 Good evening. We're going to go ahead and get started with our event this evening. My name is Dr. Catherine Ortega. I'm the chairperson of the International Relations Committee here at the UT Health Science Center. And we'd like to welcome you, I and the International Relations Committee, to our event for International Education Week. This is a collaborative effort, as you can see on this introductory slide, that it is a collaborative effort between the International Relations Committee, the Office of International Services, the Center for Medical Humanities and Ethics, and also the Office of Academic Faculty and Student Affairs. I would like to take a moment to thank the International Relations Committee members who have worked to organize this event. They're spread around the room, but if you all would take a moment to please stand and be recognized, members of the International Relations Committee. The excellent collaboration of the Office of International Services and their support staff are back here probably still serving food. Thank you very much. There they are. Our speaker today in this event would not have happened without the efforts of Dr. Ruth Bergren and her assistant Sheila Hodgson. So thank you very much. And then, of course, the vice president for academic and faculty student affairs, Dr. Jacqueline Mock, who's right here. This is our event for International Education Week. This week is actually November 14th through the 18th. And we tend to stretch it out in order to celebrate this month. And the purpose of International Education Week is to really draw the attention to the benefits of education and exchange programs that happen across the globe. So thank you very much for joining us. And now Dr. Jacqueline Mock will present our guest speaker. Thank you, Dr. Artega. I love coming into a room where there are enthusiasts who share a passion for learning about what a guest speaker can do to elevate and illuminate our lives through the speaker's individual experiences, professional expertise, and joie de vivre, to be able to celebrate what we love. And what we love is in our tagline for our Health Science Center. We make lives better. And I know each and every one of you in this room, through your work as a student, as a faculty member, staff, and administrative leader, regardless of the category that you might be in, you really have an opportunity to celebrate that. We are very privileged today to learn from the wisdom of Dr. Robert Lawrence. Dr. Lawrence is the Center for a Livable Future Professor and Professor of Environmental Health Sciences, Health Policy, and International Health at the Johns Hopkins University Bloomberg School of Public Health, one of the most celebrated, internationally recognized schools of public health. He is a graduate of that distinguished institution from, I guess, where you couldn't choose to leave from your undergraduate level to your graduate. So he is Harvard times two. And in his life there, he really had the opportunity to learn and grow from tremendous mentors and has the ability then to share that with others. He is a master of the American College of Physicians and a fellow of the American College of Preventive Medicine, a member of the Institute of Medicine of the National Academies of Sciences, the Association for Prevention Teaching and Research, the American Public Health Association, and Physicians for Human Rights. From 1970 to 1974, he was a member of the Faculty of Medicine at the University of North Carolina at Chapel Hill, where he helped develop a primary healthcare system funded by the Office of Economic Opportunity. In 1974, he was appointed as the first Director of the Division of Primary Care at Harvard Medical School, where he subsequently served as the Charles S. Davidson Associate Professor of Medicine and Chief of Medicine at the Cambridge Hospital until 1991. From 91 to 95, he was the Director of Health Sciences at the Rockefeller Foundation, and then in 1995 to the present has had his affiliation with the Johns Hopkins Bloomberg School of Public Health. Just a tremendous scholar, mentor, relationship builder who epitomizes that value of compassion that we embrace in our practice, which makes the topic of his presentation today medical neutrality such an interesting choice of words. Because in today's era, to be neutral is not to be bland. To be neutral is not to be agnostic. To be neutral, I think we will learn, is to be human and to be caring and to be compassionate. All of the things that we look forward to hearing from you today, sir. Please, welcome. Thank you very much. It is a pleasure to be here and to see Ruth Bergman again. I knew Ruth when she was a student, and I knew her late father and her mother very well when I was a student. Well, this is a topic that's going to end up on a rather somber note, but one which I hope I can persuade all of you to become advocates for protection of health workers around the world. They are really under siege at the moment and all of the trouble spots. And I just am amazed that the story began in 1859 with the battle of Sulferino. This battle, which was the decisive battle in the struggle for Italian unification, had the Sardinian army and the French army on one side and the Austrian army on the other side, about 300,000. And it was probably one of the last battles in which there was no so-called collateral damage, no civilians, because it was fought in an empty valley near the city of Sulferino. And a traveling Swiss businessman happened upon the battle at the conclusion of the day of carnage. The number of wounded you see were over 40,000. There were 6,000 deaths. The French army had more veterinarians than it had physicians. Think about that for a moment, priorities. And up to this point, the whole concept of caring for the wounded in battle was still rather barbarous. They were left to die. Sometimes they were purposely killed, finished off by the enemy. And Henri de Nantes, this traveling Swiss businessman, he pitched in with some women in the local village of Castiglioni. And this wonderful Italian phrase, tutti flotelli, were all brothers. And the women didn't care whether the soldier being bandaged was a Sardinian or an Austrian or a French, nor did Henri de Nantes. So he went back to Geneva after spending three days working with the women of Castiglioni. And he thought about the carnage that he had witnessed. And he began to talk about it with four of his close friends, two of whom were physicians. And in 1863, they formed the Red Cross. And that was the first real humanitarian society aimed at serving the wounded in the dying of conflict, but also beginning to reach out to people who were affected by natural catastrophes. And years later, he was actually a co-recipient of the very first Nobel Peace Prize. And he shared it with a pacifist named, a French pacifist named Sassi. And this sort of carves out the two strands