Today, as Rwanda launches three months of events to commemorate the genocide that ripped apart that small central African country 20 years ago, human rights advocates are still wondering what happened to the vows of “never again.” Syria, Sudan, and the Central African Republic are engulfed in conflicts claiming the lives of hundreds of thousands of civilians, and the world is incapable of an effective response.

I remember the mornings in early April 1994 when I would pull my car over to the curb of a busy Boston street, blinded by tears and paralyzed in horror as I listened to the reporter telling of bodies piled high in parish churches as machete-wielding Hutu Interahamwe militia massacred every man, woman, and child in sight. The BBC’s coverage of Rwanda’s hate radio streamed through my car’s speaker thousands of miles and oceans away, urging Rwandan Hutu to go out and kill their Tutsi neighbors. This was indisputably genocide.

The reporting continued day after day as foreigners evacuated and desperate calls from courageous advocates and a few heroic UN officials in Kigali fell on deaf ears. The late Alison des Forges of Human Rights Watch, a tiny woman with a gigantic and prescient understanding of Rwanda and its history, produced real-time accounts of the atrocities, begging for an effective global response, and reminding us that many Hutu opposing the Interahamwe were also targets of Rwanda’s cold-blooded killers.

At Physicians for Human Rights (PHR), for the first time, we called for multilateral military intervention to stop the killing. By the end of June 1994, the most intensive rate of mass murder in modern history, with the participation of civilians mobilized by vicious propaganda, resulted in an estimated one million dead. Months later, PHR’s first delegation to Rwanda published photographs of the bodies still piled high in churches and schools and decaying on makeshift wooden scaffolding.

Having failed to stop the genocide of 1994, the international community went about prosecuting the alleged leaders of the atrocities by setting up the International Criminal Tribunal for Rwanda, in parallel with the newly established one for the Balkans. In 1996, PHR mobilized a team of forensic scientists that exhumed the Kibuye grave, the single largest grave ever unearthed and analyzed for evidentiary purposes. The grave, located near the Catholic Church in the town of Kibuye, contained almost 500 bodies, including children with machete cuts through their skulls and women with babies still strapped to their backs. Among the recovered clothing were the priest’s vestments. Public prosecutions of the lead perpetrators, we believed, would set a modern precedent and deter future crimes. At a minimum, it would deliver justice, a dignified reburial for some victims, and acknowledgment of the facts to the survivors. 

What we can admit, reluctantly, is that while Rwanda commemorates its genocide, Darfur burns and Syria continues to implode. There is no response in sight to the pleas of our Syrian medical colleagues to stop the onslaught of President Assad’s forces, who have destroyed hospitals, killed doctors and patients, tortured prisoners, and raped and plundered, while bombing indiscriminately. Genocide remains unaddressed and unpunished in Sudan, as the indicted but undeterred President Omar al Bashir remains free and continues to control the airpower over Darfur and countenances the brutal Janjaweed militias. The world’s conscience on Darfur, Eric Reeves, recently recited a litany of indiscriminate attacks against Darfuri villages in his regular update. While tens of thousands of young activists have moved on from failure to possible apathy, Reeves still calls on President Obama to fulfill his campaign promise:

“When you see a genocide in Rwanda, Bosnia, or in Darfur, that is a stain on all of us, a stain on our souls. …We can’t say ‘never again’ and then allow it to happen again, and as a president of the United States, I don’t intend to abandon people or turn a blind eye to slaughter.”

Indiscriminate killing and destruction of Darfuri villages is still happening, and the U.S. policy is to continue to support Sudan’s genocidal regime while the world remains largely silent. In Rwanda, the Kagame government’s well-documented complicity in the slaughter of more than 100,000 Hutu men, women, and children in eastern Democratic Republic of the Congo following the grim events of 1994 remains unprosecuted, and the killing in Syria continues unabated while the news blasts into our car radios every day.

In this letter, 30 medical and public health experts express concern over the government of Burma’s refusal to allow Médecins Sans Frontières (MSF) to conduct humanitarian operations in Rakhine State. The signatories urgently call on President Thein Sein to reverse the order expelling the organization from the region, as he did for other parts of the country. The letter reiterates that the removal of MSF from the health infrastructure in Rakhine State is an inexcusable act that will have devastating consequences, particularly for the Rohingya community, which is especially reliant on the health services provided by MSF.

The full letter can be found here.

