Education and debate

New challenges for humanitarian protection

Claude Bruderlein, Jennifer Leaning

Harvard Center for The fourth Geneva Convention, adopted 50 years ago,
Population and
Development
on 12 August 1949, describes the actions that warring Summary points
Studies, Cambridge, parties must take to protect civilian populations from
MA 02138, USA the worst excesses of war. Building on the concept
Claude Bruderlein Under the fourth Geneva Convention of 1949
developed in the previous three conventions—that cer-
research fellow and protection of civilians in war is accomplished by
special adviser to UN tain activities and people, especially civilians, can be
distinguishing civilian from military targets, on
Office for the seen as hors de combat—the fourth Geneva Conven-
Coordination of the assumption that the military interest is best
Humanitarian Affairs
tion defines in detail the many ways in which civilians
served by attacking only military opponents
Jennifer Leaning must be dealt with to shield them from the direct and
senior research fellow indirect effects of conflict between combatant forces. This assumption breaks down in today’s wars,
Correspondence to: Among the responsibilities that this convention sets for where irregular armies deliberately target civilians
C Bruderlein the warring parties are explicit actions that would
cbruderl@hsph.
harvard.edu
grant medical personnel, and all aspects of the medical Various strategies are being pursued to
enterprise, complete protection from interference or re-establish civilian protection and provide
BMJ 1999;319:430–5 harm. This neutral status for medical relief (and, by neutral space where medical and aid workers can
extension, all humanitarian aid) rests on the reciprocal deliver relief
assumption that those who deliver this relief are prac-
tising in accord with their professional ethics and will Physicians should participate with potential
take specified steps to maintain their neutral posture actors in developing and implementing these
vis à vis the warring parties. strategies
The moral impetus for this addition to the Geneva
Conventions derived from international reaction to the
great civilian death toll of the second world war. In vir-
tually all wars of the subsequent 50 years the fourth ian targets would provide little military advantage; and
Geneva Convention has been variously observed and that, quite apart from their legal or moral obligations,
routinely violated—and there has been no calling to parties to a conflict would thus seek to optimise their
account. Moreover, and this is what prompts new resources by targeting military assets. Therefore the
attention to the issue of humanitarian protection in most effective approach to protect civilians in
war, in recent wars the warring parties have shown an international legal treaties on the conduct of war would
increasing tendency to flout the fourth convention be to build on this assumed basic military preference
entirely. The problem is no longer a failure to abide by and promote the concept of civilian distinctiveness.
the rules but a failure to acknowledge that the rules This approach has inspired the development of
even exist.1 international humanitarian law since its inception.
This failure is particularly relevant for the medical A corollary of this approach is to designate the
community. Without the guarantees of protection armed forces of the warring parties as the principal
defined in the fourth convention, civilians can be implementing agents of the protection. International
slaughtered with impunity and physicians and other humanitarian law states that those who seek to be pro-
relief workers swept up in the ensuing carnage. Once tected cannot engage in any hostile activities without
the notion of civilian protection is abandoned, the ter- losing their protected status. If the armies confirm that
rain of war is changed utterly. At the very moment we the civilians are abiding by these constraints then the
celebrate the 50th anniversary of the Geneva Conven- armies are obliged to ensure that the civilians are
tions, we find that effective respect for humanitarian indeed protected. An essential element of this legal
protection has reached its nadir. regime therefore is the commitment of the parties to
the conflict to abide by the rules.
Traditional approach to humanitarian
protection Intensified threats to protection of
The traditional legal effort to protect civilians in war
civilians
has long centred on distinguishing between civilian The traditional approach taken by international
persons or objects and military targets. This approach humanitarian law thus rests on a particular and
was based on two key assumptions: that attacking civil- rational view of military interests and behaviour.