that reflect the original intent of the Nobel Peace Prize to honor humanitarian efforts, Henri de Nantes, and to honor those who were peacemakers and who worked actively to reduce the size of standing armies to reduce conflict. And that was represented by Sassi. So this is Henri de Nantes. He is really considered the father of the Geneva Conventions, the father of the Red Cross, and subsequently the father of the International Committee of the Red Cross. When they first formed this organization, it's rather remarkable if you think about middle of the 19th century. Of course, we were involved in a very bloody civil war where there were a number of recorded battlefield atrocities. Andersonville was a horrible prison camp where a lot of Union soldiers died. And similarly, Confederate soldiers were not very well treated in Union prison camps. But despite the age of the Enlightenment of the previous century, despite all the progress that was going on in Europe, the whole concept of medical neutrality, of treating the wounded irrespective of their prior affiliation with competing armies was a totally new idea. Now one of the five founders of the Red Cross was a physician who really did not believe in neutrality. And he and Henri de Nantes had many, many disputes that went on for about 40 years. And this Dr. Domier actually died about two months before de Nantes. And they never reconciled because de Nantes was passionate about the fact that the only humanizing principle in trying to reduce conflict between peoples was to say that when somebody was owed to combat, wounded in war, that they ceased being a fighter and became a patient and that the people caring for them also should be treated as neutral. Then a few years later, actually just one year later, in 1864, the Swiss parliament invited 12 other European states to come together at a conference that was organized by Leunan and this so-called Geneva Convention was the very first written agreement, a binding treaty among those original 12 countries, describing for the very first time this whole concept of protecting, wounded, protecting those who cared for them. Subsequently, in 1906, the Geneva, the first Geneva Convention was dealt with, land armies was expanded to include naval combatants. And then in 1929, after the horrors of World War I, it was expanded to civilians who were caught up in battle. And then after the horrors of World War II, the fourth Geneva Convention of 1949 expanded the same kind of concept of protection and a blind eye to the prior allegiance of that wounded fighter with regard to prisoners of war. Now at this point, the dates when I was putting this slide together struck me and I have a personal story to tell. My father's older brother, my uncle David, was a conscientious objector. He was a lay preacher in the Ronda Valley in Wales when the First World War broke out in 1914 and he had just turned 18. And so he had the choice of conscientious objectors in Britain in World War I go to prison for the duration of the conflict or join the ambulance corps. And he chose to join the ambulance corps. And for whatever reason they were organized in groups of 28 men. And he went off to France in the fall of 1914 with 27 other conscientious objectors. And when the war ended on November 11, 1918, for four years plus a couple of months, he was the only member of that 28 person ambulance corps still alive. And he then promptly got away from the killing fields of France and settled in Centreville, Iowa, where he married an Iowa woman. And then my grandmother couldn't allow her oldest son to be separated by an ocean. And she stimulated my eternal grandfather, who was a coal miner, and my father, and two aunts to emigrate to Brooklyn, New York. So I wouldn't be here, I wouldn't be an American citizen if it hadn't been for that harrowing experience that my uncle had. But when I began to think more about medical neutrality, I wondered how could it be after the Geneva Conventions of 1864 and 1906, that there's a mortality rate among ambulance drivers and stretcher-bearers of 95 percent? Well, the reality was they were not purposely targeted. They were caught in the crossfire as they attempted to retrieve a wounded soldier, or they happened to be too close when an errand shell exploded. But it's unlikely from the historic record of World War I that any of the ambulance drivers, nurses, doctors, field hospitals were specifically targeted. That came later. This Geneva Convention, then, in 1949, which summarized that world experience of two great wars of almost a century of activity, had 196 countries commit to signing on to the Geneva Conventions, and it became one of the most important humanitarian binding treaties of our time. It defined the basic rights of wartime prisoners. It establishes protection for the wounded and sick. That really had been there from the very beginning in 1864. It established protections for civilians in and around war zones. You probably all know some of the statistics, but World War II total casualties were about 60 to 62 million dead. The majority were civilians. The Soviet Union alone lost 25 million people, about 7 million combatants in the Red Army, and the rest were all civilians caught up in the horror of that war. And of course, we had the 6 million Jews in the Holocaust, the Roma people, people with physical and mental defects, a whole range of people who were not combatants made up that large toll. And then, finally, the Geneva Convention of 1949 defined the rights and properties of noncombatants. The additional protocols that were passed in 1977, all of this is actually quite recent when you stop and think about it, had to do with defining the new asymmetry of war that I'll talk about in a few minutes. And that is, what do you do when you have a state army and then you have non-state actors who are insurgents or guerrillas? And the Geneva Conventions did not comfortably fit with that situation for people who weren't wearing uniforms. There were a lot of language of the Geneva Conventions that had to be modified in these protocols. At the same time that this solidifying of the humanitarian law of enshrined in the Geneva Conventions, we had the remarkable growth post World War II of the human rights movement with the Universal Declaration signed and ratified by the General Assembly of the United Nations in December 10th, 1948. One of my sheroes, Eleanor Roosevelt, was the chair of the writing committee and what is truly remarkable about her diplomacy and persuasiveness was that in the middle of the Berlin Airlift, a hot, hot zone that threatened to break out into armed conflict between the Soviet Union and its three victorious partners from World War II, England, France, and the United States when the Soviets in the summer of 1948 blockaded land access to West Berlin. And for 11 months, everything that West Berliners ate, read, clothed themselves with, heated