Physicians for Human Rights (PHR) and seven other organizations sent a letter to President Obama, calling on the White House staff to lead in declassifying the Senate Select Committee on Intelligence (SSCI) report on the CIA’s detention and interrogation program. The letter emphasizes that the United States must reckon with the past in order to prevent torture in the future, and releasing the committee’s report is a foundational step in that process. The full letter can be found here.

Kenyans are currently awaiting a decision by the International Criminal Court (ICC) on whether or not the trial in The Hague against President Uhuru Kenyatta will proceed. The Kenyatta case has garnered significant attention because the defendant is a sitting head of state. However, the case is also noteworthy because it represents the only major effort to investigate and initiate prosecution of sexual violence committed against women, men, and children during Kenya’s 2007–2008 post-election violence (PEV).

While the ICC’s case against President Kenyatta has received much attention, many Kenyans will be focusing on remarkable public interest litigation unfolding in their own High Court in Nairobi next week. Despite enormous risk, eight courageous survivors broke their silence and demanded action from the government of Kenya, filing a petition in February 2013 against the attorney general, the director of public prosecutions, and members of the police and public health authorities. In addition to the eight survivors (six women and two men) who suffered sexual violence during this period, the petitioners include Physicians for Human Rights, Coalition on Violence Against Women (COVAW), the International Commission of Jurists (ICJ-Kenya), and Independent Medical-Legal Unit (IMLU).

The petition demands that it is the government’s responsibility to protect civilians against sexual violence and ensure credible police investigations and prosecutions of these crimes. The petition is premised on the notion that the primary responsibility to protect citizens and provide redress when rights are violated lies with each sovereign state. In this instance, the government of Kenya bears legal responsibility entrenched in the county’s constitution and international and regional human rights treaties adopted by Kenya to enact and enforce laws, establish effective complaint mechanisms, and support competent tribunals that prohibit and sanction sexual violence. Further, the government is obligated to promptly and impartially investigate, prosecute, and punish alleged perpetrators of sexual violence, and provide adequate compensation to victims of these crimes. Moreover, whenever such violence occurs, the government must ensure that survivors have adequate access to medical services and psychological care.

After a year of postponements and deferrals, a hearing of the petition is finally scheduled to take place in the High Court of Kenya on Tuesday, March 25, 2014, during which the eight survivors will assert their rights and have an opportunity to hold the government to account. Their testimonies will reveal that the government failed not only to train and prepare law enforcement officials to protect civilians from sexual violence, but also denied survivors emergency medical services following the violations. Furthermore, even as the director of public prosecutions insists that there is no evidence to prosecute PEV cases, the survivors will demonstrate that the police refused to document their claims and that the government’s continued inaction represents persistent and willful neglect to codify effective measures to investigate and prosecute the perpetrators. The survivors will also argue that the government has failed to provide comprehensive reparations.

The eight petitioners, of course, are not the only survivors of the widespread and brutal acts of sexual violence perpetrated during the PEV. They are representative of more than 900 other victims, whose testimonies and reports were submitted to the Commission of Inquiry into the Post-Election Violence (CIPEV) in 2008, detailing gruesome incidents of individual and gang rape, defilement, forced circumcision, sodomy, and other forms of sexual brutality. These violations resulted in severe physical injuries and detrimental psychological and socio-economic effects, among other serious health complications, that many survivors have borne over the last six years. As both international legal principles and Kenya’s constitution mandate, the state has the responsibility to comprehensively punish the perpetrators of these violations and provide redress to survivors. This case provides the government of Kenya with the chance to finally articulate its political will and commitment to meaningfully addressing PEV crimes and combatting sexual violence, particularly against vulnerable groups such as women and children who are consistently disproportionately affected by this vice. Let’s hope the government of Kenya does not miss this historic opportunity.

The recognition of sexual violence as an international crime at the International Criminal Court (ICC) is a major step forward. The Prosecutor v. Germain Katanga case is the first at the ICC to charge a defendant with crimes of sexual violence and represents a crucial milestone for the ICC and for victims of sexual violence. The Katanga verdict, to be delivered on March 7, 2014, will be the third judgment in the ICC’s 12-year history, and its legal significance cannot be overstated.

Germain Katanga, the alleged former commander of the Force de résistance patriotique en Ituri (FRPI), is accused of perpetrating war crimes and crimes against humanity on February 24, 2003 in Bogoro, a village in the northeastern Ituri Province of the Democratic Republic of the Congo (DRC). Grave human rights violations were purportedly perpetrated in Bogoro, where 200 civilians were murdered in a matter of hours, women and girls raped and sexually enslaved, and the village pillaged.