430 BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com

 Education and debate

However, military strategies from the second world war

onwards have departed significantly from this classic
perception of the non-military worth of civilian assets.
The bombardments of London, Rotterdam, Dresden,
Hamburg, Hiroshima, and Nagasaki in the second
world war were only the precursors of military tactics
aimed at obtaining significant military advantage from
the destruction, terror, flight, and chaos caused by
attacks on civilians. In the 54 years since 1945, civilians
have constituted the overwhelming majority of war
casualties.2 What has evolved now, with the waning of
the cold war, is a pattern of deliberate war against civil-
ians, waged by relatively untrained forces wielding rela-
tively light arms.3 Civilian populations have come to
acquire a strategic importance, including:

BARNABY’S PICTURE LIBRARY

x As a cover for the operations of rebel movements
x As a target of reprisals
x As a shield against air or artillery attacks
x As a lever for exerting pressure on the adverse
party, by terrorising and displacing populations, or
Dresden in 1944—obtaining military advantage through attacking civilians
even
x As a principal target of ethnic cleansing operations
and genocide. Possible new strategies
In internal conflicts civilian populations are caught The international community has thus been compelled
in the crossfire between insurgents and state forces and to reconsider its approach towards protecting civilians.
bear most of the casualties. In extreme situations When states or parties to conflicts are unable or
(Rwanda 1994; Bosnia-Herzegovina 1992-4; and unwilling to protect civilians during armed conflict, the
Kosovo 1998-9) entire segments of the civilian popula- international community must develop specific mecha-
tion have been perceived as a primary military target. nisms to ensure that protection. To that end, new
Civilian deaths in just these three wars amount to over strategies are being developed to expand the concept
1 million people—far greater than the estimated of humanitarian protection and to consider new
military casualties. alliances with other potential enforcement agents,
Death is not the only outcome of a war strategy that including the United Nations Security Council and
targets civilians. In the past decade armed conflict has regional organisations and their military outfits.
turned over 40 million people into refugees or Accordingly, human rights and humanitarian
internally displaced people. The consequences of such organisations are pursuing three distinct strategies to
displacement are severe and include: bolster the protection given to civilians: reasserting the
x Breakdown of the social fabric and disintegration of role and validity of international humanitarian law, and
communities developing new judicial implementation mechanisms;
x Production of chaotic situations, where the mixture expanding the scope of humanitarian protection; and
of civilians and combatants puts civilians at risk and diversifying the implementation strategies of humani-
endangers medical and humanitarian relief workers tarian protection, involving the use of various
x Disruption of family groupings, exposing women diplomatic and coercive measures, including the use of
and girls to sexual violence, prostitution, and sex force under chapter VII of the UN Charter.
trafficking
Reasserting the role of international humanitarian
x Forced military recruitment of children, sending
law
those as young as 7 years old into battle.
The first strategy has been to recall the objectives of
In addition, warring factions have increasingly
international humanitarian law and promote further
denied civilian populations access to humanitarian
efforts nationally and internationally for enforcing
relief. They defend their actions by appealing to the
these rules. International humanitarian law is seen as
principle of national sovereignty. Within their national
essential in determining the illegal character of
boundaries these warring parties block relief convoys, violence perpetrated against civilians in war. It should
obstruct ambulances, invade hospitals, destroy clinics, therefore be at the centre of any strategy to protect
and harass and terrorise national and international them and to restore the integrity of international law.
medical and other humanitarian relief workers.4–8 In The proponents of this approach, particularly the
these circumstances the assumption in international International Committee of the Red Cross, acknowl-
humanitarian law that civilians would be protected edge that war has changed and that civilians have
simply by establishing their distinct non-military char- increasingly become the objects of attacks. In their
acter seems outdistanced by recent changes in warfare view, however, violations of law do not necessarily
and thus fundamentally flawed. In the absence of alter- signify its obsolescence. On the contrary, international
native credible and effective enforcement mechanisms, humanitarian law remains highly relevant in contem-
it would seem that the international community can porary conflicts (such as instances of ethnic cleansing
offer little help to civilian populations targeted in and failed states) and serves to mobilise considerable
today’s wars. efforts to further its application.

BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com 431

Education and debate

The key focus of these efforts has been to effort is now underway among several such organisa-
strengthen international judicial institutions. The tions to provide documentary and forensic evidence to
culture of impunity that shelters individuals responsible the international criminal tribunals of Yugoslavia and
for violent assaults against civilians is one of the biggest Rwanda.
obstacles to protecting civilians in most conflicts. The Relief organisations, under increasing public
unwillingness or inability of states to bring these people scrutiny and subject to ever more frequent danger in
to justice undermines the effectiveness of the entire the field, have also realised that they must educate their
legal framework. An international remedy for such situ- staff in the principles of human rights and inter-
ations has been identified in the establishment of an national humanitarian law.16 Their staff will thus oper-
International Criminal Court and the creation of the ate within internationally respected norms and know
two ad hoc tribunals for the former Yugoslavia and for what should be expected from warring parties and the
Rwanda by the UN Security Council. international community in terms of humanitarian
protection.
Action from professional groups
Professional groups, including lawyers, doctors, and Expanding the scope of humanitarian protection
journalists, have also played a part in reinforcing The need to expand the scope of humanitarian
traditional mechanisms of protection by recalling the protection arises directly from the changing nature of
legal obligations of parties to armed conflicts under war. Were civilians not terrorised into fleeing from
humanitarian law. The successes of “sans-frontières” their homes, issues relating to internally displaced
non-governmental organisations, such as Medecins people would be less acute. Were regular forces fight-
Sans Frontières, International Commission of Jurists, ing according to standard rules of weaponry, the pro-
or Reporter Sans Frontières, is a demonstration of this liferation of unmarked antipersonnel landmines
mobilisation of professionals. The medical and public would be less of a problem. Were children not being
health communities, through international societies, forcibly inducted into irregular armies and then
human rights groups, or relief agencies, played a forced to commit unspeakably brutal acts, the
pioneering role here, taking a strong interest in minimum age and its enforcement would not attract
upholding established international principles of such attention.
human rights in relation to medical ethics and The increasing involvement, over the past decades,
international humanitarian law and in documenting of UN agencies and non-governmental organisations
violations. Beginning with the founding of the World in humanitarian operations has increased the number
Medical Association in 1947, the world’s national of humanitarian actors in conflict situations.17 This in
medical societies have tried to uphold professional turn has affected the perceived scope of humanitarian
norms in the face of potential or actual confrontation protection from one that is basically driven by
with developments in peace and war. An early leader international humanitarian law to one that is driven by
was the British Medical Association, which in the 1980s the many needs of specific groups of victims in specific
spurred organised medicine to combat the participa- circumstances. Children need caring adults; terrified
tion of physicians in torture.9 10 refugees need to be able to feel safe; people from
Physician based human rights organisations have diverse cultures seek respectful space for religious
sought to provide governments and judicial bodies practice; women in camps should not be forced into
with evidence of major violations of the Geneva prostitution.
Conventions during conflict or civil war in the West The humanitarian community has sought legal
Bank and Gaza in 1988-90,11 Somalia in 1992,12 confirmation of this needs based expansion by
Bosnia-Herzegovinia in 1992-5,13 Rwanda-Eastern referring to several key human rights documents that
Congo in 1994-7,14 and Kosovo in 1998-9.15 A major it regards as relevant in conflict settings. These include
the 1951 Convention Relating to the Status of
Refugees, the 1979 Convention on the Elimination of
all Forms of Discrimination against Women, the 1984
Convention against Torture, and the 1989 Convention
on the Rights of the Child. The insistence that key
provisions of these documents do, indeed, apply in a
state of conflict18 has produced a growing recognition
that just because people are trapped in war, they do
not in any moral sense, and thus should not legally,
lose the protection that they could claim if they were
living in a country at peace. International humanitar-
ian law remains the primary legal reference in
conflicts. Nevertheless, these developments in
humanitarian practice and policy, and the new guide-
MARTIN ADLER/PANOS PICTURES

lines on internally displaced peoples (which combine

elements of human rights law with international
humanitarian law) show an encouraging convergence
between these two basic ways of defining protections
for civilians in war.
The concept of humanitarian protection is also
Boy soldiers training as guerillas in El Salvador—worldwide an estimated 300 000 child being extended in terms of time frame. International
soldiers are involved in armed conflicts humanitarian law traditionally applies during the