their homes with was flown in on a constant stream of DC-3s. In the midst of that, Eleanor Roosevelt in December was able to get the Soviet Union, two of its East European allies, Saudi Arabia, South Africa, to abstain on voting for the Universal Declaration rather than voting against it. There were 60 member states at the time, so the final vote was 52 in favor, six abstentions, and two countries were absent. It's really quite remarkable to think of that happening in today's conflict. We need people like Eleanor Roosevelt. Then the Cold War took over. The Universal Declaration had combined civil and political rights and economic, social, and cultural rights. And the writing committee wisely decided that they needed to split and have two groups work parallel but necessarily apart. And one group dominated by Western democracies, worked on the Covenant for Civil and Political Rights. And the other dominated by unaligned states and by the Soviet bloc worked on economic, cultural, and social rights. And as we learned toward the end of the Soviet Union, when things really began to fall apart, Gorbachev tried to hold it together, and then the Berlin Wall came down in 1989. A lot of that commitment to economic, social, and cultural rights was really the equivalent of a Potemkin village. But nonetheless, these two great covenants came into effect in 1976, about 18 years after the Universal Declaration. They are binding law, international human rights law. So now we have the Convention for Humanitarian Protections, and we have the two great conventions of civil and political rights and social, economic, and cultural rights for human rights protection. At a time, tragically, when things were sort of spiraling out of control in new directions. I mentioned a few minutes ago the so-called asymmetric war. We no longer had standing armies fighting against each other the way we did in World War II, the way we did at Sulferino. Now it was much more likely to be a standing army supported by the state fighting against an insurgency movement. Some of these insurgencies have gone on in Colombia for 52 years. In Malaysia it lasted for a couple of decades, and of course we have internal civil conflicts with no standing armies involved, but just rival groups dominating places like South Sudan, the Eastern Democratic Congo, Darfur in Western Sudan, and these are proving to be a challenge, not just for the Geneva Convention, but also for the human rights movement. The human rights movement developed its own group of NGOs in the same way that the Red Cross and the International Committee of the Red Cross have been so important for humanitarian work. I just list a few, there are very many others that I could talk about, but I'm sure you all know Amnesty International, Human Rights Watch, and then Physicians for Human Rights, and here again it was entree through violations of medical neutrality that first attracted a group of us to work on human rights issues. In 1982, 83, I was asked to join Alfred Gelhorn to go to El Salvador to investigate the disappearance of 13 doctors and medical students. This was at the height of the Salvadoran Civil War. Archbishop Romero had been murdered a year before while celebrating mass. There were daily reports of new corpses often without their heads decapitated corpses appearing in body dumps in the capital city of San Salvador. It was a horrific situation with the military dictatorship supported by the U.S. fighting against the FMLN, the Faribundi Liberation League, and there were no holds barred. They were doing horrible things to each other on both sides. And I spent a week there, because of the circumstances of a democratically controlled Congress telling the Republican administration of Ronald Reagan, will only appropriate funds to support the Salvadoran military government if every six months there is a progress report about curbing human rights abuses. So this was led by late father Drinan who was a Jesuit member of the House of Representatives from Massachusetts and a group of others who really champions of human rights and they used that power of the purse to influence U.S. foreign policy. So when we arrived, the Salvadoran government wanted to do everything they could to make our trip successful in terms of getting access to things we asked for, not successful necessarily in exposing some of the worst atrocities. But we were able to enter the political prisons of Ilo Panko and Mariona to actually take torture testimony from people, mostly people who had been tortured by the military government because the Faribundi Marti Liberation Front, they didn't have formal prisoners. They just worked independently and committed their own forms of torture. Returned from that and a few weeks later I got a call from the American Association for the Advancement of Science Committee on Scientific Freedom and Responsibility asking me if I would go to the Philippines to investigate the murder of two young doctors. And I said, why are you calling me? And the answer was, well, you know how to do this. I said, I've done one investigation. Well, that's more than anybody else we know of. So I went off to the Philippines with Jonathan Fine and Eric Stover. Eric Stover, a PhD in anthropology who went on to do some very important work on Los Abuelos in Argentina after the dirty war. And Jonathan Fine who was a physician, a primary care internist in Boston. And we spent about two and a half weeks in the Philippines. And we found that just as had happened in Salvador, these two young doctors were killed because of the lack of understanding and lack of commitment to medical neutrality. They were able to move from government-controlled areas of Samar into the NPA, New People's Army, the Communist Insurgency on the island of Samar, and out again without any problem, because they took care of sick people in both communities. But the Marcos dictatorship and its paramilitary groups could only narrowly interpret their ability to move safely, as meaning they were in collusion with the New People's Army. So they were targeted for assassination. Everything that Henri Dunant started back in 1863, all the subsequent experience, the growth and development of an international set of standards about humanitarian treatment of combatants in the time of conflict, was set aside in El Salvador, in the Philippines, and now, sadly, many places around the world. I came back, I resumed my duties at Cambridge Hospital, and Jonathan, about three weeks after our return called and said, I am resigning as medical director of the North End Health Center in Boston. And I'm going to devote all of my time to human rights work. And I wonder if you would join me in forming a board. And that's how PHR, Physicians for Human Rights, got started. There were six of us sitting around a kitchen table and deciding that, yes, indeed, there was a role for health workers, for physicians, nurses, forensic