health

lacksThe Nuremberg Code made them do it. Or not do it, to be precise.

“They” were “three young Jewish doctors” who refused a superior’s instructions that, in the name of medical research, they should inject unknowing patients with cancer cells. As stated in The Immortal Life of Henrietta Lacks, the 2010 bestseller by Rebecca Skloot:

‘All three knew about the research Nazis had done on Jewish prisoners. They also knew about the famous Nuremberg Trials.’

Skloot proceeds with a brief account of one of the 12 Nuremberg Military Tribunal trials that followed the Trial of the Major War Criminals. In the Doctors Trial,  23 physicians – among them 1 woman – were prosecuted for conducting medical experiments on camp inmates without their consent. The tribunal’s judgment set forth a list of 10 principles that became known as the Nuremberg Code. First and foremost:

‘1. The voluntary consent of the human subject is absolutely essential.’

Although it appeared in a judgment in 1947, issued by a panel of American judges sitting in Nuremberg, as late as 1951, that injunction had not penetrated the medical establishment Stateside. That is the year that physicians in Baltimore took cells from Lacks, a 31-year-old woman who soon would die from cervical cancer. Those tissues, and others taken in the course of her autopsy, gave birth to a cell line that lives to this day – cells numbering in the billions, used for decades, worldwide, to aid research on a host of diseases and genetic disorders. Lacks’ contribution to science is inestimable. But as Skloot relates in her book, which I’ve just finished reading, it took place without full and informed consent of Lacks or her family.

Indeed, it appears the informed consent norm articulated at Nuremberg was not firm even as late as 1963. That’s when those 3 doctors mentioned at top wouldn’t go forward with the ordered injections. Their refusal began a painful but necessary process of informing the family, by then impoverished in both material and emotional sense of the word. It is heartening to learn that the work of international criminal lawyers gave rise to a norm that led to this revelation of the truth – and, one hopes, to more patient-respectful procedures in our own time.

ibc_chad_7093-1Looking forward to this week’s exploration of issues related to children in and affected by armed conflict – the subject on which I have the honored of serving as a Special Adviser to Fatou Bensouda, the Prosecutor of the International Criminal Court. (My prior posts on this issue here.)

The occasion is a 2-day event entitled “Children and Armed Conflict: Strengthening Implementation of the UN’s Children and Armed Conflict Agenda,” cosponsored by the Liechtenstein Institute on Self-Determination at New Jersey’s Princeton University and by the New York-based nongovernmental organization Watchlist on Children & Armed Conflict.

The program begins at 3:30 p.m. Thursday, December 12, 2013, with a public, plenary session – a panel discussion on “UN Efforts to End Grave Violations against Children in Conflict Situations.” Speaking will be:

► Ambassador Sylvie Lucas, Permanent Representative of Luxembourg to the United Nations and Chair of the Security Council Working Group for Children and Armed Conflict.

► Under Secretary-General Leila Zerrougui, Special Representative of the U.N. Secretary-General for Children and Armed Conflict.

► Ambassador Jean-Marc de la Sablière, formerly the Permanent Representative of France to the United Nations.  The first Chair of the Security Council Working Group for Children and Armed Conflict, de la Sablière is the author of a pivotal report on this subject.

Jo Becker, Advocacy Director of the Children’s Rights Division of Human Rights Watch.

Then on Friday,  December 13, will be a closed workshop, at which representatives of states and intergovernmental and nongovernmental organizations (as well as academics like myself) will examine the issue of children and armed conflict. Particular emphasis will be placed on the monitoring and reporting process launched U.N. Security Council Resolution 1612 (2005) and succeeding resolutions, overseen by the Special Representative Zerrougui, and watchdogged by NGOs.

At the core of the U.N. process are efforts to combat the 6 Grave Violations, a half-dozen offenses against children deemed especially reprehensible. Commission of these offenses, by state and nonstate actors alike, may result in action within the U.N. framework. The 6 are: killing or maiming of children; recruitment or use of children as soldiers; sexual violence against children; attacks against schools or hospitals; denial of humanitarian access for children; and abduction of children. (credit for AP photo)

unesco‘And so UNESCO is in the midst of a budget crisis, and the USA is poised to lose a great deal of influence over an organization that runs Tsunami warning systems, teaches literacy to the same Afghan police officers that are being trained by American soldiers, runs education programs for girls around the world, and has conferred “World Heritage” status on 22 American monuments and sites.’

– Mark Leon Goldberg, in a UN Dispatch post on events earlier today in Paris: having refused to pay its dues since UNESCO admitted Palestine as a member state in 2011, the United States lost its voting rights in that body, formally known as the United Nations Economic Social and Cultural Organization. (credit for (c) UNESCO photo of Afghan schoolchildren)

Goldberg decried the federal  legislation that required the United States to become a UNESCO deadbeat. (See § 414(a) here and § 410 here.) And he worried what could happen, to the United States and to U.N. agencies with “more obvious connections to American security” (he named the International Atomic Energy Agency, the World Health Organization, and the Organization for the Prohibition of Chemical Weapons), if such agencies likewise were to admit Palestine to membership.

unamaThe cover photo of a new U.N. report speaks a thousand words: more and more, the protracted conflict in Afghanistan is claiming children as its victims. A reader hears these running children’s screams viscerally – much as she felt viscerally the life of a photographed 8-year-old child soldier in Syria.

Sadly, this visceral impression is confirmed by the text of the 94-page Mid-Year Report on the Protection of Civilians in Armed Conflict, issued yesterday by UNAMA, the U.N. Assistance Mission in Afghanistan. The report begins with a boy’s account of his mother’s killing in a Kabul suicide attack, then sets out grim statistics:

‘Escalating deaths and injuries to Afghan children, women and men led to a 23 percent resurgence in civilian casualties in the first six months of 2013 compared to the same period in 2012. UNAMA documented 1,319 civilian deaths and 2,533 injuries (3,852 casualties) from January to June 2013 ….’

This growth, the report continued,

‘reverses the decline recorded in 2012, and marks a return to the high numbers of civilian deaths and injuries documented in 2011.’

Increasingly, killings caused by improvised explosive devices and gunfights affect children (up 30%) and women (up 61%). The UNAMA report stated that international forces’ handover of security responsibility to national forces had “met with increased attacks by Anti-Government Elements” –  elements to whom 3/4 of the deaths were attributed.

Other documented offenses against children included:

► Attacks on education; that is, attacks on students and their teachers, destruction or occupation for military use of school buildings

► Recruitment and use of children into the government’s armed forces and into armed anti-government groups

► Attacks on hospitals, other health-care facilities, and medical personnel

► Displacement, within or without the country

Recommended to stem this tide? Compliance by all parties with the law, including international humanitarian and human rights treaties aimed at protecting children. A simple answer, difficult to implement.