432 BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com

 Education and debate

actual conduct of hostilities. From a public health and

human rights perspective, however, the phases that
lead up to a conflict and the extended reconstruction
period afterwards are of equal concern. Issues such as
the repatriation of refugees19 or the status of vulnerable
groups, such as women and girls in Afghanistan,20
become central concerns of those engaged in humani-
tarian and human rights action in war.
This expansion arises out of a decade of work in
which these humanitarian concerns were slowly
shaped by bitter experience. The humanitarian
community has provided the data that has forced the
international legal and political community to develop
an expanded scope of protection. As early witnesses to
and occasional victims of child soldiers, as surgeons in

UNITED NATIONS
field hospitals overwhelmed by landmine injuries, or as
the only source of help in a region suddenly flooded by
internally displaced people, medical relief workers had
Candles and wreaths mark the site in Ovcara, Croatia, to honour the 200 civilians who were
first to act without the benefit of guidelines and were massacred in 1994
then compelled to become more systematic. Internal
critiques and published reviews of this experience21
have accelerated our understanding of the complexity and protection during displacement, and the right to a
of the issues facing those who try to provide relief secure return and reintegration.
when established norms of protection are violated and Finally, the use of children in armed conflicts has
when new forms of attacks on civilians take place in the been another dramatic feature of post cold war hostil-
absence of consensus on what the international ities. An estimated 300 000 child soldiers are actively
community should do next. involved in armed conflicts around the world.24
According to both international human rights and
International initiatives humanitarian law, the current minimum age for
To establish this expanded scope of humanitarian pro- participation in armed conflict is 15 years. Although
tection in the legal and operational sphere is a the recruitment of children as young as 7 already falls
complex challenge. Three recent initiatives, under- far below this international standard, Unicef and other
taken at international legal levels and pursued by many humanitarian organisations have tried to raise
humanitarian and human rights organisations, have awareness and affect realities on the ground by crafting
focused on protecting civilians against the use of anti- the Optional Protocol to the Convention of the Rights
personnel landmines, protecting internally displaced of the Child. This sets a minimum age of 18 years. This
persons, and prohibiting the military recruitment of campaign has also highlighted the many difficulties
children. presented by child soldiers: demobilisation, re-entry
The 1997 Ottawa Landmines Treaty (entered in into society, and education.
force in March 1999) bans the use, production,
stockpiling, and transfer of antipersonnel landmines. Diversifying implementation strategies of
Groups such as the International Campaign to Ban humanitarian protection
Landmines (comprising many humanitarian and The expansion of the concept of humanitarian protec-
human rights groups) were critical in mobilising states. tion has resulted in a more sophisticated understand-
This grass roots coalition, and others associated with it, ing of the rights of civilians in times of war. Such
has now embarked on monitoring compliance with the protection still relies primarily, however, on the ability
treaty and running local landmine awareness cam- and willingness of implementing agents (states, the UN
paigns throughout the world. Security Council, and regional organisations such as
The forced displacement of people within the bor- NATO) to enforce this protection. When warring
ders of their own countries by armed conflicts has parties fail to abide by the rules of international
become a central feature of the post cold war era. In its humanitarian law, it falls to the international
classic form international humanitarian law does not community to enforce them.
protect internally displaced people since they remain The practical importance of this responsibility
primarily under the protection of their own state. Yet remains unclear. Proponents of more assertive
some of the worst assaults on civilians in war have regimes of civilian protection believe that new political
taken place against internally displaced people and security strategies are required, to provide more
(Srebrenica),22 and some of the more intractable tactical options along a continuum within the current
humanitarian dilemmas relate to supporting those legal framework of the UN Charter’s chapter VI (entry
forced to survive away from home but within the bor- with the permission of the sovereign state) and chap-
ders of their state (Sudan).23 As a result the United ter VII (“non-permissive” entry). Such protection
Nations presented “Guiding Principles for the Protec- strategies need to involve political and military actors,
tion of Internally Displaced Persons” to the Commis- such as the UN Security Council, regional organisa-
sion on Human Rights in 1998. These combine tions, and specialised agencies (such as the UN
elements of humanitarian law and human rights law, Department of Peacekeeping Operations) and would
which recognise, among other rights, a right not to be constitute the next generation of international
unlawfully displaced, the right of access to assistance security response to humanitarian crises. The current

BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com 433

Education and debate

rationale for international political and military inter- to which regional organisation, when, and on what
vention is based on threats to international peace and grounds, can be permitted to intervene?
security; in the next generation this would also include
threats to civilian protection.
A role for the humanitarian community
Throughout this decade we have been in the midst
Yet many humanitarian organisations, including many
of that transition. In the former Yugoslavia and
engaged in medical relief, have already begun to accu-
Rwanda, the international security regime failed to act
mulate experience in humanitarian interventions that
decisively to end wars that caused great civilian suffer-
involve a mixture of players—civilian, security, and mili-
ing. Humanitarian and human rights organisations
tary.29 The future success of these strategies of humani-
decried the role that international relief organisations
tarian intervention will depend to a large extent on the
were forced to play, filling a power vacuum, assuaging
ability of humanitarian organisations to engage the
the conscience of the international community.25 In
interest of political and security authorities in the task
northern Iraq, in Somalia, and again in Kosovo, various
of developing clear, adequate, and practical options for
sets of international political and military actors took
protecting civilians.30 It is also possible that, having
more aggressive action, in each case different, and in
participated in and witnessed a series of failures and
each case with mixed and disputed results. partial small gains, having played a bit part in a drama
determined by others, the humanitarian community
Discussion and force could in future decide to play a significant role in
As we continue through this transition the humanitar- mobilising political authorities around specific pre-
ian community, including those in medical relief ferred strategic options.31 It comes back to the aim of
organisations, must participate in the discussion and creating in times of war a distinct and neutral place for
develop strategies that would maximise the humanitar- civilians, where medical and relief workers can reach
ian resources available under a given set of political the population and build a system of adequate
and security constraints. In settings where the consent supports, sustainable for as long as is necessary. The
of warring parties can be obtained such options end is the same as that described in the fourth Geneva
include establishing humanitarian corridors, deliver- Convention of 1949, but the means no longer obtain.
ing targeted relief, planning the safe exit of a The world and its wars have changed, so other means
population from an emergency, and creating protected to secure that same high purpose have to be developed
areas. and deployed.
If the warring parties do not consent and civilians
continue to be at risk, the international community
must consider using force to uphold international Competing interests: None declared.
humanitarian law. The UN Security Council might
consider intervening under chapter VII to re-establish
1 Russbach R, Fink D. Humanitarian action in current armed conflicts:
the necessary conditions for providing humanitarian Opportunities and obstacles. Med Global Survival 1994;1:188-99.
assistance and protecting civilians. These conditions 2 Sivard RL. World military and social expenditures 1996. Washington, DC:
World Priorities, 1996.
might include creating and enforcing security corri- 3 Kaldor M, Vashee B, eds. Restructuring the global military sector. Vol 1. New
dors and areas, protecting humanitarian convoys, wars. London: Pinter, 1997.
4 Leaning J. When the system doesn’t work: Somalia 1992. In: Cahill KM,
disarming populations or groups, and deploying forces ed. A framework for survival: health, human rights, and humanitarian
to protect civilians. These measures might be assistance in conflicts and disasters. New York: Basic Books, Council on For-
eign Relations, 1993:103-20.
particularly relevant in situations that have generated, 5 Ramsbotham O, Woodhouse T. Humanitarian intervention in contemporary
as a consequence of grave violations of international conflict. Cambridge: Polity Press, 1996:167-92.
6 Jean F. The problems of medical relief in the Chechen war zone. Central
humanitarian law, major displacements of population Asian Survey 1996;15:255-8.
and widening social chaos, further contributing to 7 Hansen G. Aid in war-ravaged Chechnya: a severe test for humanitarians.
Christian Science Monitor 1997 Dec 31:19.
regional and international instability. As in Kosovo, the 8 Physicians for Human Rights. Medical group documents systematic and
use of force, in association with diplomatic negotiation, pervasive abuses by Serbs against Albanian Kosovar health professionals and
could help to restore a minimal political and security Albanian Kosovar patients. Boston: PHR, 1998. (Preliminary report
23 December.)
environment, thus permitting delivery of humanitarian 9 British Medical Association. Torture report. London: BMA, 1986.
assistance and restoration of minimum levels of civilian 10 British Medical Association. Medicine betrayed. London: Zed Books, 1992.
11 Geiger HJ, Leaning J, Shapiro LA, Simon B. The casualties of conflict: medi-
protection. cal care and human rights in the West Bank and Gaza Strip. Boston:
Whenever any of these strategies have been Physicians for Human Rights, 1988.
12 De Waal A, Leaning J. No mercy in Mogadishu: the human cost of the conflict
attempted during this decade, some humanitarian and the struggle for relief. Boston, New York: Physicians for Human Rights,
analysts and practitioners have raised concerns about Africa Watch, 1992.
13 Physicians for Human Rights. Medicine under siege in the former Yugoslavia
the mixture of humanitarian and political goals.26 27 1991-1995. Boston: PHR, 1996.
The use of force mandated by the Security Council or 14 Africa Rights. Genocide in Rwanda. London: Africa Rights, 1994.
15 Physicians for Human Rights. War crimes in Kosovo 1998-1999. Boston:
regional organisations entails political agendas that PHR, 1999.
may jeopardise the neutrality of protective humanitar- 16 Porter K. Human rights medicine. 1. An introduction. Student BMJ
1996;4:146-7.
ian arrangements.28 Furthermore, the use of force 17 US Mission to the UN. Global humanitarian emergencies, 1998. New York:
against warring parties may put civilians at even more United Nations, 1998.
18 O’Donnell D. Trends in the application of international humanitarian law
at risk, as their status and safety become central issues by United Nations human rights mechanisms. Int Rev Red Cross
in resolving the conflict. Finally, the extent to which UN 1998;324:481-503.
19 Boutroue J. Missed opportunities: the role of the international community in the
Security Council members consider internal conflicts return of the Rwandan refugees from eastern Zaire July 1994-December 1996.
of the magnitude of the Kosovo crisis or the Rwanda Cambridge: Massachusetts Institute of Technology, 1998.
20 Iacopino V, Rasekh Z, Yamin AE, Freedman L, Burkhalter H, Atkinson H,
genocide to be within the competence of the council et al. The Taliban’s war on women: a health and human rights crisis in Afghani-
remains to be ascertained. The question then arises as stan. Boston: Physicians for Human Rights, 1998.

