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Children of Genocide: A Legacy of Lost Dreams

2008; American Academy of Pediatrics; Volume: 121; Issue: 3 Linguagem: Inglês

10.1542/peds.2007-2208

1098-4275

Charles N. Oberg,

Torture, Ethics, and Law

Dr Janusz Korczak was a European pediatrician, educator, and children's author from the first half of the 20th century. First as a pediatrician and then as a teacher he dedicated his life to impoverished and vulnerable children. He formed a progressive orphanage and school in Warsaw, Poland, during the 1930s to care for orphaned children of both Jewish and Catholic descent. In 1940, after the German invasion of Poland by the Nazis, Dr Korczak was ordered to close the orphanage. Instead, he moved the 200 to 300 Jewish children for whom he cared into the Warsaw ghetto and attempted to establish a safe haven within the turmoil, uncertainty, and fear of the new location. Eventually, the children were ordered to be relocated to the death camp of Treblinka. Despite being a Jew, because of his fame as Poland's "old doctor" he was encouraged on several occasions to abandon the children and return to the Aryan side of Warsaw. He refused, and on August 6, 1942, he quietly marched with his children to the trains for relocation and eventually to death at the hands of the Nazis.1 His story and the fate of these children are but an example of the many silent others who attempted to protect men, women, and especially children from the ravages of the Holocaust.This commentary has three overall goals. The first is to encourage us to not think of genocide solely as a historical event such as the Holocaust but, rather, a persistent reality that requires constant vigilance and action as it transitions from our past into the current affairs of the 21st century. Second, to realize that as part of genocidal denial, we frequently forget that the burden of these atrocities is disproportionally placed on children. Finally, as pediatricians, to advocate by being aware, informed, and active in a global effort to halt the killing of innocent children and to help heal the scars for those children and youth who have been ravaged by its effects.The Holocaust was unique in terms of its horrific magnitude. There are always concerns that comparisons to other episodes of mass killing may draw attention away from those who died during Hitler's "final solution." It is inconceivable that his attempt to exterminate the European Jewry led to the death of almost 6 million persons including 1.5 million children. However, genocide throughout the 20th century remained one of the most prevalent forms of preventable mortality and morbidity for children. Therefore, it is important to examine other episodes of genocide and the resultant mass killing and injuring of children while always acknowledging the sentinel place we must hold for those who perished during World War II. The remainder of this section will highlight several declarations and the treaty that arose from the Holocaust, as well as the gradual recognition that children have their own set of inalienable rights.The impact of genocide took on world recognition after the defeat of Germany in 1945 and the Nuremberg trials that followed. The newly formed United Nations (UN) in 1948 formulated and passed the Universal Declaration of Human Rights, which provided a broad framework for the assurance of basic human rights. The preamble states that "recognition of the inherent dignity and of the equal and inalienable rights of the human family is the foundation of freedom, justice and peace in the world" and then articulates 30 articles that delineate what those rights entail. There are 2 rights that are of particular relevance to this discussion: Article 3 proclaims that "[e]veryone has the right to life, liberty and security of person," and Article 5 states that "[n]o one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment."2The Genocide Treaty, which was passed that same year, went further and outlined the basic definition of genocide to which the ratifying countries would agree and delineates the acts that would hence be prohibited. The convention defined genocide as the committing with the intention to destroy in whole or part a national, ethic, racial, or religious group. In addition, any 1 of the following 5 acts would constitute genocide regardless of whether they are committed during a time of peace or war and represents a crime under international law. The Universal Declaration of Human Rights and the Convention on the Prevention and Punishment of Genocide established the universally accepted framework for human rights but left significant gaps regarding the specific rights of children. This evolutionary process both predated and postdated these seminal works. It began with Eglantyne Jebb, who witnessed and documented the devastating effects of World War I on European children. She drafted a set of children's rights that was later adopted by the League of Nations as the Geneva Declaration of the Rights of the Child. In 1952, the UN adopted and reaffirmed the Declaration of the Rights of the Child and directed its members to follow its principles of protection for all children. The declaration espoused the basic principle of civil and political as well as economic, societal, and cultural rights for all children. Over the course of the remainder of the 20th century, the UN tried to craft a treaty that would then do more than make a declaration but actually put the specific principles into international law. The General Assembly on November 20, 1989, passed the UN Convention on the Rights of the Child (CRC). On September 1, 1990, the CRC was put into force, making it the fastest international treaty to move from passage to ratification and implementation by member nations. The CRC established the responsibility of governments, institutions, citizens, and families for ensuring that the rights of the child are respected