scientists to apply the tools of medicine to advance the cause of human rights. And, of course, at the same time, there were other groups that were focusing on the humanitarian side, Med-San-San Frontier, got started because of the resistance among some young French positions to service in the French Army. They said, can't we do something alternatively? Can't we work peacefully and help those who are suffering from the conflicts of war, rather than supporting the French Army? And they now are among the most extraordinary group of people around the world delivering service in places which are dangerous, bereft of resources. And we have interacted with them a number of times around human rights issues. And it illustrates that when you're working in complex areas and when you're trying simultaneously to tend to the humanitarian needs of victims and to advocate for their human rights and to hold perpetrators of abuses accountable so that there cannot be impunity and continue to build the structures internationally for respect for both humanitarian law and human rights law, there are interesting combinations that occur. MSF gets into places where it works because it does not speak out unless the problems are so egregious, it does not speak out about the abuses that it finds in the host government. ICRC, the International Committee of the Red Cross, they are able to go in and examine prison conditions because of an agreement with the host government that they will not hold press conferences, they will not publicize what they find. PHR goes in and we hold press conferences and we're declared persona non grata and we're rushered out. But we've been there, we've noted the atrocities, we've written our reports and we've drawn attention to it. So there's this interesting interplay of different tools, different groups coordinating and working together to make progress. So I mentioned asymmetric war. This has probably in the last 30 years been the most challenging development for international aid work, for humanitarian assistance and for honoring human rights. We have examples all over the world now where, of course, our attention is drawn to the Middle East where we have extreme violence, groups like the Islamic State. But northern Nigeria, under the Boko Haram, there are now 3 million people facing starvation. UNICEF estimates that something isn't done to open access, to deliver food and supplies that as many as 50,000 children will starve in the next four or five months. We have the persistence of problems in Somalia, the Horn of Africa, with al-Shabaab. We have the conflicts I've already alluded to in the Congo, Mali. They're just countless places where the respect for the basic human qualities of each other have been swept away. Here are just a few examples of health facilities under attack as part of this violation of medical neutrality. And my colleague, Glenn Rubenstein, is heading up an effort to document and to forge international agreements with both multinational groups like WHO and UNICEF, as well as with individual governments to rededicate ourselves to preserving the sanctity of health facilities and health workers in times of armed conflict. But you can see that we have Colombia, we have Mali, we have Cote d'Ivoire, Nigeria, Central African Republic, Sudan, Somalia, Yemen, the several countries in the Middle East, Pakistan, Myanmar. It's a very, very sobering collection of documented attacks on medical facilities. Just this year, the WHO released its first very serious accounting, finally nudged into action by advocacy from a group of NGOs to actually count what's happening. Because if you don't have a baseline, if you don't do the epidemiology, if you don't actually quantify what is happening to health workers and health facilities, then the political will that's needed in Geneva, it's needed in Washington and London and Moscow, doesn't get generated if people don't have a sense that there's progress being made or we're slipping back and so on. So this is an important development. I hope it continues and expands. But they noted that in 2014 and 2015, there were nearly 600 health facilities that were placed under direct attack, killing more than 950 patients and health workers. The UN Security Council did this year issue resolution 2286, which calls upon member states of the United Nations to recommit to the Geneva Conventions and to expand the coverage to include these asymmetric war situations. The safeguarding health in conflict coalition that Len Rubenstein is heading up is now doing that kind of ground-truthing of data from 19 countries where there have been a number of attacks. So how do we begin to tease this apart and look for opportunities to change the mentality of the people who are committing these atrocities? The MSF hospital in Konduz, Afghanistan, which was serving about 25,000 people, was bombed by U.S. military. The MSF had notified the military of the location of its hospital. The hospital roof had markings making it very clear that it was a health facility. And it was a huge embarrassment for the United States that our armed forces had bombed a facility behaving in the same way that Hafez Assad in delivering barrel bombs and bombing facilities in Syria was behaving. Well, there was an internal investigation that the military carried out, but unfortunately there was really no accountability. And until we have external nonpartisan objective evaluators saying, yes, this looks like maybe it was a mistake without intent or no, this was the outcome of a careless lack of following the military code. So until we have these kinds of prosecutions, and I think in Konduz there was enough evidence that was presented that they could have held some of those responsible guilty of gross negligence. And we need to lead. If we can't, as the world's greatest democracy, demonstrate our commitment to the importance of protecting patients and health workers, it's not going to be very likely that we'll find it elsewhere. Yemen, this was a hospital bombed a few months ago. And again, it was this coordinated Saudi attack on the dissident groups in Yemen and the United States is supporting our ally in that region, Saudi Arabia, raises some very, very troubling questions about the role of military intervention in these internal conflicts, because the Yemen situation is classic Shia-Sunni conflict. They don't have territorial aggrandizement or expansion. They are just fighting it out in a bitter, bitter civil war, and Saudi Arabia stepping in to support the Sunni side, and the United States is stepping in to support our allies, and you end up with things like this tragic bombing of a hospital. So there are many different violations, types of violations that are going on now. Direct targeting, such as we've seen in Syria and Benghazi and Kosovo during the war in the form of Yugoslavia when the Serbs were in control of Kosovo, which is mostly made up