, (e.g., Air Pollution in Kuwait, effects of Nerve Gas warfare and Depleted Uranium in Iraq, bombing in Serbia,) but not their social and environmental determinants. These discussions have raised questions as to the benefits and risks of scenarios of intervention vs. non-intervention, and the ethical responsibilities of public health workers. Methods: Five scenarios will be examined: (1) the genocides in Rwanda and former Yugoslavia; (2) the pre-war, war and post-war situations in Iraq; (3) the deaths from starvation and political repression in North Korea; (4) the relationships between poverty, terror and violence in several states in India; and (5) the Israeli-Palestinian Conflict before and after September 2000 in the light of standard UN definitions of terror and genocide. We use literature and web-based reviews, ecological studies, and timelines developed from available data. Results: The age-sex pattern of the victims enables us to distinguish between war vs. genocide and terror. Mass killing and violence usually occurs without severe Malthusian population pressures (Yugoslavia, Kashmir), but may sometimes serve to aggravate tensions. (Rwanda). Suppression and repression biases are effective in concealing mass killing and adverse public health impacts (infant mortality) in authoritarian regimes during so-called quiet periods, (North Korea) but are less effective in concealing immediate and post war impacts. (Iraq). Political terror is more apt to lead to poverty than vice versa. (India). Incitement is a highly predictive indicator of mass violence and mass killing. (Everywhere) Conclusions: Use of epidemiologic tools and concepts such as timelines and response time, suppression and repression bias, cross sectional and longitudinal comparison of public health indicators before, during and after episodes of mass violence, add strength to efforts to evaluate the benefits and costs of reporting, detection, and response to war, mass violence, terror and genocide.