Genocide is the deliberate and systematic destruction of a group of people defined by their nationality, or by their ethnic, cultural, or religious background. While public health has long been concerned with the promotion, provision, and protection of a population's health during war and conflict, genocide became of interest to the field of public health only in the late twentieth century. The public health impact of genocide is enormous; in the last half of the twentieth century alone, dozens of genocides—accounting for over 23 million deaths—occurred, including in Bosnia-Herzegovina, Rwanda, Burundi, Cambodia, and Bangladesh. Recognizing the relationship between public health and genocide is important because of the contributions public health professionals can make to preventing and mitigating genocide and its impact.
Genocide may include a direct assault on public health as it did in Bosnia-Herzegovina. There, public health came face to face with genocide when acts were committed to destroy the public health of the population, thereby threatening to destroy people through inflicting serious harm to their health. Food, fuel, electricity, running water, and medical supplies were cut off from Sarajevo and its environs during the siege of that city. Since many things are essential to public health, including housing, nutrition, sanitation, and access to public health, any acts committed to destroy or seriously undermine the conditions needed for health are potentially acts of genocide if they are committed against a specific population. For instance, during the siege of Sarajevo, waterborne diseases such as hepatitis A increased because the sanitation systems no longer worked properly, 10 percent of the city's population was moderately malnourished, and the combined effects of malnutrition, cold, and lack of adequate medical care led to increased illness and deaths. In the case of Bosnia-Herzegovina, genocide disproportionately affected the most vulnerable Bosnians—the very young, the elderly, women, the chronically ill, and the disabled.
Genocide may also include indirect assaults on public health, as it did in Rwanda in 1994. There, massive displacement of persons from their homes created large-scale health risks to the internally displaced and refugees. While the high morbidity and mortality in the Rwandan refugee population was recognized as a public health crisis, it was also the product of genocide. Refugees from the genocide who were living in camps did not contract cholera solely because of the infectious agent, but also because they were forced to flee their homes and encounter grossly unsanitary conditions due to their status as members of an ethnic group (the Tutsi) and resultant attacks by the Hutu government. CONTIUE