After the ICC issued an arrest warrant for Katanga, Congolese authorities surrendered him to the ICC, and he was transferred to The Hague in October 2007. He was charged with seven counts of war crimes and three counts of crimes against humanity, including gender-based crimes of sexual slavery and rape. Similarly, Mathieu Ngudjolo Chui – alleged former leader of the Front des nationalistes et intégrationnistes (FNI), another militia accused of committing atrocities in Bogoro – was arrested, transferred to the ICC in February 2008, and charged with the same set of crimes as Katanga. The ICC combined the Katanga and Ngudjolo cases in March 2008 as the two defendants were on trial for the same crimes.

In November 2012, six months after closing arguments, the ICC severed the Katanga and Ngudjolo cases, citing a re-characterization of the facts in the case against Katanga. A month later, the ICC acquitted Ngudjolo of all charges, citing insufficient and unreliable evidence. This poses a significant concern for the upcoming March 7 Katanga verdict as the case against Katanga relies upon the same evidence.

The Ngudjolo acquittal highlights the importance of forensic medical evidence to substantiate the commission of sexual violence crimes. Given the scarcity of forensic medical evidence, the prosecution’s case relied primarily on oral testimony of witnesses and written reports by UN agencies, independent NGOs, and third-party states. The judges noted that one witness’s testimony was “too vague” and found another’s “contradictory.” Sexual violence survivors need medical evidence to bolster their claims, and Physicians for Human Rights (PHR) is leading efforts to train doctors, police officials, lawyers, and judges on collecting, documenting, and preserving forensic medical evidence for future prosecutions. By enhancing basic evidence collection and documentation, PHR aims to ensure that sexual violence survivors will have the evidence they need to end impunity against their perpetrators and attain justice.

Despite the lack of forensic medical evidence in the Katanga case, it offers important legal contributions to survivors of sexual violence. The inclusion of charges of sexual and gender-based crimes in a case adjudicated by a prominent international legal body validates the harm caused by sexual violence and helps survivors achieve justice by ending impunity for these crimes. The Katanga case has given sexual violence victims the chance to tell their story, be legally represented, and qualify for reparations.

Even if the March 7 judgment does not render a guilty verdict for Katanga, the case already has moved the jurisprudence of sexual and gender-based crimes forward. Both the Katanga and Ngudjolo cases illustrate how the collection, documentation, and preservation of forensic medical evidence are essential to ensuring that future prosecutions of international crimes result in guilty verdicts and justice for survivors.

While the news that Médecins Sans Frontieres (MSF) will be allowed to continue their work in most of Burma is certainly welcome, the decision by the Burmese government to shut down MSF’s operations in Rakhine state continues a trend of denying rights to the Muslim population who lives there. The lack of medical care puts lives at risk, but the international community and media continue to focus primarily on the potential market that is Burma.

Many communities in Burma remain under siege. Ethnic and religious minorities continue to live in fear and are suffering the consequences of forced displacement. The government of Burma, in an apparent pique over MSF disclosing that it had treated 22 patients who had suffered ”violence-related injuries” in an area where the government claimed only one police officer had died, made the short-sighted and ill-advised decision to shut down MSF’s operations.

The government has an obligation to ensure the right to health for all of its people. If it is unable to do so – whether because it lacks the resources or because of conflict – it must seek international assistance to meet that obligation. MSF has a long history of working in Burma and has focused on serving populations within the country that otherwise would not be able to access health care. This includes approximately 30,000 people living with HIV/AIDS, several thousand living with TB, and members of marginalized groups such as the Rohingya.

However, this is not the first time MSF has had to close down one of its operations in Burma. The organization was forced to close its malaria control program in Karen state because the government implemented restrictions that made it impossible for MSF to work properly.

Ongoing conflict, forced displacement, and poverty have all had an impact on the general health of people living in certain parts of Burma. MSF’s work has been lifesaving. The government, in shutting down the clinics where MSF provided much-needed services, is playing roulette with the lives of individuals and with the health of the general population. Not even the former military Juntas shut down operations of international organizations in Rakhine state, despite their clear dislike of the presence of outsiders in the region.