and all actions are directed toward achieving the "best interest of the child."The essential themes of the UN CRC include the right to the basic needs for optimal growth and development; civil and political rights; and a right to safety and protection. Safety and protection frequently are interpreted as freedom from forced child labor and unsafe working conditions. However, they also have a much broader focus and include safety from child maltreatment, domestic violence, and the witnessing of violence in the home and/or the larger communities. They also encompass freedom from sexual exploitation and death. The UN CRC is the first legally binding international document to recognize the civil, political, economic, social, and cultural rights of the child.3There is a growing awareness that an international response will be necessary to address acts of genocide, mass murders, and other crimes against humanity. In Rome at the end of the 20th century (July 17, 1998), 120 nations voted to create the International Criminal Court (ICC), and on July 1, 2002, it was ratified by the necessary 60 countries and its jurisdiction began. The ICC is an expansion and institutional formalization of the International Criminal Tribunal for the Former Yugoslavia (the "Hague tribunal"), which was established by the UN Security Council in 1993 to investigate and prosecute the ethnic cleansing by Bosnian Serbs and the International Criminal Tribunal for Rwanda in 1994. The world court was designed to provide an ongoing mechanism for investigating and prosecuting genocide and other crimes against humanity. The United States has not ratified the ICC and refuses to acknowledge its jurisdiction over US matters. However, the US did abstain from a veto when the UN Security Council referred the Darfur situation to the ICC for investigation in March 2005, which helped to establish its credibility.4Since the passage of the Declaration on the Rights of the Child and the subsequent Universal Declaration of Human Rights, Convention on the Prevention and Punishment of Genocide, and CRC, we must acknowledge that genocide has not been eliminated but has continued to occur throughout the 20th century and into the new millennium. This includes but is not limited to the Armenian genocide between 1915 and 1923; the 1971 genocide and famine in Bangladesh; the "killing fields" of the Khmer Rouge in Cambodia in 1975–1979; the Rwandan massacre of Tutsis in 1994; the Balkan mass killings in Kosovo in 1998–1999; and, most recently, in Darfur, Sudan.Author and journalist Samantha Powers, in her seminal Pulitzer Prize–winning book A Problem From Hell: America and the Age of Genocide, eloquently speaks to the recurring normative response to these atrocities. As a society we take each independently and lock it in time, defining each by the economic, geopolitical, and sociodemographic parameters of their particular historical situation and then quickly set it aside.5 Frequently, it is also the response to not want to accept the realization that children are frequently the target of ethnic cleansing and mass killings. The ramifications ripple on long after the specific dates of the atrocities. The adverse outcomes include not only the children who perished during the genocide but those who die as a result of starvation and famine afterward, disease brought about by the disruption of health care infrastructure, and children left alone either on the streets or those who live the remainder of their childhood and adolescence in youth-headed households (YHHs) and/or orphanages. This section will highlight specific examples of the violation of the 5 components of the Genocide Treaty.Figure 1 provides a schematic of the 5 acts that constitute genocide and provides examples on how children have been affected in 5 case studies. Each example provided highlights a particular aspect of genocide committed against children; it is important to remember, as is reflected in the Venn diagram, that there are many similarities that overlap each of these episodes of genocide, and the case studies were designed to provide insight and nuance to particular aspects that are evident from an examination of each one.The Yale Cambodian Genocide Project estimated that 1.7 million persons died as a result of the Khmer Rouge's killing fields between 1975 and 1979.6 Children were a particular target of the Khmer Rouge. The regime minimized the importance of the family and at times even banned family contact. Children were separated from their families, brainwashed, and inundated with propaganda designed to have them embrace the revolution. However, not all children were recruited. Children who were from families of the intellectual elite and/or of a different ethnicity such as Chinese, Vietnamese, and Muslim Chams were executed. The intent of the Khmer Rouge was to eliminate all "class enemies" or those who were not considered to be "true Cambodians." These enemies included anyone from the cities or those who were considered educated (defined by anyone who had completed the seventh grade). These children were occasionally killed by the children who had been recruited, resulting in the killing of children by children. Second, as a result of the collectivization and creation of rural communes for agricultural production, children died disproportionately as a result of overwork, exhaustion, and starvation while attempting to meet the agricultural quotas set by the regime. Finally, there was the disproportionate killing of children and youth at concentration camps such as Tuol Sleng, a former high school in Phnom Penh that was converted into Security Prison 21.In a recent study at the end of the 20th century, then-Cambodians who had survived the killing fields were asked about how many had lost sons and daughters during the time of Pol Pot. From a total of 400 respondents there were 554 child deaths reported, averaging >1 child per survey respondent; illness accounted for a