Comment

2 Mutume G. Reversing Africa’s ‘brain drain’. Africa Recovery 2003; 17: 1.
http://www.un.org/ecosocdev/geninfo/afrec/vol17no2/172brain.htm
(accessed Feb 15, 2008).
3 Martens P, Kovats RS, Nijhof S, et al. Climate change and future populations
at risk of malaria. Glob Environ Change 1999; 9 (suppl 1): 89–107.
4 The PLoS Medicine Editors. The impact factor game. PLoS Med 2006; 3: e291.
5 Pang T, Pablos-Mendez A, Ijsselmuiden C. From Bangkok to Mexico:
towards a framework for turning knowledge into action to improve health
systems. Bull World Health Organ 2004; 82: 720–22.
6 Bennett S, Green A, eds. Sound choices: enhancing capacity for
evidence-informed health policy. Geneva: Alliance for Health Policy and
Systems Research, 2007.
7 McCoy D, Sanders D, Baum F, Narayan T Legge D. Pushing the international
health research agenda towards equity and effectiveness. Lancet 2004;
364: 1630–31.
8 Commission for Research Partnership with Developing Countries (KFPE).
Guidelines for research in partnership with developing countries. 1998.
http://www.kfpe.ch/key_activities/publications/guidelines/guidelines_
e.php (accessed Mar 3, 2008).
9 Costello A, Zumla A. Moving to research partnerships in developing
countries. BMJ 2000; 321: 827–29.

Health and human rights under assault in Zimbabwe

Although state-sanctioned torture and political violence targeted with a distressing increase in the incidence of See World Report page 1059

are not new to Zimbabwe, the methodical and targeted attacks against women and in private homes. 80% of
brutality directed against political opposition during the 414 interviewees in Solidarity Peace Trust’s report
the past year is alarming. With upcoming elections had physical injuries with corroborating medical
scheduled for March 29, political violence will likely documentation.6 Researchers from the Bellevue/NYU
escalate. The international community and particularly Program for Survivors of Torture evaluated 24 people for
the African community must do all that is possible gross evidence of physical and psychological abuse. We
to prevent torture and violence in Zimbabwe and to saw a variety of injuries: broken arms and ankles; scars
protect citizens, including health professionals, who from being repeatedly hit on the back, arms, and soles
assist victims of political violence. of feet; and gaping, open wounds from being kicked
Political repression complicates and fuels the ongoing or shot. We also heard evidence of the psychological
crisis in health and human rights in Zimbabwe. The wounds: sleeplessness, weight loss, vigilance, tearfulness,
country currently has among the highest infant nightmares, and hiding away to avoid further danger or
mortality rate and the lowest life expectancy in the risk putting others in danger.
world1 in a backdrop of unemployment, empty shelves Targeted political violence has also disrupted the
in shops, and 100 000% inflation.2 Political repression provision of legal and medical services. In interviews
and economic hardship have driven an estimated
50% of Zimbabwe’s workforce to emigrate, and an
estimated half a million more are internally displaced.3
The societal consequences of torture perpetrated by
those in authority are very similar to the traumatised
response in an individual—hyperarousal, mistrust,
and avoidance. These reactions interfere with political
process, resilience, outcry, and healing. The printed journal
After a peaceful prayer rally in March, 2007, there was
an upsurge in political violence in Zimbabwe.4 Research includes an image merely
from the Bellevue/NYU Program for Survivors of Torture5
and the South African non-governmental organisation,
for illustration
Solidarity Peace Trust (SPT)6 provides new medical
documentation that the Zimbabwean government
is systematically using torture and violence to deter
political opposition.
The reports found that community organisers,
prominent political leaders, and community members
AP

with only peripheral involvement were deliberately Nelson Chamisa, opposition spokesperson, in intensive care in Harare, Zimbabwe, 2007