of Muslim Kosovar Albanian people. There were almost over 100 medical clinics that were burned by the Serbs. PHR sent three training missions to Kosovo after the cessation of armed hostilities, and I was privileged to participate in one of them, and I went out each day with my Kosovar Albanian interpreter to hold a workshop with physicians and dentists and nurses, 30 or 40 people at a time, all of them Albanian Kosovars, and I would just go through in six or eight hours with them the basic underpinnings of the two great conventions, to talk about the Geneva Convention, and at the end of the day, each time in six different cities, I said, and I have drafted a short letter that I wonder if you would consider signing on and sending it to your Serbian physician, nurse, dentist counterparts, and basically it was reaching out a hand of friendship and saying that we are dedicating ourselves to serving the people of Kosovo, and we would like to work together with you to rebuild our country, and then each time the room erupted in loud conversation, multiple conversations, and I let them go on for four or five minutes and that would turn to my translator and say, what are they saying? Well, I'm not sure you're going to like what they're saying. Tell me, I mean let's stop the discussion and you tell me what they're saying and then I'll respond, and uniformly it was these are wonderful ideas, lofty goals, but it's too early to do this. So that's the challenge we face all over the world when people finally lay down their arms, these deeply held resentments, and some of them are clearly quite appropriate when you stop and think of the treatment that they've received. But sadly what's happening in Kosovo 15 years after that series of trainings is that the divisions are deeper than ever. Very few Serbian professionals are still in Kosovo and these burned out clinics have been rebuilt, but a lot of mistrust and hatred lives on. Another strategy that's often used is the obstruction at checkpoints, or the obstruction of aid convoys, or preventing people from having ready access to care, and this is going on in the West Bank, it's going on in Ukraine. In the Ukraine, prior to the Russian move into the Ukraine taking over the Crimea and then spreading out into other parts of Ukraine, there was a very robust HIV and hepatitis C treatment program funded by the Open Society Foundation in New York, and they had people in large, large numbers participating in methadone treatment beginning to get treated for hepatitis C, decriminalization of injection drug use by the Ukrainian authorities to encourage people to come step forward and seek care. All of that has been shut down. The Russians are not allowing any of the supplies, so all those methadone clinics have essentially closed in the last 18 months, and that represents a violation of medical neutrality. The northern Nigeria, I've already mentioned, the Rohingya people in Burma, the Rohingya are Muslims, they are stateless people because they are straddling the border between Bangladesh and Myanmar, and the Bangladeshis don't want them in Bangladesh because they're a slightly different kind of Muslim, and also they are living in a very crowded environment with not much economic opportunity, and the Burmese don't want them because they're Muslims, and Burma is predominantly Buddhist. So the Rohingya, both sides, and this is sort of equal opportunity offense against human rights and humanitarian care, both the Bangladeshi and the Burmese officials' posture toward them is that let's make life so miserable for them that they'll cross the border into the other country. So access to medical care, basic medical care, is severely lacking. Tax on ambulances, more than 300 ambulances have been destroyed in Yemen. Punishment of health workers who are treating both sides of a conflict. The example I gave you from Samar, Chechnya, there were actually some physicians in Chechnya who were hounded by both the Chechens and by the Russians because they were equally suspect of colluding with the enemy. Bahrain, I don't know how many of you remember a couple of years ago, there was a demonstration that became violent when the Bahraini government tried to suppress it, and there were a group of doctors and nurses who were providing aid in the emergency room of the hospitals where they worked full-time to demonstrators who had been injured in that conflict, and the doctors and nurses were punished, tortured, and several are now serving 15 to 20-year prison terms. Despite the active advocacy of PHR and other human rights groups, the scorched earth strategy in the new air territory of South Sudan, as long as the rebels were controlling an area of ethnic homogeneity, everybody was a new air tribal member, there was great respect for health clinics and for the workers there, the doctors and nurses, but as soon as the boundary of the conflict shifted a little bit and you began to have non-new air tribal groups caught up in this conflict, the rebels began to adopt a scorched earth policy and burned down health clinics, harassed doctors and nurses, killed some of them, so we are seeing emerging in many, many different ways these problems. Here's an example of a shot-up ambulance in Yemen, a bombed-out hospital in Syria just this past summer, another one in Aleppo, the situation in Aleppo is so grave right now, I'll show you a final slide about that, another bombed-out hospital, the Nigerian refugees in the Red Cross, when they were fleeing the Boko Haram in northern Nigeria, there was difficulty getting the Red Cross in to provide humanitarian aid, of course we also have chronic problems of refugees and internally displaced people, the Zaatari refugee camp in Jordan now has a population of Syrians that's almost greater than the Jordanian population, Kotevoir election violence goes on and on, but let me summarize and close with just a couple of challenges to all of us, so here is a slide that's probably impossible for all of you to read, but it's a snapshot of what kind of publication is going on with UN agencies and with other governments and this is Eastern Aleppo and the figures at the top and see if I can read it, it's 275,000 people live in Eastern Aleppo, there have been 531 total deaths of children, 140 deaths of women and the number of wounded and treated is equally horrific and there's no protection, no respect, the people of Aleppo have turned to a cave in a hill to escape the barrel bombs of the Syrian army, they're practicing medicine underground, literally digging out spaces that are protected from attack and these brave people are doing all of this while the world has basically turned away, the security council resolution 2286 that showed some promise five or six months ago, has revealed yet again the fatal flaw of the UN security system, five permanent members each of whom has the power of the veto, so with the Soviet, with the Russians