434 BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com

 Education and debate

21 Joint Evaluation of Emergency Assistance to Rwanda. The International multimandate relief operations in political emergencies. London: African
response to conflict and genocide: Lessons from the Rwanda experience. Copen- Rights, 1994.
hagen: Steering Committee of the Joint Evaluation of Emergency Assist- 27 Perrin P. The risks of military participation. In: Leaning J, Briggs SM,
ance to Rwanda, 1996. Chen LC, eds. Humanitarian crises: the medical and public health response.
22 Ignatieff M. The warrior’s honor: ethnic war and the modern conscience. New Cambridge: Harvard University Press, 1999:309-23.
York: Henry Holt, 1997. 28 Sandoz, Y. The establishment of safety zones for persons displaced within
23 Hart M, vanPraet S. The Sudan: dying a slow death. In: World in crisis: The their country of origin. In: Al-Nauimi NN, Meese R, eds. International legal
politics of survival at the end of the 20th century. London, New York: issues arising under the United Nations Decade of International Law.
Medecins Sans Frontières, 1997:181-203. Dordrecht: Kluwer Law International, 1995:899-927.
24 Brett R, McCallin M. Children: the invisible soldiers. Stockholm: Swedish 29 Minear L, Weiss TG. Humanitarian action in times of war: a handbook for
Save the Children, 1998. practitioners. London: Lynne Rienner, 1993.
25 Martin I. Hard choices after genocide: human rights and political failures 30 Stremlau J. People in peril: human rights, humanitarian action, and preventing
in Rwanda. In: Moore JM, ed. Hard choices: moral dilemmas in humanitarian deadly conflict. New York: Carnegie Corporation, 1998.
intervention. Lanham, MD: Rowman and Littlefield, 1998:157-75. 31 Weiss TG. Military-civilian interactions: intervening in humanitarian crises.
26 De Waal A. Humanitarianism unbound? Current dilemmas facing Lanham, MD: Rowman and Littlefield, 1999.