www.thelancet.com Vol 371 March 29, 2008 1057

 Comment
with community activists and professionals we learned
that medical and legal professionals who assist victims
of political violence, including Zimbabwe Association of
Doctors for Human Rights and Zimbabwean Lawyers for
Human Rights, risk ongoing threats and harassment.5,7,8
Political prisoners, including individuals imprisoned
under the guise of terrorism, are commonly denied
access to medical and legal services. There is little
recourse in a setting where 90% of abuses documented
in Solidarity Peace Trust’s report were by state agencies,
such as police and army. Perpetrators show a high
assumption of impunity. To date, almost a year later,
nobody has been held legally accountable for these well-
documented cases of torture and shootings.
Such a toxic environment raises profound concerns
about the fairness of upcoming elections. The Southern
African Development Community initiative, which
began in May, 2007, as a response to the political
violence in Zimbabwe, seemed to be an opportunity
to level the electoral playing field ahead of the 2008
elections. President Thabo Mbeki of South Africa
brokered talks between the ZANU PF and Movement
for Democratic Change aimed at electoral reform.
However, useful talks have been marred by continued
political repression and the ruling party’s insistence on
a March election.9 Furthermore, historical allegiance to
Mugabe’s fight for independence, fear of working on
behalf of US or European governments, and a multitude
of internal stressors have contributed to African states’
reluctance to condemn the violence.
Medical organisations, including the South
African Medical Association10 and the World Medical
Association,11 have condemned state-sponsored
violence in Zimbabwe. The World Medical Association
called for efforts to protect physicians who are
threatened or intimidated for fulfilling their professional
obligations. The world, and Africa in particular, must
heed such calls. Short-term monitoring focused on
1058
elections is woefully inadequate. An ongoing presence of
international medical and legal professionals to monitor
political violence and support Zimbabwean colleagues
is essential. The international community and African
nations must demand that the violence stops and those
responsible for this violence be held accountable.
*Allen S Keller, Samantha A Stewart, Shari Eppel
Department of Medicine (ASK) and Department of Psychiatry
(SAS), New York University School of Medicine, Bellevue/NYU
Program for Survivors of Torture, New York, NY 10016, USA
(ASK, SAS); and Solidarity Peace Trust, Johannesburg, South Africa
(SE)
ask45@aol.com
Funding was provided by Foundation Open Society Institute (ZUG) and
Solidarity Peace Trust. We are grateful to Dana Dasch-Goldberg for reviewing the
manuscript.
We declare that we have no conflict of interest.
1 World Health Organization. World health report 2007:working together for
health. Geneva: WHO, 2007.
2 BBC News. Zimbabwe inflation hits 100 000. Feb 20, 2008. http://news.
bbc.co.uk/2/hi/business/7255588.stm (accessed Feb 21, 2008).
3 Garcia S, Duplat P. Zimbabwe exodus: too little, but not too late. Nov 7,
2007. http://www.refugeesinternational.org/content/article/detail/10280/
(accessed Feb 13, 2008).
4 Human Rights Watch. Bashing dissent: escalating violence and state
repression in Zimbabwe. 2007. http://hrw.org/reports/2007/
zimbabwe0507/ (accessed Feb 13, 2008).
5 The Open Society Initiative for Southern Africa, The Open Society Institute,
The Bellevue/NYU Program for Survivors of Torture. We have degrees in
violence: a report on torture and human rights abuses in Zimbabwe. 2007.
http://www.soros.org/resources/articles_publications/publications/
zimbabwe_20071201/zimbabwe_20071130.pdf (accessed Feb 13, 2008).
6 Solidarity Peace Trust. Destructive engagement: violence, mediation and
politics in Zimbabwe. 2007. http://www.solidaritypeacetrust.org/reports/
destructive_engagement.pdf (accessed Feb 13, 2008).
7 Pincock S. Douglas Gwatidzo: defending human rights in Zimbabwe.
Lancet 2005; 366: 363.
8 Front line. Ongoing harassment of human rights lawyers in Zimbabwe.
http://www.frontlinedefenders.org/node/961 (accessed Feb 21, 2008).
9 Fabricius P: Mbeki to brief SADC leaders on mediation progress in
Zimbabwe. Jan 1, 2008. http://www.zwnews.com/issuefull.
cfm?ArticleID=18160. (accessed Feb 13, 2008).
10 South African Medical Association. SA doctors plead for Zimbabwean
opposition. 2007. http://www.samedical.org/article.asp?pageid=64&Articl
eID=1998 (accessed Feb 13, 2008).
11 World Medical Association. World Medical Association resolution on health
and human rights in Zimbabwe. 2007. http://www.wma.net/e/policy/a29.
htm (accessed Feb 13, 2008).
www.thelancet.com Vol 371 March 29, 2008