and Chinese both interested in Syria for strategic reasons and with France, Britain and the United States pushing an agenda of peaceful resolution, we have another stalemate and the people of Aleppo are suffering increasingly difficult to get in and out with medical supplies, there are only about 25 doctors left, there used to be about 300 in that one part of the city of Aleppo, so it's time for a rebirth of the passions that led to these two great movements of the Geneva Convention and the enshrinement of the concept of medical neutrality and the right to health, the right to security of the person, all of the rights that are enshrined in the two great conventions and I say to all of you especially to students in the health sciences that there are opportunities for advocacy, you don't have to try to get to Aleppo, it's the impossible to get there because it's totally surrounded now by Syrian forces but you do have an opportunity to use your understanding of the importance of humanitarian assistance, of competent medical services to speak out and inform your neighbors, your friends, your family and to try to build the kind of political will that will finally be necessary to bring these things to a close. Well thank you for your attention, do we have time for a question or two? So we have time for questions, this lecture we're so grateful to our colleagues at Nowcast who is both webcasting this and then we'll archive it but if you've got questions the thing that we would ask you to do is to come to the microphones on either side so that we're able to capture this on the webcast. So Dr. Berggrin are you gonna offer to be the first one up to pose a question? All right thank you. Well thank you so much Dr. Lawrence for coming to San Antonio and visiting us and sharing that really powerful message. It seems to me that back in the early days when you got involved with this that it was enough to go to El Salvador and expose what was going on and in fact it seems almost like an organization like Physicians for Human Rights really just needed to go out and show the dirty laundry, show what was bad, put it out there in a report and the shame that accrued to whatever government was allowing the atrocities would be enough to modify behavior. You also alluded to the fact that American political will could then based on reports of what was going on with human rights decide whether aid would flow or wouldn't flow. It seems to me we live in a new era and with the internet we see atrocities every single day. I think we've all become immune to them. So how does an organization like Physicians for Human Rights which relied previously on careful documentation and science to show that human rights were being violated, how does an organization like that change with the new technology and the change in our global culture? Two ways in particular. First of all we do have new forms of surveillance and access. If you have people with a smartphone in South Sudan or you have people who are collaborating with PHR in eastern Congo or in Kenya where rape as a weapon of war is now a rampant problem, then we can process that information as well as have staff go and provide support and advocate with local governments. But we can process that information and take it to the UN, to our own government, to other sources. So the numbing effect of how much social media deluges us with all of these atrocities is counterbalanced a little bit. I'm not sure it's counterbalanced totally at all by the fact that it has given us essentially the equivalent of many, many more eyes and ears on the ground to document, record early warning signals and so forth. But the other way that has made it more difficult is that the focal point, the pressure point for naming and shaming and for advocating for change is now much more diffuse. So if you have a government that is trying to suppress a rebellion, they still want to appear on the world stage as a responsible member of the United Nations responsible government. Now we are often dealing with conflicting groups that don't represent a state that have little regard for public opinion that don't respond to naming and shaming and that actually exploit fear as part of their strategy for advancing their cause. So we are in a very difficult place in a very difficult time. But I have to say that the people, the Syrian medical, the Syrian American Medical Association for example is made up of a group of extraordinarily dedicated courageous people who settled in the United States decades ago and they now regularly go back through Turkey, cross the border, render assistance and provide the kind of material support as well as the enormous amount of moral support. I'm sure we're all curious in light of the recent election results, what consequences if any do you foresee in terms of accountability for violations of medical neutrality? I think it's too early to say. I am hopeful that the new president will surround himself with experienced foreign policy people. We're very anxious, the NGO community today is very anxious about the magnitude of the work ahead. We are about to lose an extraordinary ambassador to the United Nations and I don't know who's going to replace her but it would be hard to do with somebody any better than she is. So I think we're anxious. And so the rhetoric for NATO, withdrawal of NATO supports and all the... I think the reality of the strength and value of NATO to peace and security in Europe and North America is so overwhelming that it really I think was part of campaign rhetoric. Good evening sir, Matthew Garcia. You do a great job of explaining why medical neutrality needs to be exhibited to patients within hospitals and prisons. Before the patients get there, a form of medical neutrality is exhibited by soldiers administering first aid to enemy fighters. What would you say to the soldier who needs to administer first aid needs to exhibit medical neutrality but is seeing his friends get killed and quite frankly may not be inclined to act with humanity? What developed in the 60 or 70 years after the first Geneva Convention was a growing awareness and recognition that there were core aspects of humanity that we needed to nurture and keep alive even under the most horrendous circumstances and one argument that was frequently put forward was you might be in that person's position and to encourage through military training and through the military code of justice the concept that this is a international agreement and if you happen to be wounded some day in combat and are cared for by a medic from the other side you'll be very grateful for this as well but that is easy to say and I cannot say honestly how I would react if I had been in the horrors of active combat one of my closest friends had been killed we finally overwhelmed whatever unit it was we were fighting against and then I was being called upon to render assistance now the people