Eugenics and human rights

Daniel J Kevles

During the Nazi era in Germany, eugenics prompted Division of

Humanities,
the sterilisation of several hundred thousand people Summary points California Institute
then helped lead to antisemitic programmes of eutha- of Technology,
nasia and ultimately, of course, to the death camps. The Pasadena, CA
Although eugenics programmes are usually 91125, USA
association of eugenics with the Nazis is so strong that
associated with Nazi Germany, they could, and Daniel J Kevles
many people were surprised at the news several years professor
did, happen everywhere
ago that Sweden had sterilised around 60 000 people kevles@its.
(mostly women) between the 1930s and 1970s. The They focused on manipulating heredity or caltech.edu
intention was to reduce the number of children born breeding to produce better people and on
with genetic diseases and disorders. After the turn of eliminating those considered biologically inferior
BMJ 1999;319:435–8

the century, eugenics movements—including demands

for sterilisation of people considered unfit—had, in fact, In the 1920s and 1930s eugenic sterilisation laws
blossomed in the United States, Canada, Britain, and were passed in 24 of the American states, in
Scandinavia, not to mention elsewhere in Europe and Canada, and in Sweden
in parts of Latin America and Asia. Eugenics was not
therefore unique to the Nazis. It could, and did, happen Eugenics was criticised increasingly between the
everywhere. wars and was attacked widely when its role in the
holocaust was revealed

Origins of eugenics Many people believed that individual human

rights mattered far more than those sanctioned
Modern eugenics was rooted in the social darwinism of
by science, law, and social needs
the late 19th century, with all its metaphors of fitness,
competition, and rationalisations of inequality. Indeed,
Francis Galton, a cousin of Charles Darwin and an
accomplished scientist in his own right, coined the retarded) were responsible for a wide range of social
word eugenics. Galton promoted the ideal of problems and were proliferating at a rate that
improving the human race by getting rid of the “unde- threatened social resources and stability. Feebleminded
sirables” and multiplying the “desirables.” Eugenics women were held to be driven by a heedless sexuality,
began to flourish after the rediscovery, in 1900, of the product of biologically grounded flaws in their moral
Mendel’s theory that the biological make up of organ- character that led them to prostitution and producing
isms is determined by certain factors, later identified illegitimate children. “Hereditarian” biology attributed
with genes. The application of mendelism to human poverty and criminality to bad genes rather than to flaws
beings reinforced the idea that we are determined in the social corpus.
almost entirely by our “germ plasm.”
Eugenic doctrines were articulated by physicians,
mental health professionals, and scientists—notably
A drive for social improvement
biologists who were pursuing the new discipline of Much of eugenics belonged to the wave of progressive
genetics—and were widely popularised in books, social reform that swept through western Europe and
lectures, and articles for the educated public of the day. North America during the early decades of the
Publications were bolstered by the research pouring out century. For progressives, eugenics was a branch of the
of institutes for the study of eugenics or “race biology.” drive for social improvement or perfection that many
These had been established in several countries, includ- reformers of the day thought might be achieved
ing Denmark, Sweden, Britain, and the United States. through the deployment of science to good social
The experts raised the spectre of social degeneration, ends. Eugenics, of course, also drew appreciable
insisting that “feebleminded” people (the term then support from social conservatives, concerned to
commonly applied to people believed to be mentally prevent the proliferation of lower income groups and

BMJ VOLUME 319 14 AUGUST 1999 www.bmj.com 435