Depriving people of essential medicines such as anti-retrovirals and antibiotics for tuberculosis not only places individual patients at risk of illness and death, but may contribute to the emergence of strains of HIV or TB that are resistant to the medicines – placing a much larger group of people at risk.

Since anti-Muslim violence hit Rakhine state in 2012, there has been great risk to lives of civilians there. The local police supported Buddhist mobs and military units mostly did not intervene to stop the violence. Rohingya in Rakhine state have very little protection. The loss of an international presence greatly increases their risk of suffering more human rights abuses.

The health and human rights conditions of Rohingya in Rakhine state are unacceptable and the recent actions of the Burmese government indicate that they will get much worse.

The government of Burma should re-think its decision regarding MSF operations in the country, and must heed the calls for an independent investigation of the massacre that initiated this incident. Moreover, the international community should recognize that the health crisis in Rakhine state has politics at its root and that the lives of 135,000 internally displaced Rohingya, in addition to several hundred thousand Rohingya in the region, are at great risk if the international community fails to take this grave situation seriously.

This post originally appeared on Syria Deeply.

Physicians across the world share deeply held convictions and characteristics. We believe in the value of hard work and discipline, are devoted to our patients, respect scientific rigor, and are committed to continuous learning. Our dedication to our calling and our sense of collegiality with other doctors cuts across culture, ethnicity, religion, and politics. We teach each other, we consult with one another, and we innovate together.

We imagine that the elements present in our own work circumstances are similar to those of most physicians across the world: autonomy, respect, financial security, and personal safety, as well as intellectual and professional challenges. However, at a recent Physicians for Human Rights (PHR) training for Syrian doctors on the documentation of torture, my eyes were opened to levels of courage and commitment I have never experienced in my 30 years of practice and international work. I had to come to grips with my own ignorance and shame as I saw the challenges faced by our brother and sister physicians in Syria and by those who are refugees in neighboring countries.

Their daily efforts to care for their patients far exceeded my wildest imagination. Many of us have worked in other countries for weeks at a time in less than optimal settings: without electricity or water, without PowerPoint or books, without MRIs or cotton swabs, dealing with patients who lack insurance or any money to pay for care. I have worked in a number of locations with limited public health resources and challenging settings for health professionals, including Sierra Leone, Haiti, and the Democratic Republic of the Congo. Yet, rarely have we seen physicians directly targeted for providing medical care, as we now witness in Syria. Doctors and other health professionals in Syria are regularly targeted and harassed, and hospitals and other medical facilities are shelled. Denying medical access has become a dangerous tactic of war, with brutal public health consequences for entire communities.

Only the bravest among us risk imprisonment in order to care for our people. Only the bravest of us put our own lives and those of our families at risk on a daily basis because we are committed to serving all patients, regardless of religious or political affiliation. Only the bravest travel daily across borders and through checkpoints to provide care, receive training, or reunite with families after weeks of working 24/7 in dangerous environments.

Syrian doctors are building and staffing field hospitals, which are regularly the only option for providing care. Health professionals are miraculously performing amputations, complicated abdominal surgeries, and removing shrapnel with limited supplies. They have been forced to work through the sights and sounds of barrel bombs and rockets directed at their clinics and hospitals, never knowing if they will live through the day.

They refuse to leave their posts, despite the personal costs: insomnia, nightmares, flashbacks about legs and arms in operating room buckets, children with abdomens torn open from gunfire, family distress, and intense sadness. They admit to feeling numbness, anger, irritability, rage, hopelessness, pain, and grief. The physicians working in Syria describe terror and darkness in their hearts, as they receive constant streams of injured and tortured patients daily. The physicians living as refugees in neighboring countries describe feelings of guilt and regret that they cannot go back to serve their people directly. They cannot practice legally in their country of refuge, leaving them unable to generate income or support their families. Several of these amazing doctors, pharmacists, and lawyers are returning to Syria because this is the only way of being with their families and assuring themselves that they are doing all they can to support their people.

When the doctors arrived at the recent PHR training, we saw vacant faces and hearts full of grief, but this wariness began to fade as the training week progressed. Laughter crept into conversations, stories and photographs of death were brought up less, and breathing became slower and deeper. One memorable night even included singing and dancing. Our training allowed these physicians to not only build on their medical skills, but also provided them with a forum to meet with colleagues who have endured similar hardships. And while divided in many ways by tragedy, we all came together as one, committed to supporting one another as we look towards a post-conflict Syria.