who do render the assistance the medics the doctors the nurses they are deeply imbued with these values I mean that is part of the ethic of being a health professional but it's a huge struggle and the people who successfully overcome those tendencies are in my mind great heroes thank you so sorry first of all thanks for coming and speaking it was a great talk but sorry to bring up the election things again but um given that the candidate was elected you know kind of bragging about and you know campaigning on war crimes and torture and increased waterboarding I was wondering if you could talk at all about ihpr's experience with working against torture and how that might relate to what we can do for advocating against that kind of going forward um well I didn't mention in my talk there were too many things to try to cover the history of the international criminal court and the the United States led by presidents from both parties resisted the development of the ICC and we were just overwhelmed by the rest of the world that recognized the importance of the rule of law the rule of the importance of fair judicial proceedings and the importance of having an international body we've always had the Hague serving as a court for countries that accuse another country of violations of either the civil and political rights code or the economic social and cultural rights but we have not until the ICC was established we've not actually had a place where you could try somebody for war crimes as was successfully done with the special tribunal on the former Yugoslavia and now has been done with Malian perpetrators of defiling sacred statutes which is quite an extraordinary thing when you consider that that's a war crime nobody was killed nobody was wounded but a cultural assault was done that rose to the level of a crime against humanity so I'm encouraged by the fact that the court is growing and it's developing more and more experience and it has documented successful imprisonment Robert Taylor from Liberia is another example so I think that we would repeat some of the problems that occurred in the Iraq invasion with great great vulnerability to being hauled before the criminal court and again as I said to the other question I think a lot of that was campaign rhetoric I hope it was and I hope that we will settle down and they will embrace the rule of law and respect these international obligations I do I have since Tuesday I must say I have probably had nine emails from Anthony Romero and the ACLU I don't know how many of you are ACLU hard-carrying members but if you are and if you support ACLU you you're getting the same emails from from Anthony who is a real skilled lawyer running a superb organization and they're going to be watching the new administration like the hawk litigation works answer the young man that asked the question about the met the field medic having been my career was in the Air Force Medical Service and having deployed to Afghanistan and Bosnia and Kosovo there's a great emphasis on the law of our conflict for all our medical and operational forces and if you go to our theater hospitals you'll find that half of the patients are civilians to include Taliban and so we're very mindful of that our duties as international citizens and we do everything we can in our power having been a former pilot to de-conflict medical sites it is in the term was used complex environment these are very dynamic complex environments and I agree if there is dereliction of duty we have to hold people accountable for that professionally but I can assure you as a U.S. former officer that we have every focus on this and we need to do so in the future I agree with you a hundred percent thank you sir I wanted to say thank you for giving this lecture and raising awareness about these important topics and also for your work in this very important field I noticed that in your lot in your talk you talked about a lot of different a lot of different medical neutrality issues in the Middle East and one topic that I did not hear you mention and it was wondering whether or not your organization works with it is the conflict with the issue of medical neutrality in the state of Israel with their because they've had issues with medical neutrality due to bombings of hospitals in the Palestinian territories and also withholding medical supplies from the Palestinian territories so does your organization do any work with that issue or I did mention the checkpoints in the West Bank which is greatly interfering with the ability of Palestinians to access medical care in a timely way PHR was very careful in sending a team to investigate reports from the first Intifada of purposeful breaking of the forearms of adolescent boys by the Israeli Defense Forces and so we've assembled the team that had two Jews and two non-Jews to go and we made it very clear to our constituency that we reported back to that we were taking as objective a view of what was happening as possible and we reviewed x-rays and the pattern of the breaks in the forearm was so consistent in the opinion of the radiologists that it had to be done purposely purposefully and it was clearly an Israeli defense force strategy to control the stone throwing in the first Intifada they were rebuked by the Israeli people the first counterpart to physicians for human rights is the Israeli physicians for human rights and they are doing inside Israel an extraordinary job of advocating for honoring both the Geneva Convention and the two great covenants I think the problems of Gaza the what do appear like purposeful destruction of medical facilities and the interruption of supply lines is a real human rights issue and there's a wonderful book that a young Israeli physician Danny Phil F. I. L. has written about the discrimination the structural discrimination that goes on Israeli Jews Israeli Arabs non-Israeli Arabs Palestinians and then immigrants from places like Eritrea and Somalia and he has laid out and stark detail counting cases documenting things and it's a tribute to Israel's functioning as a democracy that Danny was recently promoted to full professor in the School of Medicine at Bersheva so people are speaking out but we need to speak out and I'm sad to say that the American Jewish community has often been represented by people who are real hardliners in support of the Israel Defense Forces and Prime Minister Netanyahu but it is an ongoing issue that we're very concerned about at PHR. Thank you. Hi Dr. Lawrence I just wanted to say first thank you for coming here and taking the time to speak to us I just had a quick question so earlier in your lecture you talked about how or you gave examples about how medical personnel were accused of colluding with I guess enemy forces and so that's why they were taken out or yeah so I was just wondering what you would have to say about cases where that's actually kind of happened such as I had to