majority of the deaths among 100 000 children annually.11The Rwandan massacre of 1994 resulted in the loss of many children, similar to the loss of life during the Khmer Rouge regime in Cambodia under Pol Pot. However, a unique situation has emerged from this African country: the large number of children who have lost parents. A recent UNICEF report revealed that 80% of Rwandan children interviewed had lost at least 1 family member. It is estimated that immediately after the genocide there were 90 000 to 115 000 orphans, and by 1996, more than 5000 children were being cared for in 52 orphanages throughout Rwanda.12 In addition, a large percentage of children and youth found themselves living together on the streets and/or in YHHs. In 1998, UNICEF reported that there were up to 300 000 children living in child-headed households.13 By the removal of adults, the children are forced to live in insular poverty, where basic human rights are ignored or are difficult to obtain. The right to economic and social justice is denied because of their inability to achieve basic human needs such as adequate food and shelter and barriers to obtaining a necessary primary education. These issues adversely affect their growth and development. A recent study revealed that a majority of young children living in YHHs are in fair or poor health and that depression and social isolation are frequent symptoms.14The partition of the south Asian continent resulted in a predominantly Hindu India and Muslim Pakistan in 1947–1948. However, the Pakistan nation was geographically separated into a west and east Pakistan separated by the northern region of India and by ethnic and language differences. The government was based in west Pakistan. After a major flood of east Pakistan in August of 1970, the west Pakistan relief efforts were viewed as inadequate and poorly administered. Many in Europe and the United States recall the Concert for Bangladesh that George Harrison and Ravi Shankar sponsored in 1971 for famine relief. The famine indeed was secondary to the natural disaster flood of 1970. However, famine and war frequently go hand in hand, and the famine was accentuated by a west Pakistan response to east Pakistan's call for greater autonomy, which led to a repressive response by the government that escalated into a "root-to-branch" effort to eliminate the Bengalese resistance. There was mass killing of men and women. However, it was the "gendercide" and the systematic large-scale sexual violence toward women that characterized this genocidal event. It was not only characterized by the gang rape of Bengalese girls and women but also the brutal physical violence that often resulted in their disfigurement and/or death.15 In addition, the intent of the violence was also to decimate the reproductive health of an ethnic group. It must be remembered that in the Muslim faith, virginity is sanctified, and there is a strong prohibition against premarital sex. The exploitation and violation of Bengalese women was an effort to eliminate future births of subsequent generations.A military coup led to the overthrow of Argentina's government and President Isabel Peron in 1976 and was replaced by a dictatorship that governed from 1976 to 1983. During this regime it is estimated that up to 30 000 Argentineans "disappeared" because of their political beliefs and presumed threat to the new military dictatorship.16 One of the most unethical and atrocious aspects of these killings was that women who were pregnant were allowed to complete their pregnancies before their executions; their infants were given up for illegal adoptions to military families, in essence to be raised by the institution that murdered their parents. There has been an international call for Argentina to provide a fuller account of these missing children. It is important to note that Jorge Videla, who led the coup and became Argentina's de facto president from 1976 to 1981, was arrested in connection with human rights abuses under the military dictatorship. He was imprisoned in 1985 but was then pardoned by President Carols Menem in 1990. However, he was rearrested in 1998, specifically in relation to the seizure and illegal adoption of 5 children to military families. A group of women in 1977 formed the Abuelas (Grandmothers) de Plaza de Mayo, who continue to search for >200 of these "lost children" who disappeared with their parents after being taken into custody by members of the police or military security forces.17The American Academy of Pediatrics incorporates advocacy into its mission and vision and is acknowledged as an organization that is dedicated to the well-being of all children. We must become more active in addressing genocide both at the individual and organization levels. The following are but a few efforts that might be undertaken. First, we need to incorporate the topic of genocide as part of the advocacy curriculum in pediatric postsecondary residency training. Second, as an organization we must continue to call for the ratification of the UN CRC by the US Senate. The United States is the only international government that has failed to ratify the treaty. Third, the American Academy of Pediatrics should develop a policy paper on the impact of genocide on children, to expand on Resolution 61, entitled "Response to Genocide Adopted by the American Academy of Pediatrics 2005 Annual Leadership Forum." We need to support our colleagues who are participating in relief efforts, such as those working with Doctors Without Borders. Finally, as physicians, we no longer need to travel the world to influence the health of international children. Many families and children have emigrated to our communities from both developed and developing countries, so we must remain vigilant in our awareness of international events. Most specifically, we must assist those children who have survived genocide as they struggle to restore their health and rediscover their dreams.