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Guard against the oblivion: a role of public health in war

Dario Sambunjak, Luka Kovačić
DOI: http://dx.doi.org/10.1093/eurpub/ckl028 231-232 First published online: 2 June 2006

Not to remember means to side with the executioners against its victims; not to remember means to kill the victims a second time; not to remember means to become an accomplice of the enemy. On the other hand, to remember means to feel compassion for the victims of all persecutions.

(Elie Wiesel, excerpt from the Miami Beach Holocaust Memorial dedication, 4 February 1990)

In 1991, Croatia entered the list of world's crisis areas ravaged by armed conflicts. The scenes of war, once thought to be safely buried in the textbooks of European history, resurrected before the eyes of shocked nations. As if all the tragic lessons of previous wars were forgotten, a new bloodshed began, bringing new deaths and suffering, family tragedies, and community destructions. This time, everyone agreed, the horrors of war must be remembered. This time, the lessons must be learned.

Yet today, only 15 years later, can we really claim that our memory is not failing us? Were the people killed during the war in Croatia counted in hundreds, thousands, or tens of thousands? What is the name of the farm where more than 200 patients taken from Vukovar hospital were beaten and then executed?And what time of year did that terrible crime happen–fall or winter? In 1991 or 1992?

Responsibility of health workers

Human memory is indeed ‘a net full of holes’, and many facts about war-related events can easily become distorted and misused for political purposes. There is a great need to guard against the oblivion. Geiger and Cook-Deegan pointed out that health workers cannot shy away from that responsibility: ‘The skills of physicians, medical and forensic scientists, and other health workers are uniquely valuable in human rights investigations and documentation, producing evidence of abuse more credible and less vulnerable to challenge than traditional methods of case reporting’.1

During the 1991–1995 war in Croatia, the documenting of civilian casualties and human rights abuses was recognized as a public health priority. However, the scope of the task was such that it required involvement not only of public health workers but also many other professionals, including university professors and medical students. Supported by the Ministry of Health of the Republic of Croatia, Zagreb University School of Medicine established a communication and medical documentation network intended to gather files, messages, and documents from regional medical centres in war-stricken areas and besieged cities, and to give instructions for preventive public health measures.2 A detailed database of war casualties was created and continuously updated. Special efforts were made to track missing persons and mortal remains, although this task proved to be extremely difficult to accomplish.2

Looking for ‘10 righteous people in the city’

The role of public health as a guard against oblivion, no matter how difficult it may be, should go even beyond documenting casualties and human rights abuses. What about the good deeds done by the righteous people during the war? Should they not be recorded with the same diligence as the war crimes? To begin with, public health workers should carefully document their own activities, such as taking measures against epidemics, preventing food and water poisoning, building shelters for refugees, foreseeing the war-related dangers for the environment, cleaning and burying animal carcasses in the war zones, supporting actions against land mines, and caring for old, disabled, poor, or abandoned people. Furthermore, public health workers should actively seek for accounts of individuals taking action, or even sacrificing themselves, to save lives of other people and communities. Following the example of Yad Vashem Memorial for the victims of Holocaust, righteous deeds should be registered systematically to preserve the memory of them.3

Art and science

The importance of data collection in war circumstances can hardly be overestimated. However, documenting does not end with data collection. To really produce ‘more credible and less vulnerable’ evidence, public health workers have to adhere to scientific principles. And scientific principles require that data must be processed, analysed, and published, preferably after a peer review. War circumstances should not be an excuse for scientific sloppiness. On the contrary, the graveness of the situation and far-reaching consequences of deficient documentation should be an impetus for public health workers to excel in both their scientific and field work. Defined as ‘the art and science of promoting health, preventing disease, and prolonging life’, public health bears equal responsibility for immediate practical actions as it does for studious, scientific approach to health issues, including documentation. Comprehensive data collection is a sign of a keen field work, and builds a solid foundation for theoretical deliberations and development of new peace-promoting strategies.

On the basis of their first-hand experiences, as well as the facts and figures gathered during the wars in South Eastern Europe, Croatian experts were able to disclose the weaknesses of historical models of public health in a war situation. They also outlined new theoretical models in which public health had a major professional responsibility in preventing war and dealing with its consequences.4

Record keepers

Finally, to guard against the oblivion means to keep the record safe for the future generations. But to whom should the duty of record keeping be entrusted? Without any intention to belittle the importance of news media and official government documents, we argue that scientific journals in general, and medical or public health journals in particular, should play a special role in preventing the facts to be distorted and misused. Reports published in those journals are subjected to scientific scrutiny, which gives them additional credibility.

The Croatian Medical Journal (CMJ), whose establishment coincided with the beginning of 1991–1995 war in Croatia, took the role of record keeper from its earliest days: a war supplement was published even before the first regular issue came out of the press. In spite of being produced under most difficult conditions, the CMJ was issued regularly, bringing reports on civilian deaths and massacres, child casualties, displaced persons, prisoners of war, and destruction of medical institutions. Special attention was given to the descriptions of public health service and organization of medical care in war.5 Since 1991, the CMJ published more than 220 war-related articles. The editors of the CMJ offered their expertise to Croatian medical and public health professionals, helping them to write more than 100 war-related articles published in journals other than the CMJ. In this way, the war in Croatia became one of the best documented armed conflicts in modern history, at least from the medical point of view.

Guarding against the oblivion is not an easy task. Human beings are prone to forgetfulness, and seldom learn anything from the mistakes of past. A proverb says that ‘to remember means to write down’. Therefore, to keep the memory of war reliable and instructive, to prevent the repetition of mistakes, someone has to write down and safeguard the truth. Why not public health workers?

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