look it up I couldn't remember off the top of my head but in Pakistan when CIA forces used a sham hepatitis B vaccination project to collect DNA in the neighborhood where Bin Laden was hiding I guess if what if anything can PHR do to I guess stop people from doing that so they actually trust medical professionals again. Thank you for that question it was another thing that had to be left on the cutting board but PHR two of us then Les Roberts at Columbia Mailman School of Public Health and I when we learned of that egregious misuse and misrepresentation of medical personnel by having that sham vaccine campaign to try to obtain DNA evidence for the abadabad compound to confirm that family members of Osama Bin Laden were living there and then he was exposed and the fallout of that there were about 40 polio vaccinators in Pakistan and in other parts of the world who were murdered in retaliation for that it unleashed retribution against completely innocent people so what Les and I did first of all we said well we ought to write to John Kerry no no we ought to write to Barack Obama no we ought to have people more important than us write to Barack Obama so what we did was we drafted a letter and he got his dean and I got my dean and then we got the deans of the 12 schools of public health that have the largest international health departments to sign on to this letter all 12 agreed to do it it went to the white house silence no response seven months later a spokesperson for the president wrote those 12 deans and said that and we must it must have taken them this time to vet the whole process the security concerns and so on that there was a order that the CIA and no other branch of the U.S. government would ever again use a health worker to collect intelligence so we feel really good about that and it's an example of bad thinking and an example of of unintended negative consequences of the highest order what that effort to document the DNA of the people living in in that compound in Abbott Abad did for global public health is tragic we're still dealing with the after the fallout there's so much suspicion it just fed into all the propaganda about health workers intruding in your home forcing vaccines on you and so on well thanks for that thank you I think I just wanted to follow up a little bit on something that was said earlier about the role of the U.S. military when they are embedded or involved in these conflicts and I think it's certainly true that the military medical personnel have a very strong commitment to taking care of whoever is wounded whoever is injured regardless of their affiliation however I think this doesn't is not reflected in the upper echelons of the military have several family members who were very involved in the conflicts in Iraq and Afghanistan and the military personnel the medical personnel were very committed to taking care of the injured and wounded from IEDs no matter what their affiliation but the administration of these military hospitals was very eager to transfer these people to civilian hospitals to hospitals that did not have the infrastructure and in fact at the time in Baghdad there was no electricity and patients on ventilators were being the hospital administration was urging that these patients be transferred to civilian hospitals because they were not Americans and many of these people that I happen to know have come back with a great deal of stress PTSD related to these these ethical dilemmas that they faced there were stories of burned children being brought to the American hospital and turned away because they were not Americans so I think it's important to recognize that our military medical personnel are put in these environment where you know their first instinct is to help and to care and to take care of people and yet the military infrastructure the the administration often poses barriers to those folks and this results in a lot of psychological distress so I just wanted to highlight that the military really has some issues and concerns and many of the people who have come back the military personnel who've come back from those conflicts have been very distressed as a result of those choices that they were forced to make. Thank you. Last question. Thank you again for coming and sharing your wisdom and experience with all of us. My question is related to to rape and conflict I think one of the most amazing things PHR does is address this very important issue that kind of gets I think sometimes brushed under the rug and I was wondering what so in places where like here we don't very handle rape cases very well so how once the evidence is gathered or if it's able to be gathered how does where do y'all take this in terms of justice for the victims of of rape and I guess my secondary question with this is a lot of the trauma and social repercussions for being raped that people think that you're that you're less than because of it how do you address kind of this how does PHR address this kind of psychosocial issues surrounding rape? Part of the PHR program to eliminate rape as a victim as a tool of war instrument of war has to do actually with collaborating with other groups that are training lawyers training people how to keep maintain the evidence chain training local judiciary training and supporting all that side of accountability and prosecution and so on but because we are a group of health professionals our main attention has been on helping the victims and there's a wonderful Congolese Dr. Mukweji who himself has been has his life threatened the bodyguard was killed PHR brought him to the United States for four months to have asylum and he wanted to go back and his family wanted him to go back so he's back in eastern Congo repairing the fistulas and the other complications of forcible rape and many victims have been raped repeatedly by you know half a dozen soldiers and so on so it's a complicated issue as they all are but combining the training and not necessarily of fully credentialed people but training people on such basic things as maintaining a chain of evidence turns out to be critically important and then supporting local judiciary open society foundation the global health program there focus is a great deal on these kinds of use of litigation use of strengthening people in understanding the law and understanding both humanitarian and human rights law but as with everything else we've talked about this afternoon you know it does come down to how effective we are in reaching out to people who are being abused and victimized and how much compassion and concern we can communicate it's the same with the person who's sick on a ward in the hospital here who is feeling shut off and lonely and maybe is a victim of domestic abuse you do the medical part you do the psychological part you do the social support part and you try to encompass them in all the avenues